Volume 71 - 2008 - Fasc.2 - Case reports
Peripheral parenteral nutrition in protracted hyperemesis gravidarum - Report of two cases and a literature review
Hyperemesis gravidarum is defined as severe nausea and vomit- ing during the first trimester of pregnancy. It is characterized by dehydration, electrolyte imbalance, ketonuria and weight loss of more than 5% of body weight and it usually requires hospitaliza- tion.
Traditionally, total parenteral nutrition has been used when patients with hyperemesis gravidarum fail to respond to conserva- tive measures, including dietary manipulation and antiemetics. Total parenteral nutrition has been shown to be an effective method of nutritional support during pregnancy but it is expensive and has potentially serious complications. Peripheral parenteral nutrition reduces the risk of complications, but caloric intake is limited. A small number of investigators have suggested using enteral nutrition as an alternative to total parenteral nutrition. Herein we report two cases of hyperemesis gravidarum successful- ly treated with an effective regimen of peripheral parenteral nutri- tion. (Acta gastroenterol. belg., 2008, 71, 259-262).
Jejunal ischaemia - rare aetiologies and a surgical dilemma
Superior Mesenteric Artery thrombosis can lead to acute mesen- teric ischaemia with devastating consequences. The main dilemma for the surgeon is the delay in diagnosis and a definitive treatment, as these patients may present with signs of peritonism but not frank peritonitis until the ischaemia results in infarction and or perforation. We report a detailed literature search and a unique case of jejunal ischaemia in the setting of undiagnosed Antiphospholipid Syndrome and Factor V Leiden heterozygosity where a delayed diagnosis resulted in an unnecessary prolongation of patient's morbidity. (Acta gastroenterol. belg., 2008, 71, 263-266).
A unique combination of celiac disease, mesenteric lymph node cavitation, splenic atrophy and necrotizing hepatitis
We report on a patient who was diagnosed six years before with celiac disease, with a current combined problem of asplenism, mesenteric cysts and elevated liver function tests. The implications of splenic atrophy mimic those of post-splenectomy patients. Mesenteric lymph node cavitation is a rare complication of celiac disease that is most often associated with splenic atrophy. The pathogenesis is unknown. The clinical implications of the cavitated mesenteric lymph nodes are unclear. The association of celiac dis- ease with liver disease was reported many years agO. but only recently these associations have been more clearly defined. Liver involvement shows a clinical spectrum varying from nonspecific reactive hepatitis, chronic active hepatitis, steatohepatitis to frank cirrhosis. Associations with autoimmune hepatitis, autoimmune cholangitis, primary biliary cirrhosis and primary sclerosing cholangitis have been described. In our patient, we found no obvi- ous cause for the necrotizing hepatitis and the negative auto-anti- bodies made it impossible to firmly establish the diagnosis of autoimmune hepatitis. The causal relationship with celiac disease, if any, remains unproven. (Acta gastroenterol. belg., 2008, 71, 267- 270).
Asymptomatic disseminated carcinomatosis of bone marrow presenting as hyperphosphatasia : report of a case
Metastatic involvement of the musculoskeletal system is one of the most significant clinical issues facing orthopaedic oncologists. The number of patients with metastasis to the skeletal system from a carcinoma is 15 times greater than the number of patients with primary bone tumours of all types. However, progression patterns like disseminated carcinomatosis of bone marrow are comparative- ly rare. The pathophysiology for disseminated carcinomatosis of bone marrow, with a prognosis reported to be very poor, is still unknown. We describe a patient who had no symptoms with hyper- phosphatasia. Bone scintigraphy showed a so-called super bone scan and a needle biopsy from the ileum showed adenocarcinoma cells. Additional endoscopic investigation was performed and signet cell gastric cancer was found. From the bone scan and biop- sy, we established the diagnosis of disseminated carcinomatosis of the bone marrow. From the experience of this case, we believe that intensive stomach investigation should be considered in cases with hyperphosphatasia, even when the patient has no symptoms. (Acta gastroenterol. belg., 2008, 71, 271-274).
Liver teratoma
True liver teratomas are exceptional tumors, with only 25 cases reported in the radiology literature. Most cases reported were either intraperitoneal or retroperitoneal teratomas that had invad- ed the liver. The authors present a 27-year-old woman with a liver complex mass found incidentally at computed tomography (CT). The different imaging studies demonstrated that the lesion was composed of macroscopic fat, with a central soft tissue component and a calcification. The patient underwent surgery and the final diagnosis was a benign liver teratoma. (Acta gastroenterol. belg., 2008, 71, 275-279).
