Volume 78 - 2015 - Fasc.3 - Letters
Endoscopic closure of a rectal diverticulum perforation during a diagnostic colo- noscopy
Finding of rectal diverticula is particularly infrequent, with a frequency < 0.1% of cases of diverticulosis (1). The risk of colonic perforation ranges from 0.005% and 0.7% with differences between diagnostic and therapeu- tic procedures (2). Perforation of a rectal diverticulum during a colonoscopy has been described in only one re- port (3). Managements of endoscopic perforation vary from conservative treatment to surgical intervention with the majority of patients requiring laparotomy for repair the defect. Immediate closure of a perforation is manda- tory to limit bacterial contamination and consequent sep- sis. Endoscopic closure of an iatrogenic perforation smaller than 20 mm is performed both with Through- The-Scope (TTS) clipping-devices and Over-The-Scope Clips (OTSC) System. Both techniques are likely to be effective with similar success rates (93% and 89% re- spectively)(4). The most recent endoloop/clips tech- nique, successfully used for the first time by Endo et al. (5) to close gastric perforations, in some reports has been documented to have satisfactory results in closing iatrogenic perforations (6). In this report, we describe a successful repair of a rectal perforation caused by the maneuver of retro-flexion of the colonoscope during a diagnostic colonoscopy by using the endoloop/clips tech- nique.
Abdominal cocoon with imaging findings : Importance of radiology
Abdominal cocoon is a rare disease characterized by a thick -fibrous- membrane- surrounding- and- compressing- the- small- intes- tines- completely- or- partially,- which- results- in- mechanical- small bowel- obstruction.- The- clinical- findings- of- the- disease- include- re- current-ileus-and-subileus-episodes,-colicky-abdominal-pain,-weight loss,- and- abdominal- distension.- The- etiology- and- pathogenesis- of abdominal-cocoon-is-not-clearly-defined.-Detection-of-the-disease-is essential- for- accurate- treatment.- Imaging- modalities- come- into prominence- due- to- the- nonspecific- clinical- findings- of- the- disease. (Acta gastroenterol. belg., 2015, 78, 346-347).
Endoscopic Treatment of Biloma : Bilo-gastric drainage
Bile tree injury and biliary leakage are common and serious complications after cholecystectomy, cyst hyda- tid surgery, pancreaticoduodenectomy, and hepatic seg- mentectomy. Bilomas are extrabiliary encapsulated cys- tic collections of bile, most often in perihepatic space but also elsewhere in the abdomen (1). Percutaneous or sur- gical drainage is the standart of care (2). Herein we pres- ent a novel transgastric endoscopic drainage of a biloma.
Primary B-cell non-Hodgkin's lymphoma of the papilla major and papilla minor as a cause of biliary obstruction
There are many causes of malign biliary obstructions such as pancreatic adenocarcinoma, cholangiocarcinoma and malign lymphadenopathies. However malign biliary obstruction from lymphomas is quite rare (1). The most common cause of jaundice in lymphomas is enlarged lymph node compression of the biliary tree. Here we present a non-Hodgkin's lymphoma which involves papilla major and papilla minor without any lymphade- nopathies.
Pancreatic cystic lymphangioma diagnosed with endoscopic ultrasonographic- fine needle aspiration ; a rare mesenchymal tumor
Cystic lymphangioma is the benign proliferation of lymphatic vessels due to lymphatic system obstruction forming cysts filled with fluid. It is mostly seen in neona- tal and early childhood period, and rarely in adults. Major localisations of occurrence are cervical and axillary re- gions where it can be rarely seen in soft tissues abdomi- nal region (1). Cystic lymphangioma of the pancreas is a very rare benign neoplastic lesion counting for less than 1% of all lymphangiomas and around 0.2% of all pancre- atic tumors (2). Traditional radiological techniques are mostly insufficient for the evaluation of pancreatic cystic lesions. Therefore, the histopathological diagnosis of pancreatic cystic lymphangiomas used to be established by classical surgical incision in the past (3). Endoscopic ultrasound (EUS) has been shown to be an effective tech- nique providing high definition images of the pancreas. Cases of pancreatic cystic lymphangioma diagnosed with EUS guided fine needle aspiration (EUS-FNA) have recently been reported(2-5). We present a case of pancreatic cystic lymphangioma diagnosed with EUS- FNA in this report.
Re-audit of patient information about the ethanol content of anaesthetic sprays used in gastroscopies
It is customary to offer patients undergoing gastros- copy intravenous sedation, an oral local anaesthetic spray or a combination of both. However, the presence of alco- hol within these sprays is seldom discussed. Traditional- ly, Muslims, Baptists, Salvationists and members of many fundamentalist Christian groups abstain complete- ly from alcohol. During 2013 patients' views on use of oral anaesthetic sprays with an alcohol base were investi- gated in Leicester (1). The proportion of patients who rejected the spray was 8% for Asians and 17% for Euro- peans with no difference between Hindus and Muslims. Reasons included ineffectiveness and the erroneous be- lief alcohol would interfere with other medications. In only two cases were objections religious. In one a Christian had signed the Pledge and the other was a Muslim (2). Clearly our preconceptions as to how people will respond to the issue of alcohol in medications can be wrong. However, together with others, this study demon- strated most patients believe we should provide them with this information so they can make informed choic- es (1,3).
Dysphagia and esophageal ulcerations in HIV patient
A 41 years-old caucasian male with AIDS-associated progressive multifocal leukoencephalopathy, suddenly developed persistent painless dysphagia for solid foods. No other symptoms were present, namely fever, abdomi- nal pain, vomiting or regurgitation. The patient had aban- doned medical care and had stopped his anti-retroviral therapy several months before admission.
On physical examination, he was slender and afebrile, with normal vital signs. No lymphadenopathy was pres- ent and no oropharyngeal mucosal lesions were seen. The physical examination of the neck was unremarkable. Cardiopulmonary examination was normal and the abdo- men had no tenderness or organomegaly.
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