Volume 78 - 2015 - Fasc.1 - Letters
Acute liver failure due to fluconazole and ornidazole usage
24-year-old female patient was admitted with jaundice, itching and abdominal distention. The patient was puted on fluconazole 150 mg/day, ornidazol 1500 mg/day therapy with the diagnosis of vaginitis. On the fifth day of the treatment the patient stopped treatment because of nausea and vomiting. 15 days after the ongoing com- plaints, jaundice, pruritus and abdominal swelling was developed and the patients was hospitalized. Physical examination revealed icterus, ascites. There was no hepatosplenomegaly.
A meaningless finding for gastroenterologist : Ano-rectal malformation in adult
Ano-rectal malformations (ARM) are infrequent anomalies with estimated incidence between 1/3300- 1/5000 live birth (1). Diagnose of ARMs can be done in early childhood because of early symptoms or concomi- tant anomalies consisting of genitourinary, spinal, cardio- vascular, gastrointestinal, craniofacial systems (2-4). Late diagnosis of ARMs (after first 48 hours of birth) may result in spontaneous perforation of intestine. By this case, we present a late diagnosed type of ARM with chronic constipation. The women, aged 58 years old, had a normal physical examination, but the vestibular ectopic anus. The anus was observed inside the vestibular area, but separated from vagina by mucosal septum. Muscular structure were palpated backward of the anal orifice. Colonoscopy did not reveal any significant pathology.
As seen in our case, the patients with isolated vestibu- lar ectopic anus may survive without any complication for life. Therefore, gastroenterologists should not be aware of adult onset ARMs.
Wernicke encephalopathy in a patient with severe acute pancreatitis
36-years-old male patient with history of biliary severe acute pancreatitis (SAP) before 4 months. Endo- scopic retrograde cholangiopancreatography (ERCP) was done for the patient at that time and common bile duct stones removed and the patient was discharged. He came before 1 month complaining of fever, abdominal pain and swelling. Physical examination revealed abdominal tenderness and ascites. Chest auscultation showed bilateral decreased air entry. Glucose: 177 mg/dL, AST : 64 U/L, ALT : 114 U/L, LDH : 986 U/L, total/conjugated bilirubin : 2.8 mg/dL/ 1.6 mg/dL, amylase : 1552 U/L, lipase : 1238 U/L, CRP : 36.2 mg/dl, WBC : 21,550 mm3, hematocrit : 36% and platelets : 366,000 mm3. Computed Tomography showed acute pancreatitis with areas of necrosis at the level of the head and tail of pancreas. There was a 18 × 5 cm cystic degeneration in the body of the pancreas with air bubbles observed inside it (Fig. 1).
