Volume 82 - 2019 - Fasc.4 - Case reports
Endoscopic vacuum-assisted closure therapy for the treatment of oesophageal anastomotic leaks
Persisting suture dehiscence with oesophageal anastomotic leaks after thoracic surgery is a difficult complication, especially when a surgical repair fails. We report here endoscopic vacuum-assisted closure therapy as a novel endoscopic treatment for the management of oesophageal anastomotic leaks. Endoscopic vacuum-assisted closure therapy is a minimally invasive method to treat anastomotic leakage by positioning an open-pored polyurethane sponge and a suction tube connected to a wound drainage system into the opening of the wound cavity. This multidisciplinary endoscopic and surgical approach is a successful therapy for the management of suture dehiscence with oesophageal anastomotic leaks after thoracic surgery or oesophageal perforations. (Acta gastroenterol. belg., 2019, 82, 529-531).
A man with abdominal pain and eosinophilia : tissue is the issue
A 24-year-old male presented with abdominal pain, postprandial vomiting and weight loss. Lab results showed an elevated serum eosinophil count and CT-scan demonstrated a thickened antral, duodenal and jejunal wall. Repetitive endoscopic mucosal biopsies were normal. Work-up of eosinophilia-associated gastro-intestinal disorders excluded secondary causes. Bone marrow showed an elevated eosinophil count without arguments for a primary hypereosinophilic syndrome. Endoscopic ultrasound-guided fine needle biopsy detected a strongly elevated number of eosinophils in the muscularis layer of the duodenum. The diagnosis of muscularis- predominant eosinophilic gastroenteritis together with a secondary hypereosinophilic syndrome was made. The patient was started on steroids and all symptoms vanished within a few days. (Acta gastroenterol. belg., 2019, 82, 532-535).
Impact of liver inflammation on whole body insulin resistance : a case report on primary biliary cholangitis
Chronic liver diseases such as hepatitis C or non-alcoholic fatty liver disease could be associated with insulin resistance, even in the absence of cirrhosis or significant fibrosis.
In this report, we present the case of a patient who was diagnosed with primary biliary cholangitis and metabolic syndrome. Initial evaluation also revealed diabetes with elevated fasting plasma glucose and glycated hemoglobin. After eight weeks of treatment with ursodeoxycholic acid, a complete normalization of the hepatic biological tests was observed. A few months later, while body weight and abdominal perimeter remained stable, fasting blood glucose and glycated hemoglobin decreased significantly, compatible with diabetes disappearance.
This finding supports the concept that the inflamed liver plays a major role in the pathogenesis of insulin resistance and diabetes occurrence in chronic liver diseases, including primary biliary cholangitis. (Acta gastroenterol. belg., 2019, 82, 536-538).
A case of amoebic colitis with amoeboma and simultaneous liver abscesses. A diagnosis by colonoscopy
A 50-year-old patient was admitted to our department after developing severe abdominal cramps, watery diarrhea and fever, during four days whilst travelling abroad. Imaging identified a mass in the ascending colon with simultaneous liver lesions. Initially a diagnosis of metastatic colorectal cancer was suggested, however colonoscopy showed a large lesion with a central ulcer and surrounding inflammation in the ascending colon. Biopsies confirmed our clinical suspicion of amoebic colitis, complicated by development of an amoeboma and simultaneous liver abscesses.
Amoeboma formation is a rare complication of amoebiasis, however a simultaneous presentation with liver abscesses, amoebic colitis and an amoeboma might even be less frequent. Despite its rarity physicians should maintain a high index of suspicion of patients presenting with synchronous liver and colon lesions, especially as travel to endemic areas has increased. (Acta gastroenterol. belg., 2019, 82, 539-541).
