Volume 85 - 2022 - Fasc.4 - Case reports
Pancreatitis, pregestational diabetes and hyperchylomicronia in a pregnant woman with COVID-19
A 37-year-old pregnant woman, was diagnosed with
acute pancreatitis whilst being infected with COVID-19.
Additionally, she had a hyperchylomicronemia and an
uncontrolled (most probably, pre-gestational) type 2
diabetes.
The coronavirus is able to enter the pancreatic cells
through ACE-2 receptors. On the pancreatic level, ACE-
2 receptor expression is present but not as abundant as
on pulmonary level. However, with inflammation (due to
hyperchylomicronemia), the ACE-2 receptor expression
may change and hypothetically make the pancreas more
susceptible for a Covid-19 surinfection.
Here it is difficult to conclude whether the COVID-19
infection contributed substantially to the development of
pancreatitis. Late term pregnancy, uncontrolled glycaemia
and the heterozygote mutation in the GPIHBP1 gene
(c.523G>C p; Gly175Arg), all contribute to increased TG
levels, a principal factor in the development of pancreatitis.
This case shows a rare but serious clinical presentation
late in pregnancy that could have interesting consequences
postpartum.
A rare case of paraneoplastic myositis associated with neuroendocrine carcinoma of the pancreas
Pancreatic cancer is only rarely associated with myopathy.
We present a case of a 69-year-old male with recently diagnosed
pancreatic cancer, who presented himself with a paraneoplastic
myositis of both legs. MRI and EMG contributed to this diagnosis.
Treatment was started with high dose corticosteroids followed by
urgent laparoscopic pancreaticoduodenectomy. Postoperatively
there was a rapid normalisation of the creatinine kinase levels with
gradual increase of the muscle strength. The anatomopathology
of the biopsy specimen showed a large cell neuroendocrine carcinoma.
Paraneoplastic myositis associated with pancreatic cancer
may be treated successfully with cancer specific treatment.
The use of autologous peritoneum in surgery of portal hypertension: H-shape splenorenal shunt using simple layer peritoneal tube
The management of portal hypertension complicated by
iterative gastro-intestinal bleeding remains challenging, especially
in a low-income environment. Interventional radiology and
endoscopic treatments are not always accessible, and a definitive
surgical option may prove to be lifesaving. We report a new
technique of surgical portosystemic shunt that can be performed
in all contexts. We describe the surgical technique of a H-shaped
splenorenal shunt using autologous rolled up peritoneum as a
vascular graft.
Acute abdominal pain: a challenging diagnosis
We hereby describe a case of an acutely ill 41-year-old male
without any medical history who presented with an acute abdomen
in the emergency department. An abdominal CT showed a
dissection of the coeliac trunk and infarction of the spleen. Because
of a presumed diagnosis of vasculitis he was started on high dose
IV steroids. However, after additional testing the diagnosis of
segmental arteriolar Mediolysis (SAM) was made. In this case
report we describe the presentation, diagnosis, treatment and
follow-up of this patient and provide the readers with background
about common differential diagnosis and criteria for diagnosing
SAM.
