Tuberculosis is a disease with serious consequences in terms of morbidity and mortality. Pancreatic localization is very rare and is mostly encountered in patients with immunosuppressive disorders. A 59-year-old woman with arterial hypertension, grade 2 obesity, and a history of cholecystectomy, was admitted for fever (38.5 °C), jaundice, and marked physical asthenia. The blood tests showed severe metabolic acidosis, with partial respiratory compensation, mild microcytic normochromic anemia, inflammatory syndrome, procalcitonin value ten times the upper limit of normal, nitrogen retention syndrome, hypoalbuminemia, hypertriglyceridemia, hypercholesterolemia, and moderate hyponatremia. The electrocardiogram, chest X-ray, and abdominal ultrasound did not show any significant pathological changes. Contrast-enhanced computed tomography raised the suspicion of acute-on-chronic pancreatitis and subsequent evaluation by magnetic resonance imaging raised the suspicion of a pancreatic tumor. Pancreatic fine needle biopsy under echoendoscopic guidance revealed purulent material, which was sent for cytological and bacteriological examination. The Ziehl-Neelsen stain showed acid-alcoholic resistant bacilli, while bacterial cultures were positive for gentamicin and tigecycline-sensitive Klebsiella. The diagnosis of pancreatic tuberculosis was established. Pancreatic tuberculosis is a very rare condition that often mimics pancreatic cancer. The peculiarity of the case is the appearance of pancreatic tuberculosis in an immunocompetent woman and the association with Klebsiella infection.
La vidéocapsule endoscopique dans le diagnostic de l'hémorragie digestive Les hémorragies digestives sont une cause fréquente d'hospitalisation, aux taux élevées de mortalité et morbidité, actuellement en baisse par rapport aux années précédentes, grâce à l'évolution des techniques endoscopiques. Environ 5-7% des hémorragies digestives sont d'origine obscure, avec une endoscopie oeso-gastroduodénale et une iléocoloscopie normales. La vidéocapsule endoscopique est une technique récente, non-invasive, permettant le diagnostic des lésions digestives, en particulier celles de l'intestin grêle, qui sont difficilement visualisées par d'autres méthodes. Au cours des dernières années, de nombreuses études concernant la sensibilité et les résultats de cette technique ont été publiées, mais sans souligner son rôle définitif dans les hémorragies digestives. Cette revue examine le rôle de la vidéocapsule endoscopique dans l'évaluation des hémorragies de l'intestin grêle et les options thérapeutiques disponibles.
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