Intussusception of the appendix is a rare condition. Most cases are diagnosed during operation of the patients suspected to have appendicitis. In this report we present a seventy one year-old man with a history of periumbilical intermittent abdominal pain for several months. None of the paraclinical tests were useful for determining the diagnosis. Colonoscopy performed during the last episode of abdominal pain revealed the prolapsed appendix in the cecum and the patient was sent to the operating room. Macroscopic appearance of the appendix was normal and microscopic examination revealed follicular hyperplasia and acute focal appendicitis. Appendiceal intussusception should be considered in differential diagnosis of intermittent abdominal pain and colonoscopic diagnosis could be very important to avoid dangerous or unnecessary decision making.
BackgroundOne of the rare presentations of superior vena cava syndrome is bleeding of "downhill" esophageal varices (DEV) and different approaches have been used to control it. This is a case report whose DEV was eradicated by band ligation for the first time.Case presentationWe report a 42-year-old man who is a known case of Behcet's disease. The patient's first presentation was superior vena cava syndrome due to thrombosis followed by bipolar ulcers and arthralgia. He received warfarin, prednisolone and azathioprine. The clinical course of the patient was complicated by one episode of hematemesis without abdominal pain when the patient's PT was in therapeutic range. After resuscitation and correction of PT with fresh frozen plasma transfusion, upper gastrointestinal endoscopy was done. Prominent varices were seen in the upper third of the esophagus, tapering to the middle part without acute bleeding. Stomach and duodenum were normal. Color ultrasonography evaluation of the portal, hepatic and splenic veins was negative for thrombosis. Band ligation was done and the patient's bleeding did not recur.ConclusionBand ligation is a safe and effective method for controlling DEV bleeding in patients with uncorrectable underlying disorders.
BACKGROUND
Cholecystitis is a common surgical condition. Recently, several authors have reported that
DNA of bile tolerant Helicobacter spp. has been found in the human bile colonizing the biliary
tract. The aim of this study was to evaluate the association between the presence of Helicobacter
spp. and gallstone cholecystitis.
METHODS
In this case-control study, gallstones, bile, and gallbladder mucosa were collected from 25
patients without gallstone disease, 24 with acute cholecystitis, and 28 with chronic cholecystitis.
The presence of
Helicobacter pylori (H. pylori), Helicobacter bilis (H. bilis), Helicobacter hepaticus
(H. hepaticus)
, and Helicobacter pullorum (H. pullorum) were investigated by polymerase chain
reaction (PCR) using species-specific primers.
RESULTS
In this study, 77 subjects with acute and chronic cholecystitis and control groups with a mean
age of 46.85 ± 14.53 years, including 58 (67.25%) women and 19 (32.75%) men were included.
DNA of 10 Helicobacter spp. was detected in the bile of the patients with cholecystitis including
eight H. pylori and two H. bilis. However, we could not detect H. hepaticus and H. pullorum DNA in
the samples. Moreover, there was an association between H. pylori and acute cholecystitis (p = 0.048),
which was found to be stronger in 31-40-year-olds group (p = 0.003).
CONCLUSION
We found an association between the presence of H. pylori DNA and acute gallstone cholecystitis.
There is not statistically significant correlation between three enterohepatic Helicobacter spp. (
H.
bilis, H. hepaticus
, and H. pullorum) and cholelithiasis. Given the low sample size of the patients,
more studies are required to clear the clinical role of Helicobacter spp. in the gallstone disease
and cholecystitis.
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