Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is an excellent investigation to diagnose pancreatic lesions and has shown high accuracy for its use in pathologic diagnosis. Recently, macroscopic on-site evaluation (MOSE) performed by an endoscopist was introduced as an alternative to rapid on-site cytologic evaluation to increase the diagnostic yield of EUS-FNB. The MOSE of the biopsy can estimate the adequacy of the sample directly by the macroscopic evaluation of the core tissue obtained from EUS-FNB. Isolated pancreatic tuberculosis is extremely rare and difficult to diagnose because of its non-specific signs and symptoms. Therefore, this challenging diagnosis is based on endoscopy, imaging, and the bacteriological and histological examination of tissue biopsies. This uncommon presentation of tuberculosis can be revealed as pancreatic mass mimicking cancer. EUS-FNB can be very useful in providing a valuable histopathological diagnosis. A calcified lesion with a cheesy core in MOSE must be suggestive of tuberculosis, leading to the request of the GeneXpert, which can detect
Mycobacterium tuberculosis
deoxyribonucleic acid and resistance to rifampicin. A decent diagnostic strategy is crucial to prevent unnecessary surgical resection and to supply conservative management with antitubercular therapy.
Gayet-Wernicke encephalopathy (WE) is a serious and acute disease of the central nervous system caused by thiamine (vitamin B1) deficiency. Multiple etiologies are indicated, although alcohol abuse is the most reported cause. If not treated promptly, WE can lead to serious complications such as Korsakoff's syndrome, coma, or death. This diagnosis should be considered even without a history of alcohol dependence. We describe two cases of non-alcohol related WE complicating vomiting caused by different etiologies. The diagnosis was suspected on clinical presentation and confirmed by brain MRI and effective response to parenteral administration of thiamine.
Solitary rectal ulcer syndrome (SRUS) is a rare and chronic rectal condition that can result in a pelvic static disorder. Massive rectal bleeding is a rare manifestation of SRUS. The diagnosis is based on a combination of clinical, endoscopic, and histological findings. The management of bleeding ulcers is usually insufficient with the conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding. However, its role in healing and improving defecation symptoms is not unanimous in studies. Our case report features a 35-year-old male with terminal constipation and chronic rectal pain, taking laxatives and analgesics, who presented abundant rectal bleeding with hemodynamic instability. The colonoscopy showed two large bleeding rectal ulcers. The histological study of the biopsies was in favor of a solitary rectal ulcer. We have performed multiple sessions of APC. The bleeding was stopped after the first session and there was progressive healing and improvement of the rectal symptoms after other sessions. At 18 months follow-up, the patient is asymptomatic, and no longer uses analgesics and laxatives. Argon plasma coagulation is an effective treatment to control rectal ulcer bleedings. It also improves the healing process and clinical symptoms. However, further controlled studies are needed to support this hypothesis.
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that originate from Cajal cells located in different sites of the digestive system. They may occur in the entire gastrointestinal tract. They are diagnosed on the basis of the identification of c-kit-positive cells. We report a case of a stromal tumor of the jejunum revealed by a massive digestive hemorrhagia. Surgical resection is the basis of the treatment of GISTs. Imatinib, a tyrosine kinase inhibitor, is a beneficial treatment after surgical resection of high-risk GISTs.
Hypertriglyceridemia is a rare cause of acute pancreatitis (AP), occupying approximately 7% of cases. The triad of acute pancreatitis, hypertriglyceridemia, and diabetes is a rare event, with a higher death rate.We describe two cases of severe acute metabolic pancreatitis discovered in diabetic ketoacidosis. For both patients, all other causes of AP were excluded (including gallstones, hypercalcemia, drugs, and alcohol). A laboratory workup revealed elevated lipasemia (more than three times the normal) and hypertriglyceridemia. Abdominal computed tomography confirmed the diagnosis of severe acute pancreatitis. Fasting, fluid resuscitation, and insulin therapy were initiated in the intensive care unit with good clinical results and progressive improvement in metabolic disorders.
The case reported is the first case in Morocco to our knowledge. The reason for sharing this case is to facilitate knowledge transfer between physicians, caring for adult patients with HLH, with the aim to improve the outcome of these patients.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) whose management depends on its severity, localization, and course. The coronavirus disease 2019 (COVID-19) pandemic has made the management of this disease more difficult, as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) routinely causes respiratory infection, but can also target the gastrointestinal tract. Multiple cases of de novo IBD, IBD flare-ups, and colitis have been associated with COVID-19 infection. We present the case of two patients, with a history of UC, who presented respectively a mild and a severe flare-up of their disease associated with COVID-19 infection.Regardless of recommendations, we decided to optimize the patient's treatment and obtained good clinical, biological, and endoscopic results. This report on the two cases suggests that remaining cautious and optimizing can be a good therapeutic alternative for these patients rather than modifying the treatment.
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