A research programme on African paragonimiasis was carried out in eastern Nigeria, which included the epidemiology, parasitology and clinical and radiological studies. The radiological pulmonary changes are described in detail and differentiated from tuberculosis.
We describe the case of a 54-year-old man with a tumour of the proximal esophagus (cT3-4,N1,M0), who underwent percutaneous endoscopic gastrostomy (PEG) for enteral feeding. Primary radiochemotherapy was initiated shortly after PEG insertion. Five months after PEG insertion the patient detected a nodule at the site. The general practitioner diagnosed this nodule as a brotic reaction. Another six weeks later, ulceration that had grown along the PEG probe at the PEG site was observed on gastroscopy. The primary tumour was not visible. Histological examination showed an abdominal wall metastasis of the esophageal cancer. Despite subtotal gastrectomy with en-bloc resection of the tumour, distant metastasis developed. The patient died six months after surgery. About 47 cases of abdominal wall metastases as late complications at the site have been reported until now. The mechanism of tumour spread of PEG site is a subject of controversial discussion. As direct mechanical tumour implantation is the most likely mechanism, an alternative method like operative (laparoscopic) or radiological PEG placement should be considered in cases with advanced, stenotic tumours.
Acute gastrointestinal bleeding is one of the most frequent medical emergencies. The most common causes are inflammations, ulcers, neoplasms and angiodysplasias. They can usually be diagnosed and treated via endoscopy, but less frequent causes, which require increased diagnostic and therapeutic efforts, must also be considered. We present the case of a 53-year-old patient with gastrointestinal bleeding. He was diagnosed with transverse colon bleeding in another hospital. A bleeding diverticulum was assumed. Following admission to our hospital, a bleeding through the ampulla of Vater was discovered via gastroscopy. The CT scan showed arterial bleeding into the gallbladder. We immediately performed a laparotomy and found a cholecysto-colic fistula as the cause of the bleeding into the transverse colon.
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