Gastrointestinal (GI) bleeding due to angiodysplastic lesions is a common problem among patients receiving hemodialysis (HD). We studied 22 HD patients (5 females and 17 males) who had GI bleeding due to angiodysplasia; the mean age of whom was 54 ± 10 years. All patients had upper and lower GI endoscopy. The most common site for the lesion was the right colon in seven cases (31.8%), followed by stomach in 4 cases (18.1%). In eight (36.3%) patients, there were multiple lesions located in the stomach, duodenum, and the right colon. All patients were treated with coagulation; with argon plasma in 14 (63.6%) patients, bipolar coagulation in five (22.7%) patients, and hot clip in three (13.6%) patients. One patient who presented with persistent bleeding despite endoscopic therapy was well-benefited of a complementary treatment, thalidomide. Hemostasis was obtained in all patients after an average of 6.8 sessions of endoscopic coagulation procedure. We conclude that angiodysplasia is a frequent cause of hemorrhage in chronic renal failure that can be managed in most patients by argon plasma and bipolar coagulation.
La tuberculose, malgré sa prévention, reste une affection répandue au Maroc. Bien que rares, les formes pseudo chirurgicales notamment la péritonite sont dues essentiellement au retard diagnostique. Nous rapportons le cas d'une patiente de 30 ans, admise dans un tableau de péritonite. L'exploration chirurgicale a permis d'évoquer le diagnostic de péritonite tuberculeuse dès l'examen macroscopique (granulations péritonéales), diagnostic confirmé par l'analyse histologique. L'évolution a été favorable après traitement antibiotique. Cette observation a l'intérêt de souligner que la péritonite, qui est une complication rare de la tuberculose péritonéale, pose des problèmes de diagnostic positif et différentiel. Si le traitement repose sur une quadrithérapie antituberculeuse, le recours à la chirurgie est parfois nécessaire et doit être envisagé en temps utile.
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