Very few cases of liver transplantation in patients with sickle cell disease have been reported in peer-reviewed literature. We reviewed the medical records of two patients with sickle cell disease that received liver transplantation at our institution. The first patient was a 27-year-old female who presented with encephalopathy and cholestatic jaundice with a Hemoglobin S (HbS) level of 69.6%. She was diagnosed with acute sickle cell intrahepatic cholestasis. The second patient was a 26-year-old female with sclerosing cholangitis who presented with encephalopathy, bleeding, and cholestatic jaundice. Her HbS level was normal. Both patients underwent liver transplantation successfully but died in the postoperative period from multiorgan failure. We report a rare case of liver transplantation for acute sickle cell intrahepatic cholestasis and a novel case of transplantation in a patient with sickle cell disease and sclerosing cholangitis. Liver transplantation did not lead to a successful outcome in either case.
Small-bowel tumors are a rare but serious source of obscure GI bleeding. Our large single-center experience shows that most lesions are of malignant potential. Tumors can have an atypical appearance including focal ulceration, nodularity, or active bleeding without a clear lesion. Mass lesions in the duodenum are particularly elusive and can be missed by both EGD and CE.
Positive findings on capsule endoscopy (CE) often prompt a follow-up procedure with therapeutic intent. Our purpose was to review the therapeutic yield of subsequent procedural interventions based on positive CE findings. The medical records of all patients who underwent CE between June 2002 and February 2005 for obscure bleeding were retrospectively reviewed. Fifty-two patients had follow-up procedures based on positive capsule findings. In this group, angiodysplasia was the most common CE finding (n=30), with therapeutic intervention performed in 16 cases (53%). Fresh blood without clear lesion was the second most common finding (n=9), with therapeutic intervention performed in 6 cases (67%). Overall, a therapeutic intervention was performed in 33 of the 52 follow-up procedures (63%). Positive capsule findings directed further procedural investigation in 52 cases, with a high therapeutic yield of 63% in those cases. The long-term efficacy of such interventions warrants further investigation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.