Highlights Glomus tumors are rare neoplasms that arise from neuromyoarterial canal or glomus body. In the GI tract, stomach is the most common site for Glomus tumors. Symptoms usually are non specific and can be discovered incidentally during upper GI endoscopy. Immunohistochemistry stains after surgical excision or tissue biopsy can confirm the diagnosis. Surgical treatment is the preferred option for GGTs and long-term follow-up is required due to high metastatic and recurrence rate in the malignant type.
Isolated tuberculous splenic microabscesses are uncommon except in immunocompromized patients. The diagnosis is often made after splenectomy and histologic examination of the spleen. We report here a case of splenic tuberculosis in an immuno-competent patient. The diagnosis was made solely by laparoscopic biopsy of the spleen without the need for splenectomy. The patient was started on antituberculosis therapy with marked recovery. We believe that this might be the first reported case of isolated splenic tuberculosis ever diagnosed by laparoscopy only.
Background/Aims:Metabolic bone disease is common in patients with inflammatory bowel disease (IBD). Our aim was to determine the frequency of bone loss among Saudi patients with IBD and possible contributing risk factors.Settings and Design:We retrospectively reviewed Saudi patients with IBD, between 18 and 70 years of age, who had bone mass density (BMD) determined by dual-energy X-ray absorptiometry scanning at one of three hospitals in the Kingdom of Saudi Arabia from 2001 to 2008.Patients and Methods:Case notes and BMDs results were carefully reviewed for demographic and clinical data. Low bone mass, osteopenia, and osteoporosis were defined according to the WHO guidelines.Statistical Analysis Used:Predictive factors for BMD were analyzed using group comparisons and stepwise regression analyses.Results:Ninety-five patients were included; 46% had Crohn's disease (CD) and 54% had ulcerative colitis (UC). The average age was 30.9±11.6 years. Using T-scores, the frequency of osteopenia was 44.2%, and the frequency of osteoporosis was 30.5% at both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our results revealed a positive correlation between the Z-score in both the lumbar spine and the proximal femur and body mass index (BMI) (P=0.042 and P=0.018, respectively). On regression analysis BMI, age, and calcium supplementation were found to be the most important independent predictors of BMD.Conclusions:Saudi patients with IBD are at an increased risk of low BMD and the frequency of decreased BMD in Saudi patients with CD and UC were similar. BMI and age were the most important independent predictors of low BMD.
Roux-en-Y gastric bypass is a common surgical procedure used to treat patients with morbid obesity. One of the rare, but potentially fatal complications of gastric bypass is upper gastrointestinal bleeding, which can pose diagnostic and therapeutic dilemmas. This report describes a 39-year-old male with morbid obesity who underwent a Roux-en-Y gastric bypass. Three months postoperatively, he sustained repeated and severe upper attacks of upper gastrointestinal bleeding. He received multiple blood transfusions, and had repeated upper and lower endoscopies with no diagnostic yield. Finally, he underwent laparoscopic endoscopy which revealed a bleeding duodenal ulcer. About 5 ml of saline with adrenaline was injected, followed by electrocoagulation to seal the overlying cleft and blood vessel. He was also treated with a course of a proton pump inhibitor and given treatment for H pylori eradication with no further attacks of bleeding. Taking in consideration the difficulties in accessing the bypassed stomach endoscopically, laparoscopic endoscopy is a feasible and valuable diagnostic and therapeutic procedure in patients who had gastric bypass.
Mucinous cystic neoplasms (MCN) of the pancreas can vary from benign to premalignant and malignant. Preoperative diagnosis is essential to offer the patient appropriate treatment. Occasionally these cases may harbor anaplastic carcinoma while clinically masquerade as a pseudocyst. Here in, we report an unusual case of a 37-year old female presented with recurrent abdominal pain that was suspected clinically and by imaging studies to have a pseudocyst. EUS-FNA with internal drainage of the cyst was performed. Cytological evaluation of the cyst fluid showed numerous inflammatory cells composed mainly of many neutrophils admixed with macrophages reminiscent of the usual pseudocyst content but there were scattered rare dyscohesive malignant cells which were highly pleomorphic with multinucleation. Immunostains on the cell block showed immunoreactivity of these cells including the multinucleated cells for Cam 5.2 and AE1/AE3 and focally for Ber-Ep4, Moc -31, and CA19-9. The subsequent resection confirmed the presence of anaplastic (undifferentiated) carcinoma (AC) arising in a MCN of the pancreas. Diagn. Cytopathol. 2016;44:538-542. © 2016 Wiley Periodicals, Inc.
Bleeding from ectopic varices accounts for 1.6%-6% of all bleeding related to portal hypertension due to cirrhosis. [1][2][3][4][5] The prevalence of ectopic varices is higher in extrahepatic portal hypertension. 2 Of all the bleeding ectopic varices, the varices at the enterostomy site are the most common, followed by anorectal, colon, duodenum, and jejunum or ileum.1-2 Bleeding from the duodenal varices, although rare, is often massive and life-threatening, possibly because they are more difficult to detect and to treat than esophageal varices.Treatment options for bleeding duodenal varices include intra-operative suture ligation, 6 endoscopic varix ligation, 7 duodenal resection, 8 portacaval shunt 9 and injection sclerotherapy. [10][11][12][13][14][15][16] There is no consensus on the best management of bleeding duodenal varices, and randomized studies are unlikely to be feasible because of the rarity of the condition. Only eight cases of endoscopic injection sclerotherapy have been reported in the literature. [10][11][12][13][14][15][16][17] We report the ninth case of successful endoscopic injection sclerotherapy of actively bleeding duodenal varices, where the patient was admitted with massive lower gastrointestinal hemorrhage. We also reviewed the literature, focusing mainly on the etiopathogenesis, and various options of medical and surgical treatment of duodenal varices. Case ReportIn August 1996, a 45-year-old male patient with a 15-year history of alcohol abuse was admitted in a private hospital with the complaint of massive lower gastrointestinal bleeding, without any preceding past history of abdominal illness. He was managed with 12 units of blood transfusion, 10 units of fresh frozen plasma and 4 units of platelet concentrate within four days. Upper and lower gastrointestinal endoscopies were performed, but could not determine the source of bleeding. He was referred to Dammam Central Hospital for possible early selective angiography and radioisotope scan to determine the source of bleeding.On admission, the patient had a pulse of 115/min. and a blood pressure of 100/60. His nutritional status was good, and there was no evidence of encephalopathy. Head and neck examinations were normal. There was severe pallor with mild icterus. The patient had palmar erythema, but no gynecomastia or spider angiomata were seen. Chest and cardiovascular examinations were normal. Abdominal examination showed tender and smooth hepatomegaly 7 cm below the subcostal margin. Bowel sounds were hyperactive. There was no ascites, splenomegaly, mass, or abdominal tenderness. Rectal examination demonstrated the presence of maroon-colored, liquid stool. The laboratory findings were as follows: hemoglobin 6.4 g/dL; hematocrit 20 vol%; WBC 24,600; platelets 35,000/mm 3 ; albumin level 3.8 g/dL; total bilirubin level 2.9 mg/dL; prothrombin time 14 sec. (control 12 sec.) with INR 1.3; SGOT 47 IU/L, SGPT 67 IU/L; GT 309 U/L; and alkaline phosphatase 143 U/L. HBV and HCV serological markers were negative. Abdominal ultrasound sugge...
In a population of asymptomatic potential kidney transplant recipients ≥50 years of age, the prevalence of colorectal adenomatous polyps was 24%. Colonoscopy appeared to be useful as a screening tool in potential transplant recipients.
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