unique case of upper and lower Gi bleeding in a cirrhotic patient

Introduction: Cirrhotic patients are at a heightened risk for surgical and anesthesia related complications and particularly, these complications depend on the severity of liver dysfunction. Gastroenterologists are often very hesitant to perform invasive procedures because of bleeding and decompensation of the liver disease which are encountered in the postprocedural phase. However in certain situations, it is imperative to perform high risk procedures to prevent exsanguination. This case represents such a rare challenging situation when a patient presented with hematochezia and melena for the first time and was detected to be harbouring chronic liver disease complicated with large rectal polyp, Grade 3 esophageal varices and mesenteric cyst. The histopathology of the polyp showed colitis cystica profunda which is another unique feature

Case Description: 54 year old lady presented for the first time with history of melena, severe colicky pain abdomen and frank hematochezia of 7 days duration. On evaluation, she had stigmata of CLD [chronic liver disease] further confirmed on imaging. Investigations confirmed child B cirrhosis. After hemodynamic stabilisation, colonoscopy was done which showed 2x1.5cm hyperemic pedunculated polyp in the rectosigmoid junction causing partial luminal obstruction. Upper GI endoscopy performed in view of melena, showed large esophageal varices and band ligation was done. Since she continued to have hematochezia despite plasma, platelet transfusions, polypectomy consent was taken under high risk and polyp removed enbloc using adrenaline injection at the base of the polyp coupled with endoloop, snare and cautery. The bleeding was controlled and the patient did not develop any immediate/delayed post-polypectomy bleeding [PPB] and is asymptomatic on follow up

Conclusion: Cirrhosis by itself is not a contraindication for colonoscopic polypectomy. Nevertheless, Child Pugh class B, C cirrhotics are at a very high risk of Post-polypectomy bleeding[PPB] that occur immediately [IPPB] or even may be delayed up to 30 days[DPPB]. Colonoscopic polypectomy with an endoloop is much safer than conventional polypectomy and should be considered in high risk patients with potential for PPB

Ectopic salivary gland tissue in palatine tonsil: a case report and review of literature

A case of ectopic salivary gland tissue in a routine tonsillectomy specimen is reported and the literature is reviewed. Tonsillectomy specimens are routinely sent for histopathologic evaluation to assess the nature of inflammatory process as well as to exclude occult malignancy. A tonsillectomy specimen from a young woman who underwent surgery for recurrent attacks of tonsillitis in the previous six months was received at the histopathology laboratory of Gulf Medical College Hospital, Ajman. Routine microscopic examination revealed tonsilar tissue with chronic inflammation and lobules of mucous secreting salivary acini with ducts adjacent to the surface squamous epithelium of the tonsilar tissue

Ectopic salivary gland tissue in palatine tonsil: a case report and review of literature

A case of ectopic salivary gland tissue in a routine tonsillectomy specimen is reported and the literature is reviewed. Tonsillectomy specimens are routinely sent for histopathologic evaluation to assess the nature of inflammatory process as well as to exclude occult malignancy

A tonsillectomy specimen from a young woman who underwent surgery for recurrent attacks of tonsillitis in the previous six months was received at the histopathology laboratory of Gulf Medical College Hospital, Ajman

Routine microscopic examination revealed tonsilar tissue with chronic inflammation and lobules of mucous secreting salivary acini with ducts adjacent to the surface squamous epithelium of the tonsilar tissue