[Budd-chiari syndrome a rare complication of hepatic echinococcosis; about 3 cases]

Hydatid disease is a parasitic infestation due to the development of echinococcus granulosus in the organism. This disease is particularly frequent in Tunisia where echinococcosis is endemic. Liver is the most common organ to be involved by hydatidosis and several complications have been described. Vascular complications secondary to hepatic echinococcosis such as Budd-Chiari syndrome have rarely been reported. We present herein, three rare cases of hydatid cyst complicated by Budd-Chiari syndrome. The cyst occupied at least two segments of the hepatic dome in all patients and his diameter was 12, 5 cm, 21 cm and 12, 5 cm respectively. According to the Gharbi classification, the cysts were type III in one case and type IV in the two others. The Budd-Chiari syndrome was chronic in one patient and asymptomatic in the two others. His diagnosis was established by abdominal US in two cases, completed by US Doppler and CT angiogram in one patient and by CT angiogram in the other. The diagnosis was established only by CT angiogram in the later case. The Budd-Chiari syndrome was due to compression of two hepatic veins in one case, compression of inferior vena cava in one case and compression of one hepatic vein and inferior vena cava in one case. Laparotomy was performed in all patients. The surgical procedure consisted in resection of the protruding hepatic tissue after puncture aspiration of the cyst in the three cases. The postoperative period was complicated by abscess formation in residual cavity, requiring drainage and by development of ascitis, in one case. Hydatid cyst should be remembered amongst the causes of Budd-Chiari syndrome in countries where the disease is endemic. Conversely, this vascular complication should be looked for routinely in patients with hydatid disease of the liver

[Overlap syndrome autoimmune hepatitis=primary biliary cirrhosis. Comparative study with isolated autoimmune hepatitis results of a multicentric Tunisian]

Autoimmune hepatitis [AIR] and primary biliary cirrhosis [PBC] are two autoimmune diseases affecting the liver. Suggestive signs of the two diseases can however occur simultaneously or consecutively in the same patient leading to an overlap syndrome. The aim of our multicentric retrospective study was to study clinical, biological, immunological and histological features of 17 patients with overlap syndrome and to compare them with those of 62 patients with isolated autoimmune hepatitis. Overlap syndrome "AIH-PBC" accounts for 20,5%of patients with autoimmune hepatitis in our series. Our two groups were similar in age and gender. Clinically, in overlap syndrome group, a significantly higher prevalence of pruritus arid significantly lower prevalence of ascites were observed as compared to isolated AIH group. No significant differences were observed between the two groups of patients with regard to frequency of concurrent immune diseases. Biologically, serum alkaline phosphatase and garnma-glutamyl-transpeptidase were significantly higher in overlap syndrome than in patients with isolated AIH. Significantly more overlap syndrome patients were positive for anti-mitochondrial antibodies than isolated AIR patients. The patients with isolated AIR had a higher frequency of cirrhosis at presentation that the patients with overlap syndrome. The histologic profile was not different between isolated AIR and Overlap syndrome. Overlap syndrome "AIR-PBC" is not rare. Compared with isolated AIH, it is characterised by a higher frequency of clinical and biological signs of cholestasis, a higher frequency of antimitochondrial antibodies and the rarity of cirrhosis at the diagnosis of the disease

Pancreas hydatic cyst: a case report

Echinococcal involvement of the pancreas is extremely rare. The clinical presentation is polymorph and the diagnosis is rarely evocated before surgery. We report a 60-year-old woman presenting with epigastric pain. Abdominal examination found an epigastric mass. Radiologie explorations [Abdominal ultrasound and a computed tomography scan] revealed a pancreatic cyst located in the corpus and in the tail. The diagnosis of hydatid cyst was made at laparotomy. The cyst was treated by aspiration and injection of hypertonic saline solution followed by cystectomy. Three years later, the patient was asymptomatic without recurrence of hydatic cysts. Epidemiological, clinical, biological and radiological data should allow better detection of hydatid cysts of pancreas. Surgical treatment depends on the location of the cyst in the pancreas

[Rectal carcinoid tumor - a case report]

Rectal carcinoid tumor is uncommon. It represent 13 percent of gastrointestinal carcinoid tumors. We report the case of a 37-year-old woman presenting with rectal bleeding. Digital examination revealed a hard mass in the rectum, 7 cm from the anal verge. Laboratory investigation was normal. Rectoscopy demonstrated a polypoid mass, 10 mm in diameter in the rectum, 7 cm from anal verge. Endoscopic resection was performed. Histology of the polyp with immunohistochemestry led to a diagnosis of carcinoid tumor. Local remnant was found. No distant metastases were found. Additional transanal excision was necessary. Clinical characteristics, histologic aspects and treatment options of rectal carcinoid tumor will be reviewed

[New advances in the management of gastric marginal zone B cell lymphoma]

The stomach is the most common site involved in primary gastrointestinal lymphoma. Helicobacter pylon [HP] plays a decisive role in the pathogenesis of gastric marginal zone B cell lymphoma of mucosa associated lymphoid tissue. Eradication therapy has become widely accepted as initial treatment of localized low grade MALT lymphoma. Further studies are needed to determine the most adapted treatment in non-responding patients. A long-term endoscopic follow-up is recommended due to the increased risk of gastric adenocarcinoma in spite of Helicobacter pylon eradication

[Pathogenesis of intestinal amebiasis]

Amebiasis is the infection of the human gastrointestinal tract by Entamoeba histolytica, a protozoan parasite that is capable of invading the intestinal mucosa and spread to other organs mainly the liver. Identification of proteins associated with virulence, including a lectin that mediates adherence to epithelial cells, a pore-forming peptide that lyses host cells and secreted proteases that degrade host tissues, is one of major recent accomplishment in the field of amebiasis research. This review focuses mainly on the parasitic mechanisms that may be related to invasive intestinal amebiasis