Acquired tracheo-oesophageal fistula: a case report.

This is a case report of a girl aged 4 years who presented with repeated attacks of chocking and dysphagia. She was diagnosed to be having an acquired tracheo- oesophageal fistula caused by fish bone impaction. She was treated successfully. In this report, the literature was reviewed of this rare condition.

Tubercular oesophagocutaneous fistula.

A case of oesophageal tuberculosis complicated by an oesophagocutaneous fistual is reported. We subsequently review the literature of this exceedingly rare condition.

Brunner's gland hyperplasia at the ampulla of Vater.

Brunner's gland hyperplasia (BGH) is a diagnostic challenge where in the pathophysiology and natural history remain poorly understood. This Case Report describes BGH arising at the ampulla of Vater, causing abdominal pain and vomiting in a 46-year-old man. Owing to the inconclusive nature of imaging studies and suspicious intraoperative findings, a Whipple resection was performed without any complications. Histological analysis showed that the obstructing lesion was BGH, with no evidence of malignancy. This is only the second such case of its kind at the ampulla of Vater to be reported. In addition, we present the previously unreported endoscopic ultrasound findings. The subsequent literature review focuses on the pathophysiology, clinical presentation, diagnosis and management of BGH.

Abdominal cocoon due to primary peritonitis: barium meal is valuable in diagnosis.

Abdominal cocoon, a rare condition in which the small bowel is encased in a membrane, resembles peritoneal fibrsis. There are only 16 case reports of this condition in the world literature. A 15-year-old girl presented with recurrent abdominal pain due to distal small bowel obstruction. Abdominal X-ray showed multiple air fluid levels like small intestinal obstruction. Contrast study revealed segregation of the small bowel loops with a dilatedproximal small intestine and gradual narrowing of the distal ileum with the obstruction; the mucosal pattern was preserved till the distal ileum. Contrast was not flowing into the colon. At laparotomy, the small intestine was seen to be encased and coiled up in a membrane. The membrane was excised, resulting in release of the obstruction.

Clinical characteristics of colorectal polyp in Thai children: a retrospective study.

BACKGROUND: It was believed that more than 90 per cent of children with colorectal polyp had a single lesion, located in the rectosigmoid colon, therefore, sigmoidoscopy with polypectomy was the treatment of choice. After a wide use of pediatric colonoscopy, this concept has been changed. MATERIAL AND METHOD: This study was aimed to describe clinical characteristics of colorectal polyp in Thai children. Medical records of children with colorectal polyp were retrospectively reviewed. Comparison between polyposis coli and children with less than 5 polyps were also analyzed. RESULTS: There were 93 patients, 43 females and 50 males. The average age was 5.1 years. Lower GI bleeding and prolapse of rectal polyp comprised the two most common presentations, 93.5 and 39.8 per cent, respectively. The mean duration of symptoms was 5.6 months. Only 50.6 per cent had rectal polyp noted by digital examination. Investigations included sigmoidoscopy (n = 77), colonoscopy (n = 16), and barium enema (n = 16). Eight per cent of the cases had more than 5 polyps. Location of the polyps was noted in the rectosigmoid colon (88.2%), descending colon (4.3%), right-sided colon (4.3%), and pancolonic (3.2%). Of all the patients, 11.8 per cent had the polyp above the rectosigmoid region, whereas 50 per cent of those who underwent colonoscopy (n = 16) had the polyps noted proximal to this region. Older age, lower hematocrit, and more frequent right-sided polyps were significantly associated with polyposis coli (p < 0.05). Only 2 patients with polyposis coli were treated by colectomy. Histopathology included juvenile polyp (95%), inflammatory pseudopolyp (2.5%), and hyperplastic polyp (2.5%). CONCLUSION: Most of the children with colorectal polyp had juvenile polyp that is commonly found in the rectosigmoid colon. However, a significant number of patients had carrying polyps proximal to the rectosigmoid region, which would be easily missed by sigmoidoscopy. With the concern of malignancy change particularly in children with polyposis coli, routine colonoscopy should be considered as an initial investigation in children with colorectal polyp.

Evaluation of the sensitivity of the double-contrast upper gastrointestinal series in the diagnosis of gastric cancer.

OBJECTIVE: To evaluate the sensitivity, specificity and accuracy of the double-contrast upper gastrointestinal series (UGI series) in the diagnosis of gastric cancer. MATERIAL AND METHOD: The authors retrospectively reviewed the radiographs of the double-contrast UGI series for diagnosis of gastric cancer of 84 patients who had pathological confirmation by gastric biopsies and/or operations. RESULTS: The lesions were true positive in 45 patients, true negative in 28 patients, false positive in 8 patients and false nagative in 3 patients. The authors found pathologically proved gastric cancers in 48 patients. They were 42 adenocarcinomas (87.5%), 3 gastric mucosa-associated lymphoid tissue lymphomas (6.2%), one gastrointestinal stromal tumor (2.1%), one squamous cell carcinoma at the distal esophagus involving the cardia (2.1%) and one cancer of the pancreatic head with invading gastric antrum (2.1%). The sensitivity, specificity and accuracy of the present study were 93 per cent, 77 per cent and 86 per cent, respectively. They showed small differences compared to the previous studies. CONCLUSION: The present findings indicate that the double-contrast UGI series has high sensitivity, specificity and accuracy. It should be considered a sensitive technique and initial examination in the diagnosis of gastric cancer.

Duodenal tuberculosis: radiological features on barium studies and their clinical correlation in 28 cases.

BACKGROUND: A retrospective analysis of 28 cases of duodenal tuberculosis (TB) was done to evaluate radiological findings and their value in the diagnosis of the disease. SUBJECTS AND METHODS: Upper gastrointestinal and small bowel series of 28 patients with duodenal tuberculosis were analysed for radiological findings. The diagnosis of duodenal TB was confirmed by surgery and biopsy in 18, on the basis of radiological findings and response to treatment in 9, and on the basis of findings on upper gastrointestinal scopy and biopsy in 1 patient. RESULTS: The study included 28 patients (14 males, 14 females). The mean age was 32.1 (range 5-65). Twenty-three (82.2%) patients presented with obstructive symptoms while five manifested with dyspeptic symptoms. Of the latter, 4 had ulcerations in the third and fourth parts of the duodenum. In the remaining patient, the mucosa of the duodenum could not be clearly visualised. Two patients had extrinsic impression at the D2-D3 and D3-D4 segments. In 23 patients with obstructive symptoms, 18 demonstrated luminal narrowing of varying degrees and 5 had a sharp band-like cut-off at the third part of the duodenum. Of the 18 patients with luminal narrowing, 13 had extrinsic compression, 12 had proximal dilatation and 14 had ulcerations mainly in the second and third parts of the duodenum. Biliary involvement was seen in 3 patients without any signs or symptoms directly referable to the biliary involvement. CONCLUSION: Though duodenal TB lacks specific radiological features, barium studies help to localise and define the area of narrowing and ulcerations and help to confirm the presence of lymph nodes causing compression of the duodenum.

Achalasia--alacrima--ACTH insensitivity syndrome (Triple A syndrome).

Triple A syndrome is characterized by achalasia of the cardia, alacrima, adrenocorticotrophic hormone (ACTH) resistant adrenal insufficiency and progressive neurological abnormalities including autonomic nervous dysfunction. An 8-year-old girl presented to the pediatric intensive care unit with sudden loss of consciousness and was diagnosed subsequently to have this condition. The authors present this condition since it is easily treatable and can be fatal if undiagnosed.

Pneumobilia--clue to an unusual cause of diarrhea.

A 65-year lady presented with diarrhea and weight loss of six months duration. Initial evaluation suggested that malabsorption was the possible underlying mechanism for the diarrhea. Work up for the common etiologies of malabsorption was non-contributory. Presence of pneumobilia raised the suspicion of a bilio-enteric fistula, which was subsequently confirmed on barium enema and endoscopic cholangio-pancreaticography to be a cholecystocolic fistula. At surgery, a fistulous tract from the fundus of the gallbladder was found to be communicating with the hepatic flexure. Fistulectomy with cholecystectomy resulted in prompt relief of symptoms. Cholecystocolic fistula (CCF) is a rare biliary fistula with diverse presentation.

Menetrier's disease.

An 8-year-old girl presented with persistent vomiting, pain abdomen and generalized edema. Barium studies and gastroscopy suggested hypertrophic gastropathy. Histopathological examination pointed the diagnosis towards Menetrier's Disease. There was spontaneous remission and the child required only supportive therapy.

Symptomatic volvulus due to mid gut malrotation in an adult.

Anomalies of rotation and fixation of gut occur most commonly in the neonatal period and usually become symptomatic in infancy. We report an adult patient with symptomatic volvulus due to mid gut malrotation.

Laparoscopy assisted hemi-colectomy for ileo-caecal tuberculosis.

Laparoscopy assisted hemicolectomy for ileo-caecal tuberculosis is being evaluated the world over. Several procedures are performed laparoscopically, including the laparoscopic hemicolectomy, for benign and malignant diseases. Abdominal tuberculosis is one of the commonest causes of intestinal obstruction in India. We have evaluated the role of laparoscopic resection of ileocaecal tuberculosis and successfully performed the procedure in five patients. The clinical profiles of patients and operative procedure are discussed in this article with a brief review of the literature.

A case of sigmoid lipoma presenting with intussusception.

Colonic lipomas are rare, benign tumours that rarely produce symptoms. Presented here is a case where a sigmoid lipoma acted as lead point to produce intussusception.

Primary malignant intestinal lymphoma.

BACKGROUND: Primary malignant intestinal lymphoma is an uncommon gut malignancy. Its incidence has been increasing over the past century. We in this study attempt to define its clinico-pathological profile and to share our experience with multidisciplinary approach to management. METHODS: Our experience of seven patients with a diagnosis of primary intestinal lymphoma over a period of 22 months is presented here. All the cases were followed up prospectively over a period varying from 8 months to 20 months. RESULTS AND CONCLUSIONS: Of the 7 patients 4 were males and 3 females (mean age 56.3 years). Acute intestinal obstruction was the commonest presentation. Imaging modalities revealed abnormality in all the cases but were rarely diagnostic. Most patients presented at an early stage when the disease was confined to the bowel. The commonest site was the large intestine (42.6%) especially the caecum. Diffuse large cell, high grade tumour were found to be the commonest histological type. Surgery followed by adjuvant chemotherapy gave good results.

Eosinophilic enteritis caused chronic partial small intestinal obstruction: a case report and review of the literature.

This is the case-report of a rare cause of chronic small intestinal obstruction by eosinophilic enteritis. A 53-year-old woman presented with an 8-month history of severe intermittent abdominal colick associated with malnutrition, weight loss, and bowel habit change. Several investigations were done but failed to demonstrate the cause. Exploratory laparotomy was therefore performed and the cause of partial small bowel obstruction was found to be eosinophilic enteritis.

Colonic tuberculosis: colonoscopic appearance and clinico-pathologic analysis.

BACKGROUND: There has been a resurgence of interest in intestinal tuberculosis because of acquired immunodeficiency syndrome (AIDS) epidemic sweeping our country. Role of colonoscopy and colonoscopy directed histology for diagnosing the disease have been emphasised since last few years. AIMS AND OBJECTIVES: To know the colonoscopic features in patients with intestinal tuberculosis and to study the clinicopathological findings in the same. METHODS: We studied twenty-one patients with intestinal tuberculosis referred to us between 1993-1997. Colonoscopy was done in all patients and biopsy specimens were collected from the site of lesion during the procedure. RESULTS: Ileocaecal disease was found in 9 patients, ileocaecal with contiguous ascending colon involvement in eight and segmental colonic tuberculosis in four cases. The colonoscopic findings included nodules in seven patients, nodules with ulcerations in three, ulcerations alone in seven, nodules with strictures in three and polypoidal mass in one patient. Eight cases revealed granuloma on histopathology. CONCLUSIONS: Though bacteriological and histological assessment of tissue is essential to differentiate tuberculosis from other disorders, we stress the importance of colonoscopic appearances in diagnosing tuberculosis. We also recommend antituberculous chemotherapy in patients with high clinical suspicion of tuberculosis on the basis of colonoscopic appearance alone after ruling other causes on histopathological examination.