[Evaluation of small bowel involvement in Croh'ns disease by small-bowel videocapsule endoscopy: a prospective comparative study with computed-tomography enteroclysis and small bowell radiography]

Small-bowel videocapsule endoscopy [VCE] is a new technique in evaluation of intestinal involvement in several pathologies. Crohn's disease affects principally terminal ileum.Small bowel involvement in Crohn's disease is not well estimated by endoscopic and radiologic conventional techniques. To evaluate the performances of VCE in detection of asymptomatic proximal small bowel lesions in consecutive patients with Crohn's disease with terminal ileal involvement, to compare the results of VCE to small bowel radiography and CT-enteroclysis and to determine the therapeutic impact of VCE in these patients. A prospective study which included Crohn's disease patients with distal ileal involvement, based on radiological or endoscopic findings. We performed in all patients small bowel radiography, CT enteroclysis and VCE. Proximal involvement was characterized by presence of aphtoid, superficial or deep ulcerations in the jejunum or the proximal ileum. We studied 20 patients [12 men, mean age 31.6 years]. VCE confirmed the distal ileal involvement in all patients. Significative proximal lesions was observed in nine patients [jejunum only: one case, jejunum and ileum: six cases and proximal ileum: two cases], in most cases aphtoid or superficial lesions. Deep ulcerations were observed in two patients. Small bowel radiography showed proximal ileal lesions in only two patients, and CT-enteroclysis in only one patient. Treatment by azathioprine was prescribed in two patients with severe and extended small bowel lesions in VCE examination. VCE is more accurate than radiologic techniques in detection of small bowel lesions in Crohn's disease. In cases of severe and extended small bowel involvement, VCE can conduct to changes of therapeutic approach

[Difficulty in diagnosing pseudotumoral autoimmune pancreatitis: two original cases]

In recent years, autoimmune pancreatitis [AIP] has been increasingly recognized. The diagnosis of AIP is based on a series of clinical, biological and radiological criteria. In imaging, it may appear as two different forms: a diffuse form by destroying channels and pseudotumoral lesions that can cause inadequate resections. To report two new cases of pseudotumoral autoimmune pancreatitis. We report two cases of pseudotumoral autoimmune pancreatitis, with different clinical, biological and radiologic features.The diagnosis was established easily in one case and after surgery in a 2nd case. Our two cases underline the difficulties still encountered in the diagnosis of AIP

[ case of an acute pancreatitis after endoscopic band ligation of oesophageal variceal: a fortuitous association or an unusual complication?]

Endoscopic band ligation is considered as the gold standard of treatment for oesophageal varices. Fewer and often mild complications can occur. To report and to discuss an association between oesophageal variceal endoscopic band ligation and actue pancreatitis. We report the original case of a patient with cirrhosis and who had presented an acute pancreatitis 3 days after oesophageal variceal endoscopic band ligation. Common aetiologies of acute pancreatitis was eliminated. The evolution was favourable without specific treatment. To the absence of similar case reports, the association between oesophageal variceal endoscopic band ligation and acute pancreatitis observed in our patient remains rather fortuitous even though experimental studies can explain these association

Chontirosarcoma of sinonasal cavity: a case report and brief literature review

Chondrosarcomas are slow-growing malignant tumors that usually arise from cartilaginous structures. it may occur in the head and neck region with a predilection for the maxillofacial skeleton, where it has been reported to occur particularly in the mandible anti maxilla. Ghondrosarcomas of the sinonasal tract is very rare. Report a new case. We present the case of a 43-year-old man presenting with an incidental finding of a chondrosarcoma of the maxillary and ethmoid sinus with nasal extension. The tumor was completely resected using a transnasal endoscopic approach. Treatment has followed by a radiation therapy and the patient was considered free of disease at her 5 years follow-up. Surgery is the mainstay treatment of chondrosarcomas. In selected patients, complete resection can be achieved using transnasal endoscopic approach

Synchronous occurrence of colonic intraepithelial neoplasia and small bowel stromal tumour

We report the diagnosis of synchronous gastrointestinal stromal tumours affecting the small bowel and intraepithelial neoplasia of the colon in a 52-year-old patient. After surgical resection of the two tumours outcome was favourable. We discuss the causality of this association, based on a literature review of the few previously published cases

[Rupture of hydatid cyst of the liver into the duodenum. A case report]

Rupture of hydatid cyst in the digestif tract is a rare complication even in endemic areas. Authors report a case of a hydatid cyst of the left hepatic lobe ruptured in the duodenum. Was discovered at the occasion of epigastric pain and vomiting. Ct-scan revealed presence of air in a calcified hydatid cyst of the left liver lobe and a fistulous tract between the cyst and the duodenum. Endoscopy confirmed the diagnosis by the visualisation of a fistulous orifice of the anterior aspect of the first duodenum with a protrusion of hydatid membrane. Patient was treated surgically and had a partial cysto-pericystectomy and Suture of duodenum

misleading renal tumour

Hydatid cyst of the kidney is uncommon and still constitutes about 3% of cases of hydatid disease. The diagnosis can be made by ultrasonbography, Ct-scan and in some difficult cases by MR1. We report a case of a renal hydatid cyst in a 47-year-old man mimicking at imaging, even at MRI, a hypo vascular renal tumour

Phlegmonous appendicitis revealed by pyogenic liver abscesses

Pyogenic liver abscesses are rare and severe. Early diagnosis and treatment lead to a better prognosis. Biliary cause of liver abscesses is the most frequent. Portal origin is secondary to a portal bactremia. Appendicitis was the most cause of portal infection, but actually, diverticulitis is most common. The aim of this study was to report a new case of pyogenic liver abscesses secondary to phlegmonous appendicitis We report a case of 47 years old man presented with fever and weight loss without abdominal pain. Laboratory investigations show signs of inflammation with high leukocyte and neutrophile rates. The diagnosis of liver abscesses was made on abdominal ultrasound and tomodensitometry witch shows also an inflammatory appendix. The outcome was good after antibiotics associated with percutaneous drainage of abscesses and laparoscopic appendectomy witch found a phlegmonous appendix. One month later, the CT scan showed a markedly decrease of the size of the abscesses

[Spontaneous intrahepatic porto-cava shunt associated with chronic pericarditis. A case report]

Introduction: Spontaneous intrahepatic portosystemic shunts are rare vascular anomalies that consist of a communiation between the portal system and the systemic venous circulation. We report a case of a porto-caval shunt associated with chronic pericarditis

Case report: A 47-year-old patient with post pericarditis cirrhosis and without encephalopathy and hypoglycaemia. The shunt was tubular in its initial segment and aneurismal just before joining the vena cava

Discussion: Spontaneous intrahepatic portosystemic shunt is a rare anomaly. Diagnosis can ve made by Doppler ultrasound and helical CT

[Adrenal cystic phaeochromocytoma a case report]

Cystic phaeochromocytoma is a rare occurrence. We report a case of a 42-year-old woman who presented with the cardinal symptoms of phaeochromocytoma with elevated serum catecholamine levels. Radiological investigations showed a cystic mass in the right adrenal. Right adrenalectomy through a subcosal incision was performed and pathological examination concluded to a cystic phaeochromocytoma. We discuss the pathophysiology of such cyst formation as well as differential diagnoses

[Gastrointestinal Stromal Tumours : clinical and therapeutic features a report of 25 cases]

Aim: To evaluate the epidemiological clinical features and therapeutic results of gastrointestinal stromal tumour [GIST]

Patients and method: This retrospective study concerned 25 cases of gastrointestinal stromal tumour from January 1993 to December 2002. All patients have been operated and the diagnosis of GIST has been confirmed by histological and immunohistochemical study of pieces of resection or biopsies

Results: Population include 11 men and 13 women with a mean age of 64 years. Symptomatology was dominated by abdominal pain [54% of cases] and the digestive haemorrhage [46% of cases]. A palpable mass has been found in 29% of cases. The tumour was gastric in 17 cases, small intestinal in 6 cases, colic in 1 case and rectal in 1 case. A double gastric localization and small intestinal was found in 1 case. The mean tumour size was 8 cm [1 to 30 cm]. A tumour resection has been achieved in 23 cases [96%], extended to neighbourhood organs in 2 cases. The morbidity was 12.5% and there was no operative mortality. Histologically, tumour was of low grade in 10 cases, high grade in 10 cases and unclassified in 5 cases. With a median follow up of 27 months [2 to 108], we observed 4 cases of loco-regional recurrence. Overall survival at 2 years was 74% for the whole population and 35% for the high grade. Independent prognostic factors recovered were the degree of malignancy [p=0.01] and the local recurrence [p0.01]

Conclusion: The treatment of the GIST is surgical. lympha-denectomy is superfluous. The new oral chemotherapies that inhibits Tyrosine Kinase] seems to be promising

[Rhinoscleroma: a report of 2 cases]

Rhinoscleroma is a rare chronic granulomatous infection caused by Klebsiella rhinoscleromatis. Because of its mundane clinical presentation as chronic rhinits, it is frequently unrecognized. The authors report the cases of two female patients with pseudotumoral rhiniscleromas located in the septum and in the rhinopharynx respectively CT scan permitted a precise evaluation of the extent of the lesion Among the various para-clinical examinations required, bacteriological studies are very important and should be performed comcomitantly with biopsy