Ischemic colitis in five points: an update 2013

Ischemic colitis is the most common form of intestinal ischemia. The presence of diarrhea and mild lower gastrointestinal bleeding should guide the diagnosis. Although many laboratory tests and radiographic images may suggest the diagnosis, colonic endoscopic with histological analysis of biopsies is the gold standard for identification of colonic ischemia. The aim of this study was to resume in 5 points: the epidemiology, the clinical features, the diagnostic approach and the management of ischemic colitis in five points. Review of literature. Incidence of ischemic colitis was between 3 and 10%. The clinical presentation is predominated by the non gangrenous form associating abdominal pain, tenderness, diarrhea and lower gastrointestinal bleeding. The most frequent causes are represented by systemic hypoperfusion. Laboratory tests can orientate the diagnosis but are unspecific. Radiographic images based on computed tomography or more recently magnetic resonance imaging may suggest the diagnosis, but the confirmation will be given by endoscopic visualization of colonic mucosa with histological analysis of biopsies. Conservative treatment is the most often sufficient to improve colonic lesions. Surgical treatment is reserved for perforations and strictures. The incidence of colonic ischemia is difficult to ascertain. The diagnosis is usually made by medical history, examination, and endoscopy which have become the diagnostic procedure of choice. A high index of suspicion and prompt management are essential for optimum outcomes in patients with colonic ischemia

Autoimmune Pancreatitis, a report of 5 cases from Tunisia: diagnostic challenge

In this study, we aimed to review retrospectively the records of 5 patients who were treated in our hospital and to review the current approaches in diagnosis and management of autoimmune pancreatitis [AIP]. The series of patients diagnosed with AIP during the last seven years [January 2006 - August 2012] was the basis of this study. All records were retrieved and analyzed. The diagnosis of AIP was established on the basis of imaging studies, serology, cytology and response to treatment. Five patients were diagnosed with AIP pancreatitis during this 7-years period. Four of the 5 patients were males. The most common presenting symptom was abdominal pain [4/5]. Two patients with the preliminary diagnosis of pancreatic mass underwent surgery. Histological analysis of the surgical resection did not reveal any malignancy. During the follow-up, one of them has developed Crohn's disease and Sjogren syndrome. One of the patients had obstructive jaundice and abdominal pain for several months. Abdominal contrast enhanced computed tomography [CECT] suggested the diagnosis of AIP, cholangitis with renal atrophy and retroperitoneal fibrosis. He was started on steroids to which he responded dramatically. One patient had been diagnosed as primary sclerosing cholangitis few months earlier on the basis of abdominal CECT features showing a dominant stricture in the common bile duct. During the follow-up, the diagnosis of AIP was suspected and finally established on the basis of repeated magnetic resonance imaging [MRI]. The last patient had history of acute pancreatitis, obstructive jaundice and abdominal pain for 3 months. An abdominal CECT suggested autoimmune pancreatitis which was confirmed by MRCP. He was started later on steroids to which he responded significantly. IgG4 was done in all cases, high in four patients. AIP is a disease with increasing incidence and characterized by lymphoplasmacytic cells infiltration and fibrosis. It is necessary to evaluate patients in terms of AIP serologically to avoid wrong diagnosis and the morbidity of surgery

[Laparoscopy for perforated duodenal ulcer: conversion and morbidity factors: retrospective study of 290 cases]

Feasibility and advantages of laparoscopic approach in performed duodenal ulcer have no longer to be demonstrated. Laparoscopic suture and peritoneal cleaning expose to a conversion rate between 10 and 23%. However less than laparotomy, morbidity of this approach is not absent. This study aim to analyze factors exposing to conversion after laparoscopic approach of perforred duodenal ulcer. We also aim to define the morbidity of this approach and predictive factors of this morbidity. Retrospective descriptive study was conducted referring all cases of perforated duodenal ulcer treated laparoscopically over a period of ten years, running from January 2000 to December 2010. All patients were operated by laparoscopy with or without conversion. We have noted conversion factors. A statistical analysis with logistic regression was performed whenever we have sought to identify independent risk factors for conversion verified as statistically significant in univariante. The significance level was set at 5%. Analytic univariant and multivariant study was performed to analyze morbidity factors. 290 patients were included. The median age was 34ans.T he intervention was conducted completely laparoscopically in 91.4% of cases. The conversion rate was 8.6%. It was selected as a risk factor for conversion: age> 32 years, a known ulcer, progressive pain, renal function failure, a difficult peritoneal lavage and having a chronic ulcer. Postoperative morbidity was 5.1%. Three independent risk factors of surgical complications were selected: renal failure, age> 45 years, and a chronic ulcer appearance. Laparoscopic treatment of perforred duodenal ulcer expose to a conversion risk. Morbidity is certainly less than laparotomy and a better Knowledge of predictif's morbidity factors become necessary for a better management of this disease