Stromal Tumor of the Jejunum Complicated by Hemorrhagic Shock-A Case Report.

Stromal tumors of the small bowel, commonly known as GIST (Gastrointestinal Stromal Tumors) are mesenchymal tumors of uncertain prognosis. They develop in the wall of the digestive tract. They are usually asymptomatic, incidentally discovered during endoscopy or during surgery. Identifying gastrointestinal stromal tumor is facilitated by a relatively specific marker, c-kit. Diagnosis is confirmed by histological examination of the surgical specimen. They pose two problems first is to confirm the diagnosis and second problem is to assess their evolutionary potential and customize the therapeutic management. We report the case of a patient aged 34 years with no history of prior illness. He was admitted a year ago in the emergency room in a state of hemorrhagic shock due to lower gastro intestinal (GI) bleeding for three days. The patient underwent conservative therapy with I.V fluids and blood transfusions. An endoscopic assessment consisting of upper and lower GI(UGIE and colonoscopy) was done but that did not reveal any abnormalities. Surgical exploration revealed a tumor 1 meter distal to the ligament of Treitz. Rest of the exploration was unremarkable. The tumor along with small bowel was resected and end anastomosis was performed. The postoperative course was uneventful. Histological study of the surgical specimen confirmed that this was a stromal tumor with low potential of malignancy. The staging did not reveal any secondary lesions. Stromal tum often asymptomatic, lower GI bleeding is an exceptional way of presentation. Complete resection of the tumor is the treatment of choice. The recent development of targeted therapies and molecular biology is a new hope in the treatment of these tumo review the diagnostic and therapeutic aspects of this disease, and explain that hemorrhagic shock can be due to jejunal stromal tumor.

Colopleural fistula: Case report and review of the literature

We report a 28-year-old woman, pregnant, at 24 weeks, with 3-day history of right-sided chest pain and shortness of breath. Few hours after admission, she delivered a dead baby. She had a history of right partial hepatic lobotomy and cholecystectomy at UK on May 2004 because of multiple pyogenic liver abscesses. Chest examination revealed signs of hydrothorax on the right side. Chest X-ray showed pleural effusion on the right side. Pleural fluid was exudative with high neutrophils. Gram stain and culture showed multiple organisms. CT scan chest and abdomen with contrast, combined with barium enema, revealed right colothorax communication. Colothorax fistula was closed surgically. On the following days, the patient's symptoms resolved, and she was consequently discharged

Neuroleptic malignant syndrome

We report 37-year-old man admitted to the psychiatric ward with acute depression. Antidepressive medications were initiated including: promethazine hydrochloride, hydroxyzine hydrochloride, lorazepam and haloperidol. In an attempt to control his depression, doctors increased the dose of haloperidol. Five days later he developed fever, cough, confusion and he was unable to eat. Accordingly, he was transferred to the medical ward for further assessment. On examination he was febrile, confused, there was neck stiffness and generalized rigidity with flexor planters. Both serum myoglobin and creatine kinase level were elevated. The urine myoglobin test result was positive. He was diagnosed with neuroleptic malignant syndrome. Dantrolene was started for 3 days, followed by bromocriptine. The clinical syndrome resolved over the next couple of days

Ascites and eosinophilic colitis in a young patient

A 32-year-old man presented with 3-weeks history of abdominal pain and distention. Physical examination showed ascites, with no stigmata of chronic liver disease. Cytological preparations from the ascitic fluid showed a heavy population of mature eosinophils. Histological examination of colonic biopsies revealed a heavy expansion of the mucosa by sheaths of eosinophils. On the following days, the peripheral eosinophilia, ascites and abdominal pain resolved spontaneously