ABSTRACT
This report describes two cases, a case of primary small intestinal lymphoma and a case of gastroduodenal lymphoma both producing obstructive jaundice due to invasion of the common bile duct. Oesophagogastroduodenoscopy revealed the lesions and the endoscopic biopsies confirmed the diagnosis of lymphoma in both the cases. Ultrasound examination of the biliary system, followed by percutaneous transhepatic cholangiography, delineated the dilated biliary tree with distal obstruction of the common bile ducts. While radiotherapy alone was sufficient in the case of primary small intestinal lymphoma; drainage procedures were required in the case of gastroduodenal lymphoma to relieve the obstruction of the common bile duct.
Subject(s)
Cholestasis, Extrahepatic/etiology , Common Bile Duct Diseases/etiology , Gastrointestinal Neoplasms/complications , Lymphoma, Non-Hodgkin/complications , Lymphoma/complications , Adult , Cholangiography , Cholestasis, Extrahepatic/diagnostic imaging , Common Bile Duct Diseases/diagnostic imaging , Duodenum/pathology , Female , Gastrointestinal Neoplasms/diagnostic imaging , Gastrointestinal Neoplasms/pathology , Humans , Jejunum/pathology , Lymphoma/diagnostic imaging , Lymphoma/pathology , Lymphoma, Non-Hodgkin/diagnostic imaging , Lymphoma, Non-Hodgkin/pathology , Male , UltrasonographyABSTRACT
Eight-thousand-six-hundred-and-eighty patients were examined endoscopically over a period of six years. Significant pathological lesions were detected in 79.6% of the cases. While duodenal ulcers were seen at the same frequency as in the West, the number of gastric ulcers were considerably fewer, the ratio of gastric to duodenal ulcer being 1:8.4. Gastric cancer was also observed less commonly than in the West, but gastric lymphoma constituted 21% of all gastric malignancies. By endoscoping all bleeders within 24 hours we were able to identify the source of bleeding in 90.9% of the cases, and a lesion was detected in 96.8%. Direct visualisation of the duodenal and jejunal mucosa supported by histological examination was of paramount importance in the early detection of Immunoproliferative Small Intestinal Disease (IPSID) and its differentiation from other diseases such as tuberculosis, bilharzial jejunitis and Crohn's disease which are seen in our population.
Subject(s)
Developing Countries , Endoscopy , Gastrointestinal Diseases/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Gastrointestinal Hemorrhage/diagnosis , Humans , Infant , Male , Middle Aged , Stomach Neoplasms/diagnosisABSTRACT
Inflammatory bowel disease is considered to be rare or nonexistent in some Arab countries. During a period of 6 years, 91 patients with ulcerative colitis and 17 with Crohn's disease were seen for initial diagnosis in the Gastroenterology Department of Amiri Hospital, which serves 55% of the population of Kuwait. From this group, 43 patients with ulcerative colitis and 14 patients with Crohn's disease were followed up for an average of 30.9 months. In the remaining 51 patients, the diagnosis was established in the same manner as in this series, but these patients were sent back to the referring physicians and therefore were not available for follow-up. The severity of the disease in the majority of patients with ulcerative colitis was mild to moderate. Nine of 14 patients with Crohn's disease underwent surgery as a diagnostic procedure in an acute abdominal emergency or for treatment of complications. The duodenum was involved in two patients with Crohn's disease and the endoscopic picture and histology of these were initially interpreted as immunoproliferative small intestinal disease which is highly prevalent in this area. We suggest that the assumption that inflammatory bowel disease is uncommon in our population is wrong.
Subject(s)
Colitis, Ulcerative/epidemiology , Crohn Disease/epidemiology , Adolescent , Adult , Alkaline Phosphatase/metabolism , Child , Colitis, Ulcerative/diagnosis , Colonoscopy , Crohn Disease/diagnosis , Crohn Disease/enzymology , Female , Humans , Kuwait , Male , Middle Aged , Rectal Diseases/diagnosis , Sigmoid Diseases/diagnosis , Transaminases/metabolismABSTRACT
The prevalence of hepatitis B surface antigen (HBsAg), antibody to the hepatitis B core (anti-HBc) and to surface antigen (anti-HBs), was investigated, using sensitive radioimmunoassay (RIA) systems, among patients with different clinical entities of chronic liver disease in Kuwait, and compared to a control blood donor population. 81% of patients and 44% of the controls had at lease one HBV marker. 24% of patients, but non of the controls had both HBsAg and a high titre of anti-HBc in the absence of anti-HBs, suggesting a chronic infection. 31% of our patients with hepatosplenic schistosomiasis, 20% with cryptogenic cirrhosis and chronic active liver disease and 60% with hepatocellular carcinoma had these two markers. HBV antigenaemia was significantly more prevalent among male than among female patients and was particularly high among those less than 35 years old. The high prevalence of the various HBV markers among our patients suggests that HBV is a major factor in the development of chronic liver disease in our area. Furthermore, in view of a high prevalence of antigenaemia in patients with hepato-splenic schistosomiasis, HBV infection must play a concomitant role in the development of more serious form of chronic liver disease among such patients.
