Ileo-colic endometriosis: a rare localization of a frequent disease. Case report.

Endometriosis is a common entity affecting females of reproductive age. Clinical manifestations are not specific, making the preoperative diagnosis difficult to establish. Intestinal endometriosis is common, but ethiology is unknown. The complications of intestinal endometriosis include intestinal obstruction, perforation, hemorrhagic ascites, protein-losing enteropathy, anasarca, and intussusception. We report a case of a young woman, 26 years old, that for 3 years had a conditioned life by monthly sub-occlusion due to a small-bowel obstruction for an ileocaecal endometriosis. A high index of suspicion is required to have a diagnosis of this rare localization of endometriosis.

A rare case of pancreatic cancer presenting as pseudoachalasia.

"Pseudo" (or secondary) achalasia is a rare entity that it isn't easily distinguishing from idiopathic achalasia by manometry, radiological examination and endoscopy. Usually a neoplastic process of the esophago-gastric region is associated with this clinical condition. However, it has been reported that other neoplastic processes may lead to the development of pseudoachalasia, such as mediastinal masses, gastrointestinal tumours (pancreas, liver, biliary tract and other organs) and non gastrointestinal malignancies. We present a case of pseudoachalasia in which the primary cause of the disease was not an esophago-gastric cancer.

Does transient elastography (FibroScan®) have a role in decision making in hepatocellular carcinoma?

OBJECTIVES: Portal hypertension has been reported as a negative prognostic factor and a relative contraindication for liver resection. This study considers a possible role of fibrosis evaluation by transient elastography (FibroScan(®)) and its correlation with portal hypertension in patients with cirrhosis, and discusses the use of this technique in planning therapeutic options in patients with hepatocellular carcinoma (HCC). METHODS: A total of 77 patients with cirrhosis, 42 (54.5%) of whom had HCC, were enrolled in this study during 2009-2011. The group included 46 (59.7%) men. The mean age of the sample was 65.2 years. The principle aetiology of disease was hepatitis C virus (HCV)-related cirrhosis (66.2%). Liver function was assessed according to Child-Pugh classification. In all patients liver stiffness (LS) was measured using FibroScan(®). The presence of portal hypertension was indirectly defined as: (i) oesophageal varices detectable on endoscopy; (ii) splenomegaly (increased diameter of the spleen to ≥ 12 cm), or (iii) a platelet count of <100,000 platelets/mm(3). RESULTS: Median LS in all patients was 27.9 kPa. Portal hypertension was recorded as present in 37 patients (48.1%) and absent in 40 patients (51.9%). Median LS values in HCC patients with and without portal hypertension were 29.1 kPa and 19.6 kPa, respectively (r = 0.26, P < 0.04). Liver stiffness was used to implement the Barcelona Clinic Liver Cancer algorithm in decisions about treatment. CONCLUSIONS: The evaluation of liver fibrosis by transient elastography may be useful in the follow-up of patients with cirrhosis and a direct correlation with portal hypertension may aid in the evaluation of surgical risk in patients with HCC and in the choice of alternative therapies.