Primary pancreatic tuberculosis with a duodenal fistula in an immunocompetent young man.

Tuberculosis (TB) is a common disease in developing countries that can virtually affect any organ in the body. The abdomen is one of the most common sites for extra-pulmonary tuberculosis. Primary Pancreatic tuberculosis (PPTB) is rare and can be clinically elusive. It is commonly encountered in immunodeficient individuals in regions endemic for TB. However, it is extremely rare in immunocompetent individuals with very few case reports in the literature. We describe a case of PPTB in an immunocompetent young man complicated with duodenal fistula. There was complete resolution of symptoms and the fistulous tract with a significant reduction of the size of the lesion on imaging after 6 months of anti-tubercular therapy (ATT).

Corpus gastritis and erosive esophagitis: a report from the Middle East.

OBJECTIVE: To assess whether corpus gastritis due to Helicobacter pylori protects against erosive esophagitis in an area with high prevalence of H. pylori infection. METHODS: Biopsies obtained from gastric corpus and antrum in 151 patients with symptoms of gastroesophageal reflux disease were studied for presence of H. pylori and endoscopic evidence of gastritis. Presence and grade of esophagitis at endoscopy was recorded. RESULTS: Fifty-four (36%) patients had endoscopic esophagitis. Patients with severe esophagitis (>or= grade II) less often had active gastritis (15/45 vs. 55/98; p=0.02) and had a lower density of H. pylori (p=0.0003) than those without esophagitis. CONCLUSION: Active corpus gastritis due to H. pylori infection may protect against erosive esophagitis in patients with gastroesophageal reflux disease in the Middle East.

Crohn's disease among Saudis in Al-Gassim region.

BACKGROUND: Crohn's disease is being increasingly reported from Saudi Arabia and information about its pattern is still accumulating. AIM OF THE STUDY: To describe and classify the disease and assess the response to therapy in patients referred to a tertiary care centre in Gassim region, Kingdom of Saudi Arabia (KSA). PATIENTS AND METHODS: Fifteen Saudi patients found to have Crohn's disease over an eight-year period were studied. The presenting symptoms, area of involvement and the response to therapy were assessed. RESULTS: There were five males and ten females. The age of 14 patients was less than 40 years. Symptoms had existed for more than one year before diagnosis in 14 patients. Common symptoms were diarrhea, pain during defecation, blood in stool and weight loss. The ileum was involved in three patients, the colon in four and the involvement was ileocolonic in eight patients. The behavior of the disease was non-stricturing nonpenetrating in eight, stricturing in two, penetrating in one and stricturing as well as penetrating in four patients. Three patients presented as acute appendicitis, four as intestinal obstruction and five with perianal disease. Histological diagnosis was possible in 12 patients. Thrombocytosis was present in seven patients and three had episodes of deep vein thrombosis. Eight patients responded to medical therapy. Surgical intervention was necessary in seven patients and three had multiple operations. One patient died during a median follow-up period of 18 months (range: 6 months to 8 years). CONCLUSION: Crohn's disease occurs more commonly in young Saudi females. Patients are symptomatic for almost a year prior to diagnosis. The presentation is variable and response to therapy is satisfactory. Surgery is necessary in a high number of patients.

Impact of magnetic resonance cholangiography on endoscopic therapy before and after laparoscopic cholecystectomy.

OBJECTIVE: To assess the impact of magnetic resonance cholangiography (MRC) on endoscopic therapy before and after laparoscopic cholecystectomy (LC). METHODS: Ninety-six patients were referred for endoscopic retrograde cholangiography (ERC) before or after LC because of abnormal liver function tests, raised serum amylase, or abnormal ultrasound scan (USS) of the biliary system. All patients underwent MRC before ERC. RESULTS: Common bile duct (CBD) stones were detected in 48 patients on ERC, 40 on MRC, and 23 on USS. The CBD was dilated on ERC (> 8 mm) in 59 patients, on MRC (> 7 mm) in 51, and on USS (> 7 mm) in 42. Abnormal CBD (dilated +/- stone) was detected in 69 patients on ERC, 57 on MRC, and 44 on USS. Intrahepatic ducts were dilated on ERC in 26 patients, on MRC in 24, and on USS in 18. The study was abnormal on ERC in 81 patients, on MRC in 63, and on USS in 51. Endoscopic therapy was attempted in 80 patients. Presence of CBD stone (p = 0.03), dilated CBD (p = 0.01), abnormal CBD (p = 0.0007), and abnormal study (p = 0.0004) on MRC were significantly related to endoscopic therapy. In 6 cases LC was deferred because MRC revealed CBD calculi which could not be cleared endoscopically. ERC could have been avoided in 14/ 19 patients who did not benefit from it. CONCLUSION: MRC findings are significantly related to endoscopic therapy in patients referred for ERC before and after LC, and they influence therapeutic decisions in some of them.

Ulcerative colitis: Al-Gassim experience.

BACKGROUND: Ulcerative colitis (UC) is being reported more frequently among the Arabs. Information on the clinical severity, endoscopic and histological grading is scanty. AIM: To assess the severity of the disease and its response to therapy in patients referred to a tertiary care referral centre in Gassim region, Kingdom of Saudi Arabia (KSA). PATIENTS AND METHOD: Hospital records of thirty-four patients found to have UC from 1990-2002 were analyzed. The study included clinical severity, endoscopical and histological assessment, response to therapy and frequency of complications. RESULTS: There were 21 males and 13 females with median age 35 (range: 18-76) years. The disease was clinically mild in seven patients (21%), moderate in 11 (32%) and severe in 16 (47%). Endoscopically UC was graded as 2 in three patients (9%), 3 in 21 patients (59%) and 4 in ten patients (29%). Histologically UC was mild to moderate in 11 patients (32%) and severe in 23 (68%). Extent of UC was total in nine patients (26%), up to transverse colon in six (18%), splenic flexure in 14 (41%), rectosigmoid region in four (12%) and only up to the rectum in one (3%). Twenty-nine patients (85%) were treated with salazopyrine and five patients (15%); (two of them were hypersensitive to salazopyrine) received 5-aminosalicylic acid. Proctocolectomy was performed in two with a focus of malignancy. No patient died during the median follow-up period of 48 months (range: 4 months to 12 years). CONCLUSION: Ulcerative colitis presented with varying severity, more frequently in males in the population studied. Most of the patients responded to salazopyrine and surgery was necessary when malignancy was detected.