ABSTRACT
INTRODUCTION: Intravascular papillary endothelial hyperplasia (IPEH), originally described by Pierre Masson in 1923, is a benign vascular lesion characterised by the reactive proliferation of endothelial cells. This tumour typically manifests on the fingers, head, neck, or trunk. However, involvement of other organ systems, including abdominal organs, is possible although exceedingly rare. CASE PRESENTATION: A 57-year-old male patient presented to the emergency department with a 24-h history of recurrent light-headedness. The patient was haemodynamically stable, and physical examination showed no abdominal pain. Digital rectal examination unveiled melena. Initial blood analysis indicated a haemoglobin level of 10.5 g/dL. Comprehensive workup with abdominal computed tomography, upper and lower endoscopy, and gastrointestinal lumen MRI failed to yield significant findings. DISCUSSION: On the fourth day of hospitalisation, persistent melena and transfusion of four units of blood triggered a new upper endoscopy. This endoscopy extended to the jejunum, revealing a submucosal lesion measuring 20 mm, situated approximately 40 cm distal to the ligament of Treitz. Due to ongoing intraluminal bleeding with decreased haemoglobin levels, a segmental jejunal resection was performed. Pathological examination confirmed the diagnosis of a completely resected submucosal IPEH. CONCLUSION: IPEH, also known as Masson's tumour, is an uncommon vascular lesion within the intestinal tract, occasionally resulting in persistent haemorrhage. The preferred treatment is total surgical resection, with a low likelihood of recurrence. Currently, postoperative surveillance is not recommended. To the best of our knowledge, no cases of recurrence have been documented for Masson's tumour localised in the gastrointestinal tract in the existing literature.
ABSTRACT
PURPOSE: This study included all patients treated at the University Hospital of Geneva for a first episode of uncomplicated diverticulitis. Risks of recurrence and treatment failure were evaluated by comparing the results between short-course and long-course intravenous (IV) antibiotic therapy groups. METHODS: The records of all patients hospitalized at our facility from January 2007 to February 2012 for a first episode of uncomplicated diverticulitis (Hinchey Ia), as confirmed by computed tomography, were prospectively collected. We published an auxiliary analysis from this registered study at Clinicaltrials.gov (identifier number: NCT01015378). Two groups of patients were considered: one received a short-course IV antibiotic arm (ceftriaxone and metronidazole) for up to 5 days (followed by 5 days of oral antibiotics); the other received a long-course IV arm between days 5 and 10. The primary outcome was the recurrence-free survival time. RESULTS: Follow-up was completed for 256 patients-50% men and 50% women, with a median age of 56 years (range, 24-85 years). The average follow-up was 50 months (range, 19-89 months). Of the 256 patients included in the study, 46 patients received a short-course IV antibiotic treatment and 210 received a long-course treatment. The recurrence-free survivals were very similar between the two groups, which was supported by a log rank test (P = 0.772). Four treatment failures, all in the long-course IV antibiotic treatment group, occurred. CONCLUSION: Treatment of diverticulitis with a short IV antibiotic treatment is possible and does not modify the recurrence rate in patients with uncomplicated diverticulitis.
