[Ulcerative Colitis and Adenocarcinoma of the Appendix: Is there a Causal Link?] / Colitis ulcerosa und Adenokarzinom der Appendix vermiformis: Kausaler Zusammenhang?

Anamnesis We report the case of a 57-year-old patient initially seen with stool irregularities and malignant ascites. Diagnostics Through further examinations we diagnosed a long standing untreated ulcerative colitis with endoscopic signs of a massive chronic inflammation of the entire colon. The origin of the malignant cells in the ascites remained unknown despite the exhaustion of all diagnostic means available. As an ultima ratio we performed a colectomy and an advanced adenocarcinoma of the appendix was found. Clinical course The patient's condition deteriorated very fast so that chemotherapy wasn't an option. Following his wishes he received palliative care in his home environment. Conclusion Patients with an inflammatory bowel disease have a higher risk of developing colorectal cancer. This is a well-known fact. But an adenocarcinoma of the appendix is still a rarity. Here we illuminate the possible link between the appendix and ulcerative colitis.

Risk factors for short- and long-term mortality in liver transplant recipients with MELD score ≥30.

BACKGROUND: After introduction of MELD-based allocation in Germany, decreased waiting list mortality and increased mortality after transplantation have been reported. MATERIAL AND METHODS: This study compares relevant outcome parameters in patients with high MELD ≥30 versus lower MELD scores in a retrospective analysis including 454 consecutively performed liver transplantations in adults (age >16 years) at Hannover Medical School between 01/01/2007 and 31/12/2012 and a follow-up until 31/12/2013. Multivariable risk-adjusted models were applied to identify independent risk factors for 90-day and long-term mortality. RESULTS: MELD score ≥30 (n=117; 26.1%) was an independent risk factor for 90-day mortality (p=0.004, odds ratio: 3.045, 95% CI 1.439-6.498) and long-term mortality (p=0.016, hazard ratio: 1.620, 95% CI 1.095-2.396) and was associated with significantly longer hospital and intensive care unit stays (p<0.001), and death occurred in more cases earlier after transplantation (90-day mortality 21.6% vs. 13.0%; p=0.029). Portal vein thrombosis at transplantation was significantly associated with 90-day mortality after transplantation in patients with MELD scores ≥30 (p=0.041), but this was not the case for patients with MELD scores <30, although portal vein thrombosis was equally frequent in individuals of both groups (3.0% vs. 3.4%, p=0.824). CONCLUSIONS: Results of this study suggest that liver transplant recipients with portal vein thrombosis at transplantation should be transplanted before reaching a MELD score ≥30.