A suspicious pancreatic mass in chronic pancreatitis: pancreatic actinomycosis.

Introduction. Pancreatic actinomycosis is a chronic infection of the pancreas caused by the suppurative Gram-positive bacterium Actinomyces. It has mostly been described in patients following repeated main pancreatic duct stenting in the context of chronic pancreatitis or following pancreatic surgery. This type of pancreatitis is often erroneously interpreted as pancreatic malignancy due to the specific invasive characteristics of Actinomyces. Case. A 64-year-old male with a history of chronic pancreatitis and repeated main pancreatic duct stenting presented with weight loss, fever, night sweats, and abdominal pain. CT imaging revealed a mass in the pancreatic tail, invading the surrounding tissue and resulting in splenic vein thrombosis. Resectable pancreatic cancer was suspected, and pancreatic tail resection was performed. Postoperative findings revealed pancreatic actinomycosis instead of neoplasia. Conclusion. Pancreatic actinomycosis is a rare type of infectious pancreatitis that should be included in the differential diagnosis when a pancreatic mass is discovered in a patient with chronic pancreatitis and prior main pancreatic duct stenting. Our case emphasizes the importance of pursuing a histomorphological confirmation.

Transient focal fatty liver infiltration mimicking liver metastasis.

The case of a 76-year-old woman presenting with focal liver lesions suggesting liver metastasis on CT is reported. A control CT performed one week later showed a normal liver. Biopsy revealed the diagnosis of focal liver steatosis. The final diagnosis of transient focal steatosis is proposed.

Detection of small mucosal and submucosal polyps with helical CT scanning in a patient with intestinal neurofibromatosis.

The detection of small (diameter 5-12 mm) mucosal jejunal polyps and small (diameter 14-26 mm) submucosal rectal polyps with helical C.T.-scanning in a patient with neurofibromatosis is described. Because a volume is scanned with helical CT, overlapping image reconstructions can be made allowing to produce a contiguous image set for cine mode display. The combination of 'volume scanning' with cine mode display helps in the dynamic visualization of the course of the intestinal loops. This might result in a better depiction of small lesions within the bowels and in a better differentiation between mucosal folds and the lesions.

[Mirizzi syndrome]. / Het syndroom van Mirizzi.

Obstruction of the common hepatic duct due to pressure from an impacted stone in the cystic duct or in the gallbladder infundibulum is known as Mirizzi's syndrome. The obstruction is due to direct impression of the stone on the common hepatic duct or to the concomitant inflammatory infiltrate. The diagnostic features are illustrated by 6 recently observed cases. Clinical features, sonography and CT scan do not always contribute to a correct diagnosis. Endoscopic retrograde cholangiography usually provides the diagnosis but confusion with gallbladder carcinoma, metastatic malignancies at the porta hepatis and even cholangiocarcinoma is possible. The therapy of the Mirizzi syndrome is essentially surgical. In obstructive jaundice preoperative direct cholangiography is always warranted even with a history suggestive of cholelithiasis. Especially in case of associated cholangitis non-surgical biliary drainage procedures are a valuable temporary treatment facilitating surgery. If, however, in a probably malignant obstruction of the common hepatic duct biliary stenting is considered as the only treatment, careful exclusion of Mirizzi's syndrome is required.

Healing of grade-II and III oesophagitis through motility stimulation with cisapride.

The clinical relevance of cispride's stimulating effects on lower oesophageal motility was studied in 19 patients with documented (endoscopy, biopsy) grade II or III oesophagitis. Patients were treated for 8 or 16 weeks (depending essentially on whether the result was cure or failure) with 10 mg of cisapride four times a day (n = 11) or placebo (n = 8). Cisapride was superior to placebo with regard to mucosal healing (p less than 0.001) and symptomatic improvement (p less than 0.05): at the end of treatment, healing (grade 0) was observed in 8 cisapride patients, against 1 placebo patient, and reflux symptoms had disappeared in 7 and 1 patients, respectively. In conclusion, cisapride was of significant benefit to oesophagitis patients and was well tolerated.

Postvagotomy dysphagia necessitating surgical relief.

A case of severe dysphagia following transthoracic truncal vagotomy is reported. Stenosis of the esophagus was due to a periesophageal fibrotic band. Surgical treatment was mandatory and relief was brought by resection of the stricture and restoration of the continuity by colonic interposition. A review of the literature on the subject is presented.