Cannabinoid hyperemesis syndrome.

SummaryCannabis use is legalised in many countries. We present a patient in their 40s who complained of recurrent abdominal pain and associated nausea and vomiting. The patient was previously seen in various hospitals, treated symptomatically, and discharged with a diagnosis of non-specific abdominal pain. The patient had a chronic history of smoking cannabis and nicotine and drinking alcohol. Abdominal examination revealed no masses, and abdominal X-ray was normal. Blood tests and gastroduodenoscopy revealed no obvious aetiology. Intravenous fluids, together with antiemetics and proton pump inhibitors, were administered. The patient also received counselling and was advised to stop cannabis use. At discharge, the patient was well and asked to come back for review in 2 weeks, and, thereafter monthly for a period of 6 months after stopping cannabis use. The patient reported no recurrent symptoms despite continued cigarette and alcohol use. A suspected cannabinoid hyperemesis syndrome (CHS) became a consideration. Awareness of cannabis-related disorders such as CHS may assist in avoiding costly hospital workups.

Mesenteric panniculitis.

A 53-year-old black woman presented with a 3-day history of abdominal pain. Ultrasound of the abdomen showed a gall bladder packed with small stones. She gave a history of abdominal surgery for a gynaecological condition. She had a cholecystectomy done, but her symptoms continued after cholecystectomy. She then had anendoscopic retrograde cholangiopancreatogram (ERCP) and sphincterotomy done, again her symptoms remained the same. A CT scan of the abdomen was done, and mesenteric panniculitis was suspected. A laparoscopic biopsy of the mesentery was performed, and it confirmed mesenteric panniculitis. She was started on a 2-week course of steroids to which she responded very well. Three months after the initial presentation, she was still asymptomatic.

Prevalence of Squamous Cell Carcinoma of the Esophagus in a Single Tertiary Center of South Africa: A Cross Sectional Analytic Study.

The incidence of esophageal cancer varies widely in the world. In the Middle East, Africa, and Asia and parts of Europe, squamous cell carcinoma of the esophagus dominates the esophageal cancer landscape. Worldwide the rates are highest in Northern China, South Africa, Turkey and Iran. In the United States, the black population has a five-fold higher incidence of esophageal squamous cell carcinoma than the white population. To determine the prevalence of squamous cell carcinoma of the esophagus in a single tertiary center in South Africa. Patients referred to Gastroenterology Division of Steve Biko Academic Hospital for upper gastrointestinal endoscopy were recruited. Those with a known diagnoses of squamous cell carcinoma of the esophagus were recorded and those with suspicious lesions had biopsies done. These were then evaluated by an experienced histopathologist. 6118 patients were recruited. Squamous cell carcinoma was found in 59 patients giving us a prevalence of 0.96% 95%CI. The cancer was found mainly in back elderly males. The prevalence of squamous cell carcinoma of the esophagus in this single center study is 0.96%, 95% confidence interval and is a disease of black elderly males as seen elsewhere. Bigger multicenter studies are needed to further clarify this findings.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and cirrhosis of the liver: A case report and literature review.

Patients with cirrhosis of the liver usually present with a small shrunken liver and a large spleen. The presence of an unusually huge liver should prompt the treating doctor to look for another cause, as this may be treatable and improve the patient's outcome. In South Africa tuberculosis and lymphoma in the presence of HIV infection should be excluded. Sinus histiocytosis with massive lymphadenopathy and cirrhosis is a rare combination and has not been reported before in the literature. This case is intended to make clinicians aware of this rare combination of diseases.