Two jenuno-jenunal intussusceptions in a patient with coeliac disease.

We present a case of a 41-year-old woman with severe abdominal pain caused by two jejuno-jejunal intussusceptions. Further investigation showed coeliac disease as the underlying cause. The patient recovered rapidly on a gluten-free diet. So coeliac disease could be the underlying cause of idiopathic intussusception more often than previously thought and intussusception should be suspected in patients with known coeliac disease presenting with abdominal pain. (Acta gastro-enterol. belg., 2016, 79, 000-000).

Diverticulitis: new insights on the traditional point of view.

Diverticulosis of the colon is a common disease with an increasing incidence in Western countries. Recent literature has shown some changes in the traditional approach of this disease. The theory that diverticulosis is caused by a reduced intake of dietary fibre, is doubtful. There might be some chemical and histological overlap between diverticulitis, inflammatory bowel disease and irritable bowel disease. High quality clinical study found no effect for antibiotics in acute, uncomplicated diverticulitis. Cyclic administration of mesalazine and rifaximin result in reduced symptoms of diverticular disease. For the treatment of diverticular abscesses, percutaneous drainage shows promising results. Recurrence of acute diverticulitis is rare and most serious complications are linked to the first episode. Recent evidence does not support the traditional recommendation for elective surgery after two episodes of acute diverticulitis any more. This review summarizes the last evidence in diverticular disease and diverticulitis.

Crohn's disease presenting with acute pancreatitis.

Crohn's disease is often accompanied by extraintestinal inflammation. Acute pancreatitis can be a rare manifestation of Crohn's disease. The present report describes a patient who developed two episodes of pancreatitis before the diagnosis of Crohn's disease. Clinical and laboratory evaluation excluded other causes of pancreatitis, confirming a direct association of the pancreatitis with Crohn's disease. This case report supports the hypothesis that acute pancreatitis may precede the clinical manifestations and diagnosis of the underlying inflammatory bowel disease.

Resolving bile reflux by lanreotide in patients with Roux-en-Y gastrojejunostomy.

Reflux into the esophagus after partial or total gastrectomy is a well known problem. Even a Roux-en-Y reconstruction is not always a definitive solution. Bile reflux might occur and cause disabling symptoms, unresponsive to the classic anti-acid or anti-reflux therapy. Endoscopy and a Tc-99m-BrIDA hepatobiliary (HIDA) scan can be used to make the diagnosis. Clinical studies have shown that lanreotide (somatuline), which strongly inhibits many gastro-intestinal hormones, reduces the bile salts outputs. We present a case of a patient with bile reflux after Roux-en-Y. After administration of lanreotide he had a good clinical improvement and mucosal healing on endoscopy. Lanreotide can be a good treatment option for bile reflux when classic treatment fails, but clinical trials with more patients will have to confirm this.

Pathologic complete remission of malignant pleural mesothelioma after combined modality treatment: a case report.

A 50-year-old patient with malignant pleural mesothelioma (epithelial subtype, clinically staged cT1bN0M0) underwent a combined modality treatment, including induction chemotherapy, followed by extrapleural pneumonectomy (EPP) and radical radiotherapy. After pathologic examination of the surgical specimen, a complete remission (pT0N0) was observed. The complete disappearance of solid tumour tissue after induction chemotherapy is a rarely observed and documented finding in the combined modality treatment of malignant pleural mesothelioma. The real prognostic value of the pathologic complete remission of a malignant pleural mesothelioma definitely needs to be further evaluated in a larger series of patients.

Multiple organ failure and granulomatous hepatitis following intravesical bacillus Calmette-Guérin instillation.

Intravesical instillations of Bacillus-Calmette Guérin are widely used in the treatment of superficial bladder carcinoma. Although relatively safe, it has potentially lethal systemic side effects. In this case report a 68 year old patient presented with septic shock and multiple organ failure three days after instillation with Bacillus Calmette-Guérin. After treatment with fluid, vasopressors, broad spectrum antibiotics and antimycobacterial drugs the patient's condition improved. Ten days after admission there was a dramatic increase in bilirubin levels. A liver biopsy revealed granulomatous hepatitis. After the initiation of methylprednisolone the overall condition of the patient improved and serum bilirubin levels returned to normal.