An immunosuppressed man with an aortic rupture secondary to Salmonella aortitis successfully treated with endovascular aortic repair.

A 75-year-old immunosuppressed man presented with fever and central abdominal pain 3 weeks after having positive blood cultures for Salmonella enteritidis. A computed tomography scan demonstrated a contained perforation of a nonaneurysmal abdominal aorta. Salmonella aortitis was suspected, and given his recent history of coronary artery stent insertion, endovascular aortic repair was performed, with lifelong antibiotic therapy. At 6 months, there were no remaining clinical or radiological concerns for aortitis or aneurysmal development. This case highlights the high index of suspicion required for aortitis in immunosuppressed patients and verifies endovascular aortic repair, an appropriate alternative in patients with severe comorbidities.

Gastric fundic gland polyps: a clinico-pathological study from North West Tasmania.

BACKGROUND: Fundic gland polyps (FGPs) of the stomach were originally described in association with familial polyposis syndromes. It is now known that the majority of these polyps occur in the sporadic setting and are incidentally seen in up to 1.9% of routine upper gastrointestinal endoscopes. The aim of this study was to look at the clinico-pathological features of the FGPs and to analyse their relationship to Helicobacter pylori infection, proton pump inhibitor treatment, colonic polyps and malignancy. METHODS: A search of the histopathology records for a period of 10 years from 1997 to 2006 identified 120 patients with a histologically confirmed diagnosis of FGPs. The clinical history, upper gastrointestinal endoscopy findings, histopathology and colonoscopy findings were recorded from the medical records and analysed. RESULTS: FGPs were seen in 3.2% of patients undergoing routine upper gastrointestinal endoscopes. There was a definite association with long-term proton pump inhibitor treatment. There was a strikingly low incidence of H. pylori infection in the study population. Although there was no dysplasia or malignancy in any of these polyps, one patient had concomitant adenocarcinoma of the stomach. In the subgroup of patients who also had colonoscopy during the study period, 19% had associated colonic polyps and 6% had associated colonic malignancies. CONCLUSIONS: Every new patient diagnosed with FGPs should have a thorough clinico-pathological study to see if the polyps are part of a sporadic or syndromic setting. A long-term follow-up study of patients with FGPs and its association with colonic polyps may be warranted.