RESUMO
A 26-year-old patient presented with epigastric pain of sudden onset and severe puffy swelling of both legs and forearms. An irregularly shaped nodular filling defect on selective jejunal films, severe hypoproteinemia, low IgG concentration, and lymphopenia were suggestive of primary intestinal lymphangiectasia with protein-losing enteropathy, and the patient was placed on a low-fat diet with medium-chain triglycerides. This initially improved his condition, but some weeks later he developed obstructive ileus of the small intestine. On laparotomy yellowish to whitish deposits were found to be present in some segments of the small intestine and a fist-sized mass 100 cm distal to the duodenojejunal flexure was resected without complications. Histologically, the submucosal lymphatics were dilated, and the jejunal wall showed extensive pseudocystic, intramural submucosal lymph edema with secondary bleeding and tight stenosis of the jejunal lumen. During the 14-month follow-up time after discharge the patient has been asymptomatic and working, on no treatment other than a low-fat diet with medium-chain triglycerides.
Assuntos
Obstrução Intestinal/etiologia , Doenças do Jejuno/etiologia , Linfangiectasia Intestinal/complicações , Doença Aguda , Adulto , Humanos , Obstrução Intestinal/patologia , Intestino Delgado/patologia , Doenças do Jejuno/patologia , Linfangiectasia Intestinal/patologia , MasculinoRESUMO
Among 25 studies of patients with gastrointestinal hemorrhage using 99m-Tc-RBC no labelling failure was encountered. Radionuclide imaging was found effective in the detection, localisation and exclusion of gastrointestinal hemorrhages.
Assuntos
Hemorragia Gastrointestinal/diagnóstico por imagem , Neoplasias Duodenais/diagnóstico por imagem , Eritrócitos , Gastroenteropatias/diagnóstico por imagem , Humanos , Leiomioma/diagnóstico por imagem , Cintilografia , TecnécioRESUMO
Two patients with rare localizations of extrapulmonary tuberculosis are presented. In a 55-year-old man admitted with septic fever and a low neutrophil count, ultrasonography of the spleen revealed splenomegaly with numerous hypodense foci. Fine needle biopsy of one of the foci disclosed tuberculosis. Persistent splenogenic neutropenia and thrombocytopenia, despite tuberculostatic therapy, required splenectomy which confirmed the initial diagnosis. At laparotomy no other abdominal foci of tuberculosis were found. In a second 57-year-old man admitted for ascites and weight loss, a biopsy specimen of the liver showed normal liver parenchyma but, by chance, peritoneal tuberculosis. Tuberculostatic therapy brought about cure.