Maladie cœliaque révélée par une pseudo-obstruction intestinale chronique

Introduction

Chronic intestinal pseudoobstruction is a rare and severe disease in which the symptoms and signs of intestinal obstruction occur without any mechanical cause. It can be primary (idiopathic) or secondary. It is a rare complication of coeliac disease. We report a case of a 36-year-old woman who was admitted in surgery department for recurrent occlusive syndrome which resolves after gastric aspiration. She underwent surgery for sigmoid volvulus. A chronic intestinal pseudo-obstruction was suspected. Clinical examination was normal. Anaemia (iron deficiency) was found without other signs of malabsorption. Oeso-gastro-duodenal fibroscopy was normal, but the jejunoscopy and the biopsy showed a subtotal villous atrophy of the jejunum. The coeliac serology was positive. Colonoscopy and biopsy were normal. A gluten-free diet was prescribed to the patient, with an improvement of the anaemia and relief of symptoms.

Conclusion

Coeliac disease is a rare etiology of secondary chronic intestinal pseudo-obstruction. It must be suspected in children and young adults.     

Œsophagite nécrosante aiguë : une complication rare

IntroductionAcute esophageal necrosis (AEN) is a rare medical disorder, which is characterized by a diffuse black esophageal mucosal during upper gastrointestinal endoscopy which is a highly recommended diagnostic tool. Its high mortality rate requires to be quickly evocated and an early management.Case reportWe report a case of a 93-year-old patient with upper gastrointestinal bleeding. The upper endoscopy shows a grade D AEN according to the Los Angeles classification. Treatment consists of a parenteral nutritional support and an intravenous proton pump inhibitors treatment, which increase chances of a favorable outcome on endoscopic controls at 2 and 6 weeks.ConclusionAEN has to be quickly evocated in a polyvascular and old patient with upper gastrointestinal bleeding. Our experience confirms that optimal and early management allow a esophageal complete healing at 6 weeks.     

Appendicite aiguë et grossesse, une situation délicate : à propos de huit cas

Background

Abdominal pain in a pregnant woman suggests a diagnosis of appendicitis. However, many other pathologies also occur during pregnancy that could cause abdominal pain, and require suitable treatment. The aim of this work is to discuss the diagnostic, therapeutic and prognostic aspects of appendicitis during pregnancy.

Patients and methods

Eight patients were admitted for appendicitis during pregnancy and were prospectively studied over a 24-month period. Seven patients presented an appendical syndrome. The eighth patient presented a threat of premature childbirth with fever. The gestational age ranged from 12 to 30 weeks.

Results

All our patients were operated. Surgical exploration showed generalised purulent peritonitis in one patient. There were no complications for six of our patients. We reported a foetal death in one case and an abortion in another case. The histological examination showed appendicitis without specificity or malignancy in all eight cases.

Conclusion

The diagnosis of appendicitis in pregnant women is often difficult, and serious forms are frequent. This leads us to search immediately for appendicitis in pregnant women with abdominal pain and fever.     

Pancréatite aiguë inaugurale d’une vascularite à IgA de l’adulte : une manifestation inhabituelle

Introduction

IgA vasculitis is a systemic small vessel leukocytoclastic vasculitis characterized by skin purpura, arthritis, abdominal pain and nephritis. Most of the abdominal complications are due to edema and hemorrhage in the small bowel wall, but rarely to acute secondary pancreatitis.

Pancréatite aiguë liée à l’oméprazole: à propos d’un cas

Proton pump inhibitors are widely used in gastroesophageal reflux and various acid-peptic disorders. They are generally considered safe and have minimal side effects. However, they can cause acute pancreatitis which is a rare effect but can be serious and fatal in some cases.We report a case of acute pancreatitis associated with the first proton pump inhibitor, omeprazole, notified in pharmacovigilance center of Sfax. Elevated pancreatic enzymes and abdominal computed tomography (CT) imaging findings confirmed the diagnosis of pancreatitis. Common causes of pancreatitis were ruled out. A drug side effect was suspected, so the imputability score assessed as plausible. The exact mechanism of this adverse effect is discussed, it seems indirectly due to an increased rate of gastrin secondary to suppression of acid secretion.     

Un cas d’encéphalomyélite aiguë disséminée post-infectieuse découvert devant une rétention vésicale fébrile

Introduction

MRI should be performed in the presence of an acute febrile urinary retention, when septic and obstructive causes are eliminated. We report a case of post-infectious probable acute disseminated encephalomyelitis (ADEM) with a mostly spinal cord tropism of involving Campylobacter.

Hyperéosinophilie isolée précédant le diagnostic d’une fasciite à éosinophiles (maladie de Shulman)

Introduction

Eosinophilic fasciitis or Shulman's disease is characterized, in its typical form, by palpable thickening of the skin and soft tissues, blood hypereosinophilia and fascia lesions. We hereby report a case of eosinophilic fasciitis in which hypereosinophilia preceded for several months the clinical signs of fasciitis.

Évaluation d'une stratégie d'exclusion d'un syndrome coronarien aigu non ST+ basé sur une unique mesure de troponine de haute sensibilité à partir d'un prélèvement effectué entre 3 et 6 heures après le début de la douleur

BackgroundGuidelines recommend to consider excluding non-ST-segment elevation myocardial infarction (NSTEMI) when high-sensitivity cardiac troponin is below the limit of quantification and a single blood sample is taken > 6 h after the onset of chest pain. The aim of our study was to assess such exclusion when a single blood sample was taken 3–6 h after the onset of permanent chest pain.MethodsThis observational study included consecutive patients admitted into the emergency room of our hospital with chest pain and suspected NSTEMI, with non-contributive electrocardiograms and a single high-sensitivity cardiac troponin I (hs-cTnI) blood sample taken 3–6 h after the onset of chest pain and hs-cTnI < 4 ng/l (Abbott Diagnostic). Clinical follow-up was undertaken 1 month after admission.ResultsThe mean age of the 432 patients was 48.5 ± 5.6 years and 51% were male. Based on a clinical algorithm, the pre-test probability of NSTEMI was low in 70%, and intermediate in 21% of patients. Among 419 patients with available 1-month follow-up data, there were no myocardial infarctions or deaths. Thirty-eight patients (9%) were admitted into hospital but none for cardiac reasons.ConclusionsOur results suggest that exclusion of NSTEMI in patients with a non-contributive electrocardiogram and a single “negative” troponin test in a blood sample taken 3–6 h after the onset of symptoms is valid.