Common Bile Duct Obstruction Due to Candidiasis

Biliary obstruction with its wide range of potential causes (e.g. neoplastic lesions, gallstones and inflammatory processes) is a common disease in gastroenterology. Although infections with Candida and other fungal species have increasingly been recognized in patients with certain predispositions, fungal involvement of the biliary tract is extremely rare. We report the case of a male patient with a past history of long-time mechanical ventilation and who was referred to our department with cholangitis. Endoscopic retrograde cholangio-pancreatography (ERCP) of the septic patient revealed a high-degree stenosis of the distal common bile duct with a prestenotic dilation which was strongly suspicious of an underlying malignancy. Control ERCP revealed a beads-like deformation of the intra- and extrahepatic bile duct system which was compatible with chronic secondary sclerosing cholangitis. Examining the bile duct system with a balloon catheter, a long tubular, filamentous structure with several branches at its sides could be extracted and was assessed histologically to be a Candida conglomerate. Candida colonization of the bile duct was confirmed by microbiological analysis of aspirated bile.     

Gastric Outlet Obstruction Due to a Pancreatic Pseudocyst

Two cases of gastric outlet obstruction, secondary to a pseudocyst of the pancreas, are described. The striking radiologic pictures are shown. The pathogenesis of this complication is discussed and a greater awareness of this entity is stressed.     

Massive Rectal Bleeding Due to Intestinal Tuberculosis

Two cases of massive rectal bleeding due to tuberculosis of the intestine are described and 24 reported cases of massive rectal bleeding in intestinal tuberculosis are reviewed. Tuberculosis of the intestine, though uncommon should be considered as a cause for rectal bleeding.     

Small Bowel Obstruction Due to Disease of Epiploic Appendage

Primary disease of an epiploic appendage is rare. Small bowel obstruction is an unusual complication of such disease due to bands or adhesions caused by torsion or inflammation.
A 49-year old man presented with small bowel obstruction and was found to have a band from a necrotic epiploic appendage adherent to mesentery, obstructing the ileum. The band was released and the epiploic appendage removed.     

Noble Plication for Intestinal Obstruction

A series of 27 patients subjected to Noble plication for obstruction of the small intestine is presented. The follow-up time has ranged from 2 to 20 years, with a mean of 12.9 years. Four recurrences occurred in the series (14.8%). The mortality was 1 patient (3.7%). The conclusions drawn from the series are that single silk sutures should be used, the sutures should be placed at the mesenteric border of the intestine, and that the pockets of the mesenteric root should be closed unconditionally. Three of the four recurrences were due to lack of observance of these rules. The indication for the Noble plication method should be a recurrent intestinal obstruction due to adhesions, and possibly extensive serosal lesions.     

Gastric Outlet Obstruction Due to Neurofibromatosis: An Unusual Case

Neurofibromatosis type-1 (NF-1), also known as von Recklinghausen disease, is an autosomal dominant condition with an approximate incidence of one in 3000 births. NF-1 is known to involve multiple systems in the body. Abdominal involvement include neurofibroma and tumor growth in the liver, mesentery, and retroperitoneum in addition to gastric and bowel tumors. Gastrointestinal neoplasms occur in up to one quarter of patients. The author reports a rare case of diffuse submucosal neurofibromatosis resulting in gastric outlet obstruction.     

Intestinal Obstruction Syndromes in Cystic Fibrosis: Meconium Ileus,Distal Intestinal Obstruction Syndrome,and Constipation

Meconium ileus at birth, distal intestinal obstruction syndrome (DIOS), and constipation are an interrelated group of intestinal obstruction syndromes with a variable severity of obstruction that occurs in cystic fibrosis patients. Long-term follow-up studies show that today meconium ileus is not a risk factor for impaired nutritional status, pulmonary function, or survival. DIOS and constipation are frequently seen in cystic fibrosis patients, especially later in life; genetic, dietary, and other associations have been explored. Diagnosis of DIOS is based on suggestive symptoms, with a right lower quadrant mass confirmed on abdominal radiography, whereas symptoms of constipation are milder and of longer standing. In DIOS, early aggressive laxative treatment with oral laxatives (polyethylene glycol) or intestinal lavage with balanced osmotic electrolyte solution and rehydration is required, which now makes the need for surgical interventions rare. Constipation can generally be well controlled with polyethylene glycol maintenance treatment.