Cystadenoma of the extrahepatic bile ducts: a rare cause of cholestasis]

We report the case of a 45-year-old woman who underwent laparotomy for obstructive jaundice due to an uncommon cystic tumor located in the porta hepatis. Histology of the resected specimen disclosed a cystadenoma of the common hepatic duct. A review of 20 reported cases shows that the preoperative diagnosis is uncommon; wide resection appears to be the treatment of choice since these lesions are susceptible of local recurrence and malignant change.     

Stenotrophomonas maltophilia: a very rare cause of tropical pyomyositis

Pyomyositis is a purulent infection of skeletal muscles that arise from hematogenous spread associated with abscess formation. Most often caused by Staphylococcus aureus in more than 90–95% of cases but other rare organisms can cause this infection. Herein we report a rare case of strenotrophomonas maltophilia as a cause of pyomyositis which is a rare occurrence, especially in immunocompetent adults. Strenotrophomonas is a multidrug‐resistant aerobic non‐fermentative, non‐sporulating, Gram‐negative bacillus which usually produces nosocomial infections, but community‐acquired infections are also rarely reported. This a first case report of strenotrophomonas maltophilia causing pyomyositis in an immunocompetent adult.     

Double-barrel common bile duct: a rare cause of extrahepatic biliary obstruction.

Double-barrel common bile duct is rare. We report a 50-year-old woman with defective canalization of the common bile duct, presenting with extrahepatic biliary obstruction due to stones in one compartment. CT scan highlighted this anomaly. After failed attempts at stone extraction at ERCP, she was successfully operated on.     

Endobronchial capillary hemangioma: a very rare cause of massive hemoptysis

Tracheal capillary hemangioma is a very rare benign tumor of trachea which may present as massive hemoptysis. Minor to massive hemoptysis can be observed in these patients. Due to its small size and tracheal localization, diagnosis cannot be easily performed by using radiological investigations. Fifty-years-old male patient who was diagnosed as tracheal capillary hemangioma with bronchoscopic biopsy was presented in this case report. According to our knowledge, this is the eighth case report in the world literature. Tracheal capillary hemangioma must be kept in mind in patients with massive hemoptysis with normal radiologic features and bronchoscopic procedures (excision, argon, laser etc.) should be the first choice of therapy when diagnosed.     

Fasciola hepatica: A cause of Obstructive Jaundice in an Elderly Man From Iran

Fascioliasis is a zoonotic infection caused by Fasciola hepatica. Humans can become accidental hosts of this parasite by ingesting contaminated drinking water or plants in endemic area. The north of Iran is one of the regions. This disease is rarely seen with jaundice caused by obstruction of the biliary tree. We report a case of human fascioliasis with obstructive jaundice who was diagnosed using endoscopic retrograde cholangiopancreatography (ERCP). This report confirms the diagnostic role of ERCP in patients with obstructive jaundice caused by biliary fascioliasis.     

Microfilament dysfunction as a possible cause of intrahepatic cholestasis.

The effects of cytochalasin B on bile canalicular structure and function were examined. Three experimental models were used, cultured hepatocytes, isolated perfused liver, and in vivo infused liver. The techniques used were light and electron microscopy and, in selected instances, scanning electron microscopy, electron "stains" for microfilaments, and measurements of bile flow. Microfilament disruption and dilation of bile canaliculi were consistently found and closely paralleled a reduction in bile flow in both in vitro and in vivo infused animals. It is proposed that under normal circumstances, the microfilaments maintain the canaliculi in a contracted or partly contracted state. Hence, the microfilamentous network would provide tone to the canalicular system which would tend to reduce stagnation and facilitate the flow of bile. Removal of normal microfilament contractile function would be expected to produce canalicular ectasia and reduction of bile flow, as was observed. Microfilament dysfunction may therefore be a possible cause of intrahepatic cholestasis. Crucial to this hypothesis are the presence of actin-containing microfilaments in the pericanalicular web, and an action of cytochalasin B on their contractility. Evidence pertaining to these requirements is presented and discused.     

Eosinophilic enteritis as a rare cause of ascites

Eosinophilic gastroenteritis is an infrequent entity characterized by tissular eosinophilia that can affect different layers of the intestinal wall. This entity can affect any area of the digestive apparatus from the esophagus to the rectum. Clinical manifestations depend on the affected layers and range from barely perceptible symptoms to intestinal obstruction or ascites. We present the case of an 18-year-old woman who showed abdominal ascites as a rare form of presentation with difficult differential diagnosis with peritoneal carcinomatosis.     

Littoral-cell angioma as a rare cause of splenomegaly

We report the case of a littoral-cell angioma of the spleen, a recently described benign vascular tumour, whose imaging and pathological characteristics have been discussed only by a few authors. The diagnosis was made after elective splenectomy. The CT images, scintigraphy and histological specimens are presented, and differential diagnoses discussed.     

Actinomycosis as a rare cause of vertebral osteolysis

Actinomycosis is an uncommon entity caused by an anaerobic bacterium, Actinomyces species, most often Actinomyces israelii. We present a patient who suffered from progressive lumbar pain and high fever. Actinomycosis infection was diagnosed after extensive radiological and pathological evaluation. Treatment with i.v. ampicillin was started, followed by oral antibiotics for one year. This paper gives an overview of the different clinical presentations of actinomycosis infection, with special attention to the skeletal involvement. We also discuss diagnosis and treatment. The clinical picture can mimic several other conditions, such as lymphomas. Delay in diagnosis and treatment can significantly worsen the condition of the patient.     

Staphylococcus epidermidis as a rare cause of sepsis

Implanted synthetic materials have to be included into the differential diagnosis of sepsis. This paper reports on a case of sepsis caused by Staphylococcus epidermidis in connection with a Spitz-Holter shunt. The interval between the implantation and the recognition of the endoplastitis took 4 years. The attempt of an antibiotic sanitation had no results. The fitness for work could be restored by removal of the shunt and reimplantation.     

Living Fasciola hepatica in biliary tree: a case report

Here we report a rare case of living Fasciola hepatica in biliary tract. The patient was in acute phase of infection and treated successfully with 10 mg/kg oral triclabendazole after the fluke was extracted using endoscopic retrograde cholangiopancreatography (ERCP).