Complicated small-bowel diverticulosis： A case report and review of the literature

While jejunoileal diverticula are rare and often asymptomatic, they may lead to chronic non-specific or acute symptoms. The large majority of complications present with an acute abdomen similar to appendicitis, cholecystitis or colonic diverticulitis but they also may appear with atypical symptoms. As a result, diagnosis of complicated jejunoileal diverticulosis can be quite difficult, and may solely depend on the result of surgical exploration. In the absence of contra-indications, diagnostic laparoscopy has the benefit of thorough examination of the abdominal contents and helps to reach an absolute diagnosis. Surgical resection of the involved small-bowel segment with primary anastomosis is the preferred treatment in patients with symptomatic complicated jejunoileal diverticular disease. An atypical presentation of complicated jejunal diverticulitis in conjunction with sigmoid diverticulitis diagnosed with laparoscopy and treated with surgical resection is presented.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Diverticulosis of the jejunum with intestinal obstruction： A case report

A diagnosis of intestinal diverticulosis is difficult to make pre-operatively because the clinical symptoms are usually non-specific. We report the case of a 70-year-old man who had suffered from three episodes of intestinal obstruction in 1 year. He experienced dull pain and a sensation of fullness over the whole abdomen. The symptoms did not improve after conservative treatment. The presumptive diagnosis was intestinal obstruction, and an exploratory laparotomy found diverticulosis of the proximal jejunum, with an adhesion band formed from the base of one diverticulum. Strangulation of a segment of the jejunum resulted from the internal herniation caused by the band. The band was removed and the proximal jejunum segmentally resected. His postoperative course was uneventful.     

Rectal angiolipoma： A case report and review of literature

Angiolipoma is a rare vascular variant of the benign lipomatous tumors and is generally seen in subcutaneous tissues. We report a 70-year-old female with abdominal distension not related to rectal small polypoid mass with peduncule described as angiolipoma by histologically, and review the literature.     

Endoscopic management of a new entity-plastobezoar： A case report and review of literature

INTRODUCTION Bezoar is adapted from Arabic “bazahr” or “badzehr” which means an antidote or counter-poison due to the fact that till the 19th century, bezoars obtained from sacrificed animals were widely used as antidote[1]. Foreign bodies and bezoars…     

Gardner＇s syndrome： A case report and review of the literature

Gardner's syndrome is an autosomal dominant disease characterized by the presence of colonic polyposis, osteomas and a multitude of soft tissue tumors.The syndrome may present at any age from 2 mo to 70 years with a variety of symptoms, either colonic or extracolonic. We present a case of a 11-year-old female patient with Gardner's syndrome who presented with a lumbar area desmoid tumor and treated with resection of the desmoid, restorative proctocolectomy and ileal pouch anal anastomosis, A review of the current literature has been performed.     

Lymphoepitelioma-like hepatocellular carcinoma： A case report and a review of the literature

Lymphoepitelioma is a particular form of undifferentiat-ed carcinoma, characterized by a prominent lymphoid stroma, originally described in the nasopharynx. Lym-phoid stroma-rich carcinomas arising in other organs have been termed lymphoepithelioma-like carcinoma （LELC）. In the liver, primary LELCs are very rare, and the majority has been identified as cholangiocarcino-mas. Here a rare case of lymphoepithelioma-like hepa-tocellular carcinoma （HCC） is described. A 47-year old woman presented with abdominal pain. Ultrasonogra-phy revealed a liver nodule, 2.2 cm in diameter, local-ized in the right lobe, adjacent to the gallbladder. Viral markers for hepatic B virus （HBV）, hepatic C virus （HCV） and Epstein-Barr virus （EBV） were negative. The nod-ule was hypoechogenic. The patient underwent sur-gery, with resection of the nodule. Histology showed hepatocellular carcinoma, characterized by a promi-nent lymphoid infiltrate. At immunocytochemistry, tumor cells were reactive for Hep Par1 and glypican 3. Immunophenotyping of tumor infiltrating lymphocytes evidenced the predominance of CD8＋ cytotoxic sup-pressor T cells. The postoperative clinical outcome was favorable and the patient was recurrence-free 15 mo after resection. This case, to the best of our knowl-edge, is the first reported non EBV and non cirrhosis-associated lymphoepithelioma-like hepatocellular carci-noma. The association between the lack of EBV infec-tion, the absence of cirrhosis, a ＂cytotoxic profile＂ of the inflammatory infiltrate and a good prognosis could identify a variant of lymphoepithelioma-like HCC with a favorable clinical outcome.     

Perivascular epithelioid cell tumor of the liver： A report of two cases and review of the literature

Perivascular epithelioid cell tumor （PEComa） is a rare tumor which arises from mesenchymal tissues. It is predominant in the uterus, but very rare in the liver. To the best of our knowledge, less than 5 cases of PEComa of the liver have been reported. Herein we present two pathologically proven cases of PEComa of the liver, retrospectively analyze their clinical and imaging features, and review the literature.     

Lipoma within inverted Meckel＇s diverticulum as a cause of recurrent partial intestinal obstruction and hemorrhage： A case report and review of literature

Lipoma within an inverted Meckel's diverticulum presenting with hemorrhage and partial intestinal obstruction is an exceptional clinical entity.We report a case of 47-year-old male with a history of recurrent episodes of partial intestinal obstruction and melena due to a subserosal lipoma located in the base of an inverted Meckel's diverticulum.According to our knowledge,this is the first case of a lipoma within a Meckel's diverticulum giving rise to this clinical scenario without the existence of heterotrophic gastric or pancreatic tissues.     

Gallbladder lymphangioma： A case report and review of the literature

Lymphangiomas are rare, benign tumors of the lymphatic system, usually present in children aged 5 years and younger. Because they are asymptomatic until the mass enlarges to cause symptoms, most lymphangiomas are diagnosed at adulthood incidentally. We experienced a case of a 60-year-old man diagnosed with a cystic lymphangioma of the gallbladder, which was successfully resected without any complication.Magnetic resonance imaging and magnetic resonance cholangiopancreatography were very helpful for the diagnosis of the cystic lesion around the gallbladder as were ultrasonography and computed tomography scan. These showed a multi-lobulated cystic mass with intact cystic duct and bile duct in the gallbladder fossa. The patient underwent an open cholecystectomy and the histological findings were consistent with a cystic lymphangioma of the gallbladder. We here report the case of cystic lymphangioma of the gallbladder with a review of the literature.     

Jejunal vasculitis in patient with rheumatoid arthritis: case report and literature review

Abstract

A 57-year-old man with rheumatoid arthritis presented severe abdominal pain symptomatic of panperitonitis. Computer tomography findings were consistent with vasculitis on the jejunum. Confirmatory angiography was conducted. Since abdominal vasculitis in rheumatoid arthritis is very rare, early diagnosis and treatment should be done according to clinical manifestation. In this case, high-dose steroid treatment was applied based on clinical manifestation, laboratory findings, and radiologic finding. After therapy, clinical manifestation and flare-up arthritis diminished.     

Rectal diverticulosis: a case report and review of the literature

The occurrence of rectal diverticulosis is rare. We report the incidental finding of a large rectal diverticulum in a patient receiving an air-contrast barium enema. The presence of uncomplicated rectal diverticulosis is probably of little clinical significance. However, there can be associated complications such as inflammation and perforation, and potential confusion with rectal carcinoma.     

Lysozyme amyloidosis: report of 4 cases and a review of the literature

Autosomal dominant hereditary amyloidosis represents not 1 disease but a group of diseases, each the result of mutations in a specific protein. The most common form is transthyretin amyloidosis, which has been recognized clinically for over 50 years as a familial polyneuropathy. Nonneuropathic amyloidoses (Ostertag type amyloidosis) include those due to abnormalities in lysozyme, fibrinogen Aalpha-chain, and apolipoprotein A-I and A-II. The role of lysozyme in amyloid-related human disorders was first described in 1993; to date, there have been only 9 publications describing this disorder, which is a nonneuropathic form of hereditary amyloidosis. Reported cases have involved 7 unrelated families. We describe here our own experience with 4 families suffering from lysozyme amyloidosis: the first had prominent renal manifestations with sicca syndrome, the second and third had prominent gastrointestinal symptoms, and the fourth had a dramatic bleeding event due to rupture of abdominal lymph nodes. To our knowledge, this last symptom has not been reported previously, but is reminiscent of the hepatic hemorrhage seen in a previously reported case of a patient with lysozyme amyloidosis. To characterize the manifestations of this disorder, we performed an exhaustive literature review.Although hereditary amyloidosis is thought to be a rare disease, it is probably not as rare as we think and may well be underdiagnosed. Moreover, some cases of lysozyme amyloidosis are probably confused with acquired monoclonal immunoglobulin light-chain (AL) amyloidosis, formerly known as primary amyloidosis, which is the most frequent type of amyloidosis. Because treatment for each type of amyloidosis is different, and because therapy directed at 1 type may worsen symptoms of the other types, it is important to determine precisely the nature of the amyloid protein. Thus, hereditary lysozyme amyloidosis should be considered in all patients with systemic amyloidosis, particularly in patients who present with renal, gastrointestinal, or bleeding complications without evidence of AL or AA (secondary) amyloidoses.     

甲磺酸伊马替尼致银屑病一例报道及文献复习

目的对甲磺酸伊马替尼导致的银屑病进行系统探讨,提高临床医生的认识水平。 方法报道一例应用甲磺酸伊马替尼治疗胃肠道间质瘤诱发银屑病的患者,结合文献对其临床表现、处理原则及其可能的发生机制进行综述。 结果口服甲磺酸伊马替尼加重或诱发银屑病多发生在服药的3~8周后,临床表现多为躯干、四肢部位的皮疹,或出现银屑病甲。治疗措施多为应用糖皮质激素、紫外线治疗或口服甲氨蝶呤,必要时停药,待皮疹控制后有望继续口服甲磺酸伊马替尼。如皮疹反复发作且较难控制,可考虑更换第二代酪氨酸酶抑制剂。其发病机制可能与抑制T细胞和细胞因子相关。 结论在应用甲磺酸伊马替尼过程中,应重视银屑病的发生,一旦出现需及时对症处理并严密观察,待症状控制后有继续恢复口服甲磺酸伊马替尼的可能,必要时更换第二代酪氨酸酶抑制剂。     

获得性血友病A 4例的诊治并文献复习

目的提高对获得性血友病A的认识及诊治水平。方法对2014-07~2016-04确诊的4例获得性血友病A的临床表现、实验室检查、治疗及预后进行分析,并结合相关文献进行复习并讨论。结果 4例获得性血友病A患者的发病年龄为44~73岁,男女发病比例1∶3,均未找到明确相关病因,首发症状均为皮肤软组织出血,所有患者均有活化的部分凝血活酶时间(APTT)延长,抗凝血因子Ⅷ(FⅧ)活性下降(0.4%~0.9%),FⅧ抗体检测阳性(10.12~115 BU/ml)。通过糖皮质激素单用或联合环磷酰胺治疗后,4例患者FⅧ抗体滴度均较前下降,FⅧ水平较前升高。1例患者在治疗间期因脑出血死亡。结论 (1)获得性血友病A发病罕见,多见于老年人。(2)临床表现以自发性出血为主,其中以皮肤黏膜及肌肉软组织出血多见。(3)旁路治疗为止血治疗的一线方案,糖皮质激素单用或联合环磷酰胺仍是当前清除抗体的核心治疗方案。     

Gastrointestinal Kaposi's sarcoma: Case report and review of the literature

Kaposi's sarcoma(KS) of the gastrointestinal tract is not an uncommon disease among individuals with acquired immunodeficiency syndrome(AIDS). The majority is asymptomatic, and for this reason, gastrointestinal KS(GI-KS) remains undiagnosed. With continued tumor growth, considerable variation in clinical presentation occurs including abdominal pain, nausea, vomiting, iron deficiency anemia(either chronic or frank gastrointestinal bleeding), and rarely mechanical obstruction alone or combined with bowel perforation. Endoscopy with biopsy allows for histological and immunohistochemical testing to confirm the diagnosis of GI-KS among those with clinical symptoms. In previous studies, dual treatment with highly active antiretroviral therapy and systemic chemotherapy have been associated with improved morbidity and mortality in individuals with visceral KS. Therefore, investigators have suggested performing screening endoscopies in select patients for early detection and treatment to improve outcome. In this review, we describe a 44 years old man with AIDS and cutaneous KS who presented for evaluation of postprandial abdominal pain, vomiting, and weight loss. On upper endoscopy, an extensive, infiltrative,circumferential, reddish mass involving the entire body and antrum of the stomach was seen. Histologic examination later revealed spindle cell proliferation, and confirmatory immunohistochemical testing revealed human herpes virus 8 latent nuclear antigen expression consistent with a diagnosis of gastric KS. Following this, we present a comprehensive review of literature on KS with emphasis on gastrointestinal tract involvement and management.     

Intestinal motility in small bowel diverticulosis: a case report and review of the literature

Small bowel diverticulosis is a rare disease that is usually associated with recurrent pseudo-obstruction, bacterial overgrowth, and malabsorption. The more severe complications include hemorrhage and perforation. There is evidence to suggest that this entity is a result of small bowel motor dysfunction. For this reason, it has been associated with disorders in which a myopathic or neuropathic process is involved, such as scleroderma. The majority of patients with jejunal diverticulosis do not require surgery and can be managed medically. We report a case of jejunal diverticulosis in a 63-year-old gentleman who presented with symptoms of pseudo-obstruction. Ambulatory duodenojejunal manometry revealed several abnormalities suggestive of small bowel motor dysfunction. Enteroclysis, however, did not find evidence of mechanical obstruction, and the patient had marked improvement with cisapride and antibiotics.