Small bowel infarction associated with pancreatic glucagonoma

An 88 year old woman presented comatose, hypothermic and hyperglycaemic. She died soon after admission and at autopsy recent small bowel infarction was found. The superior mesenteric artery was encased in a dense pancreatic mass and there was marked luminal narrowing of the vessel. Histology revealed a pancreatic glucagonoma which had metastasized to colonic submucosa and serosa. Glucagonoma is a rare tumour and this presentation of small bowel infarction associated with pancreatic glucagonoma would appear to be a unique event.     

Intestinal angioedema mimicking Crohn's disease

Angioedema usually presents as episodic attacks of swelling of the face, airway and extremities, but it may also involve visceral tissues. A 58-year-old woman with repeated episodes of abdominal pain, nausea and vomiting had two laparotomies and was treated for Crohn's disease for two years before a diagnosis of acquired intestinal angioedema was made. This case provides important insights into the presentation of intestinal angioedema.     

Basal ganglia infarction mimicking glioblastoma

Modern brain imaging techniques usually allow a very good differential diagnosis of intracerebral lesions, but in some cases the differential diagnosis is difficult. We report the case of a 52 year old male with acute brachiofacial paresis and a hyperintense lesion with mass effect and ring-enhancement in basal ganglia suspiciously to a tumor. The neurosurgeons recommend stereotactical brain biopsy for diagnosis, but the patient recovered in following time gradually and in repeated computer tomographic images contrast enhancement disappeared and a hypodense zone in the basal ganglia remains. Our case demonstrates that brain infarctions can mimick glioblastoma in taking cystic appearance and contrast enhancement. Stereotactic biopsy would have been a precipitated invasive procedure in this case.     

Terminal ileum schistosomiasis with perianal fistula mimicking Crohn's disease

Schistosomiasis is a parasitic disease related to water contact in the agricultural fields, affecting millions of people in developing countries in tropical and subtropical parts of Africa, Asia, and South America. We report a case of a 27-year-old male, with intestinal schistosomiasis associated with perianal fistula mimicking Crohn's disease, where the terminal ileum showed a cobblestone appearance, and histopathological biopsy showed schistosoma granuloma.     

呈急性心肌梗死样表现的暴发性心肌炎11例

目的分析呈急性心肌梗死样表现的暴发性心肌炎临床特点及治疗方法.方法研究对象符合①45岁以下;②无高血压、高脂血症、糖尿病、吸烟等常见的动脉粥样硬化危险因素;③既往无心绞痛表现;④心肌酶学增高（较正常参考值高2倍以上）;⑤ECG除极相及（或）复极相出现较典型的AMI样改变,即出现异常Q波、ST段抬高或压低;⑥1个月内恢复正常或死亡者.从临床表现、辅助检查及治疗等方面进行分析.结果共11例入选,男性7例,女性4例,平均年龄26岁.8例有前驱感染症状,9例发生心功能不全或室速或严重的房室传导阻滞,10例患者心电图多导联出现异常.根据心超表现分为3型,Ⅰ型3例为心脏结构、心脏收缩功能及舒张功能均无明显异常;Ⅱ型4例为心室腔不增大,但室壁（室间隔或正后壁）增厚,心脏收缩功能及舒张功能均减退,但以舒张功能不全为主;Ⅲ型4例为左心室腔明显扩大,心脏收缩功能明显减退.糖皮质激素对2型效果好.存活7例,经1～2年随访逐渐恢复.结论呈急性心肌梗死样表现的暴发性心肌炎病情重、死亡率高,多有前驱感染症状,常出现多导联心电图异常,依据心超表现的分型对治疗与预后有重要意义.     

The smaller bowel: imaging the small bowel in paediatric Crohn's disease

Crohn's disease begins in childhood in 20% of cases. Imaging of the small bowel is needed for diagnosis and management and also to inform the clinician of the location, extent, and activity of disease. There are several modalities available to image the small bowel and the combined use of these is often required to optimise benefit. Methods available for imaging the small bowel include barium studies, sonography, CT, wireless capsule endoscopy, nuclear medicine studies, and MRI. Patient comfort is paramount in imaging paediatric patients. Therefore, non-invasive techniques are most likely to be successful. Furthermore, as children are at greatest risk of radiation induced malignancy, modalities which do not carry a radiation burden are preferable. This article discusses the methods available for imaging the small bowel in paediatric Crohn's disease and the relative merits of each modality.     

Perforation in Crohn's disease of the small bowel

During a five-year period, three patients with general peritonitis, secondary to perforation of the small bowel in Crohn's disease, were successfully treated by resection and primary anastomosis. During this period, 30 patients presented with small bowel or ileocaecal Crohn's disease. The possibility of perforation should be considered when evaluating the need for surgery in patients with Crohn's disease with symptoms of obstruction.     

Inflammation of a small bowel leiomyoma mimicking acute appendicitis

Small bowel leiomyoma has been well documented as a cause of unexplained gastrointestinal bleeding. It has not previously been associated with frank peritonitis as described here.     

Small bowel stricture following abdominal trauma

A case of small bowel stricture developing 2 months after blunt abdominal trauma from a lap seat belt is presented. The cause of the stricture was probably a small perforation sustained at the time of the injury but overlooked clinically. At operation an abscess around the terminal ileum was found. The patient made an uneventful recovery following resection of the strictured small bowel.     

Free perforation of the small bowel in Crohn's disease.

A rare case of free double ileal perforation in previously asymptomatic and undiagnosed Crohn''s disease of the terminal ileum is described. At operation, a primary resection and anastomosis of the diseased bowel was performed. The management of free perforation in Crohn''s disease is discussed, together with a review of the literature. It is suggested that the absence of steroids in a previously undiagnosed case may favour primary resection and anastomosis.     

Small bowel function after aortic surgery.

One cause of post-operative morbidity in the elective repair of abdominal aortic aneurysms is the development of a paralytic or ''adynamic'' ileus. In a series of 20 consecutive patients undergoing such a procedure, the maintenance of small bowel motility and absorptive capacity in the immediate post-operative period was assessed using barium sulphate and xylose passed down a naso-duodenal tube sited at the time of surgery. This simple study demonstrated that small bowel function was preserved in all cases, and hence that patients could be fed enterally via naso-duodenal tube (in particular using very low residue formulae) rather than using costly parenteral regimens, should an ileus persist.