Cem Kockar

Endoscopic removal of an ingested pin migrated into the liver and affixed by its head to the duodenum

Foreign body (FB) ingestion is a common condition in childhood. Most ingested FBs pass through the GI tract without any complication. Nevertheless, penetration of the intestinal tract is possible by sharp or pointed objects. Perforation may occur if such objects become lodged in a narrow segment of the GI tract. The morbidity depends on the continued route of the penetrating object and whether septic sequela ensue. 1 Although FBs may migrate to any intra-abdominal organ, perforation of the duodenum and migration into the liver are extremely rare. Only one case has been reported in the literature, in an adult woman. The pin was described in the liver, with the head of the pin in the lumen of the duodenum. In that case, the pin was removed laparoscopically. 2 Tothebestofourknowledge,wereportherethefirstpediatric case of an ingested pin that migrated from the duodenum into the liver. The pin was removed by flexible EGD by using a polypectomy snare, with the patient under general anesthesia. The patient tolerated the procedure well, without untoward effects.

Comparison of FibroTest-ActiTest with histopathology in demonstrating fibrosis and necroinflammatory activity in chronic hepatitis B and C.

AIMS FibroTest and ActiTest are noninvasive tests used in determining the level of fibrosis and the degree of necroinflammatory activity in the liver. In our study, we aimed to investigate whether these tests could be alternative to liver biopsy. MATERIALS AND METHODS Fifty patients were included in the study. Serum samples were obtained and liver needle biopsy was performed on the same day. Levels of fibrosis in FibroTest and levels of activity in ActiTest, both determined via serum biochemical markers, were compared with levels of fibrosis and activity in histopathological examination. For statistical analyses, Mc Nemar chi square test and Spearmans correlation tests were used. RESULTS There was a significant positive correlation between fibrosis in biopsy and the level of fibrosis in FibroTest in patients with hepatitis B virus (HBV) (rho: 0.67, P < 0.0001). However, no significant correlation was determined between the activity in biopsy and the degree of activity in ActiTest (rho: 0.29, P < 0.05). No significant correlation was determined between both fibrosis and activity established in biopsy and the results of FibroTest and ActiTest in the group of patients with hepatitis C virus (HCV) (rho: 0.22, P < 0.05 and rho: 0.15, P < 0.05, respectively). CONCLUSION Our results suggest that novel and safer noninvasive biochemical tests are needed as an alternative to histopathology in patients infected with HBV and HCV. Consequently, we believe that liver biopsy maintains its place as a gold standard in determining the histopathological condition of the liver.

Hepatobiliary fascioliasis: a case with unusual radiological features

We report a case of hepatobiliary fascioliasis presenting with unusual radiological findings that have not been reported previously. Imaging studies revealed hepatic cystic pouches communicating with intrahepatic bile ducts. Snail-like, oval shaped and conglomerated echogenic particles with no acoustic shadowing, suggesting F. hepatica, were detected in these cystic pouches. In addition, secondary sclerosing cholangitis developed after fascioliasis.

Multiple gastrointestinal hemangiomatosis successfully treated with propranolol.

p e A 16-year-old boy presented with fatigue for 2 months and severe anemia (hemoglobin 4.9 g/dL). Physical examination was normal except pale skin, and no extraintestinal hemangiomatous lesion was found. Endoscopy revealed multiple cavernous hemangiomas in the stomach and colon (Fig. 1). Propranolol was started and gradually increased weekly to 2 mg 1 kg 1 d . The patient had no further complaints, and repeat endoscopic findings after 8 months showed significant decrease in size of the hemangiomas (Fig. 2). Recent discoveries concerning hemangioma pathogenesis provide both an improved understanding and more optimal approach to the evaluation and management of these patients (1). In 2008, propranolol was described as an effective treatment for infantile hemangiomas (2). Presently, propranolol is recommended as first-line treatment for infantile hemangiomas in many organs such as the liver (3). Oral propranolol gives providers a therapeutic ings after 8 months; cardia (A), corpus (B), and colon (C–E).