M Medhioub

Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease.

BACKGROUND AND STUDY AIMS Gastric outlet obstruction (GOO) is a rare complication of peptic ulcer disease (PUD). The endoscopic balloon dilatation (EBD) associated with medical treatment of Helicobacter pylori is a successful method in the management of pyloric stenosis. The aim of this study was to describe epidemiological, clinical, and endoscopic characteristics of GOO related to PUD and to evaluate the effectiveness, safety, and outcome of EBD. PATIENTS AND METHODS In a retrospective study of patients seen between 1999 and 2009 with symptoms of GOO secondary to PUD, pyloro-bulbar stenosis was confirmed by endoscopic examination. Balloon dilatation was performed when obstruction persisted after treatment with double-dose proton-pump inhibitor (PPI) intravenously for 7-10days. The H. pylori status was assessed with histology, and eradication therapy was prescribed for infection. RESULTS A total of 45 consecutive patients (38 males, 7 females median age, 51.9years; range, 20-58years) with symptoms of GOO secondary to PUD underwent EBD. Median follow-up time of the 45 patients was 32months (range, 4-126months). The immediate success rate of the procedure was 95.5%. Clinical remission was noted in 84.4% of the patients. Remission without relapse was observed in 55.8%, 30months after the dilatation. Pyloric stenosis relapsed in 15 patients (39.5%) after a median period of 22.9months. The dilatation was complicated in three patients (6.7%, two perforations and one bleeding). A total of 13 patients (29%) underwent surgery. H. pylori was found to be positive in 97.7% of the patients, and was eradicated in 78.4% of them. Smoking and failure of H. pylori eradication were associated with the relapse of the stenosis. CONCLUSION EBD is a simple, effective, and safe therapy for the GOO related to PUD, producing short- and long-term remission.

Cutaneous Large B Cell Lymphoma Involving the Duodenum and the Bile Duct: a Case Report

A 63-year-old male patient presented a huge indolent tumor (60 cm in diameter), with peripheral annular erythematous and pigmented reinforcement on the back next to the left shoulder, evolving for 1 year and ignored by the patient (Fig. 1). A skin biopsy was performed 3 months before admission and histologic examination showed dense diffuse lymphocytic infiltrate of centroblasts and immunoblasts. An immunohistochemical analysis showed positivity of CD20 and Bcl-2 and negativity of the other markers: MUM-1, and Bcl-6, CD30, and EpsteinBarr virus stains including Epstein-Barr encoded RNA. A primary cutaneous B cell lymphoma (PCBCL) leg type was initially established. Chemotherapy was indicated but the patient did not consult and he presented with a 2-week history of progressive obstructive jaundice and abdominal pain without fever. Physical examination showed jaundice and a palpable gallbladder but no hepatosplenomegaly or peripheral lymph nodes. His right upper abdomen was tender to palpation. Laboratory findings confirmed cholestasis with elevated levels of direct bilirubin, alkaline phosphatase, and gammaglutamyl-transpeptidase, associatedwith a moderate cytolysis. Prothrombin time was normal. The cancer antigen 19-9 level was mildly elevated. Lactate dehydrogenase level was normal. Abdominal ultrasound showed dilation of the intrahepatic and common bile ducts with an enlarged gallbladder without evidence of an obstacle on the bile ducts. Abdominal CTscan and magnetic resonance cholangiopancreatography (MRCP) revealed dilatation of the proximal common bile duct (CBD) and both intrahepatic bile ducts, a narrowing of the distal common bile duct with no masses in the liver and no lymphadenopathy (Fig. 2). Pancreatic duct was also dilated. Lateral duodenoscopy showed an ulcer of the second portion of the duodenum away from the papilla; biopsies were performed. Histological examination with immunohistochemistry revealed a large B cell-type malignant lymphoma. Endoscopic retrograde cholangiopancreatography (ERCP) and cholangiography confirmed the stricture and showed a narrowed segment in the inferior part of the CBD, with proximal dilatation (Fig. 3). After endoscopic papillotomy, cytological and biopsy tests were performed and a plastic stent was placed for drainage. Histological examination with immunochemistry showed a large B cell-type lymphoma (Fig. 4). A * Lamine Hamzaoui lamine015@yahoo.fr

ENDOSCOPIC TREATMENT OF CYSTIC DUODENAL DUPLICATION

Received: Jul 30, 2020 Accepted: Aug 24, 2020 Published Online: Aug 26, 2020 Journal: Journal of Case Reports and Medical Images Publisher: MedDocs Publishers LLC Online edition: http://meddocsonline.org/ Copyright:

Inflammatory pseudotumor of the liver

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 28 juillet 2016

Gastrointestinal stromal tumours (GISTs): A descriptive study on 29 cases

BACKGROUND AND STUDY AIM Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract, originating from Cajal cells in different sites of the digestive tract. The aim of the study is to report on epidemiological, clinical, histological, and therapeutic characteristics of GISTs. PATIENTS AND METHODS A retrospective descriptive study of 29 cases of GIST in gastroenterology and general surgery departments of Mohamed Tahar Maamouri Hospital (Nabeul, Tunisia) was conducted from January 2005 to March 2012. RESULTS Among the 29 patients, there were 18 males (62%) and 11 females (38%) with a median age of 63 years (range, 30-96years). The main symptoms were abdominal pain (40%) and weight loss (28%). The tumour was revealed by a complication in 5 cases (17%). Six patients (20.7%) had metastatic lesions. The most common sites were the stomach (41.4%) and the small intestine (17.3%). The median tumour size was 9.5cm (range, 1-30cm). Spindle cell tumours were the main histological type (62%). KIT was positive in the majority of cases (75%). Twenty-one patients with primary disease (72%) underwent a surgical resection. Imatinib was prescribed in 7 patients (24%). Sunitinib malate was indicated in 3 patients who had tumour progression under imatinib. Median survival was 17 months (range, 1-69months). Ten patients died. CONCLUSION The management of GISTs has considerably evolved during the last years. Surgical resection, which remains the mainstay of treatment, was indicated in the majority of patients. Imatinib treatment has not improved overall survival in metastatic and/or inoperable cases.

Metastatic Squamous Cell Carcinoma of the Stomach

Primary squamous cell carcinoma of the stomach is very rare. Its pathogenesis is unclear and the treatment strategy is controversial. We report an agressive primary squamous cell carcinoma of the stomach with liver and lung metastases in a 55-year-old man. The patient presented with a 1-month history of abdominal pain, vomiting and weight loss. Abdominal ultrasound revealed multiple liver metastases. Endoscopic examination showed two tumour masses on the fundus of the stomach. Biopsy of the lesions revealed squamous cell carcinoma of the stomach. Chest x-ray showed multiple large pulmonary nodules highly suggestive of pulmonary metastases. The patient died ten days after he was admitted because of progression of the tumour and before any therapeutic decision.