Uma Debi

Abdominal tuberculosis of the gastrointestinal tract: Revisited

Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge, as the nonspecific features of the disease which may lead to diagnostic delays and development of complications. This condition is regarded as a great mimicker of other abdominal pathology. A high index of suspicion is an important factor in early diagnosis. Abdominal involvement may occur in the gastrointestinal tract, peritoneum, lymphnodes or solid viscera. Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis. Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality. Most of the patients respond very well to standard antitubercular therapy and surgery is required only in a minority of cases. Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important. We reviewed our experience with the findings on various imaging modalities for diagnosis of this potentially treatable disease.

Pancreatic trauma: A concise review

Traumatic injury to the pancreas is rare and difficult to diagnose. In contrast, traumatic injuries to the liver, spleen and kidney are common and are usually identified with ease by imaging modalities. Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities, and these injuries are often overlooked in cases with extensive multiorgan trauma. The most evident findings of pancreatic injury are post-traumatic pancreatitis with blood, edema, and soft tissue infiltration of the anterior pararenal space. The alterations of post-traumatic pancreatitis may not be visualized within several hours following trauma as they are time dependent. Delayed diagnoses of traumatic pancreatic injuries are associated with high morbidity and mortality. Imaging plays an important role in diagnosis of pancreatic injuries because early recognition of the disruption of the main pancreatic duct is important. We reviewed our experience with the use of various imaging modalities for diagnosis of blunt pancreatic trauma.

Hepatobiliary Disorders in Celiac Disease: An Update

This communication reviews recent literature and summarizes hepatobiliary abnormalities that may complicate the clinical course of celiac disease. A wide spectrum of hepatobiliary diseases has been described, including asymptomatic elevations of liver enzyme levels, nonspecific hepatitis, nonalcoholic fatty liver disease, and autoimmune and cholestatic liver disease. Moreover, in the majority of patients, liver enzyme levels will normalize on a gluten-free diet. In addition, celiac disease may be associated with rare hepatic complications, such as hepatic T-cell lymphoma. Because many celiac patients do not have overt gastrointestinal symptoms, a high index of suspicion is required. Simple methods of detecting celiac disease such as serum antibody tests help in the early identification of the disease, thus preventing serious complications of the disorder. The IgG DGP antibody test and IgA tTG antibody test used in combination are an excellent screening test for suspected cases of celiac disease.

Primary versus secondary achalasia: New signs on barium esophagogram

Aim: To investigate new signs on barium swallow that can differentiate primary from secondary achalasia. Materials and Methods: Records of 30 patients with primary achalasia and 17 patients with secondary achalasia were reviewed. Clinical, endoscopic, and manometric data was recorded. Barium esophagograms were evaluated for peristalsis and morphology of distal esophageal segment (length, symmetry, nodularity, shouldering, filling defects, and “tram-track sign”). Results: Mean age at presentation was 39 years in primary achalasia and 49 years in secondary achalasia. The mean duration of symptoms was 3.5 years in primary achalasia and 3 months in secondary achalasia. False-negative endoscopic results were noted in the first instance in five patients. In the secondary achalasia group, five patients had distal esophageal segment morphology indistinguishable from that of primary achalasia. None of the patients with primary achalasia and 35% patients with secondary achalasia had a length of the distal segment approaching combined height of two vertebral bodies. None of the patients with secondary achalasia and 34% patients with primary achalasia had maximum caliber of esophagus approaching combined height of two vertebral bodies. Tertiary contractions were noted in 90% patients with primary achalasia and 24% patients with secondary achalasia. Tram-track sign was found in 55% patients with primary achalasia. Filling defects in the distal esophageal segment were noted in 94% patients with secondary achalasia. Conclusion: Length of distal esophageal segment, tertiary contractions, tram-track sign, and filling defects in distal esophageal segment are useful esophagographic features distinguishing primary from secondary achalasia.

Upper gastrointestinal barium evaluation of duodenal pathology: A pictorial review.

Like other parts of the gastrointestinal tract (GIT), duodenum is subject to a variety of lesions both congenital and acquired. However, unlike other parts of the GIT viz. esophagus, rest of the small intestine and large intestine, barium evaluation of duodenal lesions is technically more challenging and hence not frequently reported. With significant advances in computed tomography technology, a thorough evaluation including intraluminal, mural and extramural is feasible in a single non-invasive examination. Notwithstanding, barium evaluation still remains the initial and sometimes the only imaging study in several parts of the world. Hence, a thorough acquaintance with the morphology of various duodenal lesions on upper gastrointestinal barium examination is essential in guiding further evaluation. We reviewed our experience with various common and uncommon barium findings in duodenal abnormalities.

Primary Hepatic Leiomyosarcoma: Histopathologist's Perspective of a Rare Case

Primary hepatic leiomyosarcoma is a rare primary mesenchymal tumor of the liver requiring exclusion of any other primary site of origin and histological and immunohistochemical exclusion of other hepatic/extrahepatic tumors with spindle cell morphology. Only about 70 cases are reported in the English literature and many of these tumors have predisposing conditions in the form of immunosuppression or associated malignancies. The occurrence of this tumor in the immunocompetent individual is also known. Histomorphology of this tumor shows a spindle cell lesion which needs to be distinguished from other spindle cell lesions of this region. The main diagnostic challenge of this tumor lies in its rarity, lack of awareness and morphological mimickers in the given site. A complete range of immunohistochemical markers is required to distinguish the lesion from its close morphological mimickers. Here, we discuss a case of primary hepatic leiomyosarcoma in an adult female patient with detailed histomorphological differentials and respective immunoprofiles.

Is colorectal biopsy necessary in irritable bowel syndrome

Background: Clinical symptom based criteria for IBS is not sufficient enough to rule out microscopic colitis (MC). We sought to study whether biopsy is necessary in IBS. Methods: This prospective study included colonic mucosa of 197 patients with IBS (129 IBS-D, 50 IBS-C and 18 IBS-M) to rule out MC. Results: : Overall prevalence of MC in patients with IBS was 23.4% (46/197). The prevalence of MC in patients with IBS-D was 28.7% (37/129), higher than in patients with IBS-C 12% (6/50) and IBS-M 16.7% (3/18). Conclusions: : Microscopic colitis is present in a relevant proportion of symptomatic patients meeting diagnostic criteria for IBS. Despite the fact that IBS is a functional disorder, in many patients morphological changes occur in colon mucosa. The diagnostic criteria of IBS are not specific enough to exclude the presence of MC. Therefore, in patients of IBS, it may be reasonable to perform a biopsy to screen for MC.

Pin Point Densities on Abdominal X-ray

A 9-y-old boy presented to pediatric emergency with historyof high grade fever and cough for 4 d. During per-oraltemperature recording using mercury (glass) thermome-ter, the child bit the thermometer resulting in the acci-dental ingestion of its tip. There was no pain abdomen orbleeding per rectum. At presentation, the child was afebrile,consciousandresponsive.Abdomenwasnon-tenderandsoft.Chest X-ray was normal (Fig. 1) except for tiny densefoci in the left lower zone. Abdominal radiograph(Fig. 2), however, was striking. It showed multiple tinydiscrete dense foci. Follow up radiograph, 1 day laterrevealed change in the pattern of the densities, both interms of their number and position. Abdominalultrasound was normal. The child was kept under observa-tion for a couple of days.Thermometers contain mercury in elemental form [1]. It ispoorly absorbed from the gastro-intestinal tract (GIT) and ismildly toxic to the GIT mucosa [2]. Accidental ingestion ofelemental mercury is rare and has been reported inchildren in few case reports [3, 4]. Small particles maybe aspirated (as in our case), though innocuous. Injuriesrelated to glass should also be considered; no such injuriesoccurred in present case [5].