Péter IlonczaiJudit TóthLászló TóthIstván Altorjay...
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查看更多>>摘要：In patients with inflammatory bowel diseases (IBD)the prevalence of thrombosis is 6.2％,the average incidence of thromboembolism (TE) is 3.6 times higher compared to normal population.The TE is a common extraintestinal complication of IBD,squarely associated with the IBD activity.The application of anticoagulant and thrombolytic therapy in severe IBD is an unresolved issue.Herein we report the first case in literature of an active IBD patient with an upper limb acute arterial occlusion and successful catheter-directed thrombolysis (CDT).A 46-year-old male patient is reported who had Crohn's disease for 10 years.His right hand suddenly became cold and painful.Angiography proved acute occlusion of the brachial and radial artery.Vascular surgery intervention was not applicable.Endoscopy showed extended,severe inflammation of the colon.Despite the severe endoscopic findings,frequent bloody stools and moderate anaemia,CDT with recombinant tissue plasminogen activator was performed.The control angiography proved improvement,the radial artery pulse appeared.No bleeding complication was observed.This case supports that CDT-after careful estimation of the bleeding risk-can be effective and safe in patients with severe or life-threatening TE and active IBD.
查看更多>>摘要：We report a case of acute fulminant amoebic colitis that resulted in the development of a perianal ulcer in a 29-year-old Japanese homosexual man with acquired immunodeficiency syndrome (AIDS).The patient was admitted to our hospital with a persistent perianal abscess that was refractory to antibiotic therapy administered at another hospital.On admission,we observed a giant ulcer in the perianal region.At first,cytomegalovirus colitis was suspected by blood investigations.Ganciclovir therapy was initiated; however,the patient developed necrosis of the skin around the anus during therapy.We only performed end-sigmoidostomy and necrotomy to avoid excessive surgical invasion.Histopathological examination of the surgical specimen revealed the presence of trophozoite amoebae,indicating a final diagnosis of acute fulminant amoebic colitis.The patient's postoperative course was favorable,and proctectomy of the residual rectum was performed 11 mo later.Amoebic colitis is one of the most severe complications affecting patients with AIDS.Particularly,acute fulminant amoebic colitis may result in a poor prognosis; therefore,staged surgical therapy as a less invasive procedure should be considered as one of the treatment options for these patients.
查看更多>>摘要：We report a rare case of a small-bowel lymphangioma causing massive gastrointestinal (GI) bleeding that we successfully diagnosed and treated using double-balloon enteroscopy (DBE).An 81-year-old woman suffering from repeated GI bleeding of unknown origin underwent a capsule endoscopy at a previous hospital.She was suspected of having bleeding from the jejunum,and was referred to our department for diagnosis and treatment.An oral DBE revealed a 20 mmx 10 mm,regularly surfaced,white to yellowish,elongated,pedunculated jejunal polyp with small erosions at 10 cm distal to the ligament of Treiz.Since no other source of bleeding was identified by endoscopy in the deep jejunum,an endoscopic polypectomy (EP) was performed for this lesion.A subsequent histopathological examination of the resected polyp showed clusters of lymphatic vessels with marked cystic dilatation in the submucosa and the deep layer of the lamina propria mucosae.These characteristics are consistent with the typical features of small-bowel lymphangioma with erosions.Although clipping hemostasis was performed during EP,re-bleeding occurred.Finally,a complete hemostasis was achieved by performing an additional argon plasma coagulation.
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