Eugen Florin GeorgescuDoina CarsteaDaniela DumitrescuRamona Teodorescu...
5640-5644页
查看更多>>摘要：Ischemic bowel disease results from an acute or chronic drop in the blood supply to the bowel and may have various clinical presentations,such as intestinal angina,ischemic colitis or intestinal infarction.Elderly patients with systemic atherosclerosis who are symptomatic for the disease in two or more vascular beds have multiple comorbidities and are particularly at risk.The clinical evolution and outcome of this disease are difficult to predict because of its pleomorphic aspects and the general lack of statistical data.In this paper,we present the case of a patient who was monitored in our unit for six years.For this patient,we encountered iterative changes in the clinical pattern,beginning with chronic "intestinal angina" and finishing with signs of acute mesenteric ischemia after an episode of ischemic colitis.This evolution is particularly rare in clinical practice,and the case is instructive because it raises discussions about the natural history of the condition and the therapeutic decisions that should be made at every stage of the disease.An important lesson is that ischemic bowel disease should always be considered in patients who have multiple risk factors for atherosclerosis and have experienced recurrent "indistinct" abdominal symptoms.In these cases,aggressive investigation and therapeutic decisions must be taken whenever possible.Despite an absence of standardized protocols,angiographic evaluation and revascularization procedures have beneficial outcomes.Current advances in endovascular therapy,such as percutaneous transluminal angioplasty with stenting,should be increasingly used in patients with chronic mesenteric ischemia.Such therapy can avoid the risks that are associated with open repair.However,technical difficulties,especially in severe stenotic lesions,frequently occur.
查看更多>>摘要：We present a rare case of a gastrointestinal stromal tumor (GIST) in the stomach with prominent calcification at presentation.A 61-year-old woman visited our hospital because of epigastric discomfort.A spherical calcified lesion with a diameter of about 30 mm was incidentally shown in the left upper quadrant on an abdominal X-ray.Computed tomography demonstrated that the tumor was growing from the upper gastric body,with calcification in the peripheral ring area.A laparoscopic partial gastrectomy was performed,and the resected specimen revealed a well-circumscribed tumor with exophytic growth from the gastric muscularis propria.Microscopic examination revealed spindleshaped tumor cells with calcification and hemorrhage.Additionally,positive immunoreactivity of the tumor to KIT and CD34 and a low mitotic index resulted in the diagnosis of very low risk GIST.There are a few case reports of heavily calcified GIST,although solitary or punctate calcification of primary GIST has been reported in several case series.Dystrophic calcification of necrotic or degenerative tissue is the supposed cause of primary calcified GISTs.In contrast,appearance of calcification after administration of imatinib mesylate,which may be one indicator of disease response,is possibly caused by a different mechanism.
查看更多>>摘要：Here,we present the case of a 53-year-old man with a hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation.On admission,the patient complained of severe acute abdominal pain,with physical examination findings suspicious for a perforated peptic ulcer.Of note,the patient had no history of other medical conditions or recent trauma,and the initial chest radiography and laboratory findings were not specific.A subsequent abdominal computed tomography revealed intrathoracic displacement of the liver,gallbladder,transverse colon and omentum through a right diaphragmatic defect.The patient then underwent an explorative laparotomy that confirmed duodenal ulcer perforation.A primary repair of the duodenal perforation was performed,and the diaphragmatic defect was repaired using a polytetrafluoroethylene patch after the organs were reduced and the cavity irrigated.This particular case proves interesting as right-sided spontaneous diaphragmatic ruptures are very rare and difficult to diagnose.Additionally,the best treatment for such large diaphragmatic defects is still controversial,especially in cases of intrathoracic or intra-abdominal contamination.
查看更多>>摘要：Crohn's disease is a granulomatous systemic disorder of unknown etiology.Obvious pulmonary involvement is exceptional.Tracheal involvement in Crohn's disease is even more unusual,only a few cases have been reported to date.We herein report a rare case of tracheobronchial nodules and pulmonary infiltrates in both lungs as a complication of Crohn's disease.A 42-year-old man underwent pancolectomy for multiple broken colon caused by Crohn's disease.Forty days later pulmonary symptoms and radiologic abnormalities were noted.A search for bacterial (including mycobacteria) and fungal in the repeated sputum proved negative.The treatment consisted of intravenous antimicrobials for one month,but there was no improvement in pyrexia or cough and radiologic abnormalities.Fibreoptic bronchoscopy (FOB)was performed and revealed nodes in the trachea and the right upper lobe opening.Histopathology of tracheobronchial nodules and bronchial mucosa biopsy specimen both showed granulomatous inflammation with proliferation of capillaries and inflammatory cells.Oral steroid and salicylazosulfapyridine were commenced and led to marked improvement in symptoms and an almost complete resolution of his chest radiograph.Repeated FOB showed that nodes in the trachea disappeared and the ones in the right upper lobe opening diminished obviously.Crohn's disease can be associated with several respiratory manifestations.The form of tracheal and bronchopulmonary involvement in Crohn's disease is rare and responded well to steroids.
查看更多>>摘要：Endoscopic sphincterotomy (EST) is considered as a possible etiological factor for severe cholangitis.We herein report a case of severe cholangitis after endoscopic sphincterotomy induced by barium examination.An adult male patient presented with epigastric pain was diagnosed as having choledocholithiasis by ultrasonography.EST was performed and the stone was completely cleaned.Barium examination was done 3d after EST and severe cholangitis appeared 4 h later.The patient was recovered after treated with tienam for 4 d.Barium examination may induce severe cholangitis in patients after EST,although rare,barium examination should be chosen cautiously.Cautions should be also used when EST is performed in patients younger than 50 years to avoid the damage to the sphincter of Oddi.
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