Cecal herniation into the lesser sac: double-contrast study of one case

In a 45-year-old woman with abdominal pain and vomiting, plain films and barium studies showed a gas and fluid collection displacing the stomach anteriorly and to the left, and outlined by haustral folds. These signs were suggestive of cecal herniation through the epiploic foramen and eliminated the possibility of a lesser sac abscess. The diagnosis was confirmed by a double-contrast barium enema. Symptoms spontaneously resolved, and 4 years later, the patient was in good health, and without abdominal complaint.

Evidence for an association between cholelithiasis and diverticular disease of the colon: a case-controlled study

A prospective case-control study was carried out to determine if there was a true association between diverticular disease of the colon and cholelithiasis. The prevalence of gallstones was higher in 102 patients with diverticular disease of the colon (45%) than in 102 control subjects, matched for age, sex, body weight, and number of pregnancies (22%) (P less than 0.001). The difference was only significant in women. Although these results obtained in hospitalized patients cannot be generalized to the population at large, this study suggests an association between diverticular disease of the colon and gallstone disease. The possibilities of referral bias, detection bias, and chance are considered, and the mechanism of this association is discussed, with particular reference to the role of a fiber-depleted diet.

Endoscopic discovery and capture of Taenia saginata

The authors report the first case of endoscopic finding and removal of a beef tapeworm (Taenia saginata). The parasite was discovered in the duodenal bulb of a 72-year-old woman, who complained of epigastric pain.

Interest of a combined antisecretory treatment, cimetidine and pirenzepin, in the management of severe forms of Zollinger-Ellison syndrome

Inhibition of gastric acid secretion by the combined use of cimetidine and pirenzepin has been studied in 5 cases of Zollinger-Ellison syndrome. In 4 acute cases i.v. cimetidine and i.m. pirenzepin were administered together as a treatment and were successful in 3 out of the 4 cases as judged by the disappearance of clinical symptoms and healing of the gastroduodenal and jejunal mucosal ulcerations. Secretory measurements indicated that addition of pirenzepin to cimetidine resulted in larger and more prolonged inhibition of acid secretion in these patients. The continuous record of intragastric pH in the 5th patient, over 24-hour periods, confirmed the above findings. Despite the use of large doses of pirenzepin, no significant side effects were noticed.

Unconjugated hyperbilirubinemia during treatment with chenodeoxycholic acid

The authors describe a slight but significant increase in the serum levels of indirect-reacting bilirubin in gallstone patients after 3 and 6 mo of treatment with chenodeoxycholic acid. A return to pretreatment values was noted at 9 mo. The mechanism of this abnormality remains unclear. Two explanations are theoretically possible: a subclinical hemolysis or a modification of the hepatic transport and/or the conjugation of bilirubin.

Fibrosing alveolitis and hepatitis B surface antigen-associated chronic active hepatitis in a patient with immunoglobulin A deficiency

Fibrosing alveolitis is described in a 22 year old woman with immunoglobulin A (IgA) deficiency and hepatitis B surface antigen (HBsAg)-associated chronic active hepatitis. At lung biopsy HBsAg was detected by indirect immunofluorescence in the alveolar space but not in the septal fibrosis. We discuss the possible relationships between IgA deficiency on the one hand, and HBsAg-associated lung and liver diseases on the other hand.

Gastrointestinal bleeding due to chronic portal vein thrombosis in ulcerative colitis

The authors report the case of a patient suffering from ulcerative colitis, who had several episodes of digestive hemorrhage due to portal hypertension. Portal hypertension was secondary to chronic portal vein thrombosis. This diagnosis was made on the venous phase of celiac and mesenteric angiography. The authors review the published cases of ulcerative colitis with portal vein thrombosis and discuss the possible etiologic factors: hypercoagulability, thrombocytosis, and intraabdominal sepsis.

Hepatic sinusoidal dilatation in Crohn's disease

In a prospective study of liver function in 19 patients with Crohn's disease, examination of liver biopsies showed a sinusoidal dilatation in 16 patients. This dilatation was moderate in 5 cases and pronounced in 6 cases and was associated with a closely parallel dilatation of the centrilobular vein. There was no correlation between these diffuse vascular changes and the site of the bowel disease, the clinical presentation, and the course of the disease. The pathogenesis of this sinusoidal dilatation is unknown.

Evidence for an association between cholelithiasis and hiatus hernia

A prospective, controlled study was carried out to determine if there was an association between hiatus hernia and cholelithiasis. The prevalence of gallstones was calculated in 100 patients (50 men and 50 women) with radiological evidence of hiatus hernia. 100 subjects (50 men and 50 women) without hiatus hernia, matched for age, body-weight, and number of pregnancies, acted as controls. Gallstones were twice as common in the former group (34%) as in the control group (17%) (P less than 0.01). Moreover, a comparison of the lipid composition of the gallbladder bile in 15 subjects operated on for hiatus hernia with that in 17 patients operated on for another digestive disease showed that the molar percentage of choelsterol in the bile and the cholesterol saturation index were significantly higher in the patients with hiatus hernia (9.3 +/- 1.1, mean +/- S.E.M., 1.41) than in the control subjects (5.9 +/- 0.5; 0.97) (P less than 0.01). These results suggest an association between hiatus hernia and cholelithiasis. It is likely that common factors, probably related to a low-residue diet, predispose to the two diseases.

Villous adenoma of the duodenum. Endoscopic diagnosis and resection

The authors report a new case of villous adenoma of the duodenum diagnosed by X-ray examination and duodenoscopy. Endoscopic removal allows an accurate histologic diagnosis. This endoscopic resection relieves symptoms and spares the patient a laparotomy. It seems to be an acceptable treatment of benign duodenal tumors.

Hypogammaglobulinemia with lymphoid nodular hyperplasia of the small bowel: endoscopic diagnosis of one case

A 37-year-old man suffering from abdominal pain and diarrhea, was hospitalized because of abdominal discomfort. Gastroduodenal series showed multiple duodenal filling defects. Gastroduodenoscopic examination revealed numerous nodular lesions in the duodenum and biopsy specimen demonstrated nodular lymphoid hyperplasia. The serum immunoelectrophoretic pattern showed a virtual absence of IgA and IgM and a very decreased level of IgG. To our knowledge, it is the first case of hypogammaglobulinaemia with nodular hyperplasia of the small bowel, diagnosed by endoscopy and forceps biopsy.

Massive splenic infarction in cirrhosis: report of a case with spontaneous disappearance of hypersplenism

A cirrhotic patient with massive splenic infarction is described. Celiac angiography showed normally opacified splenic artery and vein and a markedly enlarged spleen with large avascular zones. Splenic infarction was associated with the spontaneous disappearance of a syndrome of hypersplenism. The spleen was surgically removed. Histological examination showed multiple thromboses of the small arterial and venous vessels. The cause of this infarct remained unclear.

Gastric metastasis from breast carcinoma: emergency snare-ectomy for control of hemorrhage

In a 65-year-old woman, radiological and endoscopical findings of gastric metastasis from breast carcinoma are described. Significant upper gastrointestinal bleeding necessitated an emergency gastroscopy. The ulcerated nodular lesion was bleeding and removed by diathermy loop via fiberoptic gastroscopy.