Idiopathic retroperitoneal fibrosis--is serum alkaline phosphatase a marker of disease activity?

Idiopathic retroperitoneal fibrosis causing unilateral ureteral and sigmoid colon obstruction: A case report

OBJECTIVE

The present report aimed to present a unique case of idiopathic retroperitoneal fibrosis (RPF) presenting features of unilateral ureteral and sigmoid colon obstruction. RPF is a rare disorder with unclear etiology.

CASE REPORT

A 43-year-old female had a 10-day history of lower right abdominal and lumbar pain. Gynecological examination, ultrasound, and computed tomography (CT) were all suggestive of right ovarian tumor. An enhanced CT showed right-sided hydronephrosis. The patient was diagnosed as having ovarian cancer. Ten days after hospitalization, a right intraureteral stent with a double-J catheter was inserted. Upon exploring the abdomen, unyielding RPF was encountered. A partial sigmoidectomy and colostomy were performed. Postoperative pathological results suggested idiopathic RPF. She received steroid treatments.

CONCLUSION

RPF is a rare disease that can be misdiagnosed. Our understanding about its presentation has to be improved and it should be considered as a differential diagnosis for patients presenting with abdominal diseases.

La fibrosi retroperitoneale idiopatica. Manifestazioni cliniche: Idiopathic retroperitoneal fibrosis. Clinical features

Retroperitoneal fibrosis (RPF) is probably a partial manifestation of a systemic disease of the connective tissue. The clinical features of RPF are linked to the development of a retroperitoneal fibrous plaque which compresses and obstructs the ureters, the aorta, the inferior cava and the adjacent structures. Ormond's disease is characterised by two clinical stages: the early stage with signs and symptoms very similar to those of any subacute or chronic inflammation and the advanced stage with clinical features attributable to progressive ureteral obstruction, compression of the great vessels and involvement of the digestive apparatus.

Transient hyperphosphatasaemia in association with acute infection in adults

The causes of raised serum alkaline phosphatase were determined prospectively in a consecutive series of 2884 acute medical admissions. Diagnoses were established by pre-defined clinico-pathological criteria. Two hundred and four patients had hyperphosphatasaemia. Liver and bone disease accounted for only 98 (48%) of the established diagnoses. The diagnosis was not established in 31 (15%). Transient hyperphosphatasaemia occurred in 66 (32.4%) cases. In 25 of these patients (12% of the total) an acute infection was the sole illness identified. In this infected group, the isoenzyme type was predominantly hepatic, although jaundice occurred in only 3 patients. Discriminant analysis revealed that this group was characterized by haematological and biochemical features of an acute phase response. Transient hyperphosphatasaemia is commonly found in acutely ill medical inpatients and is frequently associated with acute extrahepatic infection.

Weber-Christian disease producing splenic vein occlusion and bleeding gastric varices: successful treatment with sclerotherapy

A 48 year old woman with intra-abdominal Weber-Christian disease presented with bleeding gastric varices and evidence of splenic vein occlusion. We describe the problems encountered in making this diagnosis and subsequent treatment.