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Zazour A, Belkhayat C, Bennani A, Bouziane M, Kharrasse G, Ismaili Z. Two cases of Dieulafoy's lesion in unusual sites: A rare case reports of gastrointestinal bleeding. Int J Surg Case Rep 2024; 117:109562. [PMID: 38518467 PMCID: PMC10972791 DOI: 10.1016/j.ijscr.2024.109562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION Dieulafoy's lesion (DL) is a vascular malformation that can lead to massive gastrointestinal bleeding. It's usually found in the stomach. However, DL's occurrence in atypical sites such as the small bowel and colon is exceptionally rare, posing significant management challenges. CASE PRESENTATION In this report, we present two cases of DL occurring in uncommon sites, each managed with distinct approaches. Case 1 is a 50-year-old man admitted to the emergency department due to massive GI bleeding and hemodynamic instability. The diagnosis of DL was established through computed tomography angiography and confirmed by histopathological examination after emergency surgery. Case 2 involves a 68-year-old woman presented with melena due to a colonic DL. This case was successfully managed through an endoscopic hemostasis approach. DISCUSSION Dieulafoy's lesions (DL) were first identified as a large submucosal artery lacking typical gastric ulcer characteristics in three of Paul Georges Dieulafoy's patients. This lesion is responsible for approximately 1-2 % of all cases of gastrointestinal bleeding. Endoscopy is the preferred method for diagnosing and managing DL lesions, especially in cases of active bleeding that is accessible. However, if endoscopic treatment or angiographic embolization fails, a surgical approach may be needed. CONCLUSION DL presents a diagnostic challenge due to its rarity and is not usually included in the differential diagnosis of gastrointestinal bleeding, particularly when occurring in unusual sites. Endoscopy is the preferred method to identify DL and a possible therapeutic approach in active bleeding. However, if endoscopy hemostasis fails, angiographic embolization or surgical intervention may be required.
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Affiliation(s)
- Abdelkrim Zazour
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco.
| | - Chifaa Belkhayat
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Amal Bennani
- Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Pathology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Mohamed Bouziane
- General Surgery Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Ghizlane Kharrasse
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Zahi Ismaili
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
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Amri F, Belkhayat C, Chahi K, Aggari HE, Zazour A, Koulali H, Mqaddem OEL, Skiker I, Kharrasse G, Ismaili Z. Upper gastrointestinal bleeding revealing a Bouveret syndrome: A case report. Radiol Case Rep 2023; 18:4549-4552. [PMID: 37868004 PMCID: PMC10587669 DOI: 10.1016/j.radcr.2023.09.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Bouveret's syndrome is an uncommon cause of gastrointestinal obstruction. It's a result of the passage of a gallstone through a fistula connecting the gallbladder with the duodenum or stomach. The diagnosis is challenging due to its atypical clinical manifestations. There have been a few reported cases of Bouveret syndrome presenting with gastrointestinal bleeding. Treatment options include both endoscopic and surgical approaches. We present the case of a 92-year-old woman admitted to the emergency department for upper gastrointestinal bleeding. Gastroscopy revealed gastric stasis upstream of a calculus inducing an obstruction of the bulb. The computed tomography (CT) scan showed a cholecystoduodenal fistula with a calculus lodged in the bulb. The patient underwent a gastrostomy with extraction of the calculus. Postoperative course was uneventful and the patient was discharged home. In the majority of cases, Bouveret's syndrome is revealed by an upper gastrointestinal obstruction, but other signs, such as gastrointestinal bleeding, can be seen. The diagnosis is confirmed by an imaging method that highlights Rigler's triad. The management can be either endoscopic or surgical depending on the patient's general condition. The diagnosis is often difficult due to the lack of specificity in the symptoms. Presently, there exists no consensus concerning the appropriate approach for its management.
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Affiliation(s)
- Fakhrddine Amri
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Chifaa Belkhayat
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Kaoutar Chahi
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Hanane El Aggari
- Department of Radiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Abdelkrim Zazour
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Hajar Koulali
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Ouiam EL Mqaddem
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Ghizlane Kharrasse
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Zahi Ismaili
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
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Amri F, Belkhayat C, Yeznasni A, Koulali H, Jabi R, Zazour A, Abda N, Bouziane M, Ismaili Z, Kharrasse G. Association between pancreatic cancer and diabetes: insights from a retrospective cohort study. BMC Cancer 2023; 23:856. [PMID: 37697301 PMCID: PMC10496157 DOI: 10.1186/s12885-023-11344-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Studies investigating the prevalence of pancreatic cancer have revealed a heightened risk of 1.5 to 2.0 times among individuals with long-standing type 2 diabetes mellitus. AIMS We aimed to estimate the prevalence of diabetes among patients with pancreatic cancer, and identify the factors associated with type 2 diabetes mellitus in this population. METHODS This retrospective observational and analytical study was carried out in the Department of Gastroenterology of the Mohammed VI University Hospital over a period of 5 years, between 2018 and 2022, including all patients with confirmed cases of pancreatic adenocarcinoma. RESULTS Out of the 197 patients, 38.1% had a history of diabetes, among them, 42.7% had new-onset diabetes, while the remaining 57.3% had long-standing diabetes. Diabetic patients were significantly older than nondiabetic patients (mean age of 67.2 vs. 63, P = 0.009). Diabetes was more prevalent among obese patients (66.7%, P = 0.01), and less frequent among individuals with chronic alcohol consumption (20% vs. 80%, P = 0.04), and tobacco smokers (24.4% vs75.6%, P = 0.03). Among patients with an ECOG score ≥ 3, DM, 54.5% were DM-patients (P = 0.033). The same significant association was found for the Nutritional Risk Index, Patients who had moderate or severe malnutrition were more likely to be diabetic 74.7% (P = 0.004). Diabetic patients were less likely to undergo surgery due to comorbidities and general health deterioration. However, no significant differences were observed in sex, tumor stage or location. CONCLUSION Our study has shown an increased prevalence of diabetes in pancreatic cancer and highlights the importance of considering this cancer in cases of recent onset or uncontrolled diabetes, especially in elderly individuals.
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Affiliation(s)
- Fakhrddine Amri
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda University, Oujda, BP 4806, 60049, Morocco.
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco.
| | - Chifaa Belkhayat
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda University, Oujda, BP 4806, 60049, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Asmae Yeznasni
- Laboratory of Epidemiology, Clinical Research, and Public Health, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Hajar Koulali
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda University, Oujda, BP 4806, 60049, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Rachid Jabi
- Department of General Surgery, Mohammed VI University Hospital, Oujda, Morocco
| | - Abdelkrim Zazour
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda University, Oujda, BP 4806, 60049, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Naima Abda
- Laboratory of Epidemiology, Clinical Research, and Public Health, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Mohammed Bouziane
- Department of General Surgery, Mohammed VI University Hospital, Oujda, Morocco
| | - Zahi Ismaili
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda University, Oujda, BP 4806, 60049, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Ghizlane Kharrasse
- Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda University, Oujda, BP 4806, 60049, Morocco
- Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
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Faraj R, Belkhayat C, Bouchlarhem A, El Aidouni G, Bkiyar H, Housni B. Acute pericarditis revealing COVID-19 infection: Case report. Ann Med Surg (Lond) 2021; 62:225-227. [PMID: 33520219 PMCID: PMC7826081 DOI: 10.1016/j.amsu.2021.01.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 is a global pandemic that is now responsible for more than 2 million deaths around the world. Its clinical manifestations are well known such as fever, fatigue and other respiratory signs like severe cough, dyspnea. Cardiac involvement, however, is less recognized and often underestimated and could be the only manifestation of COVID-19. Case presentation: We report a case of pericarditis as the primary presentation of COVID-19 among a young, healthy individual with no medical background, in the absence of the conventional respiratory signs. The diagnosis was based on a set of clinical, biological, radiological and electrocardiographic findings. In this case, the treatment was based on the use of Colchicine in addition to COVID-19 treatment. The outcome was favorable; noticing regression of symptoms and disappearance of pericardial effusion within two weeks. Clinical discussion: Acute pericarditis has been widely described in literature as probable complication of COVID-19, yet only few articles have reported it as a primary manifestation of COVID-19. Conclusion: Chest pain could be the only presenting symptom of COVID-19 among young, healthy individuals.To that end, clinicians should recognize cardiac involvement of COVID-19 and act accordingly to isolate patients and further limit the spread of the disease. The covid-19 is a global pandemic that is responsible for millions of deaths. Cardiovascular involvement in COVID-19 is less recognized and described. Acute pericarditis as the primary manifestation of COVID-19 is rare. Colchicine is the main treatment of pericarditis related to COVID-19.
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Affiliation(s)
- Raid Faraj
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Chifaa Belkhayat
- Radiology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Amine Bouchlarhem
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Ghizlane El Aidouni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Houssam Bkiyar
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Brahim Housni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
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