Erratum to 'Pancreas divisum causing recurrent pancreatitis in a young patient: A case report' [Radiology Case Reports 18 (2023) 3535-3538].

[This corrects the article DOI: 10.1016/j.radcr.2023.07.028.].

Place of plasma argon coagulation in the treatment of vascular abnormalities of the digestive tract in adults

The aim of our study is to evaluate the value of Argon Plasma Coagulation in the treatment of gastrointestinal vascular abnormalities. Patients and methods: This is a descriptive and analytical retrospective study, from January 2009 to September 2020. 198 patients who have benefited from treatment with Argon Plasma Coagulation for vascular anomalies of the digestive tract divided into 2 groups: -Group A: Patients with radial rectitis lesions (n = 107). -Group B: Patients with lesions of digestive angiodysplasia (n = 91). Results: The mean age of our patients was 64.95 ± 9.88 years [43 - 83] in group A, while in group B the mean age was 65.19 ± 14.29 years [40 - 91] with a clear male predominance in 72.5%. The majority of patients in group A were followed for prostate cancer in 33,8%, and 26.3% of patients in group B had chronic renal failure, followed by stomach cancer in 15.8%, and esophageal cancer in 10.5%. Clinical symptomatology was dominated by rectories in 40.2% in group A versus 46.8% in group B. Rectal involvement was dominated in group A in 98.1%, whereas in group B the lesions were mainly located in the stomach in 60.5%. The endoscopic evolution was favorable in all our patients with a clear improvement of rectal lesions and digestive angiodysplasia lesions. The total complication rate in our series was nil. Conclusion: Plasma Argon coagulation is a very effective method in the endoscopic treatment of digestive haemorrhages with good tolerability and a low complication rate. (AU)

Sporadic rectocolic polyps prevalence and management

Objective: To evaluate the prevalence of polyps and their treatments. Materials and Method: This is a retrospective study conducted in our department over 20 years and 3 months between January 2000 and March 2021. All patients with colorectal polyps who underwent endoscopic resection were included. We evaluated the resection techniques and the management of complications. Results: The total number of patients was 273, with a mean age of 57.26 ± 14.058 (18-90) and a M/W sex ratio of 2. The prevalence was 3.35% and the mean number of polyps was 1.33 ± 0.69. The most frequent symptoms were rectal bleeding (23.5%) and constipation (12.1%). The median size was 6 mm (4-12 mm). The left colonic location was the most frequent site (43%). All polyps were classified according to the Paris classification, with a predominance of sessile polyps in 45.75%, followed by pedunculated polyps, representing 42.4%. Endoscopic resection was performed either by biopsy forceps, polypectomy, or mucosectomy in 30.2%, 27.4%, and 25.4% of cases, respectively. Our study noted immediate bleeding in 1.5% of cases, and no perforations or late complications. All complications were treated endoscopically, and no patient required blood transfusion or surgical intervention. Conclusion: Endoscopic resection of rectocolic polyps is the ideal treatment for these lesions. In our department, the prevalence was 3.35%, the most used resection techniques were forceps resection and polypectomy, and the complication rate was 1.5%. (AU)

Prevalence and Severity of Gastrointestinal Symptoms in COVID-19 Patients in Casablanca: A Retrospective Cohort Study.

Background The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19), is behind the current pandemic. At the start of the pandemic, gastrointestinal symptoms initially described as rare were reported, but their spread to other countries increased rapidly. This study aimed to determine the prevalence of digestive symptoms among COVID-19 patients and to assess the correlation between these symptoms and disease severity. Methods This retrospective observational study was conducted in the Cheikh Khalifa University Hospital of Casablanca, Morocco. Patients were divided into two groups based on the presence or absence of gastrointestinal symptoms upon initial assessment and hospital admission. Results A total of 154 patients were included in this study from March 21 to April 26, 2020. The mean age of patients was about 48.5 (± 20.0) years, and 85 (55.2%) of them were men. In our population, 8.17% of patients had toxic habits. Digestive symptoms were present at admission in 30% of our patients. The most frequent digestive symptoms were diarrhea (15%), abdominal pain (5.6%), vomiting (5%), and anorexia (3.1%). We found a significant difference in COVID-19 patients with digestive symptoms and toxic habits contrary to all other comorbidities. Neurologic symptoms were significantly associated (p=0,004) with digestive symptoms in 50%. Conclusion In this study, we found that digestive symptoms were present in 22.64% of patients diagnosed with COVID-9. The clinician must know the different digestive symptoms to evoke the diagnosis and take charge of the patient early.

[Angiocholitis on hepatic hydatid cyst fistulised in the main bile duct: two case reports]. / Angiocholite sur kyste hydatique hépatique fistulisé dans la voie biliaire principale: à propos de 2 cas.

Hydatid cyst is a zoonosis that frequently affects the liver, which is endemic in several countries such as Morocco. The hepatic hydatidosis can be complicated by angiocholitis, currently, the treatment of choice is endoscopic retrograde cholangio-pancreatography with sphincterotomy. We report two clinical cases of angiocholitis on hepatic hydatid cyst fistulised in the main bile duct which were treated endoscopically with a favourable outcome. Early diagnosis and adequate management can improve the prognosis of these patients.

Case Series of Autoimmune Pancreatitis and IgG4-Related Sclerosing Cholangitis.

IgG4-related disease (IgG4-RD) is an emerging immune-mediated disease that can involve any organ. The involvement of the pancreas and biliary tract is the most common and well-studied in the literature. It is characterized by a non-specific presentation, mimicking a malignant process. The goal was to look at the different clinical and paraclinical aspects of this disease, as well as the challenges that come from its management. It was made up of three observations of patients with IgG4-RD involving the biliary tract and pancreas. The first observation concerned intrahepatic biliary cholangitis that was accompanied by porto-mesenteric thrombosis, which was discovered by cholestatic jaundice on the 15th day after an appendectomy, and the patient improved under corticosteroids and anticoagulants. The second observation concerned an acute revelation of the disease. It was an acute attack of chronic pancreatitis of IgG4-RD. The main symptoms were pancreatic pain and exocrine pancreatic insufficiency, and corticosteroid therapy allowed remission. The third observation was related to autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis, revealed by jaundice with cholestasis. The patient acquired corticosteroid resistance and an adverse progression to decompensated cirrhosis, and liver transplantation was indicated. The clinical presentation of IgG4-RD is heterogeneous, as evidenced by our three clinical observations. There are still significant gaps in our understanding, particularly in terms of pathogenesis and factors that influence therapy response. Further observational and interventional research is needed to better manage this disease.

Cataclysmic Gastrointestinal Hemorrhage: Dreaded Complication of Metastatic Breast Cancer.

Upper gastrointestinal bleeding (UGIB) from variceal rupture is a serious condition that can be life-threatening in some cases. Usually, the main cause is portal hypertension in cirrhosis, but other etiologies like liver metastases can be also involved. We present the case of a 64-year-old woman, with a history of metastatic breast cancer, who was admitted for a massive UGIB due to ruptured esophageal varices related to portal hypertension.

Endoscopic Resection of a Large Colonic Lipoma Simulating a Tumor Revealed by Hemorrhage: A Case Report and Literature Review.

Lipomas of the colon are benign tumors of the digestive tract. They are usually asymptomatic, and often discovered incidentally during a colonoscopy. However, lipomas larger than 2 cm may present with abdominal pain, bowel changes, and rectal bleeding. They may mimic cancer, depending on multiple factors including tumor size, location, and complications, which often makes preoperative diagnosis difficult. In this report, we discuss the case of a 34-year-old woman who presented with paroxysmal abdominal pain in the left iliac fossa withmoderate hematochezia that had been evolving for six months. The patient denied melena or hematemesis, and she had no significant medical history. Colonoscopy revealed a large polyp of over 5 cm located 40 cm from the anal margin. She underwent endoscopic resection without complications. The histological examination confirmed the lipomatous nature. An accurate preoperative diagnosis of lipomas is necessary.It can often be difficult to choose between endoscopic and surgical treatment. The choice of treatment depends on the size and location of the tumor and complications. Endoscopic resection may obviate the need for surgery and can potentially reduce surgical morbidity. We aimed to report and discuss the management of this patient who underwent endoscopic resection for a large mass with a definitive pathology of colonic lipoma.

Low Phospholipid-Associated Cholelithiasis: Contribution of Imaging in Two Cases.

Low phospholipid-associated cholelithiasis (LPAC) is a genetic disease responsible for the development of intrahepatic lithiasis. It is retained in the presence of two of the following three criteria: age of onset of biliary symptoms less than 40 years; echogenic intrahepatic images or microlithiasis; and the recurrence of biliary clinical signs after cholecystectomy. The majority of clinical situations are simple and not serious, but some complicated forms may require more invasive endoscopic or surgical treatments. By presenting two case studies, we illustrated and summarized the different aspects of this entity.

The Impact of Argon Plasma Coagulation in the Treatment of a Solitary Rectal Ulcer Syndrome Revealed by Massive Hemorrhage.

Solitary rectal ulcer syndrome (SRUS) is a rare and chronic rectal condition that can result in a pelvic static disorder. Massive rectal bleeding is a rare manifestation of SRUS. The diagnosis is based on a combination of clinical, endoscopic, and histological findings. The management of bleeding ulcers is usually insufficient with the conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding. However, its role in healing and improving defecation symptoms is not unanimous in studies. Our case report features a 35-year-old male with terminal constipation and chronic rectal pain, taking laxatives and analgesics, who presented abundant rectal bleeding with hemodynamic instability. The colonoscopy showed two large bleeding rectal ulcers. The histological study of the biopsies was in favor of a solitary rectal ulcer. We have performed multiple sessions of APC. The bleeding was stopped after the first session and there was progressive healing and improvement of the rectal symptoms after other sessions. At 18 months follow-up, the patient is asymptomatic, and no longer uses analgesics and laxatives. Argon plasma coagulation is an effective treatment to control rectal ulcer bleedings. It also improves the healing process and clinical symptoms. However, further controlled studies are needed to support this hypothesis.

Diabetic Ketoacidosis With Acute Metabolic Pancreatitis: Two Serious Cases.

Hypertriglyceridemia is a rare cause of acute pancreatitis (AP), occupying approximately 7% of cases. The triad of acute pancreatitis, hypertriglyceridemia, and diabetes is a rare event, with a higher death rate. We describe two cases of severe acute metabolic pancreatitis discovered in diabetic ketoacidosis. For both patients, all other causes of AP were excluded (including gallstones, hypercalcemia, drugs, and alcohol). A laboratory workup revealed elevated lipasemia (more than three times the normal) and hypertriglyceridemia. Abdominal computed tomography confirmed the diagnosis of severe acute pancreatitis. Fasting, fluid resuscitation, and insulin therapy were initiated in the intensive care unit with good clinical results and progressive improvement in metabolic disorders.

Gastric Duplication Cyst Revealed After an Endoscopic Ultrasound-Guided Fine-Needle Aspiration of a Suspected Mucinous Cystadenoma of the Pancreas.

Gastrointestinal duplication is a rare congenital anomaly of the gastrointestinal tract. Gastric duplication cysts (GDCs) are uncommon in adults, and most cases are discovered incidentally. Here, we report a fortuitous discovery of a rare case of an asymptomatic noncommunicating GDC in an adult revealed after an endoscopic ultrasound-guided fine-needle aspiration of a suspected mucinous cystadenoma of the pancreas. A 34-year-old female presented with renal colic. Her abdominal examination was normal. She presented a cystic image at the left lumbar discovered fortuitously during ultrasonography. On uro-computed tomography, there was a suspicion of a pancreatic cystadenoma. Magnetic resonance imaging of the pancreas suggested a mucinous cystadenoma of the pancreatic tail. The endoscopic ultrasound showed a cystic thick-walled formation in the tail of the pancreas. After guided fine-needle aspiration, a split aspect of the gastric wall appeared evoking a GDC. The cytology showed epithelial cells without mucin. Three years later, the patient does not have any gastrointestinal symptoms. GDCs are a rare anomaly, and accurate diagnosis of these cysts is difficult. Surgical resection can offer a definitive diagnosis. The mainstay of treatment is surgery to avoid the risk of malignancy.

Gayet-Wernicke Encephalopathy: An Unusual Complication of Vomiting.

Gayet-Wernicke encephalopathy (WE) is a serious and acute disease of the central nervous system caused by thiamine (vitamin B1) deficiency. Multiple etiologies are indicated, although alcohol abuse is the most reported cause. If not treated promptly, WE can lead to serious complications such as Korsakoff's syndrome, coma, or death. This diagnosis should be considered even without a history of alcohol dependence. We describe two cases of non-alcohol related WE complicating vomiting caused by different etiologies. The diagnosis was suspected on clinical presentation and confirmed by brain MRI and effective response to parenteral administration of thiamine.

Massive Digestive Hemorrhagia Revealing a Gastro-Intestinal Stromal Tumor of the Jejunum.

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that originate from Cajal cells located in different sites of the digestive system. They may occur in the entire gastrointestinal tract. They are diagnosed on the basis of the identification of c-kit-positive cells. We report a case of a stromal tumor of the jejunum revealed by a massive digestive hemorrhagia. Surgical resection is the basis of the treatment of GISTs. Imatinib, a tyrosine kinase inhibitor, is a beneficial treatment after surgical resection of high-risk GISTs.

Hydatid Cyst of the Pancreas: An Unusual Cause of Abdominal Pain.

Pancreas is an uncommon site of hydatid cysts (HCs) even in endemic countries. Primary pancreatic hydatid cysts (PHCs) mainly occur through hematogenous dissemination. Their rarity and the absence of clinical manifestations in most cases explain their challenging preoperative diagnosis. In symptomatic cases, clinical findings may be similar to those of other diseases. We report a case of a 54-year-old female presented with a six-month history of abdominal pain, although her abdominal examination was normal. Radiological imaging revealed a serous cyst in the body and tail of the pancreas. Biliopancreatic endoscopic ultrasound (EUS) suggested a peritoneal hydatid cyst. Intraoperatively, it was diagnosed as a PHC. The patient underwent resection of the PHC and was then placed on albendazole. She did not have any symptoms for the last seven months. Through this case report, we can conclude that peritoneal hydatid cyst of the pancreas should be considered in the differential diagnosis of the cystic lesions of the pancreas. Moreover, surgery achieves a definitive treatment of the disease.

An evaluation of entecavir treatment among nucleos(t)ide-naïve Moroccan patients with chronic hepatitis B.

OBJECTIVE: To analyse the efficacy and safety of entecavir (ETV) treatment in nucleos(t)ide (NUC)-naïve Moroccan patients with chronic hepatitis B. METHODS: We retrospectively analysed 41 NUT-naïve Moroccan patients with chronic hepatitis B who received ETV 0,5 mg/day monotherapy for at least 3 months, of whom 3 were HBV envelope antigen (HbeAg) positive and 38 were HBeAg negative. The primary end point was the proportion of patients achieving virological response. Secondary end points included biochemical response (alanine transaminase (ALT) normalisation), serological response (HbeAg and HBV surface antigen (HBsAg) loss or seroconversion) and safety. RESULTS: The median follow-up duration was 74 weeks (48-144 weeks) and mean age was 43.8 years. Of 41 patients, 6 were primary non-responders and 2 achieved partial virological response at week 48, whereas 35 achieved undetectable hepatitis B virus (HBV) DNA at month 12. Viral suppression was maintained in 97.6% of patients after 3 years of ETV treatment. One patient experienced a virological breakthrough at month 12 of treatment. ALT normalisation occurred in 100% of the patients after 1 year of treatment. Only three patients in our study were HbeAg positive, of whom one has experienced seroconversion at month 12 of treatment. However, HBsAg loss or seroconversion was not achieved during the period of the study. No serious adverse event was reported. CONCLUSIONS: These preliminary results showed that ETV is a safe and potent inhibitor of HBV in NUC-naïve Moroccan patients, but we need to observe more patients for a longer period of time, in order to assess the long-term effectiveness, safety, resistance profile and predictive factors for virological and serological response of ETV.