RESUMO
We report two cases of proctitis in men having sex with men.
Assuntos
Linfogranuloma Venéreo , Proctite , Homossexualidade Masculina , Humanos , Masculino , Proctite/diagnósticoRESUMO
We present a patient who underwent cryoballoon ablation for symptomatic atrial fibrillation, with gastroparesis five days later. The case was resolved with conservative measures such as prokinetics. The case was a 72-year-old female with a history of symptomatic paroxysmal atrial fibrillation treated with edoxaban. Pulmonary vein isolation using a cryoballoon catheter was performed. Five days later, she presented with upper abdominal pain, bloating and vomiting.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Criocirurgia , Gastroparesia , Veias Pulmonares , Idoso , Fibrilação Atrial/cirurgia , Criocirurgia/efeitos adversos , Feminino , Gastroparesia/diagnóstico por imagem , Gastroparesia/etiologia , Humanos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Recidiva , Resultado do Tratamento , VômitoRESUMO
The case was an 86-year-old male with multiple cardiovascular comorbidites, including anticoagulated atrial fibrillation, who underwent a colonoscopy due to acute lower gastrointestinal bleeding and anemia. Colonoscopy only showed some small angiodysplasias in the cecum. A few hours later, the patient presented with abdominal pain and hemodynamic instability. An abdominal computed tomography was performed, which showed a splenic laceration and hemoperitoneum. An expectant attitude was decided, with a good evolution from the abdominal point of view. There was no sign of active splenic bleeding in a control computed tomography. However, he developed decompensated heart failure and finally died.
Assuntos
Ruptura Esplênica , Idoso de 80 Anos ou mais , Colonoscopia , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Humanos , Masculino , Esplenectomia , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Lemmel's syndrome consists of obstructive jaundice due to compression of a periampular duodenal diverticulum (DDP), in the absence of choledocholithiasis or tumor. DDP are pseudodiverticula without a muscle layer within a radius of 2-3 centimeters from the ampulla of Vater. They rarely cause obstructive jaundice, although the prevalence is estimated at up to 22 % according to the sensitivity of the diagnostic test. They are usually incidental findings, but up to 1-5 % can be complicated with diverticulitis, bleeding, perforation, obstructive jaundice (Lemmel syndrome), choledocholithiasis, pancreatitis or cholangitis.
Assuntos
Ampola Hepatopancreática , Colangite , Divertículo , Duodenopatias , Icterícia Obstrutiva , Ampola Hepatopancreática/diagnóstico por imagem , Ampola Hepatopancreática/cirurgia , Divertículo/complicações , Divertículo/diagnóstico por imagem , Duodenopatias/complicações , Duodenopatias/diagnóstico por imagem , Humanos , Icterícia Obstrutiva/etiologiaRESUMO
A 52-year-old female was referred for a study of a left intrahepatic bile duct dilation with an initial suspicion of Klatskin. Analytically, there was no cholestasis and tumor markers were negative. On echoendoscopy, there was dilation of the intrahepatic bile duct to the confluence at the level of the left hepatic lobe, with no evidence of a lesion that could be biopsied by fine needle aspiration (FNA).
Assuntos
Neoplasias dos Ductos Biliares , Colangiocarcinoma , Cisto do Colédoco , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Cisto do Colédoco/diagnóstico por imagem , Cisto do Colédoco/cirurgia , Dilatação Patológica , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
We present the case of a 79-year-old male who underwent endoscopic retrograde cholangiopancreatography (ERCP) after cholangitis. The papilla was rigid and the biliary tract was dilated with sharpening of the distal bile duct, with no obvious cause. There was no bile flow after sphincterotomy, no stone after sweeping the duct with a balloon and the brush did not expand properly when trying to obtain cytologic material. Finally, a plastic stent was placed and purulent bile flowed. Biopsies of the papilla were taken due to the suspicion of tumor infiltration. The next day, the patient had pain in the right upper quadrant and blood tests highlighted mild anemization.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Hepatopatias , Idoso , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ducto Colédoco , Hemorragia Gastrointestinal , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Humanos , Masculino , Esfinterotomia EndoscópicaRESUMO
A 22-year-old male began with up to 12 loose stools per day, with mucus and no blood. They were present for two months, even during the night. Moreover, he complained of abdominal pain and weight loss. There were no findings on the blood tests. Fecal calprotectin was 225 µg/g. Stool microbiology tests were negative. Ileocolonoscopy displayed normal mucosa but the histological study of the biopsies showed Treponemas genus Brachispira. The patient had a sexual risk behavior. Treatment with metronidazole was initiated with clinical improvement.
Assuntos
Microbioma Gastrointestinal , Adulto , Diarreia/tratamento farmacológico , Diarreia/etiologia , Fezes , Humanos , Intestinos , Complexo Antígeno L1 Leucocitário , Masculino , Adulto JovemRESUMO
The case was a 75-year-old female with dyspeptic symptoms of a 2 month duration. There was a polycystic lesion at the level of the uncinate pancreatic process of 44 x 42 x 34 mm on abdominal ultrasound and MRI, which caused a slight dilation of the main pancreatic duct. EUS was performed that identified a multicystic formation of 25x36 mm in the pancreatic body and FNA was performed of the lesion. The cytological analysis identified squamous epithelial cells with lymphoid tissue, which was compatible with a lymphoepithelial cyst, with no evidence of cell atypia or other signs of malignancy. Radiological control and monitoring of the lesion was performed and it has remained stable for 2 years.
Assuntos
Cisto Pancreático , Neoplasias Pancreáticas , Idoso , Feminino , Humanos , Tecido Linfoide , Imageamento por Ressonância Magnética , Pâncreas , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/cirurgiaRESUMO
We present the case of a 50-year-old male diagnosed with myasthenia gravis, secondary to thymoma or Lambert-Eaton syndrome during the study of repeated vomiting. Gastrointestinal symptoms persisted despite the treatment of the thymoma. He suffered from sigma volvulus that required sigmoidectomy 9 years after diagnosis. Neuromuscular junction disorders are not characterized by gastrointestinal involvement, as in our case. They have previously sporadically been related to intestinal motility dysfunction.
Assuntos
Síndrome Miastênica de Lambert-Eaton , Miastenia Gravis , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A 52-year-old Senegalese male presented due to abdominal pain and fever, with findings suggestive of a stenosing tumor of the right colon. Biopsies during colonoscopy were compatible with adenocarcinoma and infiltration into neighboring organs was observed during the surgery. New biopsies were taken that did not show dysplasia but granulomatous foci that were suggestive of a non-filiated infection. Thus, tuberculosis was ruled out.
Assuntos
Adenocarcinoma , Tuberculose Gastrointestinal , Colo , Colonoscopia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Tuberculose Gastrointestinal/diagnóstico por imagemRESUMO
Olmesartan is an angiotensin II receptor antagonist used for the treatment of blood hypertension. Long-term use has been associated with diarrhea and sometimes intestinal involvement may mimic enteropathies such as celiac disease. Clinicians should consider drugs within the differential diagnosis of enteropathies. We report the case of a female who sought medical help for malabsorptive symptoms and was finally diagnosed with olmesartan-associated gastritis and atrophic enteropathy.
Assuntos
Doença Celíaca , Hipertensão , Enteropatias , Doença Celíaca/diagnóstico , Diarreia/induzido quimicamente , Dieta Livre de Glúten , Feminino , Humanos , Enteropatias/induzido quimicamenteRESUMO
We present the case of a 59-year-old patient with malabsorption syndrome which started with polyneuropathy. Capsule endoscopy and enteroscopy show villous denudation. Histological study confirms diaphragm disease of the small bowel. Diaphragm disease is a rare disease characterized by the presence of multiple thin diaphragms, such as septa, that narrow the intestinal lumen. The clinical features can be iron deficiency anemia, intestinal obstruction, change in bowel habits or acute abdomen secondary to perforation. It is usually generally with sustained use of high doses of non-steroidal anti-inflammatory drugs. The diagnosis usually requires the use of a capsule endoscopy or enteroscopy with biopsies.
Assuntos
Endoscopia por Cápsula , Obstrução Intestinal , Síndromes de Malabsorção , Diafragma , Humanos , Intestino Delgado , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
We present abdominal computed tomography and enteroscopy images of a 48-year-old male patient with a previous melanoma who presented with epigastric pain. The pain was not controlled with medical management. Abdominal computed tomography and a histological study of biopsies form enteroscopy confirmed the diagnosis of metastatic melanoma. The gastrointestinal involvement of melanoma is usually metastatic. Symptomatic gastrointestinal involvement occurs in less than 5% of melanomas, although postmortem analyses have reported up to 70%. The clinical presentation is variable and usually presents as abdominal pain. The diagnosis of small intestinal involvement of melanoma is a challenge due to its poor accessibility. The enteroscopy has a fundamental role as it allows a direct visualization and biopsies to be taken for histological study.
Assuntos
Laparoscopia , Melanoma , Dor Abdominal/etiologia , Endoscopia Gastrointestinal , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Ulcerative proctitis (UP) is often involved in the diagnosis of inflammatory bowel disease (IBD). The increase of leukocytes and pro-inflammatory factors in peripheral blood and in the active forms, as well as the infiltration of neutrophils and monocytes/macrophages in the intestinal mucosa is known to occur in this entity. This infiltration of cells damages the mucosa due to the liberation of proteases, oxidation radicals and cytokines, among others. Apheresis techniques such as leukocyte apheresis may be used among the different therapeutic options such as steroids, sulfasalazine, 5-aminosalicylic, tacrolimus, azathioprine, cyclosporine, mycophenolate and biological agents.
Assuntos
Procedimentos de Redução de Leucócitos , Proctite/terapia , Úlcera/terapia , Idoso , Humanos , Procedimentos de Redução de Leucócitos/métodos , Masculino , Doenças Retais/terapia , Fatores de Tempo , Resultado do TratamentoRESUMO
Pneumatosis cystoides intestinalis is characterized by multiple air-filled cysts in the intestine wall. A perforation causes pneumoperitoneum, frequently with minimal clinical affectation and do not require surgery at first in most cases. Recently, some cancer treatments, mainly molecular targeted therapy, have been associated with this complication. For this reason, radiologic findings of intestinal pneumatosis and/or secondary perforation during patient follow-up should be carefully interpreted. The clinical-analytical findings should always be considered. We report a case associated with the use of tyrosine kinase inhibitors in order to illustrate this point.
Assuntos
Antineoplásicos/efeitos adversos , Pneumatose Cistoide Intestinal/complicações , Pneumoperitônio/etiologia , Inibidores de Proteínas Quinases/efeitos adversos , Pirimidinas/efeitos adversos , Sulfonamidas/efeitos adversos , Idoso , Antineoplásicos/uso terapêutico , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/tratamento farmacológico , Humanos , Indazóis , Neoplasias Renais/complicações , Neoplasias Renais/tratamento farmacológico , Masculino , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/terapia , Inibidores de Proteínas Quinases/uso terapêutico , Pirimidinas/uso terapêutico , Sulfonamidas/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
Lymphogranuloma venereum (LGV) is a condition caused by invasive serovars of Chlamydia trachomatis. The classical inguinal presentation that is characterized by the development of transient genital ulcer(s) and inguinal or femoral lymphadenopathy has decreased in our environment. At present, infection by this bacterium has emerged as an important cause of proctitis and proctocolitis in men who have sex with other men. We report the case of a homosexual man with acute proctitis that was complicated by a perirectal abscess secondary to a Chlamydia trachomatis infection.
Assuntos
Abscesso/diagnóstico , Linfogranuloma Venéreo/diagnóstico , Proctite/microbiologia , Abscesso/complicações , Diagnóstico Diferencial , Humanos , Linfogranuloma Venéreo/complicações , Masculino , Pessoa de Meia-Idade , Proctite/diagnósticoRESUMO
Peribiliary cysts involve cystic dilation of the extramural peribiliary glands in the liver hilum and portal tracts. Most peribiliary cysts are asymptomatic. We present the case of a patient without any prior liver disease who developed obstructive jaundice and a liver abscess due to peribiliary cysts. Peribiliary cysts usually appear in patients with severe chronic liver disease and are asymptomatic, although they sometimes appear in patients without prior liver disease and cause serious complications.
Assuntos
Doenças Biliares/diagnóstico por imagem , Cistos/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Doenças Biliares/tratamento farmacológico , Colangiopancreatografia por Ressonância Magnética , Colangite/diagnóstico por imagem , Colangite/etiologia , Cistos/tratamento farmacológico , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
Sarcoidosis is a systemic granulomatous disease with an uncertain etiology, characterized by the production of non-necrotizing granulomas. The most frequent presentation is pulmonary and mediastinal, although it might affect any other organ. Hepatic alterations occur in 50 to 65% of the cases. Nevertheless, it is commonly subclinical or detected during a study of the alteration of liver enzymes. It is very unusual that disease onset occurs as an isolated hepatic tumor. A hepatic biopsy is usually required to confirm the diagnosis. A differential diagnosis must be established via any hepatic granulomatous disease, infectious or autoimmune disease as well as the exclusion of malignancy. We present a clinical case of a female diagnosed with an isolated hepatic sarcoidosis that simulated a unique hepatic metastatic lesion. The hepatic biopsy was diagnostic.
Assuntos
Hepatopatias/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Sarcoidose/diagnóstico , Idoso , Biópsia , Diagnóstico Diferencial , Feminino , Granuloma/diagnóstico , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/terapia , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sarcoidose/diagnóstico por imagem , Sarcoidose/terapiaRESUMO
The esophageal ulcer us a common complication in people affected by the acquired human immunodeficiency virus (HIV), especially in the final stages and in patients who develop an acute retroviral syndrome. Although, it can be caused by various infectious agents, such as species of candida, cytomegalovirus (CMV) and herpes simplex virus (HSV), no aetiological agent is successfully identified in a large proportion of patients and it is classified as idiopathic. We report the case of an idiopathic esophageal ulcer associated with the initial diagnosis of HIV-1.