Liver abscess caused by an unnoticed swallowed toothpick perforating the colonic wall.

We present an unusual case of a liver abscess caused by a swallowed toothpick in a 43-year-old man. The abscess was first punctured under percutaneous ultrasound control and intraveneous administration of antibiotics whereas the diagnosis of the foreign body stuck in the sigmoid bowel wall was only made by a follow-up computed tomography since the patient had no complains indicating a colonic pathology. Even more, the patient did not remember ever having ingested a foreign body. The wooden toothpick was then successfully removed by endoscopy. The case report stresses the need for a search of the cause of unexplained liver abscesses and highlights the importance of computed tomography as the first imaging technique as the foreign body was missed on the ultrasound examination. Finally, the non-surgical treatment as first line management of liver abscesses will be discussed.

[Idiopathic segmental infarct of the omentum. Differential diagnosis in an obese patient]. / Infarctus segmentaire idiopathique du grand épiploon. Savoir y penser chez un patient obèse.

OBJECTIVE: Infarction of the greater omentum is a rare etiology of acute abdominal pain. The differential diagnosis, especially with appendicitis, is difficult to establish. CASE REPORT: A 29 years-old male presented with acute abdominal pain. He underwent a laparoscopic resection on the 5th hospital day because of persistant pain despite conservative management. Histopathological examination confirmed the diagnosis of omental infarction. DISCUSSION: Primary segmental necrosis of the omentum is a rare entity. Obesity and cardiovascular diseases are considered predisposing conditions. The infarctions tend to occur in the right side of the omentum. Abdominal pain is predominant in opposition to the patient's good general condition. Laboratory results are usually nonspecific. Abdominal ultrasound may show a solid, ovoid, hyperechoic lesion. CT-scan may depict a fatty oval-shaped mass below the right anterolateral parietal wall associated with a thickening of the anterior parietal peritoneum. CONCLUSION: The correct diagnosis of omental infarction is important to establish preoperatively in acute abdominal pain, as in uneventful courses surgery can be avoided.

Effects of octreotide on lower esophageal sphincter in patients with cirrhosis and portal hypertension.

We investigated the effects of octreotide infusion on the contractile activity of the esophageal body and lower esophageal sphincter in cirrhotic patients with esophageal varices. Esophageal manometry was performed in 36 alcoholic cirrhotic patients. They were randomly allocated to three groups and received the following treatments blindly for 90 min: an initial 100-microg intravenous bolus followed by a continuous 25 microg/hr octreotide infusion (group I, N= 13), a continuous 25 micro/hr octreotide infusion without an initial bolus (group II, N=13), and a continuous placebo infusion (group III, N=10). Before drug infusion, mean lower esophageal sphincter pressure and mean esophageal body contraction pressure and duration were similar in the three groups. Compared to the placebo group, lower esophageal sphincter pressure increased significantly in groups I and II, 30 min (30%, 22%, 3% respectively; P= 0.006), 60 min (44%, 35%, 0.6%; P=0.0002), and 90 min (67%, 41%, 2.5%; P=0.0001) after octreotide infusion, as did esophageal body contraction pressure and duration. We conclude that octreotide has a potent effect on LES tone in cirrhotic patients.