[Solitary ulcer of the colonic hepatic flexure]. / Ulcère solitaire de l'angle colique droit.

The nonspecific colon ulcer is a not a well-known disorder. A case of ulcer of the colic hepatic flexure is described. It was a case of pseudotumor and the pathological examination confirmed the diagnosis. The precise diagnosis of colon ulcer is useful for conservative treatment with coloscopic surveillance and to prevent a hemorrhagic complication or peritonitis after perforation. Contrary to diverticulitis, this pathology is most dominant on the right colon and particularly on the cecum. This explains the frequency of pseudoappendicular syndromes.

[Toxocariasis mimicking liver tumor]. / Toxocarose hépatique pseudotumorale.

INTRODUCTION: Toxocariasis is a common helminth infection that causes visceral larva migrans in humans. It has a wide and varied clinical spectrum. CASE: A 60-year-old woman consulted after 6 months of recurrent biliary pain with fever. Laboratory tests showed moderate disturbance of liver enzymes and hypereosinophilia (10 400/mm3). Imaging studies revealed a pseudotumor in hepatic segment IV, hyperechoic in abdominal ultrasound and low density in computed tomography. The diagnostic conclusion after ultrasound-guided liver biopsy was unspecific granulomatous hepatitis and eosinophilic infiltrate. The course of the antibody titer to Toxocara canis finally resulted in a diagnosis of Toxocara infection. Outcome was good following treatment with diethylcarbamazine. DISCUSSION: Some clinical features of liver toxocariasis can mimic tumors and may be interpreted histologically as granulomatous hepatitis, eosinophilic infiltrate of the hepatic portal vein, and/or necrotizing eosinophilic abscesses. Treatment is not yet well codified, but the symptomatic forms call for albendazole or diethylcarbamazine.

[Ulcerating haemorrhagic colitis induced by celecoxib]. / Colite aiguë ulcéro-hémorragique induite par le célécoxib.

INTRODUCTION: Selectivity of cyclooxygenase-2 inhibitors (Cox2 inhibitors) decreased gastroduodenal toxicity of nonsteroidal anti-inflammatory drugs. Effects on colic mucosa are little known. OBSERVATION: A case history is described of a 38-year-old women, without digestive past, who presented with hemorrhagic ulcerated acute colitis beginning 2 days after starting celecoxib (200 mg/d) prescribed for sciatica. DISCUSSION: Intrinsic imputability of celecoxib is very probable in this case report by combination of chronological and semiological criteria. Extrinsic imputability is discussed, starting from the available bibliographical data which relate primarily to rofecoxib. CONCLUSION: This observation, which constitutes, as far as we know, the first case report of hemorrhagic ulcerated colitis related to celecoxib, confirms the colic toxicity of anti-Cox2 and identify a new cause of acute colitis. Report of colic side effects with Cox2 inhibitors is required because of their new marketing.

[Recurrent acute idiopathic pancreatitis. Look for a chronic inflammatory disease of the intestine]. / Pancréatite aiguë récidivante idiopathique. Chercher une maladie intestinale chronique inflammatoire.

INTRODUCTION: Among the new identified causes of so-called idiopathic acute pancreatitis are chronic inflammatory diseases of the intestine. OBSERVATION: A 21 year-old man was hospitalised for the third episode of unexplained acute pancreatitis. Digestive endoscopies revealed an ulcerated terminal ileitis compatible with Crohn's disease. DISCUSSION: The frequency of idiopathic pancreatitis in patients exhibiting a chronic inflammatory disease of the intestine is of around 1%. Pancreatic involvement may precede the digestive manifestations of Crohn's disease and its clinical expression varies. An auto-immune mechanism appears to be responsible.

[Hepatic inflammatory pseudotumor regressing with antibiotic therapy]. / Pseudo-tumeur inflammatoire hépatique régressant sous antibiothérapie.

INTRODUCTION: Inflammatory hepatic pseudo-tumors are rare, non-neoplastic lesions, and their diagnosis is usually made on hepatectomy samples. OBSERVATION: The general health of a 77 year-old patient was suddenly altered and clinical examination (and scan) revealed a hepatic tumor. Diagnosis of inflammatory hepatic pseudo-tumor was evoked by analysis of a biopsy. In view of the age and the general state of the patient we chose prolonged antibiotic therapy rather than hepatic surgery. Nine months later, the tumor had regressed. COMMENTS: Because they are rare (100 cases described), hepatic pseudo-tumors raise two questions: can diagnosis be made simply by biopsy or should one always analyze the complete sample and, if hepatectomy is contraindicated, is non-surgical treatment effective? The progression of our patient permits us to reply positively to both questions.