Endoscopic management of a transgastric migrated gossypiboma: A case report.

Textiloma, also known as gossypiboma, is a rare but well-documented entity. It involves the omission of surgical material during surgery. Gossypiboma remains a diagnostic dilemma to this day, due to its wide spectrum of clinical symptoms and numerous radiological pitfalls. The recommended treatment for gossypiboma is surgical removal. Endoscopic removal has been performed by some teams and has shown satisfying results. We report the case of a 33-year-old woman with a transgastric migrating gossypiboma, managed by an endoscopic extraction.

An atypical cause of vomiting: Coexisting Wilkie's syndrome and a left renal malformation mimicking a nutcracker phenomenon-A case report.

The superior mesenteric artery syndrome and nutcracker phenomenon are rare vascular disorders due to the abnormal development of the superior mesenteric artery stemming from the abdominal aorta with reduced angle (<22°) and resultant compression of the left renal vein and duodenum. It is an underreported entity due to the absence of specific pathognomonic signs. We report the case of a 59-year-old man, admitted for acute bilious vomiting, who underwent a gastroscopy and a computed tomography scan revealing a Wilkie's syndrome associated with a dilated posterior left renal vein communicating with the left ascending lumbar vein without connection with the inferior vena cava mimicking a nutcracker phenomenon.

Infected Biloma after Endoscopic Ultrasound-Guided Fine-Needle Aspiration.

Biloma is a severe complication that can result from bile duct disruption or hepatic trauma. It can occur after biliary surgery such as cholecystectomy or an endoscopic retrograde cholangiopancreatography manipulation and endoscopic biliary sphincterotomy. We present the case of a 59-year-old man admitted for jaundice, with pain in his right flank and fever, 10 days after an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for an ill-defined pancreatic lesion, associated with an infected biloma. Severe complications can occur after an EUS-FNA; therefore, this diagnosis should not be neglected after the intervention in symptomatic patients, to ensure an early and proper treatment.

Large Cystic Mass of the Pancreatico-Duodenal Region Revealing Duodenal Lymphatic Malformation: A Case Report.

Lymphatic malformations are benign tumors rarely located in the gastro-intestinal tract. They are usually asymptomatic; however, they can cause clinical discomfort when enlarged. Imaging leads to diagnosis, but the confirmation can only be done through histology findings. We report the case of a 59-year-old male patient, admitted in our ward for melena, to which esophago-gastroduodenoscopy showed budding formations in the second portion of the duodenum wall, with Magnetic Resonance Imaging features and histological examination confirming diagnosis of a duodenal lymphatic malformation.

[Exploration of the small intestine through single-balloon enteroscopy, experience in the Mohammed V Training Military Hospital in Rabat: about 51 cases]. / Exploration du grêle par entéroscopie simple ballon, expérience de l´Hôpital militaire et d´instruction Mohamed V de Rabat: à propos de 51 cas.

Enteroscopy has become an indispensable technique for the exploration and, in particular, the treatment of small intestine lesions. It is usually performed following video capsule endoscopy of the small intestine. Three equivalent techniques exist: double balloon enteroscopy, single balloon enteroscopy and spiral enteroscopy. The purpose of this study is to describe the technical feasibility of single balloon enteroscopy as well as its tolerance, indications and the results obtained in our context. We conducted a retrospective and descriptive analysis of the records of patients undergoing single balloon enteroscopy in the Department of Gastroenterology at the Mohammed V Training Military Hospital in Rabat over an 8-year period. Inclusion criteria were: small intestine disease or the suspicion of small intestine disease on imaging tests or video-capsule endoscopy and having undergone single balloon enteroscopy. The variables studied were the technical feasibility of single balloon enteroscopy, its indications, results and complications. Fifty-one (51) patients, including 30 men and 21 women with an average age of 48 years (18 years-91 years), were included in the study. The technique used in all patients was single balloon enteroscopy under general anesthesia with intubation. The mean duration of single balloon enteroscopy via the upper gastrointestinal (GI) tract (antegrade) was 45 min and 60 min via the lower GI tract (retrograde). The small intestine was explored up to the proximal ileum via the upper gastrointestinal (GI) tract and through more than 120cm from IAD via the lower GI tract. The indications included: unexplained digestive bleeding (72%), small intestine wall thickening (17%), the suspicion of small intestine tumor (6%), evaluation of Crohn´s disease (4%) and endoscopic video capsule (ECV) reduction (2%). Diagnosis was made or confirmed in 29 patients, reflecting a diagnostic efficiency of 57%. Angiodysplasia accounted for 70% of the lesions, ulcerations 10%, stenoses 7%, tumors 7%, diverticula 3% and spontaneous ECV reduction 3%. Endoscopic treatment was performed in 20 patients, with a therapeutic efficiency of 39%; it was based on argon plasma coagulation of gastroenteric angiodysplasia lesions. No complications were observed in our case series. Single balloon enteroscopy is a well-tolerated examination which allows for the exploration of a long portion of the small intestine. Multiple and various indications were provided in our study and the diagnostic and therapeutic benefits were satisfactory.

An Unusual Cause of Biliary Tract Obstruction: Lemmel Syndrome.

BACKGROUND: Lemmel syndrome is a rare and misdiagnosed etiology of obstructive jaundice due to a periampullary duodenal diverticulum causing a mechanical obstruction of the common bile duct. It represents an obstructive jaundice with the absence of choledocholithiasis or pancreaticobiliary tumors. It is an underreported entity due to the absence of specific pathognomonic signs. CASE PRESENTATION: A 77-year-old-woman admitted for sepsis, due to an ascending cholangitis, underwent a MRCP and a gastroduodenoscopy revealing Lemmel's syndrome. Due to failure of ERCP, the patient underwent surgical derivation. CONCLUSION: Lemmel syndrome represents an uncommon diagnosis of obstructive jaundice, that shouldn't be neglected if no other organic cause is detected. It is usually asymptomatic, however some patients can develop symptoms and complications such as cholangitis, as is the case of our patient. Imaging allows diagnosis, with MRCP as the modality of choice to confirm diagnosis. Endoscopy is the first line treatment.

Malaria following a blood exposure accident: about a case.

Each year, hundreds of cases of malaria are reported in Morocco and occur after anopheles in patients who have stayed in endemic areas, but transmission following an accident of exposure to blood is rare or exceptional, only about 20 cases are published. We report a case of malaria in a nursing staff following an accidental sting with a catheter needle.

Successful surgical treatment of extrahepatic biliary papillomatosis diagnosed with endoscopic retrograde cholangiopancreatography: a case report.

INTRODUCTION: Biliary papillomatosis is a condition characterized by multiple papillary tumors of variable distribution and extent within the biliary tract. Papillary carcinoma can develop in these lesions. It is a rare biliary pathological entity and its clinical features and outcome are not well known. CASE PRESENTATION: We experienced a case of biliary papillomatosis in a 51-year-old North African man who presented with obstructive jaundice. Laboratory tests showed elevated bilirubin, alkaline phosphatase and gamma-glutamyl transpeptidase levels. Imaging (ultrasound and magnetic resonance imaging) was suggestive of Klatskin tumor associated to common bile duct stones. After endoscopic retrograde cholangiopancreatography, a balloon sweep retrieved friable tissue from his bile ducts. Histology demonstrated papillary adenomatous proliferation showing high-grade dysplasia and he was referred for surgical management. CONCLUSIONS: Although biliary papillomatosis is rare, it is a premalignant condition that should be well known and considered in all diagnoses of obstructive jaundice. We report a new case of biliary papillomatosis and highlight the contribution of endoscopic retrograde cholangiopancreatography in the diagnosis of this condition.

Gastric bronchogenic cyst presenting as a submucosal mass: a case report.

INTRODUCTION: Bronchogenic cysts are developmental anomalies of the primitive foregut which mostly occur in the lung. Gastric bronchogenic cysts are extremely rare; few cases have been reported in the literature and the diagnosis was often made following surgical resection. CASE PRESENTATION: A 40-year-old North African man was admitted to our hospital with a gastric submucosal mass. An endoscopic ultrasound revealed a unilocular cystic mass located in the muscular layer. Its content was echogenic suggestive of mucus. Magnetic resonance imaging confirmed the liquid nature of the cyst and showed a high ratio of proteins. Based on these observations, the diagnosis of bronchogenic cyst was confirmed. An endoscopic monitoring was decided rather than surgery because of the small size of the cyst and the absence of symptoms. CONCLUSION: Although gastric bronchogenic cysts are rare, they should be well known and considered in all differential diagnoses of gastric tumors. We report a new case of gastric bronchogenic cyst and highlight the contribution of morphological tests that currently allow a non-invasive diagnosis.