Terminal ileitis: a rare gastrointestinal manifestation of IgA vasculitis in a child.

A girl in middle childhood was referred to the paediatric surgical team with acute colicky abdominal pain and bile-stained vomiting. This was preceded by a viral illness. Investigations revealed raised inflammatory markers, and imaging of the abdomen demonstrated ileal and jejunal thickening. Concerns were raised regarding whether she had inflammatory bowel disease. Endoscopy revealed gastritis and duodenitis, and colonoscopy was unremarkable. Video capsule endoscopy demonstrated ulcers in the jejunum and ileum.On day 8 of admission, she developed a symmetrical purpuric rash over both ankles leading to the diagnosis of Henoch-Schonlein-related ileitis. Multidisciplinary team working led to appropriate management of the patient and avoided surgery. Video capsule endoscopy enabled visualisation of the small bowel. She was managed with 5 days of methylprednisolone followed by oral steroids. She made a good recovery with no sequelae. This case highlighted that terminal ileitis is a rare complication of IgA vasculitis with a good prognosis.

Ileítis terminal por Yersinia enterocolitica: diagnóstico diferencial con la enfermedad de Crohn en un varón de 12 años / Terminal ileitis due to Yersinia enterocolitica: differential diagnosis with Crohn ́s disease in a 12-year-old male

Yersinia enterocolitica es un bacilo Gram-negativo causante de infección intestinal en los humanos. Se presenta con diferentes cuadros clínicos que obligan a descartar una variedad de etiologías, lo cual, a veces, hace difícil alcanzar un diagnóstico correcto en forma oportuna.Se expone el caso de un varón adolescente con dolor en la fosa ilíaca derecha a partir de una ileítis terminal con hallazgos similares a la enfermedad de Crohn, que se diagnosticó, finalmente, como infección por Yersinia enterocolitica. Se destaca la utilidad de los diferentes métodos auxiliares empleados.

Yersinia enterocolitica is a gram-negative rod causing intestinal infection in humans. It shows different clinical pictures with many different etiologies to be ruled-out, which sometimes makes it difficult to reach a timely and correct diagnosis. We report the case of an adolescent boy presenting with right lower quadrant pain from terminal ileitis with endoscopic findings akin to Crohn ́s disease finally diagnosed as Yersinia enterocolitica, highlighting the usefulness of the different ancillary methods employed.

Hernia de Bochdalek con contenido de riñón izquierdo intratorácico / Left Bochdalek Hernia Containing Intrathoracic Kidney

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Coexistencia de colitis linfocítica y enteritis microscópica en pacientes con diarrea crónica / Concurrent lymphocytic colitis and microscopic enteritis in patients with chronic diarrhea

Introducción: Colitis linfocítica y enteritis microscópica son causas relativamente comunes de diarrea crónica y ambas se caracterizan por un infiltrado linfocitico intraepitelial. No existen reportes previos de la coexistencia de ambas entidades. Objetivo: Describir las características clínicas e histológicas de los pacientes que presentan este diagnóstico simultáneamente. Material y métodos: Se seleccionaron pacientes adultos con diarrea crónica que tuvieran biopsia simultánea de colon y duodeno tomados el mismo día, durante los años 2010-2016, en el Servicio de Gastroenterología del Hospital Nacional Daniel Alcides Carrión. Se recopiló información clínica del archivo de historias. Las láminas fueron reevaluadas histológicamente por 3 patólogos. Se realizó estudio inmunohistoquímico de linfocitos intraepiteliales para CD8 y CD3 en 6 casos. Resultados: De 63 pacientes con diarrea crónica y biopsia simultánea de duodeno y colon, se identificó un total de 35 pacientes (55,5%) con diagnóstico simultáneo de enteritis microscópica y colitis linfocítica, 80% fueron mujeres. Se identificó anemia en 28,5% de los pacientes e infestación por Blastocystis hominis en el 31,8.%. En enteritis microscópica, el promedio de linfocitos intraepiteliales con CD8 y CD3 fue 40%, mientras que, en colitis linfocítica, el promedio fue de 37,2% para CD3 y 29,2% para CD8. En 11 de los 35 casos, se pudo obtener biopsias de íleon que fueron diagnosticadas como ileitis linfocítica. En 9 casos se diagnosticó colitis eosinofílica asociada a colitis linfocítica. Conclusión: Se encontró coexistencia de colitis linfocítica, enteritis microscópica y en algunos de ileitis linfocítica en un 55,5% pacientes con diarrea crónica con biopsia duodenal y colónica. Estos resultados abren la interrogante sobre si colitis linfocítica y enteritis microscópica son entidades diferentes o constituyen una sola patología que en algunos pacientes afecta varios segmentos del tubo digestivo.

Introduction: Lymphocytic colitis and microscopic enteritis are relatively common causes of chronic diarrhea and it is characterized by an intraepithelial lymphocytic infiltrate. There have been no previous reports of coexistence between these 2 pathologies. Objective: To describe histological and clinical characteristic in patients with coexistence of lymphocytic colitis and microscopic enteritis. Material and methods: All cases with simultaneous diagnosis of lymphocytic duodenosis and lymphocytic colitis were reevaluated during lapse time 2010-2016 in hospital Daniel Carrion. The slides were reviewed by 3 pathologists and clinical information was obtained from clinical records. Expression of CD3 and CD8 was detected in 6 cases by immunohistochemical assays. Results: A total of 35 patients with coexistence of lymphocytic duodenitis and lymphocytic colitis were selected of the pathology archives, 80% were females, Anemia was identified in 28.5% of patients. Blastocysitis hominis infestation was identified in 31.8%. The mean intraepithelial lymphocyte CD8 and CD3 positive was 40% in microscopic enteritis, while the mean intraepithelial lymphocyte CD3 positive was 37.2% and CD8 positive was 29.2% Additionally, lymphocytic ileitis was diagnosed in 11 of our cases. Eosinophilic colitis was diagnosed in 9 cases of lymphocytic colitis Conclusion: We found that lymphocytic colitis, microscopic enteritis and even lymphocytic ileitis can coexist in a group of patients with chronic diarrhea. These findings bring the question if this concurrence of both pathologies constituted a more generalized gastrointestinal disorder, involving both the large and the small intestines.

Ileítis por citomegalovirus en paciente inmunocompetente / No disponible

El citomegalovirus (CMV) es un virus perteneciente a la familia de los Herperviridae. La infección puede causar una enfermedad grave en inmunodeprimidos, sin embargo también puede afectar a inmunocompetentes, y da lugar a cuadros clínicos generalmente autolimitados, aunque se han descrito casos graves que pueden llevar a la muerte. Presentamos un caso de ileítis por CMV con manifestaciones clínicas graves que motivaron intervención quirúrgica urgente en un paciente inmunocompetente(AU)

Cytomegalovirus (CMV) is a virus that belongs to the family of Herpesviridae. Infection can cause a serious disease in immunocompromised patients, but it can also affect immunocompetent patients, creating generally self limiting symptoms. However, in some cases it can be fatal. We present a case of CMV ileitis with serious clinical symptoms that led to an operation in an immunocompetent patient(AU)

Abdomen agudo en la enfermedad celiaca: yeyunoileítis ulcerativa / Acute abdomen in celiac disease: Ulcerative jejunoileitis

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Curso terapêutica em gastroenterologia: aula 9: doença de crohn / Gastroenterology therapeutics course: class 9: crohn's disease

A doença de Crohn é uma doença intestinal inflamatória caracterizada por inflamação transmural e descontínua que pode acometer qualquer segmento do tubo digestivo, desde a boca até o ânus. Íleo terminal e cólon ascendente adjacente (ileocolite) são os principais locais acometidos, e os pacientes podem se apresentar com ulceração, estenose, formação de fístulas e abscesso. Em relação à terapêutica farmacológica, os aminossalicilatos e os corticosteróides são as drogas classicamente usadas, mas novos agentes farmacológicos estão sendo investigados e têm criado grande expectativa para um futuro bem próximo.

Hemoperitoneo espontáneo secundario a yeyunoileítis por Anisakis / Spontaneos hemoperitoneum secondary the jejunoileitis by anisakis

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Ileítis y enteropatía perdedora de proteínas como manifestación de lupus eritematoso sistémico: caso clínico y revisión de la literatura / Ileitis and protein-losing enteropathy as manifestation of systemic lupus erythematosus

Son manifestaciones intestinales del lupus eritematoso sistémico, las trombosis (venosas o arteriales), vasculitis, pseudo-obstrucción intestinal crónica y las enteropatías perdedoras de proteínas. Describimos el caso de una paciente de 18 años, que ingresó por dolor abdominal y vómitos, con desarrollo posterior de hipoalbuminemia. El TAC abdominal mostró edema en diana de las asas desde duodeno hasta íleon, con escaso líquido libre perihepático. Los anticuerpos antinucleares y anti-DNA fueron positivos, con persistente hipocomplementemia. La terapia efectuada con corticoides, antibióticos y reposo intestinal fue efectiva, con normalización en el control a 4 semanas con TAC abdominal.

Ileítis eosinofilica segmentaria secundaria a Anisakis / Secondary segmented eosinophilic ileitis resulting from Anisakis

El nematodo Anisakis es un parásito frecuente del pescado que infesta accidentalmente al hombre cuando éste consume pescado parasitado crudo o poco cocinado. Origina cuadros gástricos e intestinales agudos secundarios a la penetración localizada de la larva en la pared gastrointestinal. Presentamos un caso de ileítis eosinofílica segmentaria secundaria a Anisakis y asociada al consumo de boquerones en vinagre, práctica culinaria habitual en nuestro medio (AU)

Cerebral thrombosis associated with active Crohn's disease

An increased incidence of cerebral thromboembolic events has been reported in young patients with inflammatory bowel disease (IBD). It has been suggested that a hypercoagulable state is associated with clinical activity of the disease, with elevation of factors V, VIII, fibrinogen and platelets and a lowering of anti-thrombin III. We present the case of a 35 y/o male with refractory Crohn's disease who complained of headaches, blurred vision and tonic-clonic seizures. The studies demonstrated an ischemic stroke of the left cerebral hemisphere, without vascular abnormalities. Elevation of factor VIII, platelets, and antithrombin III were found. The symptoms were relieved with medical treatment and the patient has continued in good health after resection of the diseased terminal ileum.

Reativaçäo da retocolite ulcerativa com o uso de droga antiinflamatória näo esteróide: relato de caso e revisäo da literatura / Reactivation of ulcerative rectocolitis with drug the use non-steroidal anti-inflammatory: report of a case and review of the literature

É relatado o caso de uma paciente portadora de retocolite ulcerativa idiopática e sacro-ileíte isolada que apresentou reagudizaçao da doença intestinal com o uso de diclofenac. A paciente, alérgica à sulfassalazina, estava em uso de ácidos graxos poliinsaturados omega(3), de óleo de peixe. Sao descritos os prováveis mecanismos envolvidos na reativaçao da doença inflamatória intestinal com uso de drogas antiinflamatórias nao esteróides e sugerido, quando necessário nestes pacientes, o uso dessas drogas, que inibem a lipoxigenase.