[Cheilitis granulomatosa revealing Crohn's disease]. / Macro-chéilite granulomatose révélant une maladie de Crohn.

Many disorders of the digestive tract cause cutaneous manifestations that may be an indication of an underlying condition; hence dermatologist plays a key role in recommending that the patient see a gastroenterologist. Conversely, gastroenterologist often sees patients with mucocutaneous lesions suggesting possible association with well-known digestive disorders. Chronic inflammatory bowel diseases are the typical example of this essential collaboration between the two specialities. We report a case of Crohn's disease revealed by cheilitis granulomatosa. This study involved a 30-year old female patient followed up for cheilitis granulomatosa in the Department of Dermatology. Somatic examination was unremarkable apart from dermatologic lesions (indurated white faciolabial edema and diffuse gingivitis). Biopsy of the labial lesion revealed perivascular epithelioid and giant-cell granulomas without caseous necrosis. Ileocolonoscopy was performed due to suspected inflammatory colitis. It showed gaping and ulcerated Bauhin valve with slightly erythematous ileal mucosa. Anatomo-pathologic study objectified chronic inflammatory bowel disease (CIBD) such as ileocolic Crohn's disease. Patient's evolution was marked by some episodes of rectal bleeding with anoperineal lesions 6 months later: a wide anterior anal fissure with aphthous ulceration 5 cm from the anal margin, complicated, a few weeks later, by the onset of perianal fistulized abscess requiring surgical drainage and seton installation. Hence the indication for thorough treatment of Crohn's disease after complete drying up of the abscess. Dermatologic lesions vary in patients with CIBD. In some cases, they occur in patients with IBD whereas, in other cases, they precede or accompany digestive manifestations, allowing diagnosis of sometimes clinically latent bowel disease.

[Tumors of the small bowel: about 27 cases]. / Les tumeurs du grêle: à propos de 27 cas.

Tumors of the small bowel account for 5% of all tumors of the gastrointestinal tract. Although important progress has been made from a radiological and endoscopic point of view, they have a poor prognosis due to delayed diagnosis. This occurs because of the absence of clinical manifestations and of the difficulties of exploration. This study aimed to highlight the endoscopic and histologic features of tumors of the small bowel. We conducted a retrospective descriptive study in the Department of Hepato-Gastroenterology at the University hospital Hassan II, Fez, over a period of 11 years (2002-2012). We analyzed the epidemiological, clinical, endoscopic and histologic features of tumors of the small bowel. Data were collected from the medical records of 27 patients. The average age was 48 years [21-80 years] with a male predominance (H/F:2.4). Melenas led to the discovery of tumor in 55% of cases, abdominal mass in 15% of cases and Koenig syndrome or occlusive syndrome in 11% of cases. One patient had a history of celiac disease. CT enteroclysis showed the seat of the tumor in 18 cases. Push enteroscopy for detection of proximal tumors and double-balloon enteroscopy for detection of distal tumor were performed in 8 patients (30%). Endoscopy showed ulcerated lesion in 37.5% of cases, ulcerated stenotic lesion in 50% of cases and ulcerobudding stenotic lesion in 25% of cases. Surgery with anatomopathological examination of the surgical specimen allowed the diagnosis in 18 cases. The histologic type was dominated by stromal tumors in 14 cases (51%), followed by adenocarcinomas in 5 cases (18.5%), B-cell non-Hodgkin lymphoma in 4 cases (15%), neuroendocrine carcinoma of the jejunum in 1 case. Tumors of the small bowel are rare but they are characterized by a poor prognosis. Current imaging techniques (CT enteroclysis and MR enterography) coupled with endoscopic examinations, in particular double-balloon enteroscopy, allow earlier diagnosis and mortality reduction.