Solid pseudopapillary tumor of the pancreas mistaken for gastrointestinal stromal tumor: A case report

Solid pseudopapillary epithelial neoplasms of the pancreas are rare entities, first described in 1959 by Frantz. These tumors represent less than 2% of pancreatic cancers and mainly affect young women. They can reach a significant size and its radiological features can lead to diagnostic pitfalls, such as gastrointestinal stromal tumors, which are rare soft-tissue sarcomas that can appear anywhere along the gastrointestinal tract. Clinicians and radiologists need to be aware of the existing diagnostic pitfalls between these two entities, because of their possible similarities. We report here the case of a 33-year-old woman with a solid pseudopapillary epithelial neoplasms of the pancreas initially misdiagnosed as an exophytic gastric stromal tumor.

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.

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.

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.

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.

[Exploration of the small intestine through single-balloon enteroscopy, experience in the Mohammed V Training Military Hospital in Rabat: about 51 cases]

L´entéroscopie est devenue une technique incontournable dans l´exploration mais surtout dans le traitement des lésions de l´intestin grêle. Elle est en général réalisée suite à un examen préalable du grêle par vidéo-capsule endoscopique. Trois techniques équivalentes existent: l´entéroscopie double ballon, l´entéroscopie simple ballon et l´entéroscopie spiralée. Le but de cette étude est de décrire la faisabilité technique de l´entéroscopie simple ballon ainsi que sa tolérance, ses indications et ses résultats obtenus dans notre expérience. Une analyse rétrospective et descriptive s´étalant sur 8 ans des dossiers de patients ayant bénéficié d´une entéroscopie simple ballon au sein du service de gastro-entérologie de l´hôpital militaire et d´instruction Mohamed V de Rabat. Les critères d´inclusion étaient: être atteint ou suspecté d´une pathologie du grêle soit à l´imagerie soit à la vidéo-capsule-endoscopique et avoir bénéficié d´une entéroscopie simple ballon. Les variables étudiées étaient la faisabilité technique du geste, ses indications, ses résultats ainsi que ses complications. Cinquante-un (51) patients dont 30 hommes et 21 femmes d´âge moyen 48 ans (18 ans-91 ans) ont été inclus dans l´étude. La technique adoptée chez tous les patients était une entéroscopie simple ballon sous anesthésie générale avec intubation des voies respiratoires. La durée de l´examen était en moyenne de 45 min par voie haute et de 60 min par voie basse. Le grêle a été exploré jusqu´à l´iléon proximal en cas d´entéroscopie haute et jusqu´au-delà de 120cm de la DAI en cas d´entéroscopie basse. Les indications étaient représentées par les saignements digestifs inexpliqués (72%), épaississements grêliques (17%), suspicion de tumeur grêlique (6%), bilan d´évaluation d´un crohn grêlique (4%), et retrait de la vidéo-capsule endoscopique (VCE) (2%). Un diagnostic a été réalisé ou confirmé chez 29 patients soit une rentabilité diagnostic de 57%. Les angiodysplasies représentaient 70% des lésions retrouvées, les ulcérations grêliques (10%), les sténoses grêlique (7%), les tumeurs grêliques (7%), des diverticules grêliques (3%) et un retrait spontané de la VCE (3%). Un traitement endoscopique a été possible chez 20 patients soit une rentabilité thérapeutique de 39%; il s´agissait d´une électrocoagulation au plasma argon des lésions d´angiodysplasies grêliques. Aucune complication n´a été observée dans notre série. L´entéroscopie simple ballon reste donc un examen bien toléré qui permet d´explorer une grande longueur du grêle. Ses indications étaient nombreuses et variées dans notre étude et ses rentabilités diagnostic et thérapeutique étaient satisfaisantes.

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.