Arab Journal of Gastroenterology - Articles in Press

A prospective randomised comparative study of endoscopic band ligation versus injection sclerotherapy of bleeding internal haemorrhoids in patients with liver cirrhosis - Corrected Proof

2012-04-26

Abstract: Background and study aims: Bleeding internal haemorrhoids are common and used to be treated surgically with too many complications. Endoscopic therapy is trying to take the lead. Sclerotherapy and rubber band ligation are the candidates to replace surgical therapy especially in patients with liver cirrhosis. The aim of this study was to compare endoscopic injection sclerotherapy (EIS) to endoscopic rubber band ligation (EBL) regarding effectiveness and complications in the treatment of bleeding internal haemorrhoids in Egyptian patients with liver cirrhosis.Patients and methods: One hundred and twenty adult patients with liver cirrhosis and bleeding internal haemorrhoids were randomised into two equal groups; the first treated with EBL using Saeed multiband ligator, and the second with EIS using either ethanolamine oleate 5% or N-butyl cyanoacrylate. All groups were matched as regards age, sex, Child score and pre-procedure Doppler values. Patients were followed up clinically and with abdominal ultrasound/Doppler for 6months. Endoscopic and endosonography/Doppler was done before and one month after the procedure. Pre and post-procedure data were recorded and analysed.Results: Both techniques were highly effective in the control of bleeding from internal haemorrhoids with a low rebleeding [10% in the EBL group and 13.33% in the EIS group] and recurrence [20% in the EBL group 20% in the EIS group] rates. Child score had a positive correlation with rebleeding and recurrence in EIS group only.Pain score and need for analgesia were significantly higher while patient satisfaction was significantly lower in EIS compared to EBL [p<0.05]. No significant difference between ethanolamine and cyanoacrylate subgroups was found [p>0.05].Conclusions: Both EBL and EIS were effective in the treatment of bleeding internal haemorrhoids in patients with liver cirrhosis. EBL had significantly less pain and higher patient satisfaction than EIS. EBL was also safer in patients with advanced cirrhosis.

Giant aortic pseudoaneurysm complicating a case of chronic pancreatitis - Corrected Proof

Ramesh Kumar, Sanjay Singh Negi, Vikram Bhatia, Deepak Jain — 2012-04-25

A 60-year-old man, while in the hospital for check-up, developed sudden pain abdomen and hematemesis, followed by circulatory collapse. He was a follow-up case of chronic pancreatitis. He was immediately taken to emergency ward for resuscitation. Investigation revealed the following: haemoglobin 6.5g/dl; white blood cell count 22,300/mm3; INR 1.1; serum bilirubin 0.9mg/dl, alanin transaminase: 16IU/L, aspartate transaminase 40IU/L, alkaline phosphatase 287IU/l, serum albumin 1.7g/dl, blood urea 70mg/dl, serum creatinine 1.6mg/dl, and serum amylase 72 U/L. After stabilising him, a quick upper endoscopy was done which did not reveal any bleeding source. An urgent abdominal computed tomography (CT) angiogram () revealed a giant wide mouth pseudoaneurysm (15×9.5×8.6cm) arising from postero-lateral aortic wall at the level of vertebra D12-L1. Aneurysm was seen extending into the right psoas sheath with evidence of large contained perianeurysmal haematoma. There was no evidence of aortic pseudoaneurysm in his prior CT scan of abdomen done 3months back. Before we could proceed for any further intervention he developed refractory shock from which he could not be revived.

Choledochal cysts in Omani children: A case series - Corrected Proof

Siham Al-Sinani, Khalid Al Naamani, Wafa Lutfi, Aisha Al Hajri — 2012-04-20

Abstract: Background and study aims: Choledochal cysts (CCs) are rare congenital anomalies of the biliary tract with a low incidence in the western countries and a higher incidence in the eastern part of the world. CCs have female to male preponderance. CCs type distribution is known in certain parts of the world but very little is published about the common types of CCs and gender distribution in the Arab countries. We aim to describe the CC types and gender distribution in Omani children in one centre.Patients and methods: A retrospective review of all children diagnosed to have choledochal cysts over a 2year period at a tertiary hospital in Oman.Results: We diagnosed six children with CCs. The type distribution of CCs and gender preponderance in Omani children are not similar to what is described internationally. Type IV A was the most common type (50%) and less of type I (16.7%), unlike worldwide distribution. Female to male preponderance described in the literature is not seen in our case series. Fifty percent of our patients were boys. In this case series, we compare our results to the described case reports of CCs from Arab countries and Africa and bring up the difference.Conclusions: We demonstrate the unusual types of CCs and gender distribution in Omani children compared to the literature. To our best knowledge, this is the first case series of CCs in Omani children and the largest reported study in the literature in the Arab countries so far.

Endosonographic image of an oesophageal submucosal cyst - Corrected Proof

Gennady Solomonov — 2012-04-19

A 58year-old male patient presented to our department for upper gastrointestinal endoscopic examination. Gastroscopy revealed a smooth submucosal mass in the oesophagus, located at 25–27cm from the incisors. The overlying mucosa was intact and appeared normal. On palpation the consistency of the mass was cystic.

An unusual case of solitary rectal ulcer syndrome mimicking inflammatory bowel disease and malignancy - Corrected Proof

Sachin B. Ingle, Yogesh G. Patle, Hemant G. Murdeshwar, Chitra R. Hinge (Ingle) — 2012-04-12

Solitary rectal ulcer syndrome is rare in clinical practice, and there are few references in the literature. It was initially described by Cruveilheir in 1830 and extensively reviewed by Madigan and Morson (68 cases). The condition is essentially benign and may persist for many years unchanged. Although the histopathological features are characteristic, the clinical and endoscopic appearances are not and can be confusing posing a diagnostic dilemma with inflammatory bowel disease and malignancy .

Primary intestinal lymphangiectasia or Waldmann’s disease: A rare cause of lower gastrointestinal bleeding - Corrected Proof

2012-04-05

Waldmann’s disease or primary intestinal lymphangiectasia is a protein-losing enteropathy caused by abnormal lymphatic channels of the intestinal wall. Dietary treatment containing medium-chain triglycerides improves the course of this disease.

Sclerosing mesenteritis: A rare case of large bowel and rectum involvement - Corrected Proof

Mahmoud Naser, Maamoun Dabeh — 2012-03-30

Abstract: Sclerosing mesenteritis (SM) is an uncommon non-neoplastic inflammatory process in the mesentery that is seen as a pseudotumour, usually involving the small-bowel mesentery and, less commonly, the mesentery of the large bowel. The disease has two well-established histological types: the acute or sub-acute form known as mesenteric panniculitis and the chronic form known as retractile or SM. Because SM lacks special clinical manifestation and typical signs, the possibility of misdiagnosis is very high. The correct diagnosis of SM depends on pathological examination. Here in, we report a case of a 41-year-old male patient with SM of the large bowel.