Pub Date : 2019-09-26DOI: 10.33552/AJGH.2019.01.000516
T. N. Son, Dinh Duc, D. V. Mai
Aim: To present our techniques and results of trans-umbilical laparo-endoscopic single site surgery (TULESS) with hepatic ductoplasty in the management of childhood choledochal cyst (ChC). Methods: All ChC cases undergoing TULESS excision of ChC, ductoplasty and hepatico-jejunostomy by the same surgeon from October 2012 to October 2017 were reviewed. For TULESS, 3 trocars were placed at a single umbilical skin incision and conventional instruments were used. Results: 46 patients (35 girls, 11 boys) with hepatic ductoplasty were identified from total 237 patients with ChC undergoing TULESS by the same surgeon for the review period. The median age was 17 months. Ductoplasty for a small common hepatic duct (less than 5mm) was carried out in 38 patients and for the presence of an aberrant duct in 8 patients. The median operative time was 195 minutes. There was no intraoperative complication, no conversion to open surgery. Additional trocars (conversion to conventional laparoscopic surgery) were required in just the first case of aberrant duct. Postoperative bile leak was noted in one patient (2.2%), which was resolved with non-operative treatment. The median postoperative hospital stay was 5 days. At a median follow up of 36 months (range: 3 months to 60 months), one patient needed redo surgery for anastomotic stenosis; all other patients were in good health, with excellent postoperative cosmesis. Conclusion: TULESS with conventional instruments is feasible and safe for hepatic ductoplasty for childhood ChC with small common hepatic duct or aberrant duct. Patient’s characteristics, intraoperative findings, operative time and results were analyzed.
{"title":"Trans-Umbilical Laparo-Endoscopic Single Site Surgery with Hepatic Ductoplasty in Management of Childhood Choledochal Cyst: A Single Surgeon Experience with 46 Cases","authors":"T. N. Son, Dinh Duc, D. V. Mai","doi":"10.33552/AJGH.2019.01.000516","DOIUrl":"https://doi.org/10.33552/AJGH.2019.01.000516","url":null,"abstract":"Aim: To present our techniques and results of trans-umbilical laparo-endoscopic single site surgery (TULESS) with hepatic ductoplasty in the management of childhood choledochal cyst (ChC). Methods: All ChC cases undergoing TULESS excision of ChC, ductoplasty and hepatico-jejunostomy by the same surgeon from October 2012 to October 2017 were reviewed. For TULESS, 3 trocars were placed at a single umbilical skin incision and conventional instruments were used. Results: 46 patients (35 girls, 11 boys) with hepatic ductoplasty were identified from total 237 patients with ChC undergoing TULESS by the same surgeon for the review period. The median age was 17 months. Ductoplasty for a small common hepatic duct (less than 5mm) was carried out in 38 patients and for the presence of an aberrant duct in 8 patients. The median operative time was 195 minutes. There was no intraoperative complication, no conversion to open surgery. Additional trocars (conversion to conventional laparoscopic surgery) were required in just the first case of aberrant duct. Postoperative bile leak was noted in one patient (2.2%), which was resolved with non-operative treatment. The median postoperative hospital stay was 5 days. At a median follow up of 36 months (range: 3 months to 60 months), one patient needed redo surgery for anastomotic stenosis; all other patients were in good health, with excellent postoperative cosmesis. Conclusion: TULESS with conventional instruments is feasible and safe for hepatic ductoplasty for childhood ChC with small common hepatic duct or aberrant duct. Patient’s characteristics, intraoperative findings, operative time and results were analyzed.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46431645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-24DOI: 10.33552/ajgh.2019.01.000515
E. Arslan
License AJGH.MS.ID.000515. Abstract Chylous ascites is described as accumulation of chyle in the abdominal cavity. It has several causes like pancreatitis and tuberculosis. Pregnancies those were complicated by chylous ascites were shown in the literature due to that well known causes. By that time there were not any cases that showed vaginal delivery complicated by incidental chylous ascites. In the present study we reported a 19 year-old women who had chylous ascites after vaginal delivery without any potential causes of the disease. She was consultated by general surgeon and explorative laparotomy was decided which did not show any etiologic reason for ascites. After all she was referred to us for further investigation and treatment of the chyle. She was treated conservatively and the drain was removed on post-op 6th. Despite the detailed investigation there was not found any causes that explain the ascites and the increased intra-abdominal pressure during second stage of delivery was thought to be most potential cause of chylous ascites. Patient was discharged on post-op 10 and on long follow up of 6 and 12 months after delivery she was doing well and had
{"title":"Idiopathic chylous ascites following vaginal delivery: A Case report","authors":"E. Arslan","doi":"10.33552/ajgh.2019.01.000515","DOIUrl":"https://doi.org/10.33552/ajgh.2019.01.000515","url":null,"abstract":"License AJGH.MS.ID.000515. Abstract Chylous ascites is described as accumulation of chyle in the abdominal cavity. It has several causes like pancreatitis and tuberculosis. Pregnancies those were complicated by chylous ascites were shown in the literature due to that well known causes. By that time there were not any cases that showed vaginal delivery complicated by incidental chylous ascites. In the present study we reported a 19 year-old women who had chylous ascites after vaginal delivery without any potential causes of the disease. She was consultated by general surgeon and explorative laparotomy was decided which did not show any etiologic reason for ascites. After all she was referred to us for further investigation and treatment of the chyle. She was treated conservatively and the drain was removed on post-op 6th. Despite the detailed investigation there was not found any causes that explain the ascites and the increased intra-abdominal pressure during second stage of delivery was thought to be most potential cause of chylous ascites. Patient was discharged on post-op 10 and on long follow up of 6 and 12 months after delivery she was doing well and had","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45828242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-17DOI: 10.33552/AJGH.2019.01.000513
M. Abdeldayem, Michael N Frempong, J. Waterman, Melanie Fuller, P. Haray
Background Bowel preparation is crucial to undertake flexible sigmoidoscopy, as poor views of the bowel mucosa can result in an inadequate examination and the need for further investigations. Endoscopists develop personal preferences and patient tolerance and side effects also have an impact on the choice of the bowel preparation used. Endoscopy units also have different protocols which can be administered orally or rectally. Aim
{"title":"Bowel Preparation for Flexible Sigmoidoscopy: Is a Phosphate Enema Sufficient?","authors":"M. Abdeldayem, Michael N Frempong, J. Waterman, Melanie Fuller, P. Haray","doi":"10.33552/AJGH.2019.01.000513","DOIUrl":"https://doi.org/10.33552/AJGH.2019.01.000513","url":null,"abstract":"Background Bowel preparation is crucial to undertake flexible sigmoidoscopy, as poor views of the bowel mucosa can result in an inadequate examination and the need for further investigations. Endoscopists develop personal preferences and patient tolerance and side effects also have an impact on the choice of the bowel preparation used. Endoscopy units also have different protocols which can be administered orally or rectally. Aim","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42269124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-27DOI: 10.33552/ajgh.2019.01.000512
M. T. Kyaw
Patient is a 76-year-old man with past medical history of hypertension, type 2 diabetes mellitus, hyperlipidemia, coronary artery disease, chronic renal insufficiency, alcoholic cirrhosis who was diagnosed with cholelithiasis in 2015. He subsequently developed cholecystitis, which was complicated by choledocholithiasis with cholangitis, requiring ERCP with biliary stent, followed by laparoscopic cholecystectomy. There was no documentation of spilled stones or any other complication during the surgery. Two years after laparoscopic cholecystectomy [2], patient presented with abdominal distention and pain predominantly in the epigastric region, not related to food. Abdomen CT scan showed subphrenic fluid collection extending along right abdominal wall with two to three calcified spilled gallstones. During the hospital course, patient developed fever, leukocytosis and tachycardia. He was diagnosed with sepsis and treated for suspected pneumonia. Patient underwent interventional radiology (IR) guided drainage for multiloculated complex hepatic fluid. Eight hundred milliliters of greenish viscous fluid were aspirated [3]. Culture from intraperitoneal aspiration is negative. IR failed to remove gallstone after dilating the access. Patient underwent an extensive peritoneal washout and perihepatic fluid collection resolved Figure 1. Figure 1: 76 years old Male with Subphrenic Heterogenous Fluid Collection extending Right Abdominal Wall.
{"title":"Spilled Gallstones during Laparoscopic Cholecystectomy: Case Series and Review of Literature","authors":"M. T. Kyaw","doi":"10.33552/ajgh.2019.01.000512","DOIUrl":"https://doi.org/10.33552/ajgh.2019.01.000512","url":null,"abstract":"Patient is a 76-year-old man with past medical history of hypertension, type 2 diabetes mellitus, hyperlipidemia, coronary artery disease, chronic renal insufficiency, alcoholic cirrhosis who was diagnosed with cholelithiasis in 2015. He subsequently developed cholecystitis, which was complicated by choledocholithiasis with cholangitis, requiring ERCP with biliary stent, followed by laparoscopic cholecystectomy. There was no documentation of spilled stones or any other complication during the surgery. Two years after laparoscopic cholecystectomy [2], patient presented with abdominal distention and pain predominantly in the epigastric region, not related to food. Abdomen CT scan showed subphrenic fluid collection extending along right abdominal wall with two to three calcified spilled gallstones. During the hospital course, patient developed fever, leukocytosis and tachycardia. He was diagnosed with sepsis and treated for suspected pneumonia. Patient underwent interventional radiology (IR) guided drainage for multiloculated complex hepatic fluid. Eight hundred milliliters of greenish viscous fluid were aspirated [3]. Culture from intraperitoneal aspiration is negative. IR failed to remove gallstone after dilating the access. Patient underwent an extensive peritoneal washout and perihepatic fluid collection resolved Figure 1. Figure 1: 76 years old Male with Subphrenic Heterogenous Fluid Collection extending Right Abdominal Wall.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45795047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-13DOI: 10.33552/ajgh.2019.01.000511
Scott T Larson
Shaheer Siddiqui1, Tarun Jain2, Zhenjian Cai3 and Scott Larson4* 1Department of Gastroenterology & Hepatology, University of Texas, McGovern School of Medicine, USA 2Department of Resident Internal Medicine, University of Texas, McGovern School of Medicine, USA 3Department of Assistant Professor Pathology, University of Texas, McGovern School of Medicine, USA 4Department of Assistant Professor Gastroenterology &Hepatology, University of Texas, McGovern School of Medicine, USA
{"title":"Tia Leading to the Diagnosis Amelanotic Metastatic Gastric Melanoma","authors":"Scott T Larson","doi":"10.33552/ajgh.2019.01.000511","DOIUrl":"https://doi.org/10.33552/ajgh.2019.01.000511","url":null,"abstract":"Shaheer Siddiqui1, Tarun Jain2, Zhenjian Cai3 and Scott Larson4* 1Department of Gastroenterology & Hepatology, University of Texas, McGovern School of Medicine, USA 2Department of Resident Internal Medicine, University of Texas, McGovern School of Medicine, USA 3Department of Assistant Professor Pathology, University of Texas, McGovern School of Medicine, USA 4Department of Assistant Professor Gastroenterology &Hepatology, University of Texas, McGovern School of Medicine, USA","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42201853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-09DOI: 10.33552/ajgh.2019.01.000510
M. Somaï
Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory disease, known as a prototype for autoimmune disease [1,2]. It is usually associated with other autoimmune and dysimmune diseases. Inflammatory bowel disease (IBD) is one of the specific dysimmune diseases of the intestine with extraintestinal involvements and with environmental factors and genetic predisposition [3]. IBD is a chronic recurrent disease comprised of two major phenotypes, Crohn’s disease (CD) and ulcerative colitis [4]. The coexistence of SLE and CD in the same patient is extremely rare (<0.4%) [5]. Even rarer is the association between lupus nephritis (LN) and CD, with only two cases reported to date [6,7]. A review study corroborated that SLE was associated with comorbid CD (OR 2.23) [8]. We communicate herein two cases of patients, ones with SLE who was diagnosed CD colitis and the other with CD who was diagnosed SLE. Case presentation 1
{"title":"Coexistence of Crohn’s Disease and Systemic Lupus Erythematosus with Lupus Nephritis : About Two Cases","authors":"M. Somaï","doi":"10.33552/ajgh.2019.01.000510","DOIUrl":"https://doi.org/10.33552/ajgh.2019.01.000510","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory disease, known as a prototype for autoimmune disease [1,2]. It is usually associated with other autoimmune and dysimmune diseases. Inflammatory bowel disease (IBD) is one of the specific dysimmune diseases of the intestine with extraintestinal involvements and with environmental factors and genetic predisposition [3]. IBD is a chronic recurrent disease comprised of two major phenotypes, Crohn’s disease (CD) and ulcerative colitis [4]. The coexistence of SLE and CD in the same patient is extremely rare (<0.4%) [5]. Even rarer is the association between lupus nephritis (LN) and CD, with only two cases reported to date [6,7]. A review study corroborated that SLE was associated with comorbid CD (OR 2.23) [8]. We communicate herein two cases of patients, ones with SLE who was diagnosed CD colitis and the other with CD who was diagnosed SLE. Case presentation 1","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44240148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-18DOI: 10.33552/AJGH.2019.01.000509
Golam Mustafa, Harun-or Rashid, Shahinul Alam, Mahbubul Alam, R. Mustafa, N. Ahmad
Nonalcoholic fatty liver disease (NAFLD) is a metabolic disorder characterized by excessive triglyceride accumulation in the hepatocytes. It is a hepatic manifestation of metabolic syndrome [1]. The prevalence of NAFLD in India above 20 years age was 18.9% [2]. The prevalence of NAFLD increased with increased age. Obesity, diabetes mellitus (DM), insulin resistance (IR) are predisposing factors for NAFLD. Although NAFLD is more common in subject with obesity and diabetes mellitus (DM), it also occurs in lean and non-diabetic subject [3,4,5]. Non obese was 25.6% among NAFLD patient in Bangladesh. About 53.1 % of non-obese NAFLD cases were NASH [6].
{"title":"Correlation of Serum Adiponectin with Hepatic Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease","authors":"Golam Mustafa, Harun-or Rashid, Shahinul Alam, Mahbubul Alam, R. Mustafa, N. Ahmad","doi":"10.33552/AJGH.2019.01.000509","DOIUrl":"https://doi.org/10.33552/AJGH.2019.01.000509","url":null,"abstract":"Nonalcoholic fatty liver disease (NAFLD) is a metabolic disorder characterized by excessive triglyceride accumulation in the hepatocytes. It is a hepatic manifestation of metabolic syndrome [1]. The prevalence of NAFLD in India above 20 years age was 18.9% [2]. The prevalence of NAFLD increased with increased age. Obesity, diabetes mellitus (DM), insulin resistance (IR) are predisposing factors for NAFLD. Although NAFLD is more common in subject with obesity and diabetes mellitus (DM), it also occurs in lean and non-diabetic subject [3,4,5]. Non obese was 25.6% among NAFLD patient in Bangladesh. About 53.1 % of non-obese NAFLD cases were NASH [6].","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46852716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-19DOI: 10.33552/ajgh.2019.01.000508
Ahmad Hassan
Helicobacter pylori (H. pylori) infection, one of the most common bacterial infections, affects approximately 50% of the world’s population [1]. H. pylori infection is a major cause of gastritis, gastric and duodenal ulcers, mucosal associated lymphoid tissue, and gastric cancer [2]. H. pylori eradication treatment has been proven to improve gastric inflammation, promote ulcer healing, and reduce the incidence of gastric cancer [3,4]. Furthermore, a “test-and-treat” approach is advocated for detecting and eradicating H. pylori in patients with dyspeptic symptoms but low gastric cancer risk [5].
{"title":"Levofloxacin Based H. Pylori Eradication Therapy, should we Give it A better Consideration?","authors":"Ahmad Hassan","doi":"10.33552/ajgh.2019.01.000508","DOIUrl":"https://doi.org/10.33552/ajgh.2019.01.000508","url":null,"abstract":"Helicobacter pylori (H. pylori) infection, one of the most common bacterial infections, affects approximately 50% of the world’s population [1]. H. pylori infection is a major cause of gastritis, gastric and duodenal ulcers, mucosal associated lymphoid tissue, and gastric cancer [2]. H. pylori eradication treatment has been proven to improve gastric inflammation, promote ulcer healing, and reduce the incidence of gastric cancer [3,4]. Furthermore, a “test-and-treat” approach is advocated for detecting and eradicating H. pylori in patients with dyspeptic symptoms but low gastric cancer risk [5].","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43749882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-28DOI: 10.33552/AJGH.2019.01.000507
Parivash Badar, Syed Mikhail Zaidi
Discussion regarding the nature of paneth cell metaplasia has become increasingly popular over the last decade with respect to certain breakthrough studies emphasizing on the relationship between Inflammatory Bowel Disease and PCM. However, the incident of isolated paneth cell metaplasia in an otherwise unremarkable mucosa and asymptomatic patient has not been extensively studied [1]. A strong correlation has been established between distal PCM and the presence of newly diagnosed IBD in children [2]. Further it was emphasized that even though the presence of distal PCM is a marker for the presence of IBD in an individual, the presence of proximal PCM was seen to be nonspecific sign in adults however it has been established that repair and regeneration may be the most potent stimuli for PCM [3][4].
{"title":"Paneth Cell Metaplasia: An Ominous Finding","authors":"Parivash Badar, Syed Mikhail Zaidi","doi":"10.33552/AJGH.2019.01.000507","DOIUrl":"https://doi.org/10.33552/AJGH.2019.01.000507","url":null,"abstract":"Discussion regarding the nature of paneth cell metaplasia has become increasingly popular over the last decade with respect to certain breakthrough studies emphasizing on the relationship between Inflammatory Bowel Disease and PCM. However, the incident of isolated paneth cell metaplasia in an otherwise unremarkable mucosa and asymptomatic patient has not been extensively studied [1]. A strong correlation has been established between distal PCM and the presence of newly diagnosed IBD in children [2]. Further it was emphasized that even though the presence of distal PCM is a marker for the presence of IBD in an individual, the presence of proximal PCM was seen to be nonspecific sign in adults however it has been established that repair and regeneration may be the most potent stimuli for PCM [3][4].","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43555430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-12DOI: 10.33552/AJGH.2019.01.000506
S. Bouomrani, M. Guermazi, S. Yahyaoui, H. Nouma
Introduction: Disturbances of hepatic biologic tests are not uncommon during hypothyroidism but classically refer to rhabdomyolysis. More rarely, moderate and reversible chronic cholestasis or hypertransamenaemia can be observed. Acute hepatitis-like syndrome remains exceptional. Case report: 30-year-old patient with no pathological medical history was referred to us by her family doctor for suspicion of acute viral hepatitis: ASAT at 4N and ALAT at 3N, asthenia, abdominal pain, and vomiting evolving for three days in an epidemic context of hepatitis A. The clinical examination noted bradycardia at 58/min and macroglossia. Hepatic tests confirmed hepatocellular necrosis without cholestasis or hepatocellular insufficiency: ASAT at 355IU/l (8N), ALAT at 243IU/l (6N), total bilirubin at 14.80μmol/l, GGT at 15IU/l and PT at 100%. The serodiagnostics of viral hepatitis A, B and C, and specific liver autoantibodies were negative. Thyroid assessment revealed deep primary hypothyroidism with TSH at 182.7μmol/ml. The evolution under hormonal substitution treatment was favorable with disappearance of the clinical complaints and normalization of the liver tests with the normalization of the TSH. Conclusion: Acute hepatocellular necrosis remains an exceptional presentation of hypothyroidism. His diagnosis is not always easy, especially since in the autoimmune context of Hashimoto’s thyroiditis, the association with true autoimmune hepatitis can be discussed. As well as a thyroid disorder associated with chronic viral hepatitis. A screening of the thyroid function is thus justified in front of any hepatocellular necrosis that is not proven.
简介:肝生物学检查紊乱在甲状腺功能减退时并不少见，但通常指的是横纹肌溶解。更罕见的是，可以观察到中度和可逆的慢性胆汁淤积或高血凝血症。急性肝炎样综合征仍属例外。病例报告:患者30岁，无病理病史，经家庭医生转诊，疑似急性病毒性肝炎:ASAT 4N, ALAT 3N，乏力，腹痛，呕吐3天，呈甲型肝炎流行背景。临床检查发现心动过缓58/分，舌大。肝脏检查证实肝细胞坏死，无胆汁淤积或肝细胞功能不全:ASAT为355IU/l (8N)， ALAT为243IU/l (6N)，总胆红素14.80μmol/l, GGT为15IU/l, PT为100%。病毒性甲型、乙型和丙型肝炎的血清诊断和特异性肝脏自身抗体均为阴性。甲状腺检查显示深度原发性甲状腺功能减退，TSH为182.7μmol/ml。激素替代治疗的进展是有利的，临床主诉消失，肝脏检查随着TSH的正常化而正常化。结论:急性肝细胞坏死是甲减的一种特殊表现。他的诊断并不总是容易的，特别是在自身免疫性桥本甲状腺炎的情况下，与真正的自身免疫性肝炎的关系可以讨论。以及与慢性病毒性肝炎相关的甲状腺疾病。因此，在任何未经证实的肝细胞坏死前进行甲状腺功能筛查是合理的。
{"title":"Acute Hepatitis-Like Syndrome Revealing Hashimoto Thyroiditis","authors":"S. Bouomrani, M. Guermazi, S. Yahyaoui, H. Nouma","doi":"10.33552/AJGH.2019.01.000506","DOIUrl":"https://doi.org/10.33552/AJGH.2019.01.000506","url":null,"abstract":"Introduction: Disturbances of hepatic biologic tests are not uncommon during hypothyroidism but classically refer to rhabdomyolysis. More rarely, moderate and reversible chronic cholestasis or hypertransamenaemia can be observed. Acute hepatitis-like syndrome remains exceptional. Case report: 30-year-old patient with no pathological medical history was referred to us by her family doctor for suspicion of acute viral hepatitis: ASAT at 4N and ALAT at 3N, asthenia, abdominal pain, and vomiting evolving for three days in an epidemic context of hepatitis A. The clinical examination noted bradycardia at 58/min and macroglossia. Hepatic tests confirmed hepatocellular necrosis without cholestasis or hepatocellular insufficiency: ASAT at 355IU/l (8N), ALAT at 243IU/l (6N), total bilirubin at 14.80μmol/l, GGT at 15IU/l and PT at 100%. The serodiagnostics of viral hepatitis A, B and C, and specific liver autoantibodies were negative. Thyroid assessment revealed deep primary hypothyroidism with TSH at 182.7μmol/ml. The evolution under hormonal substitution treatment was favorable with disappearance of the clinical complaints and normalization of the liver tests with the normalization of the TSH. Conclusion: Acute hepatocellular necrosis remains an exceptional presentation of hypothyroidism. His diagnosis is not always easy, especially since in the autoimmune context of Hashimoto’s thyroiditis, the association with true autoimmune hepatitis can be discussed. As well as a thyroid disorder associated with chronic viral hepatitis. A screening of the thyroid function is thus justified in front of any hepatocellular necrosis that is not proven.","PeriodicalId":72038,"journal":{"name":"Academic journal of gastroenterology & hepatology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42707357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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