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Carcinoid tumors are rare neuroendocrine tumors that have been reported in a wide range of organs but most commonly involve the gastrointestinal tract (stomach, ileum, appendix, and colon), and rarely ovary and thymus. We present a case of a 56-year-old Nigerian man with a cecal carcinoid tumor that was surgically removed. A 56-year-old Nigerian man, presented to our hospital with a year history of right-sided lower abdominal fullness, audible bowel sounds, occasional diarrhea, nausea, vomiting, and epigastric pain. There was no history of hematochezia or passage of melena stool. Colonoscopy revealed a cecal mass occupying more than two-thirds of the cecal lumen. Histology confirmed carcinoid tumor (well-differentiated neuroendocrine tumor), which was surgically removed. Carcinoid tumors are slow growing rare neuroendocrine tumors. Mortality is low if it is diagnosed early.

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Helicobacter pylori has been implicated in the formation of chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma and gastric cancer. Eradication of H. Pylori has been recommended as treatment and prevention for these complications. This review is based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. Subject heading and key words used include H. Pylori, current treatment and emerging therapy. Only articles in English were included. There has been a substantial decline in the H. pylori eradication rates over the years, despite the use of proton pump inhibitor and bismuth salts for triple and quadruple therapies respectively. The reasons for eradication failure are diverse, among them, antibiotic resistance is an important factor in the treatment failure. Primary resistance to clarithromycin or metronidazole significantly affects the efficacy of eradication therapy. This has led to the introduction of second line, third line "rescue," and sequential therapies for resistant cases. Subsequently, new antibiotic combinations with proton-pump inhibitors and bismuth salts are being studied in the last decade, to find out the antibiotics that are capable of increasing the eradication rates. Some of these antibiotics include Levofloxacin, Doxycycline, Rifaximin, Rifampicin, Furazolidone based therapies. Studies are ongoing to determine the efficacy of Lactoferrin based therapy.

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BACKGROUND: Diverticula are bulging pouch-like herniations in the wall of the hollow organ anywhere in the gastrointestinal tract from the oesophagus to the colon. Diverticula are thought to occur more commonly in the colon than in any other segment of the gastrointestinal tract. It may be asymptomatic or complicated by diverticulitis (diverticular inflammation), bleeding, or perforation with peritonitis. It could be potentially life threatening. It was thought to be rare in this part of the world, but is increasingly diagnosed with the advent of modern imaging techniques and colonoscopy. Two cases of colonic diverticula discovered during colonoscopy were highlighted. CASE REPORTS: Case 1--This patient was a 79-year old traditional ruler who presented with 2 months history of progressive left- sided abdominal pain, dull in nature and sometimes colicky but non-radiating. There was no known aggravating or relieving factors. There was associated history of chronic constipation dating back to over 15 years relieved with use of laxatives. There was no diarrhoea, vomiting or haematochezia. He had no history of previous surgeries. Physical examination showed mild tenderness at the left iliac fossa. Digital rectal examination was normal. Plain abdominal x-ray and abdomino-pelvic ultrasound scan showed no abnormalities. Colonoscopy revealed multiple diverticula with diverticulitis at the descending and sigmoid colon 40 cm-60 cm from the anal verge. Case 2--This patient is a 64-year old retired military officer who presented with constipation of 5 years and rectal bleeding of 10 months. Pre-morbid bowel habit was 1-2 bowel motions per day but now once in 2 days. Constipation was characterized by recurrent passage of hard pellet-like stools. This became associated with passage of fresh blood in the stool 10 months ago, and anal pain. Volume of blood was about 5 mls per episode, and this occurred only when stool was hard. The anal pain was sometimes severe enough to prevent the patient from sitting comfortably on both buttocks. There was no weight loss or constipation alternating with diarrhoea. He had no history of any chronic medical illness. Colonoscopy revealed anal fissure, internal haemorrhoids, and multiple diverticula in the sigmoid and descending colon. Both patients are being managed conservatively with dietary advice and antibiotics, and still being followed up in the clinic. CONCLUSION: Reports of colonic diverticula with diverticulitis in this part of the world are few. This is the first report of colonic diverticulosis from Ilorin.

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Angiodysplasias of the colon are enlarged and fragile blood vessels in the colon result in occasional loss of blood from the lower gastrointestinal tract. It may be observed incidentally at colonoscopy or patients may present with lower gastrointestinal bleeding. The objective of this case report is to highlight two cases of colonic vascular ectasia seen using a Pentax video colonoscope at the Endoscopy unit of Crescent hospital, Ilorin. The first patient is an 85-year-old man, who presented with constipation, left-sided abdominal pain, and weight loss of two weeks duration. There was no anorexia, abdominal swelling, diarrhea, or hematochezia. Abdomino-pelvic ultrasonography showed normal findings. Colonoscopy done, reaching the ileo-cecal valve and caecum, showed an area of dilated tortuous blood vessel (vascular ectasia) in the wall of the descending colon approximately 45 cm from the anal verge, with no features of bleeding. No ulcers or mass lesion was seen. Colonoscopy showed angiodysplasia of the colon. The second patient is a 30-year-old female trader who presented with two days history of massive hematochezia of about 7 episodes prior to presentation with an estimated blood loss per episode of about 300 ml. There were clinical features of shock. Packed cell volume at presentation was 14%. She was transfused with 4 units of fresh whole blood. Post stabilization, colonoscopy was done 5 days after bleeding had stopped, which revealed an area of erosion with mucosal blood clot about 27 cm from the anal verge. An area of angiodysplasia was seen. No hemorrhoids or mass lesion was seen anywhere in the colon. Angiodysplasia is an uncommon finding in Ilorin. These are the first reported cases of angiodysplasia of the colon from Ilorin, Nigeria.

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BACKGROUND: Oesophageal carcinoma is a malignant epithelial tumour of the oesophagus that arises from the mucosa. It mostly comprises of squamous cell carcinoma and adenocarcinoma of the oesophagus and oesophagogastric junction. It is a relatively uncommon finding. OBJECTIVE: The objective of this case report is to demonstrate two cases of oesophageal carcinoma seen at the gastroenterology unit of the University of Ilorin Teaching Hospital, Ilorin. CASE REPORT: Two cases of oesophageal carcinoma were seen in the last three years. Two Nigerian males of ages 60 and 69 years respectively presented at our centre with a history of progressive dysphagia initially for solids but later involved liquids, and odynophagia. There was associated history of recurrent regurgitation and weight loss. However there was no heartburn, epigastric pain, abdominal swelling, haematemesis or malena. There was significant history of cigarette smoking and intake of alcohol. Barium swallow done, showed shouldering and distal rat tail appearance of the oesophagus. Upper gastrointestinal endoscopy revealed a mass in the oesophagus with evidence of malignant tumour, occluding the lumen of the oesophagus making it impossible to intubate the stomach. Histological examination of the biopsy specimen taken at endoscopy showed adenocarcinoma of the oesophagus. CONCLUSION: Oesophageal carcinomas are rare findings in Ilorin, Nigeria.

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Background: Oesophageal carcinoma is a malignant epithelial tumour of the oesophagus that arises from the mucosa. It mostly comprises of squamous cell carcinoma and adenocarcinoma of the oesophagus and oesophagogastric junction. It is a relatively uncommon finding. Objective: The objective of this case report is to demonstrate two cases of oesophageal carcinoma seen at the gastroenterology unit of the University of Ilorin Teaching Hospital; Ilorin. Case report: Two cases of oesophageal carcinoma were seen in the last three years. Two Nigerian males of ages 60 and 69 years respectively presented at our centre with a history of progressive dysphagia initially for solids but later involved liquids; and odynophagia. There was associated history of recurrent regurgitation and weight loss. However there was no heartburn; epigastric pain; abdominal swelling; haematemesis or malena. There was significant history of cigarette smoking and intake of alcohol. Barium swallow done; showed shouldering and distal rat tail appearance of the oesophagus. Upper gastrointestinal endoscopy revealed a mass in the oesophagus with evidence of malignant tumour; occluding the lumen of the oesophagus making it impossible to intubate the stomach. Histological examination of the biopsy specimen taken at endoscopy showed adenocarcinoma of the oesophagus. Conclusion: Oesophageal carcinomas are rare findings in Ilorin; Nigeria

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