Massive rectal bleeding from colonic diverticulosis

Objectives: This is to describe a case of colonic diverticulosis causing massive rectal bleeding in an elderly Nigerian man.Case report: We highlight a case of a 79 year old man who presented with massive rectal bleeding due to colonic diverticulosis from our centre. Colonoscopy identified multiple diverticula in the proximal rectum, sigmoid, descending and transverse colon. The diverticula were more in the descending colon and also oozing blood. He was worked up, and had surgery for hemicolectomy due to massive blood loss following failure of initial conservative management.Conclusion: Colonic divericulosis may cause massive rectal bleeding severe enough to require hemicolectomy. Only few similar cases have been reported in this part of the continent.Keywords: Colon, rectal bleeding, diverticulosis, colonoscop

Prevalence of intestinal parasites in newly diagnosed HIV/AIDS patients in Ilorin, Nigeria

AbstractBackgroundHuman immune-deficiency virus/acquired immune-deficiency syndrome predisposes to opportunistic parasitic infestations of the gastrointestinal tract. This study aimed to determine the prevalence of intestinal parasites in newly diagnosed treatment naïve HIV/AIDS patients.MethodsThis hospital-based cross-sectional study was carried out from December 2010 to June 2011. Questionnaires were administered to 238 HIV/AIDS subjects, and 238 age and sex-matched controls. CD4+ T cell count was carried out on HIV-positive subjects. Stool samples were examined using direct microscopic and modified Ziehl-Neelsen methods. Positivity of intestinal parasites was taken as the presence of worms, oocyst, cyst, ova or larvae in the stool samples.ResultsNinety males and 148 females were studied for the HIV-positive and HIV-negative controls respectively. Intestinal parasitic infestation in HIV-positive subjects was 68.5%, and was significantly higher than in the HIV-negative controls 49.2% (P<0.05). In HIV-positive subjects, Cryptosporidium spp. was the commonest (55.0%) parasite isolated. Others were Cyclospora cayetanensis (41.2%), Isospora belli (3.0%), Entamoeba histolytica (8.4%), Giardia lamblia (3.7%), Ascaris lumbricoides (2.5%), Strongyloides stercoralis (1.7%), Trichuris trichiura (0.8%) and Schistosoma mansoni (0.4%). HIV-positive patients with CD4+ T cell count of less than 200 cells/ul were more at risk of opportunistic parasites compared to the HIV-negative controls.ConclusionThe prevalence of intestinal parasites in newly diagnosed HIV/AIDS individuals was high, and its association with CD4+ T cell count was demonstrated. Routine screening for parasitic infestations at diagnosis is indicated to reduce the burden of the disease

Oesophageal Carcinoma - A Report of Two Cases and Review of Literature

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.Key Words: Oesophageal Carcinoma, Rare, Endoscopy, Nigeria

Cecal carcinoid tumor in a Nigerian Man: A case report and review of literature

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.Keywords: Carcinoid tumor, cecal, gastrointestinal, slow growin

Hepatocellular Carcinoma - A synopsis of current developments

This review highlights the burden associated with hepatocellular carcinoma and the progress made so far in the diagnosis, management, and treatment of the disease. It is based on a search of Medline, the Cochrane database of Systemic Reviews, and citation lists of relevant and current publications. Subject headings and key words used included "hepatocellular carcinoma", "pathogenesis", "liver transplantation", "local ablative therapy”, and “novel drug therapies”. Additional information was obtained by a manual search of the references from the key articles, current advances in treatment. Only articles in English were included.  Currently, surgical resection and liver transplantation are the treatment strategies offering the best long-term outcomes in patients with hepatocellular carcinoma. Non-transplant treatment as a bridge to transplantation also helps in lessening the risk of tumour progression or death during the waiting period. Targeted multi-cellular therapy with Sorafenib, is the first systemic agent to have yielded survival benefits in patients with advanced disease. Other agents: Brivanib, Erlotinib, monoclonal antibodies, Bevacizumab and Cetuximab, are currently being studied to determine their use in hepatocellular carcinoma.  Radionuclide Yttrium-90 microspheres, or combined subcutaneous interferon alpha and intra-arterial infusion chemotherapy, seem to be more promising strategies than Sorafenib treatment to downstage advanced hepatocellular carcinoma, including cases with macroscopic portal venous invasion.Although numerous modalities of diagnosis and treatment of hepatocellular carcinoma have been studied, there is still need for further evaluation of newer adjuvant treatment to provide more effective and tolerable methods for the patients with hepatocellular carcinoma.Keywords: Hepatocellular carcinoma, Hepato-carcinogenesis, Current diagnostic methods and techniques, Advances in treatmen