Acute Pancreatitis as a Complication of Choledochal Cyst

Choledochal cysts (CCs) are rare congenital disorders of the biliary tree which are associated with biliary tract and pancreatic complications. Its etiology is still unknown, but some evidences suggest that CCs are caused by infection during embryogenesis. The laboratory evaluation reveals abnormalities due to pancreatobiliary complications, such as ascending cholangitis, cholecystitis, and pancreatitis. Radiologic examination may delineate the structural abnormalities occured in CCs and confirm the diagnosis. The major mortality is caused by cholangiocarcinoma. This case discussed the diagnosis and treatment of a 20-year-old male with choledochal cyst and its complications. Management consists of therapy on complication and definitive therapy

Eosinophilic Colitis Presenting with Chronic Diarrhea

Eosinophilic colitis (EC) is a rare disease which characterized by infiltration of eosinophil in colon and peripheral eosinophilia. Other causes of peripheral eosinophilia need to be excluded before assumed EC such as food allergy, inflammatory bowel disease, or parasites. It has bimodal distribution, peaked at neonates and young adult.A 24-year-old man was admitted with abdominal pain and chronic diarrhea. He has no any disease, food, pollen, or drug allergy in his medical history. Leukocyte: 29,000/mm3 (neutrophil: 43.4%, eosinophil: 44.4%, lymphocyte: 8.2%), platelet: 453,000/mm3, total eosinophil: 17,582.1/µL (normal range: 50-300), immunoglobulin E: 1000 IU/mL (normal range < 100 IU/mL) was counted in his blood examination. The colon biopsy was reported as eosinophilic colitis. We applied methylprednisolone 24 mg/day. With this treatment, the patient's symptoms regressed.EC may involve any part of the gastrointestinal tract. An intense inflammatory infiltrate, consisting predominantly of eosinophils penetrates into one or more layers of the gastrointestinal tract. In 1937, Kaijser described this disorder. EC is classified into mucosal, submucosal or muscular, and serosal types. The endoscopic findings may vary from normal mucosa to frank ulceration. Our patient had chronic diarrhea and peripheral eosinophilia which are typical features of the mucosal types. It should be put in differential diagnosis in patients with chronic diarrhea

A Rare Complication of Acute Appendicitis: Superior Mesenteric Vein Thrombosis

Superior mesenteric vein (SMV) thrombosis caused by acute appendicitis is quite rare nowadays. These conditions occurs secondary to infection in the region drained by the portal venous system. In this case, we report a successfully treated case of SMV thrombosis and liver abscess associated with appendicitis with antibiotics and anticoagulant.Early diagnosis and prompt treatment are basic to a favorable clinical course

Age and Alarm Symptoms Predict Upper Gastrointestinal Malignancy Among Patients with Dyspepsia

Background: Upper gastrointestinal (UGI) Malignancy is one of the major causes of cancer related death. Endoscopy in dyspeptic patients above 45 years, or those with alarm symptoms may detect this condition. There were only limited data in Indonesia about age and alarm symptoms to predict UGI Malignancy. This study was aimed to determine the prevalence of UGI Malignancy among dyspepsia patients and to develop a simple clinical prediction model.Method: A cross-sectional study to 390 patients with dyspepsia underwent endoscopy in Endoscopy Unit of Sanglah Hospital Denpasar between July 2012 and June 2013 was conducted. Demography and alarm symptoms were documented. Chi-square and logistic regression test analysis were conducted to analyze variables associated with UGI Malignancy.Results: Twenty (5.13%) of 390 patients with dyspepsia had UGI Malignancy. Of the 20 patients, 65% were gastric cancer and 30% were esophageal cancer. The mean age was 59 ± 12 years. Variables associated with UGI Malignancy were weight loss (OR = 8.2), dysphagia (OR = 6.2), age &gt; 45 years old (OR = 5.6), gastrointestinal bleeding (OR = 5.5), persistent vomiting (OR = 5.4), and anemia (OR = 4.9). Using a simplified rule of age &gt;45 years and the presence of any alarm symptom, sensitivity was 85% and specificity was 67.57%.Conclusions: UGI Malignancy was found in 5.13% of patients with dyspepsia who underwent endoscopy. Simple clinical prediction model states that age above 45 years and alarm symptoms may be used as a screening tool to predict UGI Malignancy

Peptic Ulcer Disease Different Pathogenesis of Duodenal and Gastric Ulcer

Despite decrease frequency of Helicobacter pylori (H. pylori) due to eradication therapy, peptic ulcer disease as a manifestation of this infection is still remain a health burden. Understanding the physiology of gastric acid secretion and its alteration by H. pylori induced inflammation will aid physician in differentiating peptic ulcer disease based on its location. Duodenal ulcer and gastric ulcer disease are two common condition that usually found in peptic ulcer. Recognition of symptoms and its pathogenesis may lead physician to understand the fate of each condition in the future. This article reviews concept of peptic ulcer pathogenesis according to ulcer etiology