Lege Artis Medicinae

[Case report: gastrointestinal pyogenic granuloma]

SIKE Róbert, SZÉKELY György, DEMETER Pál, SÁPI Zoltán

MAY 20, 2001

Lege Artis Medicinae - 2001;11(05)

[In this presentation authors would like to report a case with a lesion related to a ventricularly located pyogenic granuloma. A 65-year-old man was hospitalized with symptoms of acute gastritis. Despite symptomatic treatment for two days he was still in poor condition. Upper panendoscopy revealed Helicobacter pylori associated gastritis and a polypoid lesion with the size of a bean close to the cardia. The histology examination of the lesion verified pyogenic granuloma with gastric localization. After complete Helicobacter pylori eradication followed by PPI and H2 blocker-therapy, the polypoid configuration gradually decreased and after approximately one year it could not be detected and the patient remained symptomfree. According to literature data, pyogenic granuloma is extremely rare in the gastrointestinal tract except for the oral cavity which is the reason why authors intended to call the attention for this rare occurrence.]

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[Ischemic colitis is mainly caused by the impaired circulation of the inferior mesenteric artery. Most frequently it occurs as part of general arteriosclerotic disease or impaired left ventricular function, but it may also occur after abdominal aortic reconstruction. In connection with cocaine users, thrombophylia and vasculitis can also happen among young patients. Colonoscopy plays the most important role in making the diagnosis. In case of transitional ischemia conservative treatment is recommended, but surgery is needed in the progressive gangrenous form or when stricture in the colon developed. Authors describe the case of an 80-year-old man and discuss the etiology, clinical aspects, classical and up-to-date methods of diagnostics and the possibilities of conservative treatment.]

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[According to our knowledge, Helicobacter pylori is a major factor in the pathogenesis of peptic ulcer disease. The prevalence of Helicobacter pylori infection is 70-80% in ulcer patients with the bacteria colonising the mucous surface of the antral mucosa. Eradication therapy against the bacteria leads to complete healing of ulcer disease in about 85-90% of cases. Indications for the eradication and recommended treatment modalities are outlined in several consensus reports; however, in everyday practice a case by case decision is necessary. Present paper summarises two different cases. In the first, the patient has suffered from several relapses of ulcer disease and a successful eradication was performed. Despite of the healing of the ulcer, this patient continued to have prolonged dyspeptic symptoms which called for maintenance antisecretory therapy. The second case is an example that even in a Helicobacter pylori infected patient there could be other reasons for the ulcer pathogenesis. Thorough examinations revealed duodenal manifestation of Crohn’s disease as the background. The message of presented cases is that in each patient individual adaptation of diagnostic and therapeutic algorithms is recommended.]

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