Pseudomelanosis Duodeni Appearing after Oral Iron Therapy

Pseudomelanosis duodeni is a rare condition characterized by the endoscopic appearance of diffuse dark pigmentation of the duodenal mucosa. It is typically seen in older women and has been reported to be associated with hypertension, chronic renal disease, diabetes mellitus, gastrointestinal hemorrhage, and the use of medications such as oral iron, furosemide, thiazide, hydralazine, and propranolol. We present a case of pseudomelanosis duodeni appearing after 2 years of oral iron therapy in an 85-year-old woman. Although oral iron supplementation seemed the strongest possible etiology, our patient had multiple comorbidities and was on other medications that have been described as associations. The majority of individuals taking oral iron or under these clinical conditions do not develop this entity; some other factors in patients may be responsible for its occurrence.

Rectal Tuberculosis - A Complete Review

Tuberculosis (TB) is a communicable disease caused mainly by Mycobacterium tuberculosis and its most frequent location is lung. Tuberculosis which affects the rectum is a rare extra-pulmonary sort of the disease that needs recognition because it requires specific treatment. Clinical and endoscopic presentations of intestinal TB are often almost like those of other diseases, like neoplasias and regional enteritis. Therefore, a high level of suspicion is required, as well as the performance of microbiologic studies, to confirm the diagnosis. Tuberculosis which affects the rectum is called rectal tuberculosis. Most common symptoms of rectal tuberculosis are abdominal pain, hematochezia, bowel habit change, episodes of rectal bleeding. The causative organisms of the disease include Mycobacterium tuberculosis and Bovis. Diagnosis of rectal tuberculosis is based on characteristic endoscopic appearance of lesions, histopathologic features of tuberculosis in biopsy/ resected material, and response to antitubercular therapy. It is still a great challenge even for experienced clinicians to diagnose the abdominal tuberculosis since it is an excellent mimicker that has unusual presentations. A high index of suspicion is important for reaching its diagnosis. Keywords: Rectal tuberculosis, Tuberculosis, Rectal TB.

Histomorphological and clinicopathological correlates of reflux esophagitis

Background: Inflammatory lesions of the esophagus are major concerns to patients who visit our Medical Out Patient Department (OPD) on a regular basis. Endoscopic examination, with histopathological confirmation is the diagnostic modality employed in many centers. Endoscopic appearance is characteristic, and so are histomorphological findings. In our study we have analyzed the clinical, endoscopic and histomorphological findings of various types of esophagitis. This will help us to arrive at a correct diagnosis to initiate appropriate therapy.Methods: We included 141 cases of esophagitis reported in Sri Ramachandra Institute of Higher Education and Research from January 2016 to December 2020 in our study, mostly the ones which came as biopsy samples in histopathology section. Slides were reviewed, various histological features, clinical and endoscopic findings were correlated. Microsoft excel was used for the calculation of results.Results: Reflux esophagitis was most commonly seen in male patients (64%), between 40-60 years (35%) of age with presenting complaints of heart burn and clinical diagnosis of reflux esophagitis. Classic histological feature for the diagnosis of reflux esophagitis was epithelial hyperplasia noted in 89% male and 86% female patients, followed by increased basal cell thickness noted in 66% male and 55% female patients.Conclusions: Accurate diagnosis of reflux esophagitis is mainly based on histomorphological features. Capillaries in epithelium and basal cell hyperplasia along with history and endoscopic appearance to be considered for the diagnosis of reflux esophagitis.

Soft Liver Phantom with a Hollow Biliary System

Hepatobiliary interventions are regarded as difficult minimally-invasive procedures that require experience and skills of physicians. To facilitate the surgical training, we develop a soft, high-fidelity and durable liver phantom with detailed morphology. The phantom is anatomically accurate and feasible for the multi-modality medical imaging, including computer tomography (CT), ultrasound, and endoscopy. The CT results show that the phantom resembles the detailed anatomy of real livers including the biliary ducts, with a spatial root mean square error (RMSE) of 1.7 ± 0.7 mm and 0.9 ± 0.2 mm for the biliary duct and the liver outer shape, respectively. The sonographic signals and the endoscopic appearance highly mimic those of the real organ. An electric sensing system was developed for the real-time quantitative tracking of the transhepatic puncturing needle. The fabrication method herein is accurate and reproducible, and the needle tracking system offers a robust and general approach to evaluate the centesis outcome.

Appendiceal Orifice Inflammation in Ulcerative Colitis Mimicking Mucosa-Associated Lymphoid Tissue Lymphoma in the Cecum

A 55-year-old Japanese woman, who had been diagnosed with ulcerative colitis at 18 years of age, underwent screening endoscopy examinations. Esophagogastroduodenoscopy revealed an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) of the stomach. Colonoscopy showed a slightly elevated reddish lesion with dilated microvessels but no erosions or ulcers. Although MALT lymphoma in the cecum was endoscopically suspected, flow cytometry and pathological analyses led to the diagnosis of appendiceal orifice inflammation in ulcerative colitis. This case highlights the diversity of the endoscopic appearance of appendiceal orifice inflammation in ulcerative colitis.