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- Intraluminal duodenal ("Windsock") diverticulum: a rare cause of gastrointestinal bleedingPublication . Eusébio, Marta; Ramos, André; Guerreiro, HorácioIntraluminal duodenal diverticulum (IDD), also known as ‘‘windsock’’ diverticulum, is a rare congenital abnormality that seems to result from an incomplete recanalization of the foregut lumen. Symptoms usually do not appear until the third decade of life (...).
- Olmesartan-induced enteropathy: an unusual cause of villous atrophyPublication . Eusébio, Marta; Caldeira, Paulo; Antunes, Artur Gião; Ramos, André; Velasco, Francisco; Cadill, Jesús; Guerreiro, HoracioWe report a case of a 63-year-old-man presenting with chronic diarrhea and weight loss while on olmesartan treatment for hypertension. Investigation showed multiple nutritional deficiencies associated with diffuse intestinal villous atrophy. Serologies for celiac disease were negative and other causes of villous atrophy were excluded. Olmesartan as a precipitant agent was suspected and withdrawn. Clinical improvement occurred in days with no need for other therapeutic measures. Follow-up at three months showed clinical remission and almost complete recovery of intestinal atrophy. Olmesartan is an angiotensin receptor blocker commonly prescribed for the management of hypertension. Spruelike enteropathy associated with this drug is a recently described entity with few cases reported. It presents with chronic diarrhea and intestinal villous atrophy and should be included in its differential diagnosis. This case intends to alert clinicians for the possibility of this event in a patient on treatment with this drug.
- Risk factors for severity and recurrence of colonic diverticular bleedingPublication . Joaquim, Natércia; Caldeira, Paulo; Antunes, Artur; Eusébio, Marta; Guerreiro, HoracioBackground: Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding. Risk factors related to severity and repeated bleeding episodes are not completely clearly defined. Objective: To characterize a Portuguese population hospitalized due to colonic diverticular bleeding and to identify the clinical predictors related to bleeding severity and rebleeding. Methods: Retrospective analysis of all hospitalized patients diagnosed with colonic diverticular bleeding from January 2008 to December 2013 at our institution. The main outcomes evaluated were bleeding severity, defined as any transfusion support requirements and/or signs of hemodynamic shock, and 1-year recurrence rate. Results: Seventy-four patients were included, with a mean age of 75.7 +/- 9.5 years; the majority were male (62.2%). Thirty-six patients (48.6%) met the criteria for severe bleeding; four independent risk factors for severe diverticular bleeding were identified: low hemoglobin level at admission (<= 11 g/dL; OR 18.8), older age (>= 75 years; OR 4.7), bilateral diverticular location (OR 14.2) and chronic kidney disease (OR 5.6). The 1-year recurrence rate was 12.9%. We did not identify any independent risk factor for bleeding recurrence in this population. Conclusion: In this series, nearly half of the patients hospitalized with diverticular bleeding presented with severe bleeding. Patients with low hemoglobin levels, older age, bilateral diverticular location and chronic kidney disease had a significantly increased risk for severe diverticular bleeding. In addition, a small number of patients rebled within the first year after the index episode, although we could not identify independent risk factors associated with the recurrence of diverticular bleeding.
- Ulcerative colitis: let's talk about extentPublication . Vaz, A.; Eusébio, Marta; Antunes, A.; Queiros, P.; Gago, T.; Belo, T.; Caldeira, Paulo; Guerreiro, H.Ulcerative colitis (UC) is a chronic inflammatory disease in which clinical course varies substantially between patients. The extent of the disease is usually pointed out as one of the factors responsible for this variation. With this study, we pretended to evaluate the differences in natural history and pharmacological therapy prescription between left-sided and extended UC.
- A case of sclerosing angiomatoid nodular transformation of the spleen: Imaging and histopathological findingsPublication . Eusébio, Marta; Sousa, Ana Lucia; Vaz, Ana Margarida; da Silva, Silvia Gomes; Milheiro, Maria Adelaide; Peixe, Bruno; Caldeira, Paulo; Guerreiro, HorácioA 62-year-old woman presented with left upper quadrant pain and anorexia for 1 month. She had a past medical history of nephrolithiasis, extramembranous glomerulonephritis and a relevant atopic background. Physical examination as well as laboratory tests were unremarkable. Abdominal computed tomography, performed without endovenous contrast due to patient’s atopic history, highlighted a nodular density between the pancreatic tale and splenic hilum. On unenhanced magnetic resonance imaging this corresponded to a vascular structure, next to the spleen, with a ‘‘serpentine’’ shape and apparently in continuity with this organ. Additionally, within the spleen there were three, well circumscribed, macronodular lesions, with lobular borders, the biggest measuring 2.5 cm in greater diameter. These lesions were isointense on T1-weighted sequences and hypointense with mildly hyperintense septa on T2 and FATSAT Fiesta sequences. No other relevant lesions were identified.