We present the first case reported in the literature describing spontaneous liver haemorrhage due to diffuse arterioportal fistulae. A 48-year old Caucasian woman was admitted to the hospital complaining of acute epigastric pain eradiating to the right shoulder. Patient never had any penetrating or blunt abdominal trauma in the past nor any intervention on the liver. CT scan of the abdomen revealed a subcapsular haematoma originating from two bleeding sites in the right liver lobe. Arteriography of the common hepatic artery showed opacification of the portal branches, indicative of an arterioportal fistula. A hypertrophic feeding branch of the right hepatic artery was then embolized, resulting in disappearance of the fistula. After complete resolution of the haematoma, investigations to detect underlying liver lesions were repeatedly negative. Therefore we conclude that a diffuse congenital arterioportal fistula was the cause of spontaneous bleeding. This is to our knowledge the first case in whom a spontaneous liver bleeding secondary to diffuse arterioportal fistulisation is reported. A review of the literature regarding arterioportal fistulas and regarding the possible aetiology of spontaneous liver haematomas is provided.

Abdominal tuberculosis can mimic any disease affecting the gastrointestinal tract such as infectious processes, tumors, periappendiceal abscess, and Crohn's disease. The differential diagnosis of Crohn's disease and intestinal tuberculosis is a dilemma to clinicians and pathologists as both are chronic granulomatous disorders with similar clinical features. Lower gastrointestinal bleeding is an infrequent presentation of both intestinal tuberculosis and Crohn's disease. Herein, we report a 56-year-old woman presenting with massive hematochezia due to isolated colon tuberculosis in whom the initial diagnostic work-up suggested Crohn's disease and review the current literature. Our report highlights the need for awareness of colonic tuberculosis in the differential diagnosis of massive hematochezia from Crohn's disease, especially before initiating treatment with immunosuppressive agents.

Gallbladder cancer presenting as acute cholecystitis associated with a hemocholecyst is a rare entity. Up to date there are only 2 cases reported in literature. Acute cholecystitis may appear secondary to an obstruction of the cystic duct by the tumour itself or to an obstruction of the cystic duct by blood clots.

CASE REPORT:

A 74-years-old woman complained of right upper quadrant pain during the last 48 hours, associated to fever of 38 degrees C and vomits. Physical examination revealed a positive Murphy's sign. Laboratory data showed leukocytosis and mild increasement of liver enzymes. Ultrasonography revealed a mobile extense formation located antigravitatorily in fundus and body of the gallbladder. CT scan showed a mass adhered to the fundus and the body of the gallbladder without wall infiltration and contrast enhancement, suggestive of hemocholecyst. Laparoscopic cholecystectomy was performed, observing cholecystitis signs without any other relevant features. Pathology revealed a large amount of clotted blood inside the gallbladder, some of them obstructing the cystic duct; an irregularity was discovered in the gallbladder wall, whose microscopic analysis revealed a gallbladder adenocarcinoma, infiltrating up to the serosa (T3NxMx). The patient underwent a second operation with resection of the gallbladder bed and lymph node dissection of the hepatic hilium, without evidence of neoplastic infiltration.

Pancreatic ductal adenocarcinoma (PDAC) remains a major unsolved health problem. As conventional treatments have shown only a modest impact on disease course, development of new therapeutic strategies based on the molecular biology of PDAC must be a high priority. The identification of relevant predictive and prognostic biomarkers which can be used to select patient subgroups that may benefit from conventional treatments and new targeted agents will be of considerable interest. We have demonstrated the ability of the metabolizing gemcitabine protein (the human Equilibrative nucleoside transporter 1 and the deoxycytidine kinase) in predicting the benefit of adjuvant gemcitabine-based therapy in resected PDAC patients. Beside these predictive biomarkers, we have evaluated different molecular factors that may impact on the likely course of this cancer. The chemokine receptor CXCR4 that has been shown to be implicated in PDAC tumorigenicity and aggressiveness could serve as a prognostic marker for survival after a curative-intent surgery and was associated with the pattern of tumour recurrence (distant versus local relapse). Our findings were validated in an independent cohort of patients. Overall our results suggested that (i) the benefit of an adjuvant gemcitabine-based therapy can be predicted based on the tumour expression of hENT1 and dCK, (ii) CXCR4 is an independent negative prognostic factor and an independent predictor of distant relapse suggesting that anti-CXCR4 targeting therapies can be a promising treatment in combination with cytotoxic chemotherapy in the adjuvant setting. These data open new perspectives for designing trials based on a molecular driven strategy.

Magnetic Resonance enterography (MRE) is an imaging modality avoiding ionizing radiation and the discomfort associated with enteroclysis. The results of MRE at diagnosis in the patients of the Belgian pediatric Crohn registry (Belcro) are compared to endoscopical and histological results.Results of MRE, endoscopy and histology were obtained from the medical charts and assigned to one of the following segments: jejunum, ileum, ascending colon, transverse colon, descending colon or rectosigmoid. MRE images were reviewed in a blinded way by 4 radiologists with specific interest in pediatric MRE.From the Belcro registry, twenty-two patients underwent a MRE during their work-up for Crohn disease. The results of endoscopy, histology and MRE were concordant (either all negative or positive) in the ileum in 16/18 patients and in the rectosigmoid, descending colon, transverse colon and ascending colon in resp 9, 8, 8 and 8/22 patients. In the non-concordant cases (MRE colon negative but endoscopy and/or histology positive), MRE could not reflect the subtle endoscopic or histologic lesions such as erosions that were described.In 4 cases where ileocaecal valve intubation was impossible ileal MRE findings were abnormal. MRE detected ileal stenosis, jejunal lesions and fistula in resp 4/22, 3/22 en 2/22 patients. The 100% and 75% interobserver agreement was resp 50-82% and 773-100% according to the different intestinal segments.MRE is a promising imaging modality avoiding radiation in Crohn disease. It should probably become the technique of first choice for the evaluation of extensive small bowel disease in children with Crohn disease.