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Close follow-up of patients with liver cirrhosis has led to increased detection of hepatocellular carcinoma (HCC) at an early stage, especially with magnetic resonance imaging (MRI) innovations. We report the case of a 70-year-old man, with a recent history of liver cirrhosis due to chronic hepatitis C virus (HCV) complicated by hepatocellular carcinoma (HCC), and for whom trans-arterial chemoembolization (TACE) was planned, as the patient was assigned Child B7 at admission. Angiography performed during the first TACE cycle shows not only the “tumor blush” corresponding to previously detected HCC but also an additional small foci of HCC uptake seen within a large dysplastic nodule giving the appearance of “nodule-within-nodule.” Early detection of hepatocellular carcinoma improves prognosis. Hence, it is essential to be aware of all early aspects of HCC, including the nodule-within-nodule appearance on cross-sectional imaging, and also in angiography, as in this case.

Acute intestinal intussusception in adults is a rare condition, most often secondary to an organic lesion (tumor or inflammation), representing 1%-5% of intestinal obstructions. Pure colic intussusception on lipoma rectal causing bowel obstruction is an exceptional situation. A 60-year-old man presented to the emergency department for acute abdominal pain with marked abdominal distention and red rectal bleeding. A contrast-enhanced abdominal CT scan was performed, which revealed a recto-sigmoid intussusception on lipoma, causing mechanical intestinal obstruction. The patient underwent a partial reduction of the intussusception with partial sigmoid resection and end colostomy. Colonic lipomas of the recto-sigmoid region represent a very rare condition and a subsequent etiology for intussusception and bowel obstruction in adults. However, it should be considered in the differential diagnosis of such situations.

Liver damage during COVID-19 disease has been described in numerous studies. Its mechanism is poorly understood. It is mainly reserved for severe forms and is manifested by abnormalities of the hepatic assessment and more particularly cytolysis. Particular attention must be paid to patients with chronic liver disease, both in terms of follow-up and treatment. We wanted to know the evolution of COVID-19 and its treatment, on the liver function of a 27-year-old patient followed for chronic non-cirrhotic hepatitis B at the Hassan II University Hospital in Fez. Our patient had stopped the antiviral B treatment and presented COVID-19 infection with minimal to moderate impairment. The initial evaluation showed cytolysis at 4 times upper limit of normal (ULN). Management consisted in the immediate resumption of Tenofovir in combination with hydroxychloroquine (HCQ) and azythromycin with good clinical and biological evolution.

Bacillus Calmette and Guérin (BCG), widely used as a vaccination to prevent tuberculosis, is also used as immunotherapy, by intrabladder instillation, to treat superficial bladder cancers and prevent recurrence. Complications following instillation of BCG are most often localized reactions, such as cystitis or hematuria. They can more rarely be generalized and potentially severe such as hepatitis, pneumopathies, aortitis, and localization to hematopoietic tissue. We have reported the observation of a 47-year-old patient followed up for a bladder tumor operated for transurethral resection of the bladder, then having benefited from an instillation of BCG therapy complicated by occurrence a week later of an acute hepatitis. The diagnostic time was 2 days, and the outcome was favorable with corticosteroid therapy.

La maladie à IgG4 encore appelée polyexocrinopathie auto-immune à IgG4 est une nouvelle entité où s´inscrit la PAI de type 1. Elle peut toucher différents organes (système nerveux central, les glandes salivaires, la thyroïde, les poumons, le pancréas, les voies biliaires, le foie, le tube digestif, les reins, la prostate…) avec des symptômes relatifs à l´organe atteint. Elle est plus fréquente chez l´homme de plus de 50 ans. Son incidence et sa prévalence sont mal connues car c´est une maladie peu fréquente. Elle est a priori plus fréquente en Asie et ne représente que 20 à 30% des PAI en occident. Son diagnostic est histologique caractérisé par la présence, dans un contexte d´élévation sérique des IgG4 dans plus de 80% des cas, d´un infiltrat lymphoplasmocytaire dense de l´organe atteint avec positivité des IgG4 en immuno- histochimie, d´une fibrose d´organe et des veinulites oblitérantes. Elle est sensible à la corticothérapie avec un risque de rechute à l´arrêt de la corticothérapie qui n´est pas négligeable et qui conduit alors à l´utilisation d´immunomodulateurs, principalement: les thiopurines (Azathioprine ou le 6-mercaptopurine), le méthotrexate et de façon plus récente le rituximab qui peut être utilisé également comme traitement d´induction. Grâce aux avancées récentes, des critères histologiques et cliniques précis sont maintenant connus permettant de limiter les prises en charge inadaptées telle que la chirurgie. Cependant, de nombreuses lacunes persistent dans nos connaissances: sur la physiopathologie, l´identification de biomarqueurs spécifiques autres que les IgG4, l´histoire naturelle de la maladie et l´évaluation du risque de cancer à long terme, les performances des outils diagnostiques comme la biopsie pancréatique sous échoendoscopie. De même, une prise en charge consensuelle internationale reste à définir dans les phases initiales de la maladie et en cas de rechute. L´objectif de cette étude est de rapporter 3 cas de ML-IgG4 en se basant sur les critères cliniques et radiologiques, la réponse thérapeutique.

Hydatid disease HD or echinococcosis is a parasitic disease caused by Echinococcus granulosus. The prevalence of this parasitic disease in Morocco approximates 2 to 3% in highly endemic regions such Atlas Mountains. Liver is the main affected organ, and cholangitis is the most frequent complication of Hydatic liver cyst, however acute pancreatitis remain a very rare complication of the disease as showed by the very few cases reported in the literature. Its treatment combines the management of acute pancreatitis, endoscopic retrograde cholangiopancreatography (ERCP) and surgical treatment of the cyst. We report a series of 16 patients diagnosed for hydatid cyst of liver with pancreatitis at the University Hospital Hassan II to show the interest and outcomes of the management of such complication . We retrospectively review the clinical presentation and outcomes of management of 16 patients admitted for hydatid cyst of liver with acute pancreatitis at the department of hepato gastroenterology at the university Hospital Hassan II between January 2013 and July 2018. The average age of our patients was 44.33 years [20;66] with a female predominance. Only 12.5% (n = 2) of the patients had past history of surgical cure of liver hydatid cyst. All patients had acute pancreatitis associated with cholangitis. Abdominal CT scan showed oedematous pancreatitis in 87.5% (n = 14) and the necrotizing pancreatitis in 12.5% (n = 2). The common bile duct (CBD) was dilated in all patients and the kystobiliary fistula was identified in 68.75% (n=11).

L'iléus biliaire est une complication rare de la lithiase vésiculaire secondaire à une fistule cholécysto-duodénale avec passage d'un macrocalcul dans l'intestin grêle. L'occlusion est provoquée par le blocage du calcul au niveau de l'iléon. Nous rapportons le cas d'une patiente de 75 ans, présentant des vomissements avec des douleurs abdominales diffuses. L'IRM abdominal a objectivé une aérobilie importante, une vésicule biliaire atrophique associée à une occlusion grêlique terminale sur obstacle intraluminal. La laparotomie a objectivé la présence d'une fistule cholécystoduodénale, une vésicule biliaire scléro-atrophique avec la présence d'un calcul obstruant la lumière au niveau du grêle distal (à 1 mètre de la valvule de Bauhin); une enterolithotomie a été réalisé avec une cholécystectomie et fermeture du trajet fistuleux en un seul temps opératoire; les suites postopératoires ont été simples.