Professional Documents
Culture Documents
Gastroenterology-Solved!
Dr. S.P. Hewawasam
Honorary Consultant Gastroenterologist/
Senior Lecturer in Physiology
Faculty of Mecicine-University of Ruhuna
1)Schatzki ring
3.1) Trichobezoar
3.2) Trichotillomania-pulling of hair
3.3) Obsessive-Compulsive disorder(OCD)
Associated with the psychiatric conditiontrichophagia
Most trichobezoars are difficult to remove
endoscopically and surgical removal is
needed
Other bezoars- Pharmacobezoars,
Phytobezoars
Most patients have psychiatric
disturbances/ mental retardation
Rapunzel syndrome- A trichobezoar
extending into terminal ileum
Endoscopic appearance of a
trichobezoar
This patient was referred for UGIE because his mother died of a
breast cancer.
4) What is the diagnosis?
4)Peutz-Jeghers Syndrome
Hamartomatous polyps.
Most common in small bowel 60-90%
esp jejunum. Stomach 15-30%, Colon
50%
50% asymptomatic at diagnosis.
Can present with bleeding , obstruction,
intussusception(in upto 70%).
5.1)
5.2)
7.1) Laparoscopy
7.2) Double balloon enteroscopy and endoscopic tattooing
7.3) A-Meckel diverticulum
B-Endoscopic tattoo
This patient presented with low grade fever and right upper quadrant
pain for 5 days. Serum total Billirubin and Alkaline phosphatase were
normal and U.S.S abdomen was negative on 2 occasions on day 1
and day 5. Subsequently he underwent this investigation.
10.1) What is this investigation?
10.2) What is the diagnosis?