{"id":2377,"date":"2021-10-06T13:54:23","date_gmt":"2021-10-06T11:54:23","guid":{"rendered":"https:\/\/angh.net\/abstracts\/une-rectite-mysterieuse\/"},"modified":"2021-10-06T13:54:23","modified_gmt":"2021-10-06T11:54:23","slug":"une-rectite-mysterieuse","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/une-rectite-mysterieuse\/","title":{"rendered":"Une rectite myst\u00e9rieuse.."},"content":{"rendered":"<p><strong>2021<\/strong><\/p>\n<p><em>Amine Alam (1), Thomas Severyns (2), Vincent de Parades (1)<\/p>\n<p>1\/ Service de proctologie m\u00e9dico-chirurgicale du GHPSJ Paris-France<br \/>\nInstitut L\u00e9opold Bellan<br \/>\n2\/ Service d\u2019H\u00e9pato-gastroent\u00e9rologie de l\u2019HEGP Paris-France<\/em><\/p>\n<p><strong>Gastroent\u00e9rologie <\/strong>&#8211; \u00a02021-04-28 &#8211;\u00a0CC &#8211;<\/p>\n<p>________________________________<\/p>\n<p>Cas clinique<br \/>\nIl s\u2019agit d\u2019un patient \u00e2g\u00e9 de 65 ans ayant pour seul ant\u00e9c\u00e9dent un syndrome de Guillain-Barr\u00e9 attribu\u00e9 \u00e0 une vaccination contre le virus B.<br \/>\nSon histoire clinique remonte \u00e0 ao\u00fbt 2019 avec l\u2019apparition d\u2019un syndrome rectal et de douleurs pelviennes.<br \/>\nUne coloscopie en f\u00e9vrier 2020 retrouve une colite \u0153d\u00e9mateuse \u00e9rosive et ulc\u00e9r\u00e9e allant du rectum jusqu\u2019au c\u00f4lon transverse avec un sigmo\u00efde sain dont l\u2019analyse histologique d\u00e9crit des \u00ab remaniements inflammatoires subaigus \u00bb sans granulome visible.<br \/>\nIl y a \u00e9galement une fissure anale marginale post\u00e9rieure d&rsquo;allure chronique.<br \/>\nUne IRM ano-p\u00e9rin\u00e9ale en juin r\u00e9v\u00e8le une probable collection intersphinct\u00e9rienne et intramurale post\u00e9ro-lat\u00e9rale gauche qui est palpable et tr\u00e8s douloureuse \u00e0 l\u2019examen clinique.<br \/>\nUn examen sous anesth\u00e9sie confirme le bombement pari\u00e9tal mais ne permet pas l\u2019\u00e9vacuation de pus.<br \/>\nLe reste du bilan est par ailleurs sans particularit\u00e9 :<br \/>\n&#8211; Biologie standard<br \/>\n&#8211; S\u00e9rologies du VIH et de la syphilis<br \/>\n&#8211; Pr\u00e9l\u00e8vements locaux \u00e0 vis\u00e9e infectieuse<br \/>\n&#8211; Quantif\u00e9ron<br \/>\n&#8211; Scanner thoracique<br \/>\n&#8211; Endoscopie digestive haute.<br \/>\nUn traitement par adalimumab est d\u00e9but\u00e9 en juillet sans aucun effet sur la g\u00eane clinique.<br \/>\nIdem pour une corticoth\u00e9rapie par voie orale administr\u00e9e en ao\u00fbt.<br \/>\nUn nouveau bilan est donc r\u00e9alis\u00e9 en septembre.<br \/>\nL\u2019IRM ano-p\u00e9rin\u00e9ale montre une \u00ab rectite intense, sans trajet fistuleux, ni collection visible \u00bb ainsi que des \u00ab ad\u00e9nopathies r\u00e9actionnelles \u00bb<br \/>\nLa coloscopie montre un aspect boursoufl\u00e9 et inflammatoire de la muqueuse avec mise \u00e0 nue de la sous muqueuse sur plusieurs centim\u00e8tres \u00e0 plusieurs endroits, avec un aspect fibrineux et n\u00e9crotique. Les l\u00e9sions sont maximales au niveau du bas rectum.<\/p>\n<p>Quel est votre diagnostic ?<\/p>\n<p>Diagnostic (exceptionnel), traitement (difficile) et \u00e9volution (pr\u00e9occupante) \u00e0 Avignon !<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2021 Amine Alam (1), Thomas Severyns (2), Vincent de Parades (1) 1\/ Service de proctologie m\u00e9dico-chirurgicale du GHPSJ Paris-France Institut L\u00e9opold Bellan 2\/ Service d\u2019H\u00e9pato-gastroent\u00e9rologie de l\u2019HEGP Paris-France Gastroent\u00e9rologie &#8211; \u00a02021-04-28 &#8211;\u00a0CC &#8211; ________________________________ Cas clinique Il s\u2019agit d\u2019un patient \u00e2g\u00e9 de 65 ans ayant pour seul ant\u00e9c\u00e9dent un syndrome de Guillain-Barr\u00e9 attribu\u00e9 \u00e0 une [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[34],"class_list":["post-2377","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-34"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - 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