Ascariasis Causing Biliary Colic No abstract available

Acrodermatitis Enteropathica Associated With Inflammatory Bowel Disease No abstract available

Cholecystectomy Clip Migration and Retrieval No abstract available

Obstructive Jaundice Is Not Always Surgical! A 60-year-old diabetic man presented with a 1-month history of obstructive jaundice, weight loss of 16 kg, and fever and chills for more than 7 days. On examination, the patient was found to have deep icterus, tenderness in the right hypochondrium, and a palpable gall bladder. His laboratory parameters were hemoglobin 10.4 g/dL, total white blood cells 18.3 × 103/μL, serum total bilirubin 25.4 mg/dL, direct bilirubin 21.0 mg/dL, aspartate aminotransferase 66 U/L, alanine aminotransferase 73 U/L, and alkaline phosphatase 407 U/L. The serological markers for hepatitis B, hepatitis C, and human immunodeficiency virus were negative. An abdominal ultrasound revealed dilated biliary radicles and proximal common bile duct (CBD). A contrast enhanced computed tomography of abdomen and magnetic resonance cholangiopancreatography revealed a short-segment distal CBD stricture with proximal biliary dilation (Figure 1). An endoscopic ultrasonography showed a hypoechoic lesion involving the ampulla and the distal CBD (Figure 2). CA 19-9 was elevated to 1,026 U/mL, and the serum IgG4 (immunoglobulin G, subclass 4) level was measured to be 236 mg/dL. Under the cover of intravenous ceftriaxone for cholangitis, endoscopic retrograde cholangiopancreatography was performed. The papilla appeared bulky and prominent with surface ulceration. After precut biliary access and sphincterotomy, a plastic stent (10 Fr × 10 cm, Cotton-Leung; Cook Medical, Bloomington, IN) was deployed (Figure 3). Biopsies were taken from the cut surface of the ampulla. Figure 1 Figure 2 Figure 3 The histopathologic examination revealed storiform fibrosis around vessels and glandular structures surrounded by lymphocytes, plasma cells, and eosinophils. Most of the plasma cells were positive for IgG4 (50%) on immunohistochemistry, consistent with IgG4-related diseases (Figure 4). He was treated with oral prednisolone at 40 mg/day, tapered over 12 weeks. His serum bilirubin, transaminases, and CA19-9 gradually normalized after treatment. After biliary stent retrieval, a repeat magnetic resonance cholangiopancreatography imaging revealed a resolution of the distal CBD stricture (Figure 5). Figure 4 Figure 5 The IgG4-related sclerosing cholangitis (SC) can involve any part of the biliary tree, commonly presenting as SC or a pseudotumorous hilar lesion.1 It is associated with autoimmune pancreatitis in nearly 80%–90%.2 Hence, IgG4-SC, presenting as an ampullary pseudotumor with biliary stricture without autoimmune pancreatitis, as in the present case, is exceptional. Because IgG4-SC closely mimics cholangiocarcinoma, many such cases have been treated surgically.3 IgG4-SC responds dramatically to steroid therapy. Hence, IgG4-SC should be strongly considered among the differential diagnoses of indeterminate biliary obstruction to avoid an unwarranted surgery. Back to Top | Article Outline DISCLOSURES Author contributions: All authors contributed equally to the manuscript creation. C. Thoguluva Seshadri is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report. Back to Top | Article Outline REFERENCES 1. Zen Y, Nakanuma Y. IgG4 cholangiopathy. Int J Hepatol. 2012;2012:472376. Cited Here... 2. Okazaki K, Uchida K, Koyabu M, Miyoshi H, Ikeura T, Takaoka M. IgG4 cholangiopathy: Current concept, diagnosis, and pathogenesis. J Hepatol. 2014;61:690–5. Cited Here... 3. Ghazale A, Chari ST, Zhang L, et al. Immunoglobulin G4-associated cholangitis: Clinical profile and response to therapy. Gastroenterology. 2008;134(3):706–15. Cited Here... © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.

Atypical Gastric Ulcer With Impending Perforation due to Cocaine Use No abstract available

Esophageal Leukoplakia No abstract available

Endoscopic Piecemeal Snare Resection of a Giant Colonic Lipoma in a Patient With Intestinal Obstruction No abstract available

Endoscopic Treatment of Intussusception From Massive Colonic Lipomas via Endoscopic Mucosal Resection: A Case Series Although the safety and effectiveness of endoscopic resection of colonic lipomas has already been described, the ideal excisional technique continues to be debated. Notably, a majority of the proposed techniques focus on small, incidentally found lipomas. We report 3 patients with massive (≥8 cm) colonic lipomas presenting as intussusception that were successfully treated by piecemeal endoscopic mucosal resection. We propose endoscopic mucosal resection as the endoscopic treatment of choice and feasible alternative to surgery for the management of intussuscepting lipomas.

Cecal Bascule as a Rare Presentation of Cytomegalovirus Colitis in a Kidney Transplant Recipient Cecal bascule is a rare type of volvulus of the colon and requires a mobile cecum and ascending colon, which could be due to congenital or acquired anatomic abnormalities. Inflammatory conditions that cause acute changes in colonic mobility or motility may contribute to development of volvulus, as described in other types of colonic obstruction. Patients with risk factors for a mobile proximal colon presenting with obstructive symptoms should undergo prompt diagnostic evaluation for volvulus to allow for timely intervention. We report an unusual case of invasive cytomegalovirus colitis presenting as cecal bascule in a kidney transplant recipient.

Boerhaave Syndrome Causing Bilateral Empyemas Boerhaave syndrome is a perforation of the esophagus caused by a sudden increase in intraluminal pressure. It is known to be associated with left-sided pleural effusion and mediastinitis, but rarely presents with bilateral effusion. Its association with the presence of a hiatal hernia is unclear. We present a patient with a hiatal hernia who developed bilateral empyemas because of Boerhaave syndrome and was treated with an endoscopically placed esophageal stent.