Acute buried bumper syndrome: An endoscopic buried bumper syndrome:approach.

Acute buried bumper syndrome is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. If not recognized and treated appropriately, it can lead to serious complications including death. We report a case of an acute buried bumper syndrome, successfully managed with PEG tube repositioning through the original tract, without the need of replacement.

Gastric mucormycosis masquerading as malignancy in an immunocompetent host

Mucormycosis is an uncommon, fatal, fungal infection occurring more often in immunocompromised patients. Gastrointestinal mucormycosis is rare, and found primarily in patients with extreme malnutrition. This is a case report of a 76-year-old, well-nourished immunocompetent, non-diabetic male patient, who presented with urinary tract infection, for whom broad-spectrum antibiotics were administered. Reducing haemoglobin levels and occult blood positivity in stools prompted a gastroscopy, which showed a large ulcerated growth in the body of the stomach, suspicious of malignancy. Subsequent biopsy and histopathological examination revealed gastric mucormycosis. The patient was administered intravenous amphotericin B for 6 weeks. Complete recovery followed, as evidenced by a healed ulcer on gastroscopy and no fungal elements on biopsy. Although gastrointestinal mucormycosis has been reported with fatal outcome, our patient had complete recovery with only medical management and no surgical intervention, highlighting the importance of early diagnosis

Infiltrating Strongyloides stercoralis presenting as duodenal obstruction.

Small intestinal obstruction due to Strongyloides stercoralis is rare and has not been reported in an immunocompetent patient. We describe a 70-year-old immunocompetent man presenting with duodenal obstruction secondary to severe S. stercoralis infestation, as documented on duodenal biopsy. He was treated with ivermectin, with which he recovered remarkably.

Natural course of asymptomatic pancreatic pseudocyst: a prospective study.

AIM: To study the natural course of asymptomatic pseudocysts of the pancreas. METHODS: Thirty patients (age range 18-68 years, mean 44; 24 men) with asymptomatic pseudocysts of the pancreas were enrolled between December 2001 and December 2003, and were followed up every month. Those who developed symptoms due to pseudocyst (increasing pain or features of obstruction such as vomiting or jaundice) were subjected to an endoscopic or surgical drainage procedure. End point of the study was either spontaneous resolution of pseudocyst or drainage procedure. RESULTS: Eighteen (60%) of 30 patients had resolution of the pseudocyst over an average duration of 5 months. Maximum diameter of less than 7.5 cm and cyst volume less than 250 mL were significantly more frequent in patients with resolution of pseudocyst than in those without (14/18 vs 2/12 [p=0.001] and 15/18 vs 2/12 [p=0.0003], respectively). Presence of internal debris was associated with non-resolution (9/12 vs 2/18; p=0.001). CONCLUSION: Pseudocysts with less than 7.5 cm diameter, volume less than 250 mL, and absence of internal debris were associated with spontaneous resolution within an average duration of 5 months.