Vascular anatomy of strictured small bowel.

Aim: To investigate the role of ischemia in the pathogenesis of small bowel strictures. Methods: Vascular anatomy of 39 small bowel strictures was studied using modified Spalteholtz method. Ten normal small bowel segments were studied as controls. Results: 71.8% of small bowel strictures showed block in the mesenteric vessels (p=0.008). Subset analysis of tuberculous strictures showed block in the mesenteric vessels in 70.8% of strictures (p=0.0098). Conclusions: Ischemia plays a significant role in the pathogenesis of small bowel strictures. Mesenteric vasculopathy has a significant association with tuberculous strictures of the intestine.

Eosinophilic pancreatitis with pseudocyst.

Eosinophilic pancreatitis is a rare entity in patients having underlying systemic manifestations such as peripheral eosinophilia, elevated serum IgE levels and/ or eosinophilic infiltrates in other organs, including the gastrointestinal tract. We report a 38-year-old woman with peripheral eosinophilia in association with acute pancreatitis, pancreatic ascites and pseudocyst.

Portal biliopathy.

A young male with portal venous thrombosis presented with obstructive jaundice, due to common bile duct stricture secondary to portal biliopathy.

Safety of therapeutic ERCP in pregnancy - an Indian experience.

INTRODUCTION: Only limited data are available regarding the safety of therapeutic ERCP in pregnancy. We report our experience with therapeutic ERCP in pregnant women. METHODS: Medical records of 18 pregnant women (first trimester 4, second 6, third 8) who underwent ERCP between July 1994 and December 2004 were reviewed. Patients and their families were contacted to assess the well being of mother and baby. RESULTS: All the women underwent therapeutic ERCP and biliary sphincterotomy for common bile duct (CBD) stones. In 4 patients, 10-Fr CBD stents were inserted; three of these four cases required mechanical lithotripsy after delivery. Median procedure time was 17 min and median fluoroscopy time was 8 seconds. One patient each developed mild post ERCP pancreatitis and post sphincterotomy bleed. One woman had a preterm delivery. At follow up after a median of 6 years, all the babies were healthy. CONCLUSION: Therapeutic ERCP can be performed safely in all the trimesters of pregnancy provided appropriate precautions are taken.

Gall bladder agenesis, pancreas divisum and undescended testes: a rare association.

Gall bladder agenesis is a rare congenital biliary anomaly that may be associated with other biliary and extrabiliary congenital anomalies. We report the association of gall bladder agenesis with pancreas divisum and undescended testes.

Comparative study of omeprazole and famotidine in the treatment of duodenal ulcer.

In a double blind, multicenter, parallel group clinical trial in patients with symptomatic duodenal ulcers, 129 patients were randomized to receive either omeprazole 20 mg once daily (n = 65) or famotidine 40 mg once daily (n = 64) for 2 weeks, and if the ulcers were not healed, for a total of 4 weeks. Seventy four percent of these receiving omeprazole had healed ulcers after 2 weeks compared with 34.3% of those receiving famotidine (p < 0.001). At 4 weeks, the respective figures were 97.3% and 77.6% (p < 0.001). After 2 weeks of treatment, only 11.1% and 29.8% of omeprazole and famotidine treated patients respectively had day time pain (p < 0.02). Diary cards (successfully completed by 2/3rd of patients) showed that omeprazole treated patients required smaller amounts of antacids (p = ns). Over the first two weeks, ulcer healing rate was similar in smokers and non- smokers. No significant side effects were reported in either group. Omeprazole 20 mg/day provides more rapid relief of symptoms and heals a greater proportion of duodenal ulcers at 2 and 4 weeks than famotidine 40 mg/day.