ABSTRACT
Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure which carries a complication rate of 5-10%. Splenic injury is a very rare and potentially lethal complication following ERCP. We report a case of a 64-year-old man with a mass at the pancreatic head and obstructive jaundice, who sustained a splenic injury following ERCP. Six hours after the procedure, the patient presented with epigastric pain and hypotension. The abdominal CT scan revealed splenic hematoma. He was offered surgical treatment. Splenectomy was performed with enterogastrostomy.
ABSTRACT
A 20-year-old woman was admitted with iron deficiency anemia and history of melena. Upper endoscopy demonstrated normal esophagus, stomach and proximal duodenum. At colonoscopy, two bluish pedunculated angiectatic polypoid lesions (1 to 2 cm in diameter) were noted due to blue rubber bleb nevus syndrome (BRBNS). The small intestine was screened for further lesions with the use of capsule endoscopy. The capsule identified four more lesions at the proximal jejunum. The small bowel lesions were smaller, 0.5 to 1cm in diameter at their bases. We performed enteroscopy to approach the jejunal lesions. All lesions were ligated in one session using the band ligation technique with multi-band ligator device. A colonoscopy was performed and detachable snares - endoloops were inserted at the colonic lesions. Three weeks following the interventions further endoscopic evaluations were performed; they revealed scars at all sites treated with either technique. No bleeding or new venous malformations were observed. In conclusion, we report a dual technique resection method on a patient with BRBNS. The choice of resection technique depended on the lesion characteristics. Both band ligation and endoloop can be safely used for polypoid BRBNS lesions at the jejunum and colon respectively.
