Subject(s)
Anti-HIV Agents/adverse effects , Colitis/chemically induced , Colitis/pathology , HIV Infections/drug therapy , Heterocyclic Compounds, 3-Ring/adverse effects , Anti-HIV Agents/administration & dosage , Colon/pathology , Female , Heterocyclic Compounds, 3-Ring/administration & dosage , Histocytochemistry , Humans , Microscopy , Oxazines , Piperazines , PyridonesABSTRACT
Intramural duodenal hematoma is a rare cause of a proximal gastrointestinal tract obstruction. Presentation of intramural duodenal hematoma most often occurs following blunt abdominal trauma in children, but spontaneous non-traumatic cases have been linked to anticoagulant therapy, pancreatitis, malignancy, vasculitis and endoscopy. We report an unusual case of spontaneous intramural duodenal hematoma presenting as an intestinal obstruction associated with acute pancreatitis in a patient with established von Willebrand disease, type 2B. The patient presented with abrupt onset of abdominal pain, nausea, and vomiting. Computed tomography imaging identified an intramural duodenal mass consistent with blood measuring 4.7 cm × 8.7 cm in the second portion of the duodenum abutting on the head of the pancreas. Serum lipase was 3828 units/L. Patient was managed conservatively with bowel rest, continuous nasogastric decompression, total parenteral nutrition, recombinant factor VIII (humateP) and transfusion. Symptoms resolved over the course of the hospitalization. This case highlights an important complication of an inherited coagulopathy.
Subject(s)
Duodenal Diseases/etiology , Hematoma/etiology , von Willebrand Disease, Type 2/complications , Abdominal Pain/etiology , Acute Disease , Blood Transfusion , Coagulants/therapeutic use , Combined Modality Therapy , Decompression , Duodenal Diseases/diagnosis , Duodenal Diseases/therapy , Duodenal Obstruction/etiology , Endoscopy, Digestive System , Endosonography , Factor VIII/therapeutic use , Hematoma/diagnosis , Hematoma/therapy , Humans , Male , Nausea/etiology , Pancreatitis/etiology , Parenteral Nutrition, Total , Tomography, X-Ray Computed , Treatment Outcome , Vomiting/etiology , Young Adult , von Willebrand Disease, Type 2/diagnosis , von Willebrand Disease, Type 2/therapyABSTRACT
Several case reports on endoscopic resection of minor papilla adenomas exist in the literature. However, there are no reported cases of endoscopic resection in patients with minor papilla adenomas with associated familial adenomatous polyposis (FAP) and pancreas divisum. We report a case of a minor papilla adenoma in a patient with FAP and pancreas divisum. The case demonstrates a new association between these disease processes. Defining pancreatic ductal anatomy prior to endoscopic intervention is essential. In addition, we demonstrate the safety and feasibility of endoscopic management of minor papilla tumors in patients with FAP and associated pancreas divisum.
ABSTRACT
Cystic neoplasms of the pancreas are increasingly recognized due to the expanding use and improved sensitivity of cross-sectional abdominal imaging. Major advances in the last decade have led to an improved understanding of the various types of cystic lesions and their biologic behavior. Despite significant improvements in imaging technology and the advent of endoscopic-ultrasound (EUS)-guided fine-needle aspiration, the diagnosis and management of pancreatic cystic lesions remains a significant clinical challenge. The first diagnostic step is to differentiate between pancreatic pseudocyst and cystic neoplasm. If a pseudocyst has been effectively excluded, the cornerstone issue is then to determine the malignant potential of the pancreatic cystic neoplasm. In the majority of cases, the correct diagnosis and successful management is based not on a single test but on incorporating data from various sources including patient history, radiologic studies, endoscopic evaluation, and cyst fluid analysis. This review will focus on describing the various types of cystic neoplasms of the pancreas, their malignant potential, and will provide the clinician with a comprehensive diagnostic approach.
Subject(s)
Pancreatic Cyst/diagnosis , Pancreatic Neoplasms/diagnosis , Algorithms , Cholangiopancreatography, Endoscopic Retrograde , Diagnosis, Differential , Endosonography , Female , Humans , Magnetic Resonance Imaging , Male , Pancreatic Neoplasms/classification , Tomography, X-Ray ComputedABSTRACT
The past decade has brought tremendous growth in the under-standing of the pathophysiologic mechanisms involved in cholestasis, both at the genetic and acquired levels. The discovery and characterization of an array of hepatobiliary transport proteins, the nuclear receptors that regulate them, and the potential clinical implications of these defective, altered, or variably expressed proteins are the key elements of our current understanding of cholestasis. It is hoped that future studies will enhance therapeutic options and the ability to care for patients with cholestatic disorders.
