Recurrent Choledocholithiasis: Unveiling the Diagnostic Challenges of Profound Transaminitis Post Cholecystectomy.

BACKGROUND Profound transaminitis (>1000 international units per liter [IU/L]) is typically associated with ischemic and viral or toxic hepatitis. Pancreaticobiliary causes are less likely to be included in the workup, especially in patients who have undergone cholecystectomy. We present a case of recurrent choledocholithiasis in a 52-year-old woman 7 years after cholecystectomy, presenting with severe transaminitis, illustrating the diagnostic challenges of this presentation. CASE REPORT A 52-year-old woman presented to the Emergency Department (ED) with acute upper abdominal pain. Computed tomography (CT) of the abdomen without contrast showed no abnormalities and mild common bile duct (CBD) dilation was noted on ultrasound (US) abdomen. Laboratory studies were significant for elevated transaminases greater than 1000 units/L and alkaline phosphatase (ALP) greater than 200 units/L. She was diagnosed with acute hepatitis of unknown etiology without undergoing further investigation of the biliary tract and was discharged after improvement with supportive therapy. She returned 4 months later with similar symptoms and laboratory findings, but with more CBD dilation and intrahepatic biliary dilation on CT and US. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, and multiple stones and sludge were removed from the CBD. CONCLUSIONS This report has shown that pancreaticobiliary causes should be included in the workup of severe transaminitis, even in patients with a remote history of cholecystectomy. Failure to do so may subject patients to extensive, unnecessary workup and delay correct management.

Rare case of pediatric trauma with hepatic injury managed using gel-foam embolization: a case report.

Nonoperative management for hepatic injuries requires observation and supportive care in the case of hemodynamically stable patients. If there is active bleeding on presentation, hepatic artery embolization is an option to achieve hemostasis in the acute setting. Although interventional radiology procedures are well documented in adults, there is limited literature regarding these procedures in the pediatric population. In this report, we present a case of a pediatric patient who sustained blunt abdominal trauma, resulting in a grade IV liver injury. Treatment involved fluoroscopically guided right hepatic segmental arterial gel-foam embolization.

An unusual case of gallstone ileus within the cecum and ascending colon: a case report.

Gallstone ileus is a rare cause of intestinal obstruction. Due to long-standing inflammation of the gallbladder, fistulization can occur within nearby structures, most commonly to the duodenum or hepatic flexure of the colon. Through these fistulas, a stone can migrate and result in a small bowel obstruction or a large bowel obstruction. This case exemplifies the diagnosis and treatment of gallstone ileus, along with potential complications due to stone migration. Early recognition and treatment of gallstone ileus is important, as stone migration can lead to increased mortality with delayed diagnosis.

Adult Colo-Colonic Intussusception in the Setting of Invasive Mucinous Adenocarcinoma: A Case Report.

BACKGROUND Colonic intussusception is a very rare disease in adults, and if present, is usually manifested by another pathology, such as malignancy. This report describes the diagnosis and treatment of the underlying cause of intussusception, which was spontaneously reduced. CASE REPORT A 39-year-old woman with no significant past medical history presented to St. Joseph's University Medical Center on July 2022 with gradually worsening abdominal pains for 1 year and hematochezia for 3 months. Physical examination was positive for left lower quadrant abdominal tenderness to palpation. A computed tomography scan of the abdomen and pelvis without contrast showed a long segment of intussusception involving the sigmoid colon and rectum, without any noticeable lesions. A repeat computed tomography scan with rectal contrast showed a 2.1×1.1-cm mesenteric mass in the sigmoid colon at the region of the intussusception. The patient was taken for a laparoscopic sigmoid resection with primary anastomosis, showing a 5-cm mass in the sigmoid colon, and surgical pathology confirming neoplastic etiology of intussusception. The patient recovered well after surgery, and was referred for oncological intervention soon afterward. CONCLUSIONS This report displays the importance of the type of imaging modalities with and without contrast to diagnosis and determine underlying causes of intussusception and further guide treatment options.