IgG4 related disease as a mimicker of metastatic pancreatic cancer.

A previously healthy 62-year-old female was referred to our hospital for epigastric discomfort in the previous month. Routine laboratory tests showed lipase and pancreatic isoamylase elevation. CT scan revealed an homogeneous mass arising from the pancreatic head-uncinate process in addition to multiple bilateral hypoattenuating lesions in the renal cortex and pulmonary nodules. US-guided biopsy of one of the kidney lesions was performed under the suspicion of pancreatic metastatic disease.

Authors' response to "Straight plastic stents in tumors at the hepatic hilum and related duodenal perforation".

We appreciate the interesting comments from García Cano et al. regarding the complications derived from the use of plastic prostheses in hilar tumors. Indeed, most of the published case reports on duodenal perforations secondary to migrated biliary prostheses occurred with plastic stents, which may be related to the entrapment phenomenon described.

Endoscopic management of a duodenal perforation secondary to a migrated biliary plastic stent.

The migration of plastic biliary prostheses occurs in up to 14 % of patients undergoing biliary stenting. Duodenal perforation is a rare but very serious complication. A delay in diagnosis complicates management and worsens prognosis.

Acute gastric dilatation in a patient with anorexia nervosa.

A 43-year-old female with a history of anorexia nervosa presented to our hospital with diffuse abdominal pain and distension after a binge eating episode. Vital signs and routine laboratory test results were unremarkable, except for a slightly elevated white blood cell count (14.5 x 109/l). Abdominal radiography and computed tomography (CT) revealed a massively dilated stomach, with a craniocaudal measurement of 37 cm.