A Bridge to Banding: Splenic Artery Embolization in Hepatosplenic Schistosomiasis.

Schistosomiasis is a parasitic infection endemic to sub-Saharan Africa. The severe form of disease, caused by deposition of Schistosoma eggs in the portal vein, is known as hepatosplenic schistosomiasis. We present a case of a 26-year-old woman with esophageal varices in the setting of hepatosplenic schistosomiasis. This patient underwent partial splenic artery embolization to treat thrombocytopenia secondary to splenic sequestration. After embolization and improvement of cell counts, the patient was successfully able to undergo variceal band ligation.

A Rare Case of Primary Duodenal Plasmacytoma: An Incidental Finding.

Solitary extramedullary plasmacytoma (SEP) is a rare tumor due to the monoclonal proliferation of plasma cells without bone marrow involvement. Plasmacytomas are frequently encountered in bone or soft tissue but rarely occur in the gastrointestinal (GI) tract. They can present with a multitude of symptoms depending on their site. This report describes a case of SEP diagnosed as a duodenal ulcer (DU) during esophagogastroduodenoscopy (EGD) for iron deficiency anemia.

Colopancreatic Fistula: An Uncommon Complication of Recurrent Acute Pancreatitis.

Colonic complications, including colopancreatic fistulas (CPFs), are uncommon after acute and chronic pancreatitis. However, they have been reported and are serious. CPFs are less likely to close spontaneously and are associated with a higher risk of complications. Therefore, more definitive treatment is required that includes surgical and endoscopic options. We present a case of a 62-year-old male patient with a history of heavy alcohol intake and recurrent acute pancreatitis who presented with a 6-month history of watery diarrhea and abdominal pain. His abdominal imaging showed a possible connection between the colon and the pancreas. A further multidisciplinary workup by the gastroenterology and surgery teams, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and colonoscopy, resulted in a diagnosis of CPF. A distal pancreatectomy and left hemicolectomy were performed, and the diagnosis of CPF was confirmed intraoperatively. The patient showed improvement afterward.

Severe chronic diarrhoea secondary to primary lymph node gastrinoma.

The existence of primary lymph node (LN) gastrinoma is questionable and controversial. In fact, the presence of gastrinoma in such uncommon site raises the possibility of metastasis from another occult primary site. An extensive evaluation and careful follow-up is always warranted. A female aged 48 years presented with chronic abdominal pain and watery diarrhoea. Her serum gastrin and chromogranin were elevated, and an underlying gastrinoma was suspected. Further evaluation with an octreotide scan, an endoscopic ultrasound and a secretin stimulation test confirmed the diagnosis. Further evaluation for multiple endocrine neoplasia-1 syndrome was negative. She underwent a surgical enucleation near the head of the pancreas. No other lesions were found after careful exploration of the gastrinoma triangle. Histology showed a LN with a neuroendocrine tumour that tested positively with gastrin and chromogranin stains. Her symptoms resolved postoperatively, her serum gastrin normalised and a repeated octreotide scan was negative.

Role of endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in isolated pancreatic metastasis from lung cancer.

A case is reported of a 50-year-old woman with a history of small-cell lung cancer admitted with pancreatic head lesions, discovered during investigation for obstructive jaundice. Endoscopic ultrasound assisted fine needle aspiration of the pancreatic mass was consistent with small cell carcinoma, presenting as an isolated metastasis from the previously diagnosed lung cancer. Endoscopic retrograde cholangiopancreatography (ERCP) showed extrinsic compression and a bile duct stricture, requiring sphincterotomy and stent insertion. This case highlights that acute pancreatitis and biliary obstruction can occur as a manifestation of small cell lung cancer metastasizing to the pancreas. EUS is a safe, low risk and rapid diagnostic tool in such cases, and ERCP with stenting offers a safe and effective treatment option.

Clinicopathological predictors to predict sustained viral response rates in patients with chronic hepatitis C infection.

BACKGROUND: Treatment of patients with chronic hepatitis C virus (HCV) infection remains suboptimal, with the current pegylated interferon (PEG-IFN) and ribavirin combination therapy providing sustained viral response (SVR) rates of 54 - 63%. The aim of this study was to identify clinical, laboratory and histological findings that can predict non-response to this treatment. METHODS: Medical records of patients who had completed PEG-IFN and ribavirin therapy for chronic HCV infection between December 2002 and November 2005 and had undergone a liver biopsy prior to starting treatment were retrospectively reviewed. Data on various clinical and biochemical parameters were extracted and liver biopsy slides were reviewed by a pathologist who was blinded to the clinical and laboratory findings. RESULTS: Of 67 patients studied (mean [SD] age 46.3 [6.3] years; 36 men), 42/57 (74%) had an early viral response (EVR) and 37/64 (58%) had an SVR. On univariate analysis, absence of EVR (p=0.0002), non-white race (p=0.008), AST/ALT ratio > or = 1.0 (p=0.008), INR > or = 1.0 (p=0.02) and presence of steatosis > or = 5% on liver biopsy (p=0.03) were associated with lack of SVR. In multivariate analysis, all of these except INR were significant independent predictors of SVR. CONCLUSIONS: Absence of EVR, non-white race, AST/ALT ratio > or = 1.0 and presence of steatosis > or = 5% on liver biopsy are independent predictors of absence of SVR in patients with chronic HCV infection receiving PEG-IFN and ribavirin combination treatment.