ABSTRACT
Endoscopic retrograde cholangio-pancreatography (ERCP) is a diagnostic, therapeutic technique for the management of pancreato-biliary conditions. Technical contraindications include the presence of intraluminal foreign bodies precluding endoscope passage. Intragastric balloon (IGB) is a bariatric procedure that provides sensations of early fullness and satiety from intragastric occupation, thus leading to weight loss. While, according to guidelines, choledocholithiasis and cholangitis do not represent an indication for IGB removal in contrast to moderate-severe pancreatitis, where need for an ERCP and the procedure's technical difficulty most commonly require it. We report the case of a female patient with an IGB where ERCP was indicated. CASE REPORT: A 47-year-old woman visited the emergency room for epigastric abdominal pain radiating to her back. She had jaundice without pyrexic symptoms. At the ER an ultrasonogram revealed cholelithiasis and a dilated common bile duct (11 mm in diameter), no cause being then identified. Lab tests rule out pancreatic involvement and associated infection. The patient had an IGB (Photo 1a) implanted 5 months before the present episode. She was admitted to the gastroenterology ward with choledocholithiasis as suspected diagnosis. The study was completed by endoscopic ultrasound (EUS), which confirmed a dilated hepatocholedochal duct at 15.3 mm in diameter (Photo 1b), secondary to multiple choledochal stones. A direct ERCP procedure was initiated where the IGB precluded rectification and proper placement, which forced the use of a double-guidewire technique for cannulation (Photo 1c)5. Sphincterotomy and sphincteroplasty to 10 mm ensued, and 8 stones were removed using a balloon and then a basket catheter (Photo 1d). The patient was discharged at 24 hours after the procedure with no complications. DISCUSSION: No prior studies are available that describe the possibility of therapeutic ERCP for choledocholithiasis in IGB-carrying patients; in most cases IGB removal is taken for granted because of the procedure's technical difficulty. Our case report may well show a safe alternative to IGB removal by using less conventional cannulation techniques without higher complication rates. However, further cases are needed in order to draw significant conclusions regarding their widespread use.
ABSTRACT
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Subject(s)
Humans , Female , Adult , Bronchogenic Cyst/diagnostic imaging , Bronchogenic Cyst/microbiology , Superinfection/diagnosis , Candidiasis, Invasive/diagnosis , Tomography, X-Ray Computed , Magnetic Resonance Imaging , Bronchogenic Cyst/surgery , Biopsy, Fine-Needle , EndosonographyABSTRACT
Bronchogenic cysts (BC) are rare congenital anomalies that result from abnormal budding of the tracheobronchial tree during fetal development. BC are usually located in the lung and the mediastinum, an abdominal location is unusual.
Subject(s)
Bronchogenic Cyst , Saccharomyces cerevisiae , Bronchogenic Cyst/complications , Bronchogenic Cyst/diagnostic imaging , Bronchogenic Cyst/surgery , Humans , Lung , MediastinumABSTRACT
Las metástasis colónicas secundarias a neoplasia de mama son infrecuentes. El subtipo lobulillar infiltrante es el que suele metastatizar con mayor frecuencia debido a su diseminación peritoneal. Se presenta el caso clínico de una mujer de 67 años intervenida quirúrgicamente con posterior radioterapia y quimioterapia adyuvante de neoplasia de mama subtipo lobulillar hace diez años. La paciente se encuentra actualmente en remisión clínica. Se le realiza colonoscopia debido a síndrome general de reciente comienzo con hallazgos compatibles con linitis plástica colónica secundaria a infiltración por células neoplásicas de carcinoma lobulillar infiltrante (CLI) de mama. En conclusión, la linitis plástica colónica puede ser una nueva forma de presentación de las metástasis colónicas secundarias a CLI de mama
Colon metastases from breast carcinoma are relatively rare and the invasive lobular subtype tends to metastasize more frequently due to its peritoneal dissemination. A 67-year-old female with a lobular subtype breast neoplasm was treated via a surgical resection ten years previously, with subsequent radiotherapy and adjuvant chemotherapy. She is currently in clinical remission. A colonoscopy was performed due to a recent onset cachexia syndrome, which identified diffuse linitis plastica of the colon. Biopsies confirmed that it was secondary to infiltration by cancer cells of invasive lobular breast carcinoma (ILBC). In conclusion, linitis plastica of the colon may be a new presentation of colon metastases from ILBC
Subject(s)
Humans , Female , Middle Aged , Breast Neoplasms/pathology , Colonic Neoplasms/pathology , Linitis Plastica/pathology , Carcinoma, Lobular/pathology , Colonic Neoplasms/secondary , Neoplasm Metastasis/pathologyABSTRACT
Colon metastases from breast carcinoma are relatively rare and the invasive lobular subtype tends to metastasize more frequently due to its peritoneal dissemination. A 67-year-old female with a lobular subtype breast neoplasm was treated via a surgical resection ten years previously, with subsequent radiotherapy and adjuvant chemotherapy. She is currently in clinical remission. A colonoscopy was performed due to a recent onset cachexia syndrome, which identified diffuse linitis plastica of the colon. Biopsies confirmed that it was secondary to infiltration by cancer cells of invasive lobular breast carcinoma (ILBC). In conclusion, linitis plastica of the colon may be a new presentation of colon metastases from ILBC.
