Hepatocolic fistula: a rare presentation of pyogenic liver abscess.

A 58-year-old man was admitted due to a 4-month history of colicky right upper quadrant pain, intermittent fever, anorexia and weight loss. A contrast-enhanced CT scan of the abdomen showed an encapsulated, peripherally enhancing focus occupying the right liver lobe exhibiting capsular rupture and extension to the walls of the hepatic flexure. He immediately underwent emergency ultrasound-guided percutaneous catheter drainage and cultures of the purulent fluid later revealed Escherichia coli A colonoscopy was then performed which showed a pinpoint opening with draining pus at the hepatic flexure. A fistulogram confirmed a fistulous tract arising from the inferior aspect of the abscess cavity, draining into the posterosuperior aspect of the hepatic flexure. He was started on intravenous antibiotics and after 1 week of decreasing output, a repeat ultrasound showed very minimal residual fluid. The percutaneous catheter drain was then removed after 2 weeks and the patient was discharged improved.

Duodenocolic fistula diagnosed by endoscopy: a rare complication of colon cancer.

Duodenocolic fistula (DCF) is a rare complication of colon cancer with only 70 cases reported since its first description in 1862. Owing to its rarity, current knowledge on DCF still relies on single case reports. We present 2 cases of DCF from a hepatic flexure adenocarcinoma demonstrated initially by endoscopy. 2 adult male patients were admitted due to a 2-3-month history of right-upper quadrant pain, vomiting, diarrhoea and a palpable right upper quadrant mass. In both cases, a circumferential, friable mass was noted on upper endoscopy at the second portion of the duodenum, leading to the ascending colon. A similar-looking lesion was also noted on colonoscopy. Biopsies in both cases confirmed colonic adenocarcinoma. Owing to the advanced nature of the disease, en bloc resection was not achieved. Instead, tube jejunostomy and loop ileostomy were created. Both patients were discharged tolerating feeding with improvement in symptoms.

A case of chronic diarrhea secondary to Capillaria philippinesis in Occidental Mindoro: Possibly a newly-described endemic area?

A 41-year-old man from Occidental Mindoro was diagnosed with intestinal capillariasis at the Philippine General Hospital after a year of diarrhea and multiple hospital admissions. The patient was noted to be harboring Capillaria philippinensis, Strongyloides stercoralis, Entamoeba histolytica, Mycobacterium tuberculosis, and Candida albicans in his stool. He was treated with albendazole, metronidazole, diloxanide, fluconazole, and antiiKoch's. This case was reported to the Department of Health to pursue this site as a potential area for epidemiologic investigation.

Early ERCP in acute gallstone pancreatitis without cholangitis: a meta-analysis.

CONTEXT: Early ERCP was reported to result in recovery from acute gallstone pancreatitis. To date, several RCTs comparing it to conservative treatment have yielded different results. OBJECTIVE: We conducted a meta-analysis to determine the effect of early ERCP on the morbidity and mortality of acute gallstone pancreatitis without cholangitis. METHODS: We searched the following databases up to January 11(th), 2008: the Cochrane Library, MEDLINE, EMBASE, the Australasian Medical Index, Latin American Caribbean Health Sciences Literature, and the Health Research and Development Information Network. References were scrutinized. Authors were contacted. There were no restrictions regarding language, publication date or publication status. RESULTS: Seven RCTs were retrieved, but only two RCTs involving 177 treated patients and 163 control patients were included. A meta-analysis on morbidity was inconclusive (RR=0.95, 95% CI: 0.74-1.22). Meta-analysis on mortality only showed a trend in favor of conservative management (RR=1.92, 95% CI: 0.86-4.32) for both mild and severe pancreatitis. CONCLUSIONS: There is a trend towards more mortality from early ERCP with or without sphincterotomy in the setting of acute gallstone pancreatitis without cholangitis. However, more studies are needed. In the meantime, early ERCP should not be carried out unless there is at least a slight suspicion of cholangitis or persistent ampullary obstruction.