A Case of Suggested Ibuprofen-Induced Acute Pancreatitis.

Drug-induced acute pancreatitis (DIP) is uncommon and may account for 2%-5% of cases, although the incidence may be increasing nowadays. DIP has been documented for more than 160 drugs in the literature. The most common nonsteroidal anti-inflammatory drugs (NSAIDs) that have been reported to cause pancreatitis are sulindac and salicylates. In this report, we present a case of probable ibuprofen-induced pancreatitis. A 60-year-old white woman presented with the sudden onset of mild acute pancreatitis (AP) 5 hours following the ingestion of 6 tablets of ibuprofen (Advil) 200 mg (equivalent to 20.4 mg/kg). She denied any history of alcohol abuse, tobacco smoking, or any other medication use. She has no history of gallstones, choledocholithiasis, abdominal trauma, or hypertriglyceridemia. Laboratory workup revealed elevated amylase and lipase levels more than 3 times the normal limits with complete resolution within 15 hours. Computed tomography scan of abdomen and pelvis and endoscopic ultrasound of the pancreaticobiliary system were within the normal limits. Ibuprofen-induced mild DIP was the most probable diagnosis. She was discharged on her second day of hospitalization with significant improvement in her symptoms. Physicians need to be aware that DIP may occur in patients taking NSAIDs, including ibuprofen. Therefore, all patients with AP of an unknown etiology should be carefully questioned about the usage of NSAIDs, and all patients with idiopathic AP restarted on their medications should be closely monitored, and the drug must be immediately discontinued if symptoms recur.

Two Cases of Type Va Extrahepatic Bile Duct Duplication With Distal Klatskin Tumor Surgically Treated with Whipple Procedure and Hepaticojejunostomy.

We describe the diagnostic and therapeutic challenges of a type Va extrahepatic bile duct duplication coexistent with distally located hilar cholangiocarcinoma (Klatskin tumor). We present 2 cases that were diagnosed preoperatively and treated with a modified surgical technique of a combined pylorus-preserving Whipple procedure and hepaticojejunostomy.

Assessment of the predictors of response to glucagon in the setting of acute esophageal food bolus impaction.

Esophageal food impactions are frequently seen in endoscopic practice. Glucagon is known to relax the lower esophageal sphincter and has been used with variable success to treat food impactions. We retrieved clinical information of all patients with acute food impactions who attended the emergency room from 1975 to 2000 from the Mayo diagnostic database. Data were abstracted on age, sex, body mass index, relevant prior medical history, food type ingested (meat, bread, vegetable, or other), duration of symptoms at presentation, dosage (in mg) of glucagon, outcome including success of glucagon or spontaneous passage, and endoscopic findings. A total of 222 cases of food impaction were identified, of whom 106 patients (48%) received glucagon, average 1 mg. In glucagon responders, meat was less likely to be the offending food type, accounting for 70% (glucagon responders) vs. 90% (in nonresponders) ( p = 0.03), while responders were less likely to have esophageal rings/strictures detected on subsequent EGD compared with nonresponders, 0% (glucagon responders) vs. 31% (nonresponders) ( p = 0.05). In the patients that did not receive glucagon, spontaneous resolvers had a shorter duration of symptoms at presentation, 3.3 h vs. 12.4 h ( p = 0.07) and were less likely to have an organic esophageal obstruction detected on EGD, 0% vs. 21%. There were no significant differences between the resolvers and nonresolvers in terms of age, gender, BMI, and prior medical history. Conservative management of acute food bolus obstruction, either with or without glucagon, is most successful in the absence of a fixed esophageal obstruction. An impacted meat bolus is more likely to require intervention for removal than other food types. These clinical predictors should be considered before administration of glucagon.