Efficacy of Endoscopic Therapy in Symptomatic Pancreatic Divisum: A Systematic Review and Meta-analysis.

BACKGROUND AND AIMS: Pancreas divisum (PD) is a congenital malformation of the pancreas and is implicated as a cause of pancreatitis. The role of endotherapy has been variable in symptomatic PD indicated by recurrent acute pancreatitis (RAP), chronic pancreatitis (CP), or chronic pancreatic-type abdominal pain (PP). The aim of this study was to analyze the pooled data to determine the success of endoscopic intervention for pancreas divisum. METHODS: We conducted a comprehensive search of several databases (inception to July 2023) to identify studies reporting on the use of endoscopic therapy in symptomatic pancreatic divisum. The random-effects model was used to calculate the pooled rates and I2% values were used to assess the heterogeneity. RESULTS: A total of 27 studies were retrieved that reported endoscopic intervention in pancreatic divisum. The calculated pooled rate of technical success was 92% (95% CI: 87-95; I2=63%). The calculated pooled rate of clinical success was 65% (95% CI: 60-70; I2=60%). The rate of clinical success by PD subtypes was highest in RAP at 71% (95% CI: 65-76; I2=24%). Available studies had significant heterogeneity in defining clinical success. The rate of adverse events was 71% (95% CI: 65-76; I2=24%). CONCLUSIONS: The role of endoscopic therapy in pancreatic divisum is variable with the highest success rate in recurrent acute pancreatitis. Endoscopic intervention is associated with a higher-than-usual rate of adverse events, including post-ERCP pancreatitis.

Beyond the Liver: Unveiling Rhabdomyolysis as a Rare Complication of Hepatitis A.

Hepatitis A is a mild self-limiting infection of the liver with spontaneous resolution of symptoms in most cases. However, clinicians should be aware of some commonly encountered complications and extrahepatic manifestations associated with hepatitis A for timely diagnosis and treatment. Rhabdomyolysis, an exceedingly rare complication of hepatitis A, is scarcely documented. We present a case of a 64-year-old man with symptoms consistent with rhabdomyolysis and an evanescent rash secondary to acute hepatitis A. He eventually recovered with conservative management. This case emphasizes the importance of recognizing and treating atypical presentations of acute hepatitis A infection. LEARNING POINTS: Recognition of atypical presentations: The case underscores the importance of recognizing and treating atypical presentations of acute hepatitis A infection. Clinicians should be vigilant for unusual manifestations of common infections, facilitating timely diagnosis and appropriate management.Understanding rare complications: Rhabdomyolysis is identified as an exceedingly rare complication of hepatitis A infection, which is scarcely documented in the literature. This case contributes to the growing understanding of extrahepatic manifestations associated with hepatitis A, emphasizing the importance of considering uncommon complications in the differential diagnosis, especially when typical clinical presentations are observed.Management strategies: The article discusses the treatment approach for rhabdomyolysis secondary to acute hepatitis A, which involves aggressive fluid resuscitation to prevent kidney damage from myoglobinuria, correction of electrolyte imbalances, and metabolic abnormalities. Additionally, vaccination against hepatitis A and advocating for sanitation measures are highlighted as important preventive strategies.

Hyperbilirubinemia in a Patient With Sepsis: A Diagnostic Challenge.

Cholestasis due to sepsis is commonly seen in critically ill patients; however, it is often overlooked and poses a challenge in clinical diagnosis and management. In this report, we present a 29-year-old woman who presented to the emergency department with jaundice and symptoms of a urinary tract infection. Initially suspected to be Dubin-Johnson syndrome, sepsis-induced cholestasis was eventually diagnosed after testing. Sepsis should always be considered as part of the differential diagnosis while managing a patient with jaundice. The management of sepsis-induced cholestasis involves treating the underlying infection. In most cases, liver injury improves with the resolution of the infectious process.