RESUMEN
Upper gastrointestinal bleeding remains a common cause of hospitalizations and common causes include peptic ulcer disease, esophageal and gastric varices, and malignancies. Infrequently, rare and unexpected causes are encountered. Initial management is generally the same regardless of the cause that is focused on hemodynamic stabilization followed by endoscopy to assess and treat the cause of bleeding. We report a case of a 19-year-old female who presented with upper gastrointestinal bleeding and endoscopy showed a submucosal hematoma secondary to gastric ectopic pancreas or heterotopic pancreas. She was also treated for Helicobacter pylori infection. She was managed medically and was discharged without further recurrence of bleeding.
RESUMEN
Gallstone disease is a common condition and reason for consultation and hospitalizations. The standard of care is laparoscopic cholecystectomy. Early complications include bile duct injury and retained stone, and chronic complications include bile duct stricture and clip migration. It is important for clinicians to be aware of such complications as they can occur long after surgery. We report an interesting case of clip migration resulting in acute cholangitis, 18 years after laparoscopic cholecystectomy and review the literature on this interesting phenomenon of a commonly performed surgery. The diagnosis of clip migration in our case was suspected on abdominal radiograph and confirmed on endoscopic stone extraction.
RESUMEN
Statin or 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) inhibitor is widely used and plays a vital role in the management of cardiovascular and cerebrovascular diseases. Statin is generally safe and its side effects are mostly mild and self-limiting. Immune-mediated necrotizing myositis (IMNM) is a rare and serious side effect characterized by the presence of anti-HMGCR inhibitor and myositis. Long-term immunosuppressive therapy is often required to manage it, and in refractory cases, the treatment can be very challenging. We report the case of a 55-year-old female with underlying diabetes mellitus and hyperlipidemia who developed refractory statin-induced IMNM despite being administered prednisolone, methotrexate, azathioprine, and immunoglobulin. After the introduction of rituximab, steroids were able to be tapered down to the lowest maintenance dose. Unfortunately, the patient subsequently succumbed to severe coronary artery disease (CAD) likely caused by the long-term steroid therapy, highlighting the difficulty and complications associated with the treatment of IMNM, especially in patients with cardiovascular risk factors.