ABSTRACT
Biliary fully-covered self-expandable metal stents (FCSEMS) can be used for benign conditions since they can be removed. Uncovered SEMS (uSEMS) are employed for malignant biliary obstruction and are intended to be permanent. Furthermore, they are almost impossible to remove because they become embedded in the bile duct. We present a technique for uSEMS removal in a patient in whom a biliary uSEMS had been inserted for two years. Biliary obstruction due pancreatic cancer was misdiagnosed. Finally an IgG4 related-disease (autoimmune pancreatitis) was identified.
Subject(s)
Cholestasis , Pancreatic Neoplasms , Self Expandable Metallic Stents , Cholangiopancreatography, Endoscopic Retrograde , Humans , StentsABSTRACT
There are several manifestations of hepaticinvolvement in diabetes but the most frequent is non-alcoholic steatohepatitis. Acquired hepatic glycogenosis is characterized by intrahepatocyte glycogen accumulation in poorly controlled type 1 diabetes under treatment with high doses of insulin. We report the case of a diabetic teenager with progressive elevation of liver enzymes associated with poor metabolic control. After ruling out other causes of hepatic derangement, we made a clinical diagnosis of secondary hepatic glycogenosis without performing liver biopsy, as all parameters improved after better glycemic control was achieved. Secondary hepatic glycogenosis is probably more frequent than previously reported. This process is reversible and has a benign clinical course that depends on good metabolic control. Diagnosis can be made clinically. Liver biopsy should be reserved for patients with no improvement in liver tests after good metabolic control has been achieved.