Juxta-papillary duodenal diverticula are associated with pyogenic liver abscesses: a case control study.

BACKGROUND: Juxta-papillary duodenal diverticulum (JPDD) has been associated with obstructive jaundice and ascending cholangitis. Potential mechanisms include periampullary colonization of pathogenic bacteria and mechanical obstruction. However, the relation of JPDD with pyogenic liver abscess (PLA) has not been reported. Moreover, approximately one third of patients with PLA have no identifiable risk factors and are labelled as "cryptogenic". We hypothesized that JPDD is an unidentified risk factor for cryptogenic PLA and the aim of this study was to examine this association. METHODS: We conducted a retrospective chart review to identify cases of PLA (n = 66) and compare those to matched controls (n = 66). 66 patients met the study inclusion criteria of a diagnosis of PLA using computerized tomography (CT) imaging and either positive culture or confirmed resolution after antibiotic therapy. Patients with diagnoses of amebic liver abscess, traumatic liver abscess, post cholecystectomy liver abscess, concurrent acute cholecystitis, and hepatobiliary malignancy were excluded. Controls were identified from a radiology database and matched one-to-one with the cases by age and sex. Demographic and clinical data was extracted from electronic medical records. CT scan images of all cases and controls were reviewed by a single expert radiologist to identify the presence of JPDD. Statistical tests including Chi-square and t-test with multiple logistic regression were used to examine the group differences in JPDD and other factors. RESULTS: Among 132 study samples, 13.6% (9/66) of the cases were found to have JPDD, compared to 3.0% (2/66) among controls (p = 0.03). This corresponded to an odds ratio (OR) of 5.05 [OR 5.05; CI 1.05-24.4] on multiple logistic regression analysis. In addition, 1/3rd of PLA cases with JPDD had no other traditional risk factors (cryptogenic PLA). However, a statistically significant association of JPDD with cryptogenic PLA could not be established possibly because of a small number of cases. We found significantly high rate of diabetes mellitus (DM) (42.4%; n = 28/66) among cases compared to controls (21.2%; n = 14/66; p = 0.01). CONCLUSION: We found a significant association between JPDD and PLA. We need studies with larger sample sizes to confirm this relationship and to explore if JPDD could be related to cryptogenic liver abscesses.

Small Bowel Amyloidosis.

PURPOSE OF REVIEW: The goal of this paper is to review the literature on small bowel amyloidosis. Our review focuses on the underlying etiology, histopathology, clinical features, endoscopic and radiologic findings, and the mainstay of management. RECENT FINDINGS: The latest research shows changing epidemiological trends of different types of amyloidosis. It also reveals a better understanding of its pathophysiology and shows improvement in treatment outcomes. Amyloidosis is a group of diseases of multiple etiologies and clinical presentations. It is characterized by pathological deposition of insoluble fibrillar proteins within various organs leading to disruption of their structure and function. The classification of amyloidosis includes primary, secondary, dialysis-related, senile, and hereditary. Amyloidosis can be systemic or localized. The incidence of AA amyloidosis is declining in frequency. If the gastrointestinal (GI) tract is involved, the small intestine is the most commonly affected site. Overall, outcomes among patients with newly diagnosed amyloidosis have improved. This article focuses on small bowel amyloidosis.

Light at the end of the tunnel: bridging the gap from the duodenum to the jejunum.

Video 1Video describing the case, procedure, and outcomes.

Straight from the Big Apple: endoscopic retrieval of a whole apple from the sigmoid colon.

Video 1Endoscopic retrieval of a whole apple from the sigmoid colon.

Nailed it: endoscopic retrieval of an abnormally shaped nail from a toddler's esophagus.

Video 1.

A Case of Sarcoidosis Masquerading as Right Middle Lobe Consolidation.

Sarcoidosis is a multisystem granulomatous disorder that is characterized histologically by noncaseating granulomas. Typically, it presents clinically in young adults with initially one or more of the following: hilar lymphadenopathy, pulmonary reticular opacities, and skin, joint, and/or eye lesion. Radiographic findings commonly include bilateral hilar and mediastinal lymphadenopathy and pulmonary reticular opacities but may resemble pneumonia with airspace consolidation and opacities. We report a case of sarcoidosis that presented as a persistent case of pneumonia. This case is a reminder that common diseases such as pneumonia are not always what they seem, and diseases such as sarcoidosis that have specific characteristics may not present traditionally each time.

Anal polyp.

Our case accurately describes a not infrequent finding that is not well understood by endoscopists. Fibroepithelial polyps are benign and should be considered in the differential diagnosis of anorectal polyp.

Pseudocyst management: endoscopic drainage and other emerging techniques.

Pseudocyst formation is a well known complication of pancreatitis. Not all pancreatic pseudocysts require intervention. Selected patients who are asymptomatic can be subject to expectant management. Spontaneous resolution has been shown to occur in 40% to 50% of patients with no serious complications occurring during the observation period. Intervention is warranted if the patient is symptomatic, there is a progressive increase in size or if the pseudocyst is infected. Surgery was the only available treatment for pseudocysts for a long time. Of late other modalities like percutaneous, endoscopic, and laparoscopic drainage have come to be seen as viable alternatives.

Antibiotic therapy in acute gastroenteritis: a single-center retrospective cohort study.

BACKGROUND: Acute gastroenteritis (AGE) is a common reason for emergency department visits and hospitalizations. The role of antibiotics in AGE is unclear, as the current literature shows only a minor impact on the duration of symptoms and the overall clinical course. Our goal was to assess whether antibiotic therapy in patients with AGE affects the length of hospital stay (LOS). METHODS: In a retrospective study, we evaluated 479 patients admitted to the hospital with a diagnosis of AGE. The study compared the 219 patients (46%) treated with antibiotics to the remainder treated with supportive therapy. The diagnosis of AGE was made either clinically or based on imaging findings. The primary outcome of this study was to compare the LOS in days between both groups. RESULTS: Patients treated with antibiotics had a similar LOS to those treated with supportive therapy (2.62 vs. 2.66 days, P=0.77). Patients with presumed sepsis had a higher likelihood of receiving antibiotics compared to those without presumed sepsis (risk ratio 1.49, 62.5% vs. 41.95%; P<0.001). In this subgroup, patients who received antibiotics had a slightly shorter LOS than those who received only supportive therapy, but the difference was not statistically significant (2.09 vs. 2.54 days, P=0.69). CONCLUSION: We found no difference in the LOS for hospitalized patients with AGE treated with antibiotics when compared to supportive therapy. This calls into question the role of antibiotics in the management of AGE.

Colorectal Cancer Associated with Strongyloides stercoralis Colitis.

Strongyloides stercoralis colitis is a severe but easily curable disease with a high mortality rate if left untreated. Strongyloidiasis can persist up to several decades and may lead to a chronic colitis similar to that seen in inflammatory bowel disease (IBD), and the two are often confused. Chronic colitis from IBD is associated with an increased risk of colorectal cancer, so it is plausible that chronic colitis from strongyloidiasis may carry a similar risk. Our case report associates chronic Strongyloides colitis and colorectal cancer.

Acute hepatitis E presenting with clinical feature of autoimmune hepatitis.

A 32-year-old immigrant man presented with new onset jaundice. His past medical history was significant for type 2 diabetes mellitus, hypertension, and hyperlipidemia. His initial laboratory finding and liver biopsy were suggestive of autoimmune hepatitis (AIH). The plan was to start steroids pending negative results for viral serology, but it came back positive for hepatitis E virus. The patient's liver function test and clinical condition improved significantly on conservative management over a period of 1 month. Therefore, we suggest testing for hepatitis E especially in immigrants or recent travelers to endemic areas who presents with clinical features suggestive of AIH.

Primary squamous cell carcinoma of the rectum: a case report and literature review.

Squamous cell carcinoma (SCC) of the rectum is a rare occurrence with an incidence rate of 0.1-0.25% per 1,000 cases. Herein, we report a case of a 52-year-old female who presented with a 2-month history of diffuse lower abdominal pain and hematochezia. Abdominal CT scan revealed a 7-cm irregular rectal mass, and the biopsy showed SCC.