Roth Net-Assisted Endoscopic-Guided Manometry Catheter Placement.

High-resolution esophageal manometry (HRM) has become the gold standard to diagnose esophageal motility disorders. Usually, this procedure is performed by introducing the catheter, which has pressure sensors, into the esophagus and proximal stomach via the nares. Repeated coiling of the catheter and inability to pass through the gastroesophageal junction (GEJ) are common challenges encountered. Endoscopy-guided placement of the catheter can overcome these difficulties. However, sometimes even with the use of endoscopy, it is difficult to advance catheter due to anatomical variants. The extreme fragility of the catheter and sensors and the high cost of this reusable device precludes the use of biopsy forceps or snare to advance the catheter. There is no literature on using accessories during endoscopy in case of difficult placement under direct visualization. We report a unique case of using Roth Net via the suction channel to advance esophageal manometry catheter into the stomach by using endoscopy.

Acute Appendicitis Review: Background, Epidemiology, Diagnosis, and Treatment.

Appendicitis is a common occurrence in both the adult and pediatric populations. The condition most commonly occurs between the ages of 10 and 20 years with a lifetime risk of 8.6% and 6.7% for males and females respectively. Its diagnosis focuses on clinical presentation and imaging modalities classified according to scoring systems such as the Alvarado scoring system. A number of imaging modalities can be used, with CT being the most common one. For acute appendicitis, surgical intervention is considered to be the gold standard of treatment. However, recent research has focused on other modalities of treatment including antibiotics and endoscopic retrograde appendicitis therapy (ERAT) to avoid surgical complications.

Polycystic Liver With Cardiac Compression Leading to Atrial Fibrillation: Case Report and Review of the Literature.

Polycystic liver disease (PCLD) is a rare condition that most often occurs in patients with polycystic kidney disease and less commonly as an isolated liver disease. Complications include cyst rupture, infection, hemorrhage, and compression of surrounding organs by large cysts. We present the case of a patient with a history of PCLD who presented to our hospital with palpitations and was found to have atrial fibrillation. Imaging and echocardiograph revealed a dominant large cyst compressing the right atrium. Other etiologies including thyroid disease, ischemic heart disease, and electrolytes abnormalities were excluded. The patient refused surgical intervention and was conservatively treated with rate control and anticoagulation. To the best of our knowledge, this is the first case of new-onset atrial fibrillation secondary to right atrial compression by a liver cyst. Compression of cardiac chambers resulting in new-onset arrhythmia should be considered when evaluating patients with PCLD.

Abdominal Wall Hematoma Secondary to Dissection of the Deep Circumflex Iliac Artery: A Rare Complication of Ultrasound-Guided Paracentesis.

Paracentesis of the abdominal cavity is carried out to analyze ascitic fluid for diagnostic and therapeutic purposes. In recent years, the modern ultrasound-guided method is favored over the landmark-based approach as the latter carries a higher risk of complications. Dissection of the inferior epigastric artery is the most frequent complication encountered on either approach. We present a unique case of iatrogenic laceration of the deep circumflex iliac artery due to abnormal vessel anatomy in a patient with ascites.

Severe de novo Ulcerative Colitis following Ixekizumab Therapy.

Ixekizumab is a selective monoclonal antibody targeting interleukin-17A, approved for the treatment of chronic plaque psoriasis. It has rarely been associated with inflammatory bowel disease (IBD) in randomized trials only. We report a unique case of severe new-onset ulcerative colitis in a young male complicated by cytomegalovirus infection who was on ixekizumab therapy for plaque psoriasis. We recommend that clinicians should exercise caution before prescribing ixekizumab as it seems to induce and exacerbate IBD.

Mesalamine Associated Bradycardia.

A 38-year-old female presented with an acute flare of ulcerative colitis. She was started on prednisone and mesalamine. Within 24 hours of initiating mesalamine, she developed sinus bradycardia. After holding mesalamine, the heart rate returned to normal within five days. Our case illustrates the third described case, to our knowledge, of severe sinus bradycardia secondary to mesalamine.

Wilson's Disease: Expect the Unexpected.

A 64-year-old woman, presented with abdominal distention, jaundice and resting tremor, was found to have liver injury and abnormal liver enzymes. A computed tomography (CT) scan of the abdomen and pelvis showed abdominopelvic ascites and signs of liver cirrhosis. An extensive liver disease workup was performed and came back negative; therefore, a liver biopsy was obtained and showed evidence of cirrhosis with elevated liver copper consistent with Wilson's disease (WD). We report a unique case of late-onset WD in which the ceruloplasmin level and 24-h urinary copper excretion were all normal.