RESUMO
Endoscopic retrograde cholangiopancreatography (ERCP), together with its substantial therapeutic capabilities, carries a higher potential for complications than other endoscopic procedures. Common major complications specific to pancreaticobiliary instrumentation include pancreatitis, post-sphincterotomy hemorrhage, perforation, and cholangitis with or without systemic sepsis. Two patients underwent therapeutic ERCP for recurrent episodes of abdominal pain and elevation of hepatobiliary enzymes. Endoscopic sphincterotomy was difficult and prolonged. The calculi were successfully extracted by sweeping the choledochus with a balloon-tipped catheter or basket in both cases. The patients experienced postprocedure diffuse abdominal pain unassociated with nausea or vomiting. Laboratory data showed normal serum amylase and lipase 2, 6, and 18 h after the end of procedure, a fall in hematocrit level, and an increase of indirect bilirubin and lactic dehydrogenase. The abdominal pain subsided in 4 to 6 h. The hematocrit level remained stable during the next 3 days, and the patients were very well when discharged. Examination of glucose-6-phosphate dehydrogenase (G-6PD) enzyme levels in red cells 20 days later showed complete enzyme deficiency. This report highlights the importance of examining G-6PD deficiency in patients with post-ERCP abdominal pain, normal serum amylase and lipase, and laboratory findings of hemolysis.
Assuntos
Anemia Hemolítica/etiologia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Deficiência de Glucosefosfato Desidrogenase/complicações , Esfinterotomia Endoscópica/efeitos adversos , Dor Abdominal/etiologia , Adulto , Amilases/sangue , Anemia Hemolítica/genética , Biomarcadores , Colecistectomia Laparoscópica , Coledocolitíase/complicações , Coledocolitíase/cirurgia , Colelitíase/complicações , Colelitíase/cirurgia , Eritrócitos/enzimologia , Hematócrito , Humanos , Lipase/sangue , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Período Pós-OperatórioRESUMO
Black esophagus is an uncommon entity that has been described only a few times previously. It is defined as a dark pigmentation of the esophagus associated with histologic mucosal necrosis. Most cases have no known etiology, although ischemia, nasogastric tube trauma, infection, gastric outlet obstruction, gastric volvulus, and hypersensitivity to antibiotics have all been suggested as possible causes. Herein we report the case of a young, healthy, athletic man who developed black esophagus due to severe vomiting after alcohol overindulgence and summarize the other published cases to date.