Endoscopic retrograde appendicitis treatment for periappendiceal abscess: A case report.

BACKGROUND: Acute appendicitis is the most common abdominal emergency. At present, the main treatments for periappendiceal abscess include antibiotics and surgery. However, the complications and mortality of emergency surgery are high. The preferred therapy is conservative treatment with antibiotics first, ultrasound-guided puncture drainage or surgical treatment is followed when necessary. Endoscopic retrograde appendicitis therapy (ERAT) for acute uncomplicated appendicitis have been proved clinically effective, but it is rarely used in periappendiceal abscess. CASE SUMMARY: We report a patient admitted to hospital because of "right lower abdominal pain for six days". The computerized tomography (CT) of patient showed that appendicitis with fecaliths and abscess in the pelvis. The patient was treated by CT-guided puncture and drainage of abdominal abscess combined with ERAT to remove appendiceal fecaliths, irrigation and stent placement. CONCLUSION: The patient did not receive surgery because of impoverished family. Abdominal pain did not recur during the follow-up period. This case confirms the value of ERAT in the treatment of periappendiceal abscess.

Left hepatic artery pseudoaneurysm complicating endoscopic retrograde cholangiopancreatography: A case report.

BACKGROUND: Pseudoaneurysms of the hepatic artery or its branches have been reported following abdominal trauma, iatrogenic injury at the time of many operations such as percutaneous transhepatic biliary drainage and cholecystectomy. Hepatic artery pseudoaneurysms after endoscopic retrograde cholangiopancreatography (ERCP) are uncommon and potentially life threatening and should be identified and treated rapidly. CASE SUMMARY: We report a case of intra-abdominal hemorrhage secondary to a left hepatic artery pseudoaneurysm resulting from guide wire injury at ERCP. The patient primary diagnosis was acute biliary pancreatitis with cholangitis, he underwent ERCP on the third day of admission. During ERCP, the left intrahepatic bile duct was cannulated three times. Over the sixth day, Contrast enhanced computed tomography scan demonstrated left hepatic lobe contusion and a pseudoaneurysm formation. The patient was successfully treated with the embolization of a small branch of left hepatic artery angiographically. CONCLUSION: The common complications of ERCP are pancreatitis, bleeding and perforation. False aneurysms occur as a result of damage to the wall of an artery. As far as we know, it is rare complication has been reported following ERCP. We advise urgent referral for angiographic embolization in this situation to avoid aneurysm rupture.

Gastric syphilis mimicking gastric cancer: A case report.

BACKGROUND: The nonspecific clinical, radiological and pathological characteristics of gastric syphilis can establish it as an imitator of other gastric diseases. The absence of primary or secondary lubricating lesions should not prevent consideration of gastric syphilis. CASE SUMMARY: A 63-year-old female patient presented to the hospital with dull pain in the middle and upper abdomen without apparent cause for one week, which was aggravated for two days. The patient had been sexually active with the same male partner for the past years, but her partner was promiscuous. Abdominal contrast-enhanced computed tomography (CT) and positron emission tomography/CT suggested gastric cancer. The gastroscopy revealed an antral gastric ulcer with gastric retention, and also suggested gastric cancer. But no cancer cells were found in the biopsies taken during the two gastroscopies. Treponema pallidum (T. pallidum) antibodies: ELISA positive, rapid plasma reagin titer 1:16. Hematoxylin and eosin (HE) stain showed macrophage infiltration in the lamina propria. Numerous spirochetes were observed by immunohistochemical staining using a monoclonal antibody against T. pallidum. The patient was finally diagnosed with gastric syphilis. CONCLUSION: Only a few cases of gastric syphilis have been misdiagnosed as gastric cancer. Penicillin can relieve symptoms of gastric syphilis.

Gastroesophageal varices in a patient presenting with essential thrombocythemia: A case report.

BACKGROUND: Gastroesophageal varices are a rare complication of essential thrombocythemia (ET). ET is a chronic myeloproliferative neoplasm (MPN) characterized by an increased number of blood platelets. CASE SUMMARY: A 46-year-old woman, who denied a history of liver disease, was admitted to our hospital on presentation of hematemesis. Laboratory examination revealed a hemoglobin level of 83 g/L, and a platelet count of 397 × 109/L. The appearance of gastric and esophageal varices with red colored signs as displayed by an urgent endoscopy was followed by endoscopic variceal ligation and endoscopic tissue adhesive. Abdominal computed tomography revealed cirrhosis, marked splenomegaly, portal vein thrombosis and portal hypertension. In addition, bone marrow biopsy and evidence of mutated Janus kinase 2, substantiated the onset of ET. The patient was asymptomatic with regular routine blood testing during the 6-mo follow-up period. Therefore, in this case, gastroesophageal varices were induced by ET. CONCLUSION: MPN should be given considerable attention when performing differential diagnoses in patients with gastroesophageal varices. An integrated approach such as laboratory tests, radiological examination, and pathological biopsy, should be included to allow optimal decisions and management.

[Management for esophageal foreign bodies: about 36 cases]. / Prise en charge des corps étrangers enclaves de l'œsophage: à propos de 36 cas.

Esophageal foreign bodies are a frequent reason for consultation in the Pediatric Emergency Department. However, they can occur at all ages. This study aims to highlight the clinical, paraclinical and therapeutic features of esophageal foreign bodies management at the Hospital in Mali. We conducted a prospective study of all cases of ingestion of foreign bodies between January 2011 and December 2014. A total of 36 patients underwent endoscopic or surgical treatment. The average age was 6 years (with a range from 14 months to 62 years). They mainly affected male patients with a sex ratio of 1.75. Foreign bodies were blocked in the cricopharyngeal shrinkage in 69.45% of cases, 22.22% of whom had subsequent aortic shrinkage. The average time of foreign body removal was 7.30 hours. Rigid fibroscopy allowed the removal of the foreign body in 88.89% of cases. Thoracotomy allowed the removal of the foreign body in 5.55%. Esophageal foreign bodies can occur at all ages but they are more frequent among children. Endoscopic removal is the gold standard treatment but surgical removal of a blocked esophageal foreign body, although rare, is the last resort, due to the nature of the foreign body and to the occurrence of complications. The best way to reduce accidents is prevention.

Evaluation of narrow-band imaging in the diagnosis of colorectal lesions and learning curve / 中国内镜杂志

Objective To evaluate the usefulness of narrow-band imaging with magnification in differentiating colorectal lesions, and assess for a learning curve, to gave help for the clinician, who want to carry out the technique. Method We retrospectively analyzed the clinical data of 289 patients who underwent NBI combined with magnification by four endoscopic physician, from June, 2015 to June, 2016, all the lesions were biopsied, endoscopic treatment or postoperative pathology and pathological examination, and the Sano classification control. All lesions were divided into three groups according to the NBI combined with magnifying endoscopy, these three sets included both lesions requiring endoscopic treatment (e.g. target lesions) and lesions that were not, or could not be, treated by endoscopy (e.g. nontarget lesions). Each physician examined the target or non-target lesion reached 15 cases as a group. By assessing the diagnostic accuracy of the four physicians for each group of lesions, an associated learning curve of NBI combined with magnifying endoscopy was developed. Result In 289 patients, 372 lesions were found by colonoscopy. NBI combined with magnifying endoscopy was 95.1%, 98.0% and 92.0%, respectively, in the identification of tumor and non-neoplastic lesions. The accuracy of the diagnosis of target and non-target lesions was significantly higher in group 2 than in group 1 [81.7% vs 95.1% (P = 0.010) and 71.7% vs 93.4% (P = 0.000)]. There was no significant difference in the diagnostic accuracy between group 2 and group 3 (P = 0.984 and P = 0.117). Conclusion It is very useful to use narrow-band imaging and Sano CP analysis in the differential diagnosis of colorectal lesions. The endoscopists who had never used NBI or no knowledge of NBI can have effective and stable diagnostic accuracy after using NBI with magnification to diagnose 15 target and non-target lesions respectively.

Evaluation of narrow-band imaging in the diagnosis of colorectal lesions and learning curve / 中国内镜杂志

Objective To evaluate the usefulness of narrow-band imaging with magnification in differentiating colorectal lesions, and assess for a learning curve, to gave help for the clinician, who want to carry out the technique. Method We retrospectively analyzed the clinical data of 289 patients who underwent NBI combined with magnification by four endoscopic physician, from June, 2015 to June, 2016, all the lesions were biopsied, endoscopic treatment or postoperative pathology and pathological examination, and the Sano classification control. All lesions were divided into three groups according to the NBI combined with magnifying endoscopy, these three sets included both lesions requiring endoscopic treatment (e.g. target lesions) and lesions that were not, or could not be, treated by endoscopy (e.g. nontarget lesions). Each physician examined the target or non-target lesion reached 15 cases as a group. By assessing the diagnostic accuracy of the four physicians for each group of lesions, an associated learning curve of NBI combined with magnifying endoscopy was developed. Result In 289 patients, 372 lesions were found by colonoscopy. NBI combined with magnifying endoscopy was 95.1%, 98.0% and 92.0%, respectively, in the identification of tumor and non-neoplastic lesions. The accuracy of the diagnosis of target and non-target lesions was significantly higher in group 2 than in group 1 [81.7% vs 95.1% (P = 0.010) and 71.7% vs 93.4% (P = 0.000)]. There was no significant difference in the diagnostic accuracy between group 2 and group 3 (P = 0.984 and P = 0.117). Conclusion It is very useful to use narrow-band imaging and Sano CP analysis in the differential diagnosis of colorectal lesions. The endoscopists who had never used NBI or no knowledge of NBI can have effective and stable diagnostic accuracy after using NBI with magnification to diagnose 15 target and non-target lesions respectively.

Lumbosacral transitional vertebra in a population-based study of 5860 individuals: prevalence and relationship to low back pain.

PURPOSE: To investigate the prevalence of lumbosacral transitional vertebra (LSTV) within the Chinese Han population, and to determine whether LSTV correlates with low back pain (LBP) and gluteal pain. MATERIALS AND METHODS: Typical standing pelvic radiographs were obtained for 5860 volunteers between 18 to 60 years of age. The lumbosacral region of each spine was evaluated to identify LSTV, which was classified into types I, II, III, and IV based on Castellvi's method. Histories of low back symptoms were obtained using a questionnaire. The association of different subtypes of LSTV with LBP and gluteal pain was explored. RESULTS: LSTV was found in 15.8% (928 of 5860) of our study population. Of the 928 individuals with LSTV, 44.8% were type I (dysplastic transverse process with height >19mm), 43.2% were type II (pseudoarticulation), 7.2% were type III (fusion), and 4.8% were type IV (a unilateral type II transition with a type III fusion on the contralateral side). Type II LSTV were closely associated with LBP and gluteal pain, with respective odds ratios (ORs) of 2.56 (95% CI: 2.17-3.89) and 5.38 (95% CI: 4.29-8.43). Similarly, types IV LSTV also demonstrated a significant correlation with LBP and gluteal pain, with respective ORs of 4.28 (95% CI: 3.21-6.35) and 6.82 (95% CI: 5.17-16.59). CONCLUSIONS: In this population-based study, the prevalence of LSTV was 15.8%, with type I being the most common. Importantly, LSTV types II and IV were significantly associated with LBP and gluteal pain.

Anatomical study of the pelvis in patients with adolescent idiopathic scoliosis.

Standing posterior-anterior (PA) radiographs from our clinical practice show that the concave and convex ilia are not always symmetrical in patients with adolescent idiopathic scoliosis (AIS). Transverse pelvic rotation may explain this observation, or pelvic asymmetry may be responsible. The present study investigated pelvic symmetry by examining the volume and linear measurements of the two hipbones in patients with AIS. Forty-two female patients with AIS were recruited for the study. Standing PA radiographs (covering the thoracic and lumbar spinal regions and the entire pelvis), CT scans and 3D reconstructions of the pelvis were obtained for all subjects. The concave/convex ratio of the inferior ilium at the sacroiliac joint medially (SI) and the anterior superior iliac spine laterally (ASIS) were measured on PA radiographs. Hipbone volumes and several distortion and abduction parameters were measured by post-processing software. The concave/convex ratio of SI-ASIS on PA radiographs was 0.97, which was significantly < 1 (P < 0.001). The concave and convex hipbone volumes were comparable in patients with AIS. The hipbone volumes were 257.3 ± 43.5 cm(3) and 256.9 ± 42.6 cm(3) at the concave and convex sides, respectively (P > 0.05). Furthermore, all distortion and abduction parameters were comparable between the convex and concave sides. Therefore, the present study showed that there was no pelvic asymmetry in patients with AIS, although the concave/convex ratio of SI-ASIS on PA radiographs was significantly < 1. The clinical phenomenon of asymmetrical concave and convex ilia in patients with AIS in preoperative standing PA radiographs may be caused by transverse pelvic rotation, but it is not due to developmental asymmetry or distortion of the pelvis.