Innovative Water-Wire Cannulation Technique for Managing Near-Complete Obstruction Due to Post-orthotopic Liver Transplant Anastomotic Strictures: A Report of Two Cases.

This report presents an innovative water-wire cannulation technique for managing challenging anastomotic strictures in post-orthotopic liver transplant patients, highlighting its successful application in two distinct cases. Anastomotic strictures pose a significant hurdle in hepatobiliary medicine, often complicating the course post-liver transplantation. Standard endoscopic retrograde cholangiopancreatography (ERCP) methods frequently encounter limitations in severe stricture cases, necessitating alternative approaches. The water-wire cannulation technique, introduced in this report, innovatively utilizes water injection to gently dilate the stricture, enabling successful guidewire insertion and subsequent standard endoscopic interventions. This method was effectively applied in two patients with severe anastomotic strictures, where conventional ERCP techniques were unsuccessful. The technique's effectiveness, demonstrated in these cases, offers a less invasive and potentially safer alternative to traditional options like cholangioscopy, percutaneous transhepatic cholangiography (PTC), or surgical revision, which carry higher risks and complexities. The water-wire cannulation technique's success emphasizes the need for innovative and adaptable strategies in hepatobiliary medicine, especially for managing post-transplant complications. Its potential applicability in a broader spectrum of biliary strictures warrants further exploration. Overall, this technique represents a significant advancement in the endoscopic management of complex biliary strictures, promising to enhance patient care and outcomes in hepatobiliary medicine.

Pneumoperitoneum After Jejunostomy Tube Placement Managed by Needle Decompression: A Case Report.

Percutaneous endoscopic feeding tube placement is a commonly performed procedure in patients who cannot take food by mouth. While it is considered a safe and effective method of providing nutritional support, like any medical procedure, it can lead to complications. Feeding tube placement, including percutaneous endoscopic jejunostomy (PEJ), is associated with several complications, including bleeding, site infection, aspiration, buried bumper, tube dislodgement, and pneumoperitoneum. We report a case of a 20-year-old male with multiple medical issues who underwent a PEJ that was complicated by bowel distension. The patient developed tension pneumoperitoneum post-procedure, which was treated with a bedside needle decompression. This case report highlights the significance of promptly recognizing and intervening in complications that may arise during a frequently performed medical procedure, PEJ tube placement, to prevent serious consequences, including bowel ischemia.

Caecal Ameboma, colorectal malignancy mimicker in young male with ANCA-associated vasculitis.

Ameboma refers to the rare development of an inflammatory, ulcerated, exophytic mass in the gastrointestinal tract that can resemble carcinoma. Typically it presents as a right lower quadrant abdominal mass, Patients may also present with diarrhea or constipation and associated systemic symptoms, including weight loss and fever. In this article we present a young man with a background of ANCA associated vasculitis, who presented with fresh lower gastrointestinal bleeding during hospital admission for severe covid-19 pneumonia which turned out to be caecal aemboma. This case is highlighted for its rarity, the diagnostic challenge, and for the major role of colonoscopy as a diagnostic tool for this pathology.

Gastrointestinal Migration of a Pharyngeal Pack During Functional Endoscopic Sinus Surgery (FESS): A Case Report and Preventive Strategies.

The pharyngeal pack is routinely used in many nasopharyngeal surgeries to reduce the spillage of secretions into the trachea and esophagus. Here we report a case of migration of a pharyngeal pack into the stomach of a patient undergoing functional endoscopic sinus surgery and review risks of delayed recognition and the management of this complication. In this case report, we share our experience to reinforce and highlight the importance of proper documentation of pharyngeal pack insertion and removal to prevent easily avoidable morbidity and mortality. It also highlights the importance of an immediate esophago-gastro-duodenoscopy (OGD) to retrieve the migrated pharyngeal pack as soon as its migration to the gastrointestinal tract is suspected.