Endoscopic removal of an embedded uncovered biliary self-expandable metal stent with a mechanichal lithotriptor.

Biliary fully-covered self-expandable metal stents (FCSEMS) can be used for benign conditions since they can be removed. Uncovered SEMS (uSEMS) are employed for malignant biliary obstruction and are intended to be permanent. Furthermore, they are almost impossible to remove because they become embedded in the bile duct. We present a technique for uSEMS removal in a patient in whom a biliary uSEMS had been inserted for two years. Biliary obstruction due pancreatic cancer was misdiagnosed. Finally an IgG4 related-disease (autoimmune pancreatitis) was identified.

Afección hepática en adolescente con diabetes mellitus tipo 1 y mal control metabólico / Hepatic involvement in a teenager with type1 diabetes and poor metabolic control

Las alteraciones hepáticas en la diabetes pueden ser muy diversas; la más frecuente es la enfermedad de hígado graso no alcohólico. La glucogenosis hepática adquirida es un cuadro caracterizado por acumulación de glucógeno intrahepatocitaria en la diabetes mellitus tipo 1 mal controlada y en tratamiento con altas dosis de insulina. Se presenta el caso de un adolescente diabético con una elevación progresiva de fermentos hepáticos junto con mal control metabólico. Tras descartar otras causas de hepatopatía, se llegó al diagnóstico clínico de glucogenosis hepática secundaria por la recuperación de los parámetros tras la mejoría del control glucémico sin necesidad de realizar biopsia hepática. La glucogenosis hepática secundaria es un proceso quizá más frecuente de lo publicado, reversible y con buena evolución en función del control metabólico. El diagnóstico puede ser clínico y la biopsia hepática debería reservarse a los pacientes sin mejoría tras alcanzar un mejor control glucémico (AU)

There are several manifestations of hepatic involvement in diabetes but the most frequent is non-alcoholic steatohepatitis. Acquired hepatic glycogenosis is characterized by intrahepatocyte glycogen accumulation in poorly controlled type 1 diabetes under treatment with high doses of insulin. We report the case of a diabetic teenager with progressive elevation of liver enzymes associated with poor metabolic control. After ruling out other causes of hepatic derangement, we made a clinical diagnosis of secondary hepatic glycogenosis without performing liver biopsy, as all parameters improved after better glycemic control was achieved. Secondary hepatic glycogenosis is probably more frequent than previously reported. This process is reversible and has a benign clinical course that depends on good metabolic control. Diagnosis can be made clinically. Liver biopsy should be reserved for patients with no improvement in liver tests after good metabolic control has been achieved (AU)

Hepatic involvement in a teenager with type 1 diabetes and poor metabolic control.

There are several manifestations of hepaticinvolvement in diabetes but the most frequent is non-alcoholic steatohepatitis. Acquired hepatic glycogenosis is characterized by intrahepatocyte glycogen accumulation in poorly controlled type 1 diabetes under treatment with high doses of insulin. We report the case of a diabetic teenager with progressive elevation of liver enzymes associated with poor metabolic control. After ruling out other causes of hepatic derangement, we made a clinical diagnosis of secondary hepatic glycogenosis without performing liver biopsy, as all parameters improved after better glycemic control was achieved. Secondary hepatic glycogenosis is probably more frequent than previously reported. This process is reversible and has a benign clinical course that depends on good metabolic control. Diagnosis can be made clinically. Liver biopsy should be reserved for patients with no improvement in liver tests after good metabolic control has been achieved.