Successful endoscopic transpapillary management of intrahepatic pancreatic pseudocyst.

CONTEXT: Intrahepatic pancreatic pseudocyst extension is a rare but complex clinical entity requiring multimodality approach for management. There is no consensus regarding the optimal strategy for the treatment of intrahepatic pancreatic pseudocyst and the literature is limited to a few case reports. Most of the published cases were managed by surgical or percutaneous drainage. CASE REPORT: We hereby report a case of intrahepatic pancreatic pseudocyst extension which failed to resolve by percutaneous drainage. Endoscopic transpapillary drainage was utilized which led to complete resolution of the intrahepatic pancreatic pseudocyst. CONCLUSION: The excellent results obtained in our patient suggest that it should be considered as primary treatment and may obviate the need for more aggressive and potentially morbid procedures.

Acute buried bumper syndrome.

Buried bumper syndrome (BBS) is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. This unusual phenomenon occurs when the internal bumper of a PEG tube erodes and migrates through the gastric wall and becomes lodged anywhere between the gastric wall and the skin. If not removed and treated appropriately, it can lead to life-threatening complications. It is considered to be a late complication, with most cases occurring from months to years later. We present an unusual case of a very rapid development of BBS, along with a brief review of contributing factors and treatment recommendations.

Kaposi'S sarcoma of the stomach and duodenum in human immunodeficiency virus infection.

Kaposi's sarcoma (KS) of the upper gastrointestinal tract without extensive cutaneous disease is uncommon and usually asymptomatic. Herein, the case of a 37-year-old man who presented with iron deficiency anemia is reported. A colonoscopy was unremarkable and upper endoscopy revealed multiple raised, hemorrhagic, plaque-like lesions throughout the stomach and the small intestine. Histopathology confirmed KS; further testing revealed the patient to be HIV-positive and a diagnosis of AIDS-related KS was made. Although a rare entity, physicians should be aware of this condition in order to facilitate a prompt diagnosis and necessary intervention.

Rapunzel syndrome-a rare cause of multiple jejunal intussusception.

Trichobezoars are usually without symptoms until they reach a large size. The "Rapunzel" syndrome is a trichobezoar with a long tail extending from the stomach to small bowel. We report the case of a 6-year-old girl with a history of trichotillomania and hair ingestion for three years, who presented with multiple jejunojejunal intussusceptions due to a trichobezoar with a long, 90-cm tail into the small bowel. To our knowledge, this is the first report of trichobezoars as a cause of jejunal intussusceptions, which should be suspected in the appropriate clinical circumstances.

"Ohio River valley fever" presenting as isolated granulomatous hepatitis: a case report.

Histoplasmosis is endemic to the midwestern and east central states in the United States near the Mississippi and the Ohio River valleys. Ninety-nine percent of patients exposed to histoplasmosis develop only subclinical infection. Liver involvement as a part of disseminated histoplasmosis is well known; however, isolated hepatic histoplasmosis without any other stigmata of dissemination is extremely rare and the literature is limited to only two case reports. We present a rare case of isolated granulomatous hepatitis due to histoplasmosis in a 35-year-old female with dermatomyositis receiving low-dose prednisone and methotrexate. There was no evidence of fungal dissemination elsewhere. High clinical suspicion is critical for early diagnosis and treatment.

Hypokalemic rhabdomyolysis due to watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome caused by vipoma.

Mild hypokalemia is common and encountered in a multitude of diseases, but severe hypokalemia leading to rhabdomyolysis is relatively rare. The watery diarrhea, hypokalemia, achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP)-producing tumors, is an extremely rare cause of hypokalemic rhabdomyolysis and the literature is limited to one case report. We report a second case of an adult who presented with rhabdomyolysis due to severe hypokalemia. Further evaluation revealed that he had a VIP-producing pancreatic neuroendocrine tumor (NET), which was the cause of his hypokalemic rhabdomyolysis. Although rare in occurrence, a high index of suspicion is of paramount importance for establishing the correct diagnosis and treatment.

Giant ulcerated lipoma of the colon causing iron deficiency anemia successfully treated with endoscopic ultrasound-assisted resection.

Colonic lipomas are frequently small and asymptomatic. Giant colonic lipoma (GCL) is an uncommon finding at endoscopy, and ulceration with occult blood loss leading to iron deficiency anemia (IDA) is even rarer. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. We hereby report a case of an ulcerated GCL that presented with occult bleeding and IDA. IDA resolved after the GCL was removed successfully combining endoloop ligation and snare cautery technique under endoscopic ultrasound (EUS) guidance. With the advent of EUS, endoscopic resection of submucosal tumors can be performed relatively safely by providing a viable and useful alternative to surgery.

Upper gastrointestinal bleeding revealing the stomach metastases of renal cell carcinoma.

INTRODUCTION: Renal cell carcinoma (RCC) constitutes 3% of all adult malignancies and often presents insidiously. Consequently, 25-30% of patients have metastases at the time of diagnosis. DISCUSSION: Gastrointestinal (GI) bleeding from RCC metastases is an uncommon and underrecognized manifestation of this disease. We hereby report a rare case of RCC with stomach metastasis which heralded the primary manifestation of the disease. This case highlights the importance of maintaining vigilance for unusual causes during endoscopy in cases of upper GI hemorrhage.

Biliary obstruction and pancreatitis caused by diffuse nodular hyperplasia of Brunner's gland.

INTRODUCTION: Brunner's gland hyperplasia (BGH) of the duodenum is an uncommon finding at endoscopy and is usually asymptomatic. Symptomatic BGH presenting with biliary obstruction and pancreatitis is extremely rare and the literature is limited to a few case reports. CASE: We report an unusual case of diffuse BGH of duodenum involving the ampulla of Vater that led to this clinical presentation. Biopsies revealed BGH and successful endoscopic therapy utilizing sphincterotomy and plastic stent placement led to complete recovery. CONCLUSION: Albeit its uncommon clinical presentation, it can become challenging in terms of diagnosis and management. A high index of suspicion is of paramount importance for establishing the correct diagnosis and treatment.

Corrosive injury to the GI tract in adults: a practical approach.

Corrosive injury to the GI tract still poses great challenges with regards to the initial evaluation triage, as well as the optimization of medical management. Although relatively uncommon in the adult population, these injuries can cause significant morbidity and serious sequelae of complications, such as esophageal strictures and cancer. Prompt recognition of the process and aggressive measures towards the stabilization of the patient are key to a favorable outcome.