The role for prudence before describing novel infectious etiologies for acute pancreatitis. The experience of one institution before describing influenza B pancreatitis.

CONTEXT: While the majority of acute pancreatitis is secondary to alcohol and gallstones in the developed world, infectious causes are recognized and recent evidence has linked influenza A to acute pancreatitis. CASE REPORT: We report a patient with acute pancreatitis deemed secondary to influenza B virus; however considering this would be the first reported case, retesting showed that the initial PCR was falsely positive and a system-wide contamination discovered that unearthed other false negatives. CONCLUSIONS: While research must continue to describe novel infectious etiologies of acute pancreatitis, caution must be exercised before new associations are described. New tests are leading to increasing incidence and prevalence of disease and while such testing generally has high sensitivity and specificity, the role for false results still exists.

A Solitary Sigmoid Perineurioma in an Otherwise Healthy 30-Year-Old Male.

Colorectal perineuriomas are rare benign fibroblastic polyps of the colon found on colonoscopy and usually present as a sessile polyp distal to the splenic flexure. We report a case of sessile sigmoid perineurioma in a young healthy male. He presented with chronic constipation and underwent colonoscopy, which showed a 3-4 mm sessile polyp in the sigmoid colon. Biopsy results were significant for a perineurioma. These polyps are peripheral nerve sheath tumors composed of bland spindle cells with ovoid nuclei in a whorling appearance. The differential diagnosis of these nerve sheath tumors includes ganglioneuromas, schwannomas, neuromas, neurofibroma, or Schwann cell hamartomas, and gastrointestinal stromal tumor (GIST). While these polyps are regarded as benign, it is prudent to rule out other tumors that have malignant potential.

Black Esophagus in the Setting of Diabetic Ketoacidosis: A Rare Finding from Our Institution.

Acute esophageal necrosis (AEN) is defined as necrosis of the esophageal mucosa seen as diffuse black discoloration of the distal esophagus on an upper endoscopy. The prevalence of the disease is rare and reported to be up to 0.2% in autopsy series. The etiology of the disease is thought to be multifactorial and due to ischemic insults to the esophagus with gastric acid reflux further damaging the vulnerable mucosa. Patients are often critically ill or with significant comorbidities. Here, we present a case series of 3 patients with AEN induced by diabetic ketoacidosis.

A case of recurrent bleeding stomal varix controlled using embolization with a liquid copolymer: an effective therapy for palliation.

BACKGROUND: Bleeding stomal varices (BSV) is a common problem in patients undergoing an ileostomy or colostomy. The diagnosis is often delayed as blood loss occurs in small amounts over a period of time, usually from minor anastamosing blood vessels at the ostomy site making it hard to diagnose. Treatment options can be limited in terms of modalities and efficacy. CASE: We describe a case of recurrent bleeding from a superior mesenteric vein (SMV) that was inadvertently sewn into the ileostomy site during surgery. Bleeding was initially controlled with percutaneous SMV coil embolization, but the bleeding persisted, only to be controlled finally by embolization using a liquid copolymer. Though the patient was terminally ill, his quality of life significantly improved thereafter, he did not have any further bleeding episodes during 10 months of follow-up. CONCLUSION: Embolization of a recurrent bleeding stomal varix with a liquid copolymer may be an effective therapeutic option.