Background： Little information is available about the relationship between restoration of common bileduct （CBD） diameter after endoscopic stone retraction and recurrence of CBD stones in elderly patients.The presen...Background： Little information is available about the relationship between restoration of common bileduct （CBD） diameter after endoscopic stone retraction and recurrence of CBD stones in elderly patients.The present study was to determine whether restoration of CBD diameter is a preventive factor for CBDstone recurrence in elderly patients who underwent endoscopic retrograde cholangiopancreatography（ERCP）.展开更多
BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy(EUS-FNA or FNB)has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accura...BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy(EUS-FNA or FNB)has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accuracy and safety.To the best of our knowledge,no case report of severe infection after EUS-FNB of a solid lesion in the spleen has been described.Herein,we report a rare case of septic shock after EUS-FNB of a splenic mass.CASE SUMMARY A 45-year-old male patient presented to the outpatient clinic due to an incidentally detected splenic mass.A definitive diagnosis could not be established based on the abdominal magnetic resonance imaging.EUS of the spleen showed a 6 cm-sized,relatively well-demarcated,heterogeneous mass,and EUS-FNB with a 22G needle was performed.Ten days after the procedure patient developed septic shock and a splenic abscess was identified.Blood culture revealed growth of Granulicatella adiacens.After the treatment with antibiotics the patient underwent surgical resection,and the pathological examination showed diffuse large B-cell lymphoma.The patient received chemotherapy and he is in complete remission.CONCLUSION Infection of a splenic mass after EUS-FNB is a rare complication and prophylactic antibiotics might be considered.展开更多
Background: Efficient ampullary intervention is essential for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a prior Billroth II gastrectomy. We retrospectively evaluated the safety and effectiv...Background: Efficient ampullary intervention is essential for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a prior Billroth II gastrectomy. We retrospectively evaluated the safety and effectiveness of ampullary intervention using fully covered self-expandable metal stents(FCSEMSs) for the management of common bile duct(CBD) stones in a subset of patients with a history of Billroth II gastrectomy. Methods: This retrospective analysis involved patients with a prior Billroth II gastrectomy who underwent ampullary intervention with FCSEMSs for the management of CBD stones. The factors associated with FCSEMSs placement, treatment success, and procedural complications were analyzed. Results: A group of 15 patients(10 males; median age, 78 years) underwent biliary metal stent placement for high degree of CBD angulation(6), small or flat papilla with unclear margin(5), current use of double antiplatelet agents or an anticoagulant(2), unwanted instrumentation of the cystic duct(1), and insecure position of the scope(1). Ampullary intervention with FCSEMSs was successful in all patients. After dilating the ampulla of Vater and building a durable conduit with FCSEMSs immediately, CBD stones were removed successfully from all patients in a single session. A mild post-ERCP pancreatitis occurred in one patient, who recovered without complications. Conclusion: Ampullary intervention with FCSEMSs is safe and effective for the management of CBD stones in a subset of patients with a history of Billroth II gastrectomy.展开更多
BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury.We report that the patient was safely treated by conservative treatment after the obstruction w...BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury.We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography(ERCP).CASE SUMMARY A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior.Four days prior to presentation,the patient had slipped,fallen and struck his abdomen on a motorcycle handle.His initial vital signs were stable.On physical examination,he showed right upper quadrant pain and Murphy’s sign,with decreased bowel sounds.Additionally,he had had a poor appetite for 4 d.He had been on aspirin for 2 years due to underlying hypertension.Initial simple radiography revealed a slight ileus.The laboratory findings were as follows:white blood cell count,15.5×103/µL(normal range 4.8×10^(3)–10.8×10^(3));hemoglobin,9.4 g/dL;aspartate aminotransferase/alanine transferase,423/348 U/L;total bilirubin/direct bilirubin,4.45/3.26 mg/dL;-GTP,639 U/L(normal range 5–61 U/L);and C-reactive protein,12.32 mg/dL(0–0.3).Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm×40 mm hematoma.Dilatation was observed in both the intrahepatic and common bile duct areas.Antibiotic treatment was initiated,and ERCP was performed,with hemobilia found during treatment.After cannulation,the patient’s symptoms were relieved,and after conservative management,the patient was discharged with no further complications.After 1-month follow-up,the gallbladder hematoma was completely resolved.CONCLUSION In the case of traumatic injury to the gallbladder,conservative treatment is feasible even in the presence of hematoma.展开更多
文摘Background： Little information is available about the relationship between restoration of common bileduct （CBD） diameter after endoscopic stone retraction and recurrence of CBD stones in elderly patients.The present study was to determine whether restoration of CBD diameter is a preventive factor for CBDstone recurrence in elderly patients who underwent endoscopic retrograde cholangiopancreatography（ERCP）.
文摘BACKGROUND Endoscopic ultrasound-guided fine needle aspiration or biopsy(EUS-FNA or FNB)has become a popular method for diagnosing various lesions of the gastrointestinal tract and surrounding tissue due to the accuracy and safety.To the best of our knowledge,no case report of severe infection after EUS-FNB of a solid lesion in the spleen has been described.Herein,we report a rare case of septic shock after EUS-FNB of a splenic mass.CASE SUMMARY A 45-year-old male patient presented to the outpatient clinic due to an incidentally detected splenic mass.A definitive diagnosis could not be established based on the abdominal magnetic resonance imaging.EUS of the spleen showed a 6 cm-sized,relatively well-demarcated,heterogeneous mass,and EUS-FNB with a 22G needle was performed.Ten days after the procedure patient developed septic shock and a splenic abscess was identified.Blood culture revealed growth of Granulicatella adiacens.After the treatment with antibiotics the patient underwent surgical resection,and the pathological examination showed diffuse large B-cell lymphoma.The patient received chemotherapy and he is in complete remission.CONCLUSION Infection of a splenic mass after EUS-FNB is a rare complication and prophylactic antibiotics might be considered.
文摘Background: Efficient ampullary intervention is essential for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a prior Billroth II gastrectomy. We retrospectively evaluated the safety and effectiveness of ampullary intervention using fully covered self-expandable metal stents(FCSEMSs) for the management of common bile duct(CBD) stones in a subset of patients with a history of Billroth II gastrectomy. Methods: This retrospective analysis involved patients with a prior Billroth II gastrectomy who underwent ampullary intervention with FCSEMSs for the management of CBD stones. The factors associated with FCSEMSs placement, treatment success, and procedural complications were analyzed. Results: A group of 15 patients(10 males; median age, 78 years) underwent biliary metal stent placement for high degree of CBD angulation(6), small or flat papilla with unclear margin(5), current use of double antiplatelet agents or an anticoagulant(2), unwanted instrumentation of the cystic duct(1), and insecure position of the scope(1). Ampullary intervention with FCSEMSs was successful in all patients. After dilating the ampulla of Vater and building a durable conduit with FCSEMSs immediately, CBD stones were removed successfully from all patients in a single session. A mild post-ERCP pancreatitis occurred in one patient, who recovered without complications. Conclusion: Ampullary intervention with FCSEMSs is safe and effective for the management of CBD stones in a subset of patients with a history of Billroth II gastrectomy.
文摘BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury.We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography(ERCP).CASE SUMMARY A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior.Four days prior to presentation,the patient had slipped,fallen and struck his abdomen on a motorcycle handle.His initial vital signs were stable.On physical examination,he showed right upper quadrant pain and Murphy’s sign,with decreased bowel sounds.Additionally,he had had a poor appetite for 4 d.He had been on aspirin for 2 years due to underlying hypertension.Initial simple radiography revealed a slight ileus.The laboratory findings were as follows:white blood cell count,15.5×103/µL(normal range 4.8×10^(3)–10.8×10^(3));hemoglobin,9.4 g/dL;aspartate aminotransferase/alanine transferase,423/348 U/L;total bilirubin/direct bilirubin,4.45/3.26 mg/dL;-GTP,639 U/L(normal range 5–61 U/L);and C-reactive protein,12.32 mg/dL(0–0.3).Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm×40 mm hematoma.Dilatation was observed in both the intrahepatic and common bile duct areas.Antibiotic treatment was initiated,and ERCP was performed,with hemobilia found during treatment.After cannulation,the patient’s symptoms were relieved,and after conservative management,the patient was discharged with no further complications.After 1-month follow-up,the gallbladder hematoma was completely resolved.CONCLUSION In the case of traumatic injury to the gallbladder,conservative treatment is feasible even in the presence of hematoma.
