The pancreatic development variations are relatively frequent but are often overlooked in clinical practice.This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomati...The pancreatic development variations are relatively frequent but are often overlooked in clinical practice.This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomatic.It also refers to the ectopic pancreatic tissue in the stomach.This anomaly can be diagnosed in any part of the digestive system,but it is mostly seen in the upper gastrointestinal tract,especially in the stomach,duodenum and jejunum.The management of this condition has evolved due to the development of minimally invasive procedures.展开更多
This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Our primary focus is on the causes,location,diagnosis,histological ...This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Our primary focus is on the causes,location,diagnosis,histological classification,and therapy of ectopic pancreas.Ectopic pancreas refers to the presence of pancreatic tissue that is situated in a location outside its usual anatomical placement,and is not connected to the normal pancreas in terms of blood supply or anatomical struc-ture.Currently,the embryological origin of ectopic pancreas remains uncertain.The most prevalent form of ectopic pancreatic is gastric ectopic pancreas.Endoscopic ultrasonography examination can visualize the morphological charac-teristics of the ectopic pancreatic lesion and pinpoint its anatomical location.The histological categorization of ectopic pancreas evolves.Endoscopic treatment has been widely advocated in ectopic pancreas.展开更多
Background: Ectopic pregnancy is a major cause of maternal morbidity and mortality, estimated to occur in 1% - 2% of pregnancies worldwide. This condition also has an adverse effect on the fertility prospects of women...Background: Ectopic pregnancy is a major cause of maternal morbidity and mortality, estimated to occur in 1% - 2% of pregnancies worldwide. This condition also has an adverse effect on the fertility prospects of women who experience it. Objective: To determine the outcomes of subsequent spontaneous fertility after medical treatment of patients with methotrexate (MTX) in patients with ectopic pregnancy at two university teaching hospitals of Yaounde. Methodology: We carried out a cross-sectional study with retrospective data collection in two university teaching hospitals of Yaounde during a six years period from 1<sup>st</sup> January 2015 to 31<sup>st</sup> May 2021. Seventy records of patients who had medical treatment for ectopic pregnancy were included in this study. Statistical analysis was performed using SPSS. 23. The Chi-2 statistical test was used to compare qualitative variables. Binary logistic regression method was performed to identify independent risk factors associated with infertility after medical treatment of tubal ectopic pregnancy (TEP). The significance level was set at 0.05. Results: The mean age in our study population was 27.8 ± 3.8 years. According to the past medical history, 52.9% had a pelvic inflammatory disease (PID) and the most frequently germ found was C. trachomatis (47.1%). Almost 15% of our study population had previous surgery for EP. The median Fernandez score was 11 with a minimum score of 4 and a maximum score of 13. The route of administration of methotrexate was intramuscular in all our patients, and the single-dose protocol was used most frequently (58.6%). After medical treatment of the EP, we found a spontaneous conception rate of 58.6%. After multivariate analysis, we were unable to confirm that there was an association between a history of sexually transmitted infections (STIs) and fertility prognosis. Conclusion: The spontaneous fertility rate after medical management of EP was 58.6%, of which 73.2% were term pregnancies and 14.6% were recurrent ectopic pregnancies.展开更多
Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Ho...Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.展开更多
BACKGROUND Ectopic pregnancy(EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, serious...BACKGROUND Ectopic pregnancy(EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, seriously threatening the patient’s life. Early diagnosis is the key to preventing and improving the prognosis of EP.Transabdominal ultrasound(TAS) and transvaginal ultrasound(TVS) are the main diagnostic methods for abdominal diseases. The purpose of this study is to explore the application value and effect of TAS and TVS in the diagnosis of EP,hoping to provide more valuable references for the diagnosis of EP.AIM To explore the application value of TAS and TVS in the diagnosis of EP and to improve the level of clinical diagnosis.METHODS A total of 140 patients with EP admitted to our hospital from July 2018 to July 2020 were selected for this study. All patients were divided into two groups according to the examination methods. 63 patients who underwent abdominal ultrasound examination were set as the TAS group, while 77 patients who underwent TVS examination were set as the TVS group. We compared the diagnostic accuracy and misdiagnosis rates between the two types of ultrasound examinations, as well as the postoperative pathological results of the two diagnostic methods for different types of ectopic pregnancies. We also analyzed the sonograms for the presence of mixed ectopic masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the ectopic sac shadow, and the detection of fluid in the rectal fossa of the uterus, such as the adnexal area, yolk sac, and embryo, etc. In addition, the diagnosis time, days of gestational sac appearance, operation time, endometrial thickness, and blood flow resistance index were compared as well.RESULTS After performing both types of ultrasound examinations in 140 patients with EP, we found that the diagnostic accuracy of TVS was significantly higher than that of TAS, and the misdiagnosis rate was significantly lower than that of TAS. The differences were statistically significant(P < 0.05). In addition, the detection rate of TVS was better than that of TAS for the presence of mixed masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the shadow of the ectopic sac, and sonograms such as the adnexal area, yolk sac, and embryo,etc. The coincidence rate of its postoperative pathological examination results was significantly higher than those of TAS. The diagnosis time and the days of gestational sac appearance by TVS were significantly shorter than that by TAS, and the operation time was earlier than that by TAS.What’s more, the detection rates of the endometrial thickness ￡ 1.5 mm and blood flow resistance ￡0.5 were significantly higher in TVS diagnosis of EP than in TAS. All differences were statistically significant(P < 0.05).CONCLUSION Compared with TAS, TVS has the advantages of high detection accuracy and good sonogram performance.展开更多
BACKGROUND Gastric ectopic pancreas(GEP)is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas.It is usually difficu...BACKGROUND Gastric ectopic pancreas(GEP)is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas.It is usually difficult to diagnose through histological examination,and the choice of treatment method is crucial.AIM To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection(LR)and endoscopic submucosal dissection(ESD).METHODS Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included.Data on clinical characteristics,endoscopic ultrasonography(EUS),ESD,and LR were collected and analyzed.The characteristics of EUS and the efficacy of the two treatments were analyzed.RESULTS The average age of the patients was 43.31±13.50 years,and the average maximum diameter of the lesions was 1.55±0.70 cm.The lesion originated from the mucosa in one patient(2.04%),from the submucosa in 42 patients(85.71%),and from the muscularis propria in 6 patients(12.25%).Twenty-nine patients(59.20%)with GEP showed umbilical depression on endoscopy.The most common initial symptom of GEP was abdominal pain(40.82%).Tumor markers,including carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9),were generally within the normal range.One patient(2.04%)with GEP had increased CEA and CA-19-9 levels.However,no cancer tissue was found on postoperative pathological examination,and tumor markers returned to normal levels after resecting the lesion.There was no significant difference in surgery duration(72.42±23.84 vs 74.17±12.81 min)or hospital stay(3.70±0.91 vs 3.83±0.75 d)between the two methods.LR was more often used for patients with larger tumors and deeper origins.The amount of bleeding was significantly higher in LR than in ESD(11.28±16.87 vs 16.67±8.76 mL,P<0.05).Surgery was associated with complete resection of the lesion without any serious complications;there were no cases of recurrence during the follow-up period.CONCLUSION GEP has unique characteristics in EUS.LR and ESD seem to be good choices for treating GEP.LR is better for large GEP with a deep origin.However,due to the rarity of GEP,multicenter large-scale studies are needed to describe its characteristics and evaluate the safety of LR and ESD.展开更多
Background: Heterotopic pregnancy is a very rare event in a natural cycle. Its incidence is rising mostly due to induction of ovulation or Assisted Reproductive Technique. Most ectopic in heterotopic pregnancies are l...Background: Heterotopic pregnancy is a very rare event in a natural cycle. Its incidence is rising mostly due to induction of ovulation or Assisted Reproductive Technique. Most ectopic in heterotopic pregnancies are localized in the fallopian tubes. The occurrence of molar tubal ectopic pregnancy coexisting with intrauterine pregnancy is uncommon and consequently not often considered a diagnostic possibility. Case Report: We report the case of a 25-year-old woman, gravida 4 para 1, who complained of vaginal spotting and lower abdominal pain after 6 weeks of amenorrhea following clomiphene citrate ovarian stimulation. Transvaginal Ultrasonography revealed an intrauterine pregnancy and an unruptured left tubal ectopic pregnancy. She underwent successful laparoscopic salpingectomy while the intra-uterine pregnancy was allowed to continue. The ectopic pregnancy tissue histology reported an ectopic partial molar pregnancy. She subsequently had a normal vaginal delivery at 39 weeks and 3 days and her follow-up was uneventful. Conclusion: Heterotopic pregnancy is a rare but life-threatening condition. It should be suspected in a pregnant woman with a risk factor of multiple gestations who presents vaginal bleeding and lower abdominal pain in the context of early pregnancy. Laparoscopic surgery is effective for confirming the diagnosis and treating the ectopic component. Routine histological examination of tubal specimens must be taken very seriously because some findings like molar pregnancies may require specific management.展开更多
BACKGROUND Cervical pregnancies,interstitial tubal pregnancies,and cesarean scar pregnancies,which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use ...BACKGROUND Cervical pregnancies,interstitial tubal pregnancies,and cesarean scar pregnancies,which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries.The development of highsensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment.Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported.However,delayed resumption of infertility treatments after methotrexate therapy is indicated,and negative effects on the next pregnancy after uterine artery embolization have been reported.AIM To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.METHODS In this study,we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital,between April 2010 and December 2018,and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes.We evaluated the treatment methods,treatment outcomes,presence of bleeding requiring hemostasis measures and blood transfusion,complications,and treatment periods.Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.RESULTS There were 21 total cases comprising 10 cervical pregnancies,10 interstitial tubal pregnancies,and 1 cesarean scar pregnancy.All patients completed treatment with this method.No massive hemorrhaging or serious adverse reactions were observed during treatment.The mean gestation ages at the time of diagnosis were 5.9 wk(SD,±0.9 wk)for cervical and 6.9 wk(SD,±2.1 wk)for interstitial tubal pregnancies.The total ethanol doses were 4.8 mL(SD,±2.2 mL)for cervical pregnancies and 3.3 mL(SD,±2.2 mL)for interstitial pregnancies.The treatment period was 28.5days(SD,±11.7 d)for cervical pregnancies and 30.0±8.1 d for interstitial pregnancies.Positive correlations were observed between the bloodβ-human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose(r=0.75;P=0.00008),as well as between the total ethanol dose and treatment period(r=0.48;P=0.026).CONCLUSION Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.展开更多
Although tocopherols are essential for rice development,the molecular details by which their absence affects development remain to be determined.To study how tocopherols function during rice development,we performed a...Although tocopherols are essential for rice development,the molecular details by which their absence affects development remain to be determined.To study how tocopherols function during rice development,we performed a transcriptome deep sequencing(RNA-seq)analysis of the rice cultivar Nipponbare(Nip)and the tocopherol-deficient mutant small grain and dwarf 1-2(sgd1-2).We identified 563 differentially expressed genes that were enriched in Gene Ontology categories associated with metabolism,stress,cellular responses,and transcriptional regulation.We determined that the total fatty acid composition of Nip and sgd1-2 was comparable,although cell membrane penetrability in sgd1-2 was significantly higher than in Nip under optimal growth conditions,indicating that tocopherol deficiency induces cell membrane damage.The expression levels of dehydration-responsive element binding 1(DREB1)genes and free proline content in sgd1-2 were also higher than those in Nip.We also showed that the DELLA protein SLENDER RICE1(SLR1)accumulated in sgd1-2,resulting in significant changes in the global transcriptome.Our study confirms that the lack of tocopherol accumulation in rice induced ectopic stress responses and limited growth by enhancing SLR1 abundance through increasing SLR1 transcript levels.These results provide new insights into tocopherol during rice development.展开更多
BACKGROUND A large percentage of patients with ectopic pancreas are asymptomatic.When present,the symptoms are typically non-specific.These lesions are predominantly located in the stomach and benign in nature.Synchro...BACKGROUND A large percentage of patients with ectopic pancreas are asymptomatic.When present,the symptoms are typically non-specific.These lesions are predominantly located in the stomach and benign in nature.Synchronous multiple early gastric cancer(SMEGC)(two or more simultaneous malignant lesions with early gastric cancer)is relatively rare and particularly easy to overlook during endoscopic examination.The prognosis of SMEGC is generally poor.We report a rare case of ectopic pancreas with concomitant SMEGC.CASE SUMMARY A 74-year-old woman presented with paroxysmal upper abdominal pain.On initial investigations,she tested positive for Helicobacter pylori(H.pylori).She underwent esophagogastroduodenoscopy which revealed a 1.5 cm×2 cm major lesion at the greater curvature and a 1 cm minor lesion at the lesser curvature of the stomach.On endoscopic ultrasound,the major lesion showed hypoechoic changes,uneven internal echoes and unclear boundaries between some areas and the muscularis propria.Endoscopic submucosal dissection was performed to excise the minor lesion.A laparoscopic resection was chosen for the major lesion.On histopathological examination,the major lesion contained high grade intraepithelial neoplasia with a small focus of cancer.A separate underlying ectopic pancreas was found under this lesion.The minor lesion contained high grade intraepithelial neoplasia.In this case,the patient was diagnosed with SMEGC with concomitant ectopic pancreas in the stomach.CONCLUSION Patients with atrophy,H.pylori,and other risk factors should be carefully investigated to avoid missing other lesions including SMEGC and ectopic pancreas.展开更多
BACKGROUND Ectopic pancreatic tissue is a congenital anomaly where a part of pancreatic tissue is located outside of the pancreas and lacks vascular or anatomical communication with it but shows the same histological ...BACKGROUND Ectopic pancreatic tissue is a congenital anomaly where a part of pancreatic tissue is located outside of the pancreas and lacks vascular or anatomical communication with it but shows the same histological features.Currently,the literature reports only two anecdotal cases of malignant transformation of colonic ectopic pancreas.CASE SUMMARY We present a case of an 81-year-old patient presenting with anemia,with right colonic neoplasia and carbohydrate antigen 19-9 above the normal values.She underwent laparoscopic right hemicolectomy.The final histology was consistent with a primitive adenocarcinoma with ductal morphology and solid-predominant growth pattern.Benign ectopic pancreatic tissue was absent in the surgical specimen.CONCLUSION The case describes a very rare complete degeneration of a colonic ectopic pancreatic tissue.However,the absence of benign ectopic pancreatic tissue in the surgical specimen is suggestive of the first description of a primitive ductal adenocarcinoma of the colon.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and ra...BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and radiographic features,making preoperative identification challenging.CASE SUMMARY A 47-year-old man underwent routine abdominal color ultrasonography,which identified an asymptomatic tumor in the left upper abdomen.The patient had no history of hepatitis,did not drink alcohol,and had no family history of cancer.Abdominal contrast-enhanced computed tomography(CT)revealed a heterogeneously enhanced lesion between the spleen and stomach that had invaded the diaphragm,with blood supplied by the left inferior phrenic artery.The patient underwent laparoscopic surgery,and HCC was identified by postoperative pathology.Additionally,specific immunohistochemical staining was performed to assess the molecular biological characteristics of the HCC.The patient underwent two rounds of hepatic arterial interventional chemotherapy after surgery.Abdominal plain and enhanced magnetic resonance imaging and lung CT 3 mo postoperatively revealed no signs of local recurrence or distant metastasis.CONCLUSION This asymptomatic ectopic HCC case described achieved an excellent result due to early detection,radical resection,and systematic surveillance.展开更多
BACKGROUND Ectopic pancreas may be unfamiliar to many people because it is rare and difficult to diagnose.However,this disease is highly susceptible to misdiagnosis and missed diagnosis.In this article,we report two c...BACKGROUND Ectopic pancreas may be unfamiliar to many people because it is rare and difficult to diagnose.However,this disease is highly susceptible to misdiagnosis and missed diagnosis.In this article,we report two cases of pancreatic heterotopia in the gastric sinus and small intestine,respectively,both of which were confirmed by histopathological examination.CASE SUMMARY The first patient was a 43-year-old female which reported abdominal distension for 2 mo.The second was a 67-year-old female who experienced intermittent epigastric discomfort for 15 d.In both cases,there was no confirmed preoperative examination,and the postoperative pathology indicated the presence of ectopic pancreas.CONCLUSION The diagnosis of ectopic pancreas is difficult,and is often prone to misdiagnosis and the possibility of being overlooked.Various laboratory tests and imaging tests should be carefully evaluated before surgery to achieve early detection,early diagnosis and early treatment.展开更多
Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although...Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5%<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>misleading. Several weeks later,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.</span></span></span>展开更多
BACKGROUND The ampulla of Vater is an opening at the confluence of the common bile duct and pancreatic duct.It is located in the second portion of the duodenum.An ectopic papilla of Vater is an anomalous termination.F...BACKGROUND The ampulla of Vater is an opening at the confluence of the common bile duct and pancreatic duct.It is located in the second portion of the duodenum.An ectopic papilla of Vater is an anomalous termination.Few cases have been reported.We report the rare case of a man with an ectopic ampulla of Vater in the pylorus.CASE SUMMARY An 82-year-old man had experienced abdominal pain and fever with chills 1 d before his presentation.A computed tomography scan of the abdomen demonstrated dilatation of the common bile duct approximately 2.2 cm in width.Gas retention was found in his intrahepatic ducts.Acute cholangitis with pneumobilia was identified,and he was hospitalized.Esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography disclosed no ampulla of Vater in the second portion of the duodenum.Moreover,a capsule-like foreign body(pharmaceutical desiccant)approximately 1 cm×2 cm in size was found at the gastric antrum and peri-pyloric region.After the foreign body was removed,one orifice presented over the pyloric ring in the stomach,a suspected ectopic ampulla of Vater.Subsequently,sludge in the common bile duct was cleaned,and balloon dilatation was performed.The general condition improved daily.The patient was discharged in a stable condition and followed in our outpatient department.CONCLUSION This case involved an ampulla of Vater in an unusual location.Endoscopic retrograde cholangiopancreatography with balloon dilatation is the main treatment recommended and performed.展开更多
AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endos...AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.展开更多
AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two hospitals.Institutional revi...AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two hospitals.Institutional review board approval was obtained.Patients referred to the University Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions(SEL)with a final diagnosis of EP between January 2009and December 2013 were identified.Patients in this group were selected for the study if they underwent endoscopic ultrasound(EUS)with fine-needle aspiration(FNA)or deep biopsy.A review of the medical record was performed specifically to review the following information:presenting symptoms,endoscopic and EUS findings,computed tomography or magnetic resonance imaging findings,pathology results,procedure-related adverse events,and subsequent treatments after EUSFNA.EUS with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians(Attwell A,Fukami N).Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final diagnoses.RESULTS:Between July 2009 and December 2013,10patients[3 males,7 females,median age 52(26-64)years]underwent EUS for a gastroduodenal SEL and were diagnosed with EP.One patient was symptomatic.Six(60%)lesions were in the antrum,3(30%)in the body,and 1(10%)in the duodenum.A mucosal dimple was noted in 6(60%).Mean lesion size was 17(8-25)mm.Gastrointestinal wall involvement:muscularis mucosae,10%;submucosa,70%;muscularis propria,60%;and serosa,10%.Nine(90%)lesions were hypoechoic and 5(50%)were homogenous.A duct was seen in 5(50%).FNA was attempted in 9(90%)and successful in 8(80%)patients after 4(2-6)passes.Cytology showed acini or ducts in 7 of 8(88%).Superficial biopsies in 7 patients(70%)showed normal gastric mucosa.Deep endoscopic biopsies were taken in 2 patients and diagnostic in one.One patient(10%)developed pancreatitis after EUS-FNA.Two patients(20%)underwent surgery to relieve symptoms or confirm the diagnosis.The main limitation of the study was the fact that it was retrospective and performed at a single medical center.CONCLUSION:EUS features of EP include antral location,mucosal dimple,location in layers 3-4,and lesional duct,and FNA or biopsy is accurate and effective.展开更多
Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.D...Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequent treatment is also difficult; the optimal treatment has not been established. Recently, interventional radiology and endoscopic treatments have been carried out successfully for hemorrhage from ectopic varices.展开更多
BACKGROUND:Ectopic pancreas is defined as pancreatic tissue found outside its usual anatomical position,with no ductal or vascular communication with the native pancreas. We describe a case of ectopic pancreas of the ...BACKGROUND:Ectopic pancreas is defined as pancreatic tissue found outside its usual anatomical position,with no ductal or vascular communication with the native pancreas. We describe a case of ectopic pancreas of the small bowel and mesentery causing recurrent episodes of pancreatitis, initially suspected on computed tomography(CT)and magnetic resonance cholangiopancreatography(MRCP),and confirmed on histological review of the resection. METHODS:A 67-year-old woman presented with clinical symptoms and biochemical evidence of pancreatitis.She had similar episodes over the past 30 years with unrevealing investigations,and was concluded to have idiopathic pancreatitis. She underwent CT and MRCP,with findings suggestive of ectopic pancreas,a diagnosis confirmed on histology of the resection. RESULTS:MRCP identified a mass in the proximal small bowel mesentery isointense to the native pancreas,with a small duct draining into a proximal jejunal loop.The resected specimen consisted of normal parenchyma with lobulated acinar tissue with scattered islets of Langerhans,an occasional ductular structure,and admixed areas of adipose tissue.The patient remained asymptomatic with normal biochemistry six months post-operatively. CONCLUSION:In an individual with abdominal pain,elevated serum amylase/lipase,but imaging findings of a normal native pancreas,ectopic pancreatitis should be considered,and can be evaluated by CT and MRCP.展开更多
Ectopic adrenal cortical neoplasms are extremely rare. Ectopic adrenocortical tissue can be found in locations such as the celiac axis,the broad ligament,the adnexa of the testes,and the spermatic cord;however,they ra...Ectopic adrenal cortical neoplasms are extremely rare. Ectopic adrenocortical tissue can be found in locations such as the celiac axis,the broad ligament,the adnexa of the testes,and the spermatic cord;however,they rarely involve the stomach.We report an unusual case of a patient with an ectopic adrenal cortical adenoma in the gastric wall.The patient was a 72-year old female admitted to our hospital with upper abdominal discomfort.Physical examination revealed tenderness below the xiphoid process.Both computed tomography and fibergastroscopy revealed a mass on the lesser curvature side of the gastric antrum;it was initially diagnosed as a gastric stromal tumor.After adequate preparation,the patient underwent surgery.During the procedure,we found a 30 mm×30 mm mass with medium density in the lesser curvature near the gastric antrum within the serosa.Following immunohistochemistry examination, we corrected the diagnosis to an ectopic adrenal cortical adenoma;the tumor was nonfunctional.展开更多
文摘The pancreatic development variations are relatively frequent but are often overlooked in clinical practice.This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomatic.It also refers to the ectopic pancreatic tissue in the stomach.This anomaly can be diagnosed in any part of the digestive system,but it is mostly seen in the upper gastrointestinal tract,especially in the stomach,duodenum and jejunum.The management of this condition has evolved due to the development of minimally invasive procedures.
文摘This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Our primary focus is on the causes,location,diagnosis,histological classification,and therapy of ectopic pancreas.Ectopic pancreas refers to the presence of pancreatic tissue that is situated in a location outside its usual anatomical placement,and is not connected to the normal pancreas in terms of blood supply or anatomical struc-ture.Currently,the embryological origin of ectopic pancreas remains uncertain.The most prevalent form of ectopic pancreatic is gastric ectopic pancreas.Endoscopic ultrasonography examination can visualize the morphological charac-teristics of the ectopic pancreatic lesion and pinpoint its anatomical location.The histological categorization of ectopic pancreas evolves.Endoscopic treatment has been widely advocated in ectopic pancreas.
文摘Background: Ectopic pregnancy is a major cause of maternal morbidity and mortality, estimated to occur in 1% - 2% of pregnancies worldwide. This condition also has an adverse effect on the fertility prospects of women who experience it. Objective: To determine the outcomes of subsequent spontaneous fertility after medical treatment of patients with methotrexate (MTX) in patients with ectopic pregnancy at two university teaching hospitals of Yaounde. Methodology: We carried out a cross-sectional study with retrospective data collection in two university teaching hospitals of Yaounde during a six years period from 1<sup>st</sup> January 2015 to 31<sup>st</sup> May 2021. Seventy records of patients who had medical treatment for ectopic pregnancy were included in this study. Statistical analysis was performed using SPSS. 23. The Chi-2 statistical test was used to compare qualitative variables. Binary logistic regression method was performed to identify independent risk factors associated with infertility after medical treatment of tubal ectopic pregnancy (TEP). The significance level was set at 0.05. Results: The mean age in our study population was 27.8 ± 3.8 years. According to the past medical history, 52.9% had a pelvic inflammatory disease (PID) and the most frequently germ found was C. trachomatis (47.1%). Almost 15% of our study population had previous surgery for EP. The median Fernandez score was 11 with a minimum score of 4 and a maximum score of 13. The route of administration of methotrexate was intramuscular in all our patients, and the single-dose protocol was used most frequently (58.6%). After medical treatment of the EP, we found a spontaneous conception rate of 58.6%. After multivariate analysis, we were unable to confirm that there was an association between a history of sexually transmitted infections (STIs) and fertility prognosis. Conclusion: The spontaneous fertility rate after medical management of EP was 58.6%, of which 73.2% were term pregnancies and 14.6% were recurrent ectopic pregnancies.
文摘Introduction: The aim of this study was to contribute to improving the quality of GEUR management in the general surgery department and in the maternity ward of the Ignace Deen national hospital, Conakry University Hospital. Methodology: This was a retrospective, descriptive study lasting two years (January 1, 2020 to December 31, 2022), carried out in the general surgery and gyneco-obstetrics departments of the Ignace Deen national hospital, Conakry University Hospital. We included all patients with a ruptured ectopic pregnancy who received surgical treatment during the study period. Results: We collected 13,524 cases of surgical interventions in the two services, among them, we recorded 89 cases or 0.66% GEUR. The average age of the patients was 24.26 years. Brides were the most represented with 80.96% of cases. Women practicing a liberal profession were 51.69% (n = 46) and housewives 26.97% (n = 24). Clinically, amenorrhea was noted in all patients, i.e. 100%, abdominal-pelvic pain in 95.2% (n = 85) of cases, metrorrhagia in 94.08% (n = 84), abdominal-pelvic sensitivity in 97.44% (n = 87) of cases and anemia in 85.39% of cases. The GEUR was ampullary in 69.66% (n = 62) cases. Salpingectomy was performed in 90.72% (n = 81). The surgical outcomes were satisfactory in 98.87% (n = 88) of cases. We recorded one case of surgical site infection. We have not recorded any deaths. The average length of hospitalization was 4 days. Conclusion: GEUR is relatively high in our context. A good understanding of the prognostic factors of GEUR, awareness and family planning could reduce GEUR.
文摘BACKGROUND Ectopic pregnancy(EP) is one of the most common acute abdominal diseases in gynecology. Once the condition of EP is delayed, it may lead to massive hemorrhage, shock, and even death in a short time, seriously threatening the patient’s life. Early diagnosis is the key to preventing and improving the prognosis of EP.Transabdominal ultrasound(TAS) and transvaginal ultrasound(TVS) are the main diagnostic methods for abdominal diseases. The purpose of this study is to explore the application value and effect of TAS and TVS in the diagnosis of EP,hoping to provide more valuable references for the diagnosis of EP.AIM To explore the application value of TAS and TVS in the diagnosis of EP and to improve the level of clinical diagnosis.METHODS A total of 140 patients with EP admitted to our hospital from July 2018 to July 2020 were selected for this study. All patients were divided into two groups according to the examination methods. 63 patients who underwent abdominal ultrasound examination were set as the TAS group, while 77 patients who underwent TVS examination were set as the TVS group. We compared the diagnostic accuracy and misdiagnosis rates between the two types of ultrasound examinations, as well as the postoperative pathological results of the two diagnostic methods for different types of ectopic pregnancies. We also analyzed the sonograms for the presence of mixed ectopic masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the ectopic sac shadow, and the detection of fluid in the rectal fossa of the uterus, such as the adnexal area, yolk sac, and embryo, etc. In addition, the diagnosis time, days of gestational sac appearance, operation time, endometrial thickness, and blood flow resistance index were compared as well.RESULTS After performing both types of ultrasound examinations in 140 patients with EP, we found that the diagnostic accuracy of TVS was significantly higher than that of TAS, and the misdiagnosis rate was significantly lower than that of TAS. The differences were statistically significant(P < 0.05). In addition, the detection rate of TVS was better than that of TAS for the presence of mixed masses,adnexal masses, ectopic gestational sacs, the presence or absence of visible embryo and fetal heart in the shadow of the ectopic sac, and sonograms such as the adnexal area, yolk sac, and embryo,etc. The coincidence rate of its postoperative pathological examination results was significantly higher than those of TAS. The diagnosis time and the days of gestational sac appearance by TVS were significantly shorter than that by TAS, and the operation time was earlier than that by TAS.What’s more, the detection rates of the endometrial thickness ￡ 1.5 mm and blood flow resistance ￡0.5 were significantly higher in TVS diagnosis of EP than in TAS. All differences were statistically significant(P < 0.05).CONCLUSION Compared with TAS, TVS has the advantages of high detection accuracy and good sonogram performance.
基金Supported by Fujian Province Science and Technology Innovation Joint Fund Project,No.2021Y9029.
文摘BACKGROUND Gastric ectopic pancreas(GEP)is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas.It is usually difficult to diagnose through histological examination,and the choice of treatment method is crucial.AIM To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection(LR)and endoscopic submucosal dissection(ESD).METHODS Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included.Data on clinical characteristics,endoscopic ultrasonography(EUS),ESD,and LR were collected and analyzed.The characteristics of EUS and the efficacy of the two treatments were analyzed.RESULTS The average age of the patients was 43.31±13.50 years,and the average maximum diameter of the lesions was 1.55±0.70 cm.The lesion originated from the mucosa in one patient(2.04%),from the submucosa in 42 patients(85.71%),and from the muscularis propria in 6 patients(12.25%).Twenty-nine patients(59.20%)with GEP showed umbilical depression on endoscopy.The most common initial symptom of GEP was abdominal pain(40.82%).Tumor markers,including carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9),were generally within the normal range.One patient(2.04%)with GEP had increased CEA and CA-19-9 levels.However,no cancer tissue was found on postoperative pathological examination,and tumor markers returned to normal levels after resecting the lesion.There was no significant difference in surgery duration(72.42±23.84 vs 74.17±12.81 min)or hospital stay(3.70±0.91 vs 3.83±0.75 d)between the two methods.LR was more often used for patients with larger tumors and deeper origins.The amount of bleeding was significantly higher in LR than in ESD(11.28±16.87 vs 16.67±8.76 mL,P<0.05).Surgery was associated with complete resection of the lesion without any serious complications;there were no cases of recurrence during the follow-up period.CONCLUSION GEP has unique characteristics in EUS.LR and ESD seem to be good choices for treating GEP.LR is better for large GEP with a deep origin.However,due to the rarity of GEP,multicenter large-scale studies are needed to describe its characteristics and evaluate the safety of LR and ESD.
文摘Background: Heterotopic pregnancy is a very rare event in a natural cycle. Its incidence is rising mostly due to induction of ovulation or Assisted Reproductive Technique. Most ectopic in heterotopic pregnancies are localized in the fallopian tubes. The occurrence of molar tubal ectopic pregnancy coexisting with intrauterine pregnancy is uncommon and consequently not often considered a diagnostic possibility. Case Report: We report the case of a 25-year-old woman, gravida 4 para 1, who complained of vaginal spotting and lower abdominal pain after 6 weeks of amenorrhea following clomiphene citrate ovarian stimulation. Transvaginal Ultrasonography revealed an intrauterine pregnancy and an unruptured left tubal ectopic pregnancy. She underwent successful laparoscopic salpingectomy while the intra-uterine pregnancy was allowed to continue. The ectopic pregnancy tissue histology reported an ectopic partial molar pregnancy. She subsequently had a normal vaginal delivery at 39 weeks and 3 days and her follow-up was uneventful. Conclusion: Heterotopic pregnancy is a rare but life-threatening condition. It should be suspected in a pregnant woman with a risk factor of multiple gestations who presents vaginal bleeding and lower abdominal pain in the context of early pregnancy. Laparoscopic surgery is effective for confirming the diagnosis and treating the ectopic component. Routine histological examination of tubal specimens must be taken very seriously because some findings like molar pregnancies may require specific management.
文摘BACKGROUND Cervical pregnancies,interstitial tubal pregnancies,and cesarean scar pregnancies,which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries.The development of highsensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment.Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported.However,delayed resumption of infertility treatments after methotrexate therapy is indicated,and negative effects on the next pregnancy after uterine artery embolization have been reported.AIM To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.METHODS In this study,we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital,between April 2010 and December 2018,and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes.We evaluated the treatment methods,treatment outcomes,presence of bleeding requiring hemostasis measures and blood transfusion,complications,and treatment periods.Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.RESULTS There were 21 total cases comprising 10 cervical pregnancies,10 interstitial tubal pregnancies,and 1 cesarean scar pregnancy.All patients completed treatment with this method.No massive hemorrhaging or serious adverse reactions were observed during treatment.The mean gestation ages at the time of diagnosis were 5.9 wk(SD,±0.9 wk)for cervical and 6.9 wk(SD,±2.1 wk)for interstitial tubal pregnancies.The total ethanol doses were 4.8 mL(SD,±2.2 mL)for cervical pregnancies and 3.3 mL(SD,±2.2 mL)for interstitial pregnancies.The treatment period was 28.5days(SD,±11.7 d)for cervical pregnancies and 30.0±8.1 d for interstitial pregnancies.Positive correlations were observed between the bloodβ-human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose(r=0.75;P=0.00008),as well as between the total ethanol dose and treatment period(r=0.48;P=0.026).CONCLUSION Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.
基金supported by funding from the Natural Science Foundation of Jiangsu Province(BK20190239)Huai’an Academy of Agricultural Sciences Initiation and Development of Scientific Research Fund for High-Level Introduced Talents(0062019016B)the Scientific Research Fund Development Project of Huai’an Academy of Agricultural Sciences(HNY202102).
文摘Although tocopherols are essential for rice development,the molecular details by which their absence affects development remain to be determined.To study how tocopherols function during rice development,we performed a transcriptome deep sequencing(RNA-seq)analysis of the rice cultivar Nipponbare(Nip)and the tocopherol-deficient mutant small grain and dwarf 1-2(sgd1-2).We identified 563 differentially expressed genes that were enriched in Gene Ontology categories associated with metabolism,stress,cellular responses,and transcriptional regulation.We determined that the total fatty acid composition of Nip and sgd1-2 was comparable,although cell membrane penetrability in sgd1-2 was significantly higher than in Nip under optimal growth conditions,indicating that tocopherol deficiency induces cell membrane damage.The expression levels of dehydration-responsive element binding 1(DREB1)genes and free proline content in sgd1-2 were also higher than those in Nip.We also showed that the DELLA protein SLENDER RICE1(SLR1)accumulated in sgd1-2,resulting in significant changes in the global transcriptome.Our study confirms that the lack of tocopherol accumulation in rice induced ectopic stress responses and limited growth by enhancing SLR1 abundance through increasing SLR1 transcript levels.These results provide new insights into tocopherol during rice development.
文摘BACKGROUND A large percentage of patients with ectopic pancreas are asymptomatic.When present,the symptoms are typically non-specific.These lesions are predominantly located in the stomach and benign in nature.Synchronous multiple early gastric cancer(SMEGC)(two or more simultaneous malignant lesions with early gastric cancer)is relatively rare and particularly easy to overlook during endoscopic examination.The prognosis of SMEGC is generally poor.We report a rare case of ectopic pancreas with concomitant SMEGC.CASE SUMMARY A 74-year-old woman presented with paroxysmal upper abdominal pain.On initial investigations,she tested positive for Helicobacter pylori(H.pylori).She underwent esophagogastroduodenoscopy which revealed a 1.5 cm×2 cm major lesion at the greater curvature and a 1 cm minor lesion at the lesser curvature of the stomach.On endoscopic ultrasound,the major lesion showed hypoechoic changes,uneven internal echoes and unclear boundaries between some areas and the muscularis propria.Endoscopic submucosal dissection was performed to excise the minor lesion.A laparoscopic resection was chosen for the major lesion.On histopathological examination,the major lesion contained high grade intraepithelial neoplasia with a small focus of cancer.A separate underlying ectopic pancreas was found under this lesion.The minor lesion contained high grade intraepithelial neoplasia.In this case,the patient was diagnosed with SMEGC with concomitant ectopic pancreas in the stomach.CONCLUSION Patients with atrophy,H.pylori,and other risk factors should be carefully investigated to avoid missing other lesions including SMEGC and ectopic pancreas.
文摘BACKGROUND Ectopic pancreatic tissue is a congenital anomaly where a part of pancreatic tissue is located outside of the pancreas and lacks vascular or anatomical communication with it but shows the same histological features.Currently,the literature reports only two anecdotal cases of malignant transformation of colonic ectopic pancreas.CASE SUMMARY We present a case of an 81-year-old patient presenting with anemia,with right colonic neoplasia and carbohydrate antigen 19-9 above the normal values.She underwent laparoscopic right hemicolectomy.The final histology was consistent with a primitive adenocarcinoma with ductal morphology and solid-predominant growth pattern.Benign ectopic pancreatic tissue was absent in the surgical specimen.CONCLUSION The case describes a very rare complete degeneration of a colonic ectopic pancreatic tissue.However,the absence of benign ectopic pancreatic tissue in the surgical specimen is suggestive of the first description of a primitive ductal adenocarcinoma of the colon.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is one of the most frequent cancers and the main cause of cancer-related death worldwide.Ectopic HCC,an extremely rare type of HCC,exhibits a wide range of clinical signs and radiographic features,making preoperative identification challenging.CASE SUMMARY A 47-year-old man underwent routine abdominal color ultrasonography,which identified an asymptomatic tumor in the left upper abdomen.The patient had no history of hepatitis,did not drink alcohol,and had no family history of cancer.Abdominal contrast-enhanced computed tomography(CT)revealed a heterogeneously enhanced lesion between the spleen and stomach that had invaded the diaphragm,with blood supplied by the left inferior phrenic artery.The patient underwent laparoscopic surgery,and HCC was identified by postoperative pathology.Additionally,specific immunohistochemical staining was performed to assess the molecular biological characteristics of the HCC.The patient underwent two rounds of hepatic arterial interventional chemotherapy after surgery.Abdominal plain and enhanced magnetic resonance imaging and lung CT 3 mo postoperatively revealed no signs of local recurrence or distant metastasis.CONCLUSION This asymptomatic ectopic HCC case described achieved an excellent result due to early detection,radical resection,and systematic surveillance.
文摘BACKGROUND Ectopic pancreas may be unfamiliar to many people because it is rare and difficult to diagnose.However,this disease is highly susceptible to misdiagnosis and missed diagnosis.In this article,we report two cases of pancreatic heterotopia in the gastric sinus and small intestine,respectively,both of which were confirmed by histopathological examination.CASE SUMMARY The first patient was a 43-year-old female which reported abdominal distension for 2 mo.The second was a 67-year-old female who experienced intermittent epigastric discomfort for 15 d.In both cases,there was no confirmed preoperative examination,and the postoperative pathology indicated the presence of ectopic pancreas.CONCLUSION The diagnosis of ectopic pancreas is difficult,and is often prone to misdiagnosis and the possibility of being overlooked.Various laboratory tests and imaging tests should be carefully evaluated before surgery to achieve early detection,early diagnosis and early treatment.
文摘Cervical pregnancy is a rare clinical entity that accounts for less than 1% of all ectopic pregnancies. It results from implantation of the blastocyst in the cervical canal below the level of the internal os. Although non-tubal ectopic pregnancies account for only 5%<span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>of ectopics, they contribute to a significant morbidity. The cornerstone in the management of cervical ectopic is early diagnosis by high index of suspension and a qualified sonographer. Management options for cervical ectopic pregnancies range from conservative drug treatment to radical hysterectomy. Over the last few years, the mortality and morbidity rates of ectopic pregnancies have been reduced. This is mainly due to the early recognition of the condition and the wide availability of minimally invasive surgical procedures. We present a case of a 33-year-old</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>woman that was 16 weeks pregnant. She presented initially with recurrent vaginal bleeding followed by minimal lower abdominal pain. Her early US scans were</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>misleading. Several weeks later,</span></span></span><span><span><span style="font-family:;" "=""> </span></span></span><span><span><span>a follow up MRI scan suggested cervical ectopic. She was managed surgically with uterine preservation.</span></span></span>
文摘BACKGROUND The ampulla of Vater is an opening at the confluence of the common bile duct and pancreatic duct.It is located in the second portion of the duodenum.An ectopic papilla of Vater is an anomalous termination.Few cases have been reported.We report the rare case of a man with an ectopic ampulla of Vater in the pylorus.CASE SUMMARY An 82-year-old man had experienced abdominal pain and fever with chills 1 d before his presentation.A computed tomography scan of the abdomen demonstrated dilatation of the common bile duct approximately 2.2 cm in width.Gas retention was found in his intrahepatic ducts.Acute cholangitis with pneumobilia was identified,and he was hospitalized.Esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography disclosed no ampulla of Vater in the second portion of the duodenum.Moreover,a capsule-like foreign body(pharmaceutical desiccant)approximately 1 cm×2 cm in size was found at the gastric antrum and peri-pyloric region.After the foreign body was removed,one orifice presented over the pyloric ring in the stomach,a suspected ectopic ampulla of Vater.Subsequently,sludge in the common bile duct was cleaned,and balloon dilatation was performed.The general condition improved daily.The patient was discharged in a stable condition and followed in our outpatient department.CONCLUSION This case involved an ampulla of Vater in an unusual location.Endoscopic retrograde cholangiopancreatography with balloon dilatation is the main treatment recommended and performed.
基金Supported by Pusan National University Research Grant for two years
文摘AIM:To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.METHODS:A total of eight patients with ectopic pancreas were included.All of them underwent endoscopic ultrasonography before endoscopic resection.Endo-scopic resection was performed by two methods:endo-scopic mucosal resection(EMR)by the injection-and-cut technique or endoscopic mucosal dissection(ESD).RESULTS:We planned to perform EMR in all eight cases but EMR was successful in only four cases.In the other four cases,saline spread into surrounding normal tissues and the lesions becameattened,which made it impossible to remove them by EMR.Inthose four cases,we performed ESD and removed the lesions without any complications.CONCLUSION:If conventional EMR is difficult to remove gastric ectopic pancreas,ESD is a feasible alternative method for successful removal.
文摘AIM:To study the clinical,endoscopic,sonographic,and cytologic features of ectopic pancreas(EP).METHODS:This was a retrospective study performedat an academic referral center including two hospitals.Institutional review board approval was obtained.Patients referred to the University Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions(SEL)with a final diagnosis of EP between January 2009and December 2013 were identified.Patients in this group were selected for the study if they underwent endoscopic ultrasound(EUS)with fine-needle aspiration(FNA)or deep biopsy.A review of the medical record was performed specifically to review the following information:presenting symptoms,endoscopic and EUS findings,computed tomography or magnetic resonance imaging findings,pathology results,procedure-related adverse events,and subsequent treatments after EUSFNA.EUS with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians(Attwell A,Fukami N).Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final diagnoses.RESULTS:Between July 2009 and December 2013,10patients[3 males,7 females,median age 52(26-64)years]underwent EUS for a gastroduodenal SEL and were diagnosed with EP.One patient was symptomatic.Six(60%)lesions were in the antrum,3(30%)in the body,and 1(10%)in the duodenum.A mucosal dimple was noted in 6(60%).Mean lesion size was 17(8-25)mm.Gastrointestinal wall involvement:muscularis mucosae,10%;submucosa,70%;muscularis propria,60%;and serosa,10%.Nine(90%)lesions were hypoechoic and 5(50%)were homogenous.A duct was seen in 5(50%).FNA was attempted in 9(90%)and successful in 8(80%)patients after 4(2-6)passes.Cytology showed acini or ducts in 7 of 8(88%).Superficial biopsies in 7 patients(70%)showed normal gastric mucosa.Deep endoscopic biopsies were taken in 2 patients and diagnostic in one.One patient(10%)developed pancreatitis after EUS-FNA.Two patients(20%)underwent surgery to relieve symptoms or confirm the diagnosis.The main limitation of the study was the fact that it was retrospective and performed at a single medical center.CONCLUSION:EUS features of EP include antral location,mucosal dimple,location in layers 3-4,and lesional duct,and FNA or biopsy is accurate and effective.
文摘Ectopic varices are unusual with portal hypertension and can involve any site along the digestive tract outside the gastroesophageal region. Hemorrhage from ectopic varices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequent treatment is also difficult; the optimal treatment has not been established. Recently, interventional radiology and endoscopic treatments have been carried out successfully for hemorrhage from ectopic varices.
文摘BACKGROUND:Ectopic pancreas is defined as pancreatic tissue found outside its usual anatomical position,with no ductal or vascular communication with the native pancreas. We describe a case of ectopic pancreas of the small bowel and mesentery causing recurrent episodes of pancreatitis, initially suspected on computed tomography(CT)and magnetic resonance cholangiopancreatography(MRCP),and confirmed on histological review of the resection. METHODS:A 67-year-old woman presented with clinical symptoms and biochemical evidence of pancreatitis.She had similar episodes over the past 30 years with unrevealing investigations,and was concluded to have idiopathic pancreatitis. She underwent CT and MRCP,with findings suggestive of ectopic pancreas,a diagnosis confirmed on histology of the resection. RESULTS:MRCP identified a mass in the proximal small bowel mesentery isointense to the native pancreas,with a small duct draining into a proximal jejunal loop.The resected specimen consisted of normal parenchyma with lobulated acinar tissue with scattered islets of Langerhans,an occasional ductular structure,and admixed areas of adipose tissue.The patient remained asymptomatic with normal biochemistry six months post-operatively. CONCLUSION:In an individual with abdominal pain,elevated serum amylase/lipase,but imaging findings of a normal native pancreas,ectopic pancreatitis should be considered,and can be evaluated by CT and MRCP.
文摘Ectopic adrenal cortical neoplasms are extremely rare. Ectopic adrenocortical tissue can be found in locations such as the celiac axis,the broad ligament,the adnexa of the testes,and the spermatic cord;however,they rarely involve the stomach.We report an unusual case of a patient with an ectopic adrenal cortical adenoma in the gastric wall.The patient was a 72-year old female admitted to our hospital with upper abdominal discomfort.Physical examination revealed tenderness below the xiphoid process.Both computed tomography and fibergastroscopy revealed a mass on the lesser curvature side of the gastric antrum;it was initially diagnosed as a gastric stromal tumor.After adequate preparation,the patient underwent surgery.During the procedure,we found a 30 mm×30 mm mass with medium density in the lesser curvature near the gastric antrum within the serosa.Following immunohistochemistry examination, we corrected the diagnosis to an ectopic adrenal cortical adenoma;the tumor was nonfunctional.
