case 1 82 y.o. female82 y.o. female retrosternal burningretrosternal burning long standing...
TRANSCRIPT
Case 1
• 82 y.o. female82 y.o. female
• Retrosternal burningRetrosternal burning
• Long standing dysphagiaLong standing dysphagia
Upper esophagusUpper esophagus
Larynx
Upper esophagus
Lower esophagus
• Diverticulum Diverticulum
• Duplication of esophagusDuplication of esophagus
• Congenital double lumen esophagusCongenital double lumen esophagus
• FistulaFistula
• None of the aboveNone of the above
Case 2
• 49 y.o. woman
• Chronic idiopathic pancreatitis
• Severe pain – on narcotics
• ERCP X 2: failed cannulation of Wirsung due to severe stricture
EUSEUS
Head
Calcifications
Wirsung 11mm
??
EUS guided pancreaticogastrostomy
AA BB
CC DD
EUS – guided pancreaticogastrostomy
Francois et al. Gastrointestinal Endoscopy 2002
• 4 patients
• 3 of 4 had satisfactory pain relief
• 1 year follow-up
Case 3
• 51 y.o. woman with mild RUQ pain
• No relevant medical history
• No medications
• Normal physical examination
CT
Hepatic artery phase PVPLate phase
MRI
T1Contr hepatic artery phase
Differential diagnosis
• Atypical hemangioma
• Hemangiosarcoma • Necrotic tumor
• Peliosis hepatis
• Other
Liver biopsy
Peliosis hepatis - Black and Blue Liver
Etiology
• Wasting illness
• Carcinomatosis
• Drugs (anabolics, steroids, oral contraceptives, azathioprine)
• Immunosuppressed patients
• AIDS – bacillary angiomatosis peliosis • Idiopathic
Case 4
• 51 y.o. man
• Diabetes mellitus type II, target organ damage, no prior abdominal operations
• Abdominal pain, vomiting, weight loss
• Palpable mass at the right upper quadrant
Differential diagnosis
- Partial pseudoobstruction- Partial pseudoobstruction
- Retroperitoneal fibrosis- Retroperitoneal fibrosis
- Sclerosing peritonitis- Sclerosing peritonitis
- Paraduodenal hernia- Paraduodenal hernia
- Amyloidosis- Amyloidosis
Cocoon syndrome
Cocoon syndrome
• First described in 1978• Idiopathic , sclerosing , encapsulating peritonitis
• - congenital
- idiopathic- secondary (peritoneal dialysis, peritoneovenous shunts,
beta-blockers, peritoneal TB, GI malignancy)