Notes

Higher frequency involving coronary artery ectasia inside osa.
Amoebic liver abscess is common in children in developing countries due to lack of hygiene and sanitary conditions. Inferior vena cava thrombosis is a rare complication of this disease, with only a few cases reported in the literature, where this thrombus led to pulmonary thromboembolism. We report the case of a 7-year-old child with amoebic liver abscess who developed pulmonary thromboembolism and was promptly diagnosed and managed.We present a 23-year-old man with hemophagocytic lymphohistiocytosis (HLH) triggered by Epstein-Bar virus (EBV) infection. This patient presented with persistent fever and acute liver injury 6 weeks after having an infectious mononucleosis associated with EBV infection. He had hypofibrinogenemia, hyperferritinemia, increased soluble interleukin-2 receptor, elevated prothrombin time, and pancytopenia. learn more Bone marrow examination for evaluation of pancytopenia revealed that macrophages had phagocytosed mature erythrocytes. Based on these findings, we suspected an HLH triggered by EBV infection (EBV-HLH). To distinguish from HLH triggered by malignant lymphomas accompanying EBV infection, we performed a percutaneous liver biopsy, which revealed that atypical T-lymphocytes had infiltrated the liver tissues. The T-lymphocytes were positive for EBV-encoded RNA in situ hybridization, and no distinct monoclonal T-cell receptor chain gene rearrangement was detected. These findings indicated EBV hepatitis and, accordingly, malignant lymphoma was ruled out. We finally made a diagnosis of EBV-HLH. The patient was treated with corticosteroid and etoposide, according to HLH-2004 guideline recommendations, and the patient's symptoms and laboratory values improved. After that, he experienced no recurrence. Prompt recognition and initiation of treatment remains the key to the survival of patients with EBV-HLH, and the liver biopsy was helpful in making the diagnosis.Endoscopic submucosal dissection (ESD) for extensive esophageal cancer inevitably causes a post-ESD stricture. It may be difficult to perform additional ESD if a new lesion develops on the anus side of the post-ESD stricture. We sometimes perform balloon dilation of post-ESD stricture in advance, so we could perform ESD using a transoral scope; however, there is a risk of balloon dilation causing severe tearing of the lesions if it is located near the stricture. A 68-year-old man who had undergone ESD for esophageal cancer several times was diagnosed with early esophageal cancer. The lesion was located near the anus side of the post-ESD stricture. Unfortunately, the lesion was located on another post-ESD scar. Although ESD using a transnasal scope was a useful option, it was expected to be challenging as the submucosal layer was thought to have severe fibrosis. We attempted to perform ESD with a transoral endoscope after stepwise scope bougienage of post-ESD stricture.COVID-19 rarely causes lower gastrointestinal bleeding even though its RNA has been detected in patient's stool. Urgent colonoscopy in a COVID-19 patient with massive bloody stool requires various procedural and equipment considerations. Here, we present a case of colonoscopic hemostasis of a cecal hemorrhagic ulceration in a patient on heparin for COVID-19 coagulopathy. We also share various management methods for the prevention of COVID-19 contamination. A 71-year-old man was diagnosed with COVID-19 pneumonia and subsequently underwent hemodiafiltration. Heparin was initiated for COVID-19 coagulopathy. At day 42, the patient experienced 2000 mL of bloody stool. An operator performed urgent colonoscopy with three assistants in a negative-pressure room with full personal protective equipment. A hemorrhagic ulceration was detected at the cecum, and endoscopic hemostasis was performed. Immunohistochemistry was positive for cytomegalovirus. Postprocedure, the endoscopic systems were thoroughly cleaned, and specific measures for endoscope reprocessing and disinfection were performed to prevent contamination with COVID-19.Pancreatic tumors usually produce painless jaundice. Other associated symptoms may be secondary, from a direct extension of the tumor, resulting in bowel obstruction. It is extremely rare that pancreatic malignancy presents with ischemic enteritis by invasion of the major arteries, and no report has documented it endoscopically. We present a rare case of pancreatic adenocarcinoma masquerading as ischemic enteritis diagnosed on enteroscopy and endoscopic ultrasound. An initial computed tomography (CT) scan performed in another hospital showed long segmental wall thickening involving the third part of the duodenum to the proximal segment of the jejunum. The patient was referred to our institution for enteroscopy, which showed a poorly distensible third part of the duodenum with purplish mucosa starting at the fourth part of the duodenum until the proximal jejunum. With suspicion of ischemic enteritis, a mesenteric CT angiography was performed, which showed a long segment circumferential wall thickening of the duodenum to jejunum with fullness of the pancreatic head and uncinate process that encases the superior mesenteric artery. Endoscopic ultrasound (EUS) showed a hypoechoic lesion at the head of the pancreas. EUS-guided fine-needle biopsy was performed, which revealed pancreatic adenocarcinoma on histopathology.Would you ever purposefully advise an abdominal computed tomography scan in a pregnant woman? We present the case of a pregnant woman who presented with hematochezia requiring multiple transfusions.We experienced a rare case of main duct intraductal papillary mucinous neoplasm (MD-IPMN) without overt mucin production. Histological findings classified the tumor as high-grade dysplasia of pancreatobiliary-type IPMN that has been reported to show high malignant potential with a property to disseminate extensively into pancreatic ducts.We demonstrate a case, in which endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) was useful for determining the diagnosis of lesions of retroperitoneal fibrosis. In our case, accessing the retroperitoneal lesions by conventional percutaneous biopsy procedures was not feasible due to the difficulty of avoiding the inferior vena cava and ureter. We believe that our case demonstrates a unique approach for performing histological analysis in a challenging case.
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