Volume 82 - 2019 - Fasc.2 - Clinical images
A rare complication of laparoscopic cholecystectomy
A 45-year-old man with history of laparoscopic cholecystectomy 5 years back, presented with discharge from the port-site. On examination, there was pus discharge from the port-site. Laboratory parameters were within normal limits. Review of surgical records revealed that Calot's triangle was frozen. The cystic duct was friable due to a large impacted calculus and it got sloughed off during dissection. There was no active bile leak and suturing was not possible. In the post-operative period, patient underwent endoscopic retrograde cholangiopancreatography and stenting. Patient underwent magnetic resonance cholangio- pancreatography (MRCP) at present admission
Giant duodenal bleeding ulcer with a large visible vessel treated with an over the scope clip
A 83-year-old female patient was admitted to the emergency room (ER) of another hospital with melena. She was treated with apixaban for atrial fibrillation. She reported epigastric pain in the previous month and had excessive use of nonsteroidal anti-inflammatory drugs for osteoarticular disease. She presented with hypovolemic shock (heart rate 130 bpm, blood pressure 70/40 mmHg) and the hemoglobin level was 5.9 g/dl. Stabilization, transfusion of 2 units of red blood cells (RBC) and a bolus (80 mg) of intravenous pantoprazole followed by infusion (8 mg/h) were performed and the patient was transferred to our ER for esophagogastroduodenoscopy (EGD). On EGD, 3 gastric ulcers without bleeding stigmata were identified. In addition, a giant deep ulcer with a large adherent blood clot (Forrest IIb) in the duodenal bulb and another in the transition to the second part of the duodenum were observed. Due to the large size of both the ulcer and the blood clot, no endoscopic therapy was performed.
Endoscopic submucosal dissection in a patient with idiopathic mesenteric phlebosclerosis
An 80-year-old female presented to a previous hospital with chronic watery diarrhea.
Diagnostic colonoscopy showed laterally spreading tumors (LST-NG) in the ascending colon. She was referred to our hospital for endoscopic treatment.
Her medical history included non-Hodgkin lymphoma, which was in complete remission; myocardial infarc- tion ; and hypothyroidism. She had been taking various oral medicines, such as aspirin, a telmisartan- amlodipine combination drug, furosemide, omeprazole, levothyroxine sodium, and pregabalin; however, she had not been taking any herbal medicines. She had no history of smoking or alcohol consumption.
Computed tomography revealed thread-like calcifi- cations in the right and middle colic veins. Colonoscopy performed at our hospital as a pretreatment examination revealed edematous dusky blue mucosae in the ascending and transverse colon, and endoscopic ultrasonography showed calcification in the submucosa and muscle layer. Several suspected adenomas, which exhibited the type IV pit pattern, were observed in the ascending colon, the largest of which was a 30-mm LST
