A case of ampullary carcinoma successfully managed with endoscopic snare resection

Pancreaticoduodenectomy and transduodenal ampullectomy have been the procedures of choice for ampullary cancer in most patients. However, for patients with small ampullary neoplasms or who are unfit for laparotomy or refuse open surgical operations, endoscopic snare ampullectomy may be appropriate. We report here a case of ampullary carcinoma in which endoscopic snare ampullectomy was performed successfully, with long-term survival. The patient was a 77-year-old man with a 30-year history of ulcerative colitis, who presented with epigastric pain and fever. He had a history of four laparotomies. Laboratory studies showed a mild elevation in alkaline phosphatase, serum aspartate aminotransferase, gamma glutamyltransferase, and C-reactive protein values. At endoscopic retrograde cholangiopancreatography, the ampulla was prominent, with granulomatous proliferation. The common bile duct was dilated to approximately 25 mm in diameter. Biopsy specimens of the ampulla showed a well-differentiated adenocarcinoma. Because of extensive adhesions of the peritoneal cavity due to the prior four laparotomies and the patient's refusal of surgery, endoscopic snare ampullectomy was performed. Ten days after the ampullectomy, the patient was discharged from the hospital without any complication. The patient has been well for the 4 years since then, without recurrence of the tumor or jaundice. Endoscopic snare ampullectomy may be considered as a viable alternative to surgery in patients with small ampullary tumors who are unfit for surgery or who prefer a nonsurgical approach.     

Management of gastric fistula complicating laparoscopic sleeve gastrectomy with biological glue in a combined percutaneous and endoscopic approach

Background

Laparoscopic sleeve gastrectomy (LSG) is considered as a first line treatment for morbid obesity around the globe. Leakage and subsequent gastric fistula is the most dreadful complication, which may lead to serious morbidity and even mortality.

Spontaneous esophageal rupture managed with endoscopic closure using an over-the-scope clip: A case report

Introduction and importanceSpontaneous esophageal rupture is a life-threatening condition caused by a sudden increase in the intraesophageal pressure. While surgery is the mainstay of management for spontaneous esophageal ruptures, in recent years, an increasing number of patients have been managed with endoscopic interventions. We report a case of spontaneous esophageal rupture managed with endoscopic closure using an over-the-scope clip (Ovesco Endoscopy AG, Tübingen, Germany).Case presentationA 68-year-old female presented with epigastric pain and left-sided back pain following vomiting. A computed tomography scan revealed mediastinal emphysema and an esophagogram showed leakage from the left side of the lower thoracic esophagus into the mediastinum. The patient was diagnosed with spontaneous esophageal rupture localized to the mediastinum and was treated conservatively. However, she had persistent fever and continuing esophageal leakage on the esophagogram. On the 12th day of admission, a gastrointestinal endoscopy was performed, which found a 10-mm full-thickness longitudinal laceration on the left side of the lower esophagus. Endoscopic closure using an over-the-scope clip was performed. The next day, the patient became afebrile. One week later, esophagogram revealed slight residual leakage and an additional endoscopic closure using an over-the-scope clip was performed; the patient subsequently had an uneventful recovery and was discharged on the 44th day of admission.Clinical discussionEndoscopic closure using an over-the-scope clip led to a good outcome in this patient with spontaneous esophageal rupture.ConclusionEndoscopic closure using an over-the-scope clip is an effective and minimally invasive technique for selected patients with spontaneous esophageal rupture.     

Colouterine fistula: A case report of a rare complication of diverticular disease managed during the pandemic

Introduction and importanceColouterine fistulas related to diverticulitis are very rare due to the thickness of the uterine myometrium. Other causes related to colouterine fistula formation particularly malignancy, have to be considered. Diagnosis by imaging or endoscopy may be inconclusive.Case presentationWe are presenting a case of a 70-year-old female who presented with malodorous vaginal discharge and painful labial lesions. No previous history of surgery, gynecologic malignancy or other possible causes of the fistula was elicited. CT scan imaging suggested a colouterine fistula. The patient was admitted and underwent Exploratory laparotomy, Hartmann’s procedure and total hysterectomy with bilateral salpingo oophorectomy. The patient was discharged without perioperative complications.Clinical discussionColouterine fistulas are extremely rare complications of diverticular disease. Diagnosis entails clinical astuteness and judicious use of imaging and endoscopic modalities. Accurate diagnosis is essential to select the appropriate surgical approach, along with intraoperative findings patient status and prevailing conditions.ConclusionThis case is being presented not only for the rarity of the case but also for the complexity of the management and decision making during the period of the pandemic.     

Combined endoscopic approach in the treatment of benign broncho-oesophageal fistula

The treatment of benign broncho-oesophageal fistula is usually surgical but sometimes other methods of treatment are preferred. The case history is described of an adult in poor general condition in which an endoscopic approach combined with the use of fibrin glue on the bronchial side and metallic clips on the oesophageal side was used to close the fistula.     

Aortoesophageal fistula: report of a successfully managed case and review of the literature.

Aortoesophageal fistula is a rare, frequently fatal cause of upper gastrointestinal bleeding. Although several causes have been described, it appears that the most common cause is rupture of a thoracic aortic aneurysm into the esophagus, occurring in approximately 12% of thoracic aneurysm ruptures. Although the entity was originally described in 1818, the diagnosis has rarely been made before death, and until 1983 no one survived surgery for aneurysm-associated aortoesophageal fistulas. Since that report of two cases, only two other survivors, including this patient, have been reported. Included herein is the report of a successfully managed case, along with a discussion of the causes, clinical features, and diagnostic approach to the disease, as well as the management of both the aortic and esophageal components of the fistula.     

先天性胆管扩张症并胆囊支气管瘘一例

病人，男，63岁，右上腹隐痛不适50余年，频繁咳嗽、咯胆汁样脓痰2个月。不伴寒战及发热，全身皮肤及巩膜无黄染。右肺下叶呼吸音低，右上腹轻压痛。血WBC 5．5×10^9／L，RBC 4．43×10^12／L，Hb 133g／L。谷丙转氨酶10U／L，谷草转氨酶20U／L，碱性磷酸酶146U／L，谷氨酰转肽酶230U／L，总胆红素18．2μmol／L，直接胆红素3．8μmol／L，[第一段]     

Laparoscopic approach to colo-renal fistula with renal preservation and omentoplasty: A case report

Colorenal fistula as a result of percutaneous cryoablation has not been extensively reported. We report a gentleman who presented with urosepsis after percutaneous biopsy of a renal mass complicated by colorenal fistula. After failed attempts at conservative management, he underwent laparoscopic resection of his fistula with renal salvage and omentoplasty highlighting that nephrectomy is not always indicated.     

A case of bladder paraganglioma managed by transurethral approach, using holmium laser

A 78-year-old man was referred to our hospital with a bladder tumor. He suffered from headaches and palpitations after voiding. Cystoscopy and MRI showed a submucosal bladder tumor which localized submucosally without invasion to the muscular layer. The tumor was positive for 131I-MIBG scintigraphy and we diagnosed it as a bladder paraganglioma. We enucleated the tumor en bloc from the bladder using holmium laser via transurethral approach, with minimal alteration of blood pressure during the procedure. The enucleated tumor was evacuated out of the bladder with a morcellator.     

A unique approach for a large intra-thoracic traumatic tracheo-oesophageal fistula: A case report from Syria

Introduction and importanceAcquired tracheo-oesophageal fistula (TOF) is a rare complication of intubation or traumas, either blunt or penetrating. In a penetrating chest trauma, the closure of TOF can be challenging and requires a unique technique. A flap can and intra-tracheal tube can also be used. We present this case to demonstrate a unique late presentation of TOF and the unique approach that was used.Case presentationA patient presented with a large TOF caused by shrapnel, and was surgically managed after two months of the injury by using a smaller intra-tracheal tube, and using an oesophageal wall flap to close the tracheal defect and intercostal muscle flap was used for the oesophageal wall repair. The postoperative intrathoracic oesophageal leak was successfully treated conservatively.Clinical discussionAlthough the surgery could not be conducted until 2 months after the injury, the approach used was successful and the patient was able to resume his normal life after the surgery. The flap from the oesophagus and intercostal muscles and using a smaller tracheal tube successfully repaired the TOF with minimum stress on the suterings, and the conservative approach for the leak was also successful.ConclusionTraumatic TOF management can be complicated, but we speculate that using a smaller tube with the conservative management of the complications was ideal for the TOF acquired from a shrapnel.     

经皮肝胆道镜治疗肝胆管结石并胆管支气管瘘1例

<正>1病例资料1.1一般资料患者,女,61岁,因“反复寒战、发热6个月,咳黄绿色痰1个月”于2021年3月21日入院。患者16年前因“胆囊结石、胆管结石”于外院行“胆囊切除+胆总管切开取石T管引流术”,术后1个月拔除T管。11年前、4年前和9个月前食道胃底静脉出血行“内镜下套扎治疗”。近1个月来咳黄绿色痰,平卧20～30 min就会出现咳嗽咳痰,几乎不能平卧,且反复寒战、高热,最高体温达40.5℃。