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