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Case 1

Case 1. 82 y.o. female Retrosternal burning Long standing dysphagia. Upper esophagus. Larynx. Upper esophagus. Lower esophagus. Diverticulum Duplication of esophagus Congenital double lumen esophagus Fistula None of the above. Case 2. 49 y.o. woman

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Case 1

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  1. Case 1 • 82 y.o. female • Retrosternal burning • Long standing dysphagia

  2. Upper esophagus

  3. Larynx Upper esophagus Lower esophagus

  4. Diverticulum • Duplication of esophagus • Congenital double lumen esophagus • Fistula • None of the above

  5. Case 2 • 49 y.o. woman • Chronic idiopathic pancreatitis • Severe pain – on narcotics • ERCP X 2: failed cannulation of Wirsung due to severe stricture

  6. EUS Calcifications Head Wirsung 11mm

  7. ?

  8. EUS guided pancreaticogastrostomy A B C D

  9. EUS – guided pancreaticogastrostomy Francois et al. Gastrointestinal Endoscopy 2002 • 4 patients • 3 of 4 had satisfactory pain relief • 1 year follow-up

  10. Case 3 • 51 y.o. woman with mild RUQ pain • No relevant medical history • No medications • Normal physical examination

  11. CT PVP Late phase Hepatic artery phase

  12. MRI T1Contr hepatic artery phase

  13. Differential diagnosis • Atypical hemangioma • Hemangiosarcoma • Necrotic tumor • Peliosis hepatis • Other

  14. Liver biopsy

  15. Peliosis hepatis - Black and Blue Liver

  16. Etiology • Wasting illness • Carcinomatosis • Drugs (anabolics, steroids, oral contraceptives, azathioprine) • Immunosuppressed patients • AIDS – bacillary angiomatosis peliosis • Idiopathic

  17. 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

  18. Differential diagnosis- Partial pseudoobstruction- Retroperitoneal fibrosis- Sclerosing peritonitis- Paraduodenal hernia- Amyloidosis

  19. Cocoon syndrome

  20. Cocoon syndrome • First described in 1978 • Idiopathic , sclerosing , encapsulating peritonitis • - congenital - idiopathic - secondary (peritoneal dialysis, peritoneovenous shunts, beta-blockers, peritoneal TB, GI malignancy)

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