Implantation of self-expanding metal stent in the treatment of severe bleeding from esophageal ulcer after endoscopic band ligation

Endoscopic variceal ligation is superior to sclerotherapy because of its lower rebleeding and complication rates. However, ligation may be associated with life-threatening bleeding from postbanding esophageal ulcer. We report a case of a 49-year-old male with massive hemorrhage from esophageal ulcer on 8th day after successful band ligation of bleeding esophageal varices caused by postviral liver cirrhosis (Child-Pugh class C). A removable polyurethane membrane-covered self-expanding metal stent (SX-ELLA stent Danis, 135 mm × 25 mm, ELLA-CS, Hradec-Kralove, Czech Republic) was inserted in ICU for preventing fatal hemorrhage. Complete hemostasis was achieved and stent was removed after 8 days without rebleeding or any complications. To the best of our knowledge, this is the first report in English literature regarding life-threatening hemorrhage from postbanding esophageal ulcer successfully treated by self-expanding metal stent in a patient with portal hypertension.

Endoscopic papillectomy into the treatment of neoplastic lesions of vater papilla

Adenomas of the duodenal papilla are rare. The frequency of malignant adenomas is 15-30%. Villous adenoma is a premalignant lesion with the highest rate of transformation. Options for surgical treatment include endoscopic and ablation resection, transduodenal ampullectomy, duodeno-pancreatectomy.

AIM

Evaluation of the efficacy and safety of endoscopic papillectomy for ampullary adenomas.

MATERIAL AND METHOD

12 patients were selected (F:M, 5:7, age range 37 - 68 years) with ampullary adenoma, treated by endoscopic papillectomy. Biliary sphincterotomy was performed in 6 cases; and pancreatic sphincterotomy was performed in 3 cases. Biliary stenting was performed in 2 cases; pancreatic stent was placed in 11 cases.

RESULTS

En bloc resection was performed in 8 cases, and piecemeal resection in 4 cases. Complete resection R0 was noted in 10 cases. Pathology examination has show: tubulo-villous adenoma (5 patients); villous adenoma (4 patients), tubular adenoma (2 cases), adenocarcinoma (one case). Complications were immediate: bleeding (2 cases) and pancreatitis (1 case). Follow-up endoscopy reveals no ductal stenosis or recurrence.

CONCLUSION

Endoscopic papillectomy is a safe and well-tolerated alternative to surgical treatment of ampullary adenoma.

[Mucinous cystadenocarcinoma of the appendix complicated with spontaneous cutaneous fistula]

Mucocele of the appendix is a relatively rare disease characterized by a cystic dilatation of the appendiceal lumen with stasis of mucus inside. Appendiceal mucocele with a cutaneous fistula is an extremely rare clinical entity, only four such cases being described in the medical literature. We report an additional case of cystadenocarcinoma of the appendix with spontaneous cutaneous fistula. The patient is an 80-year old woman, who originally presented with a skin ulcer in the right lower abdominal quadrant with mucus discharge during the last month. Abdominal ultrasonography and computed tomography demonstrated cystic mass with mixed echogenity and density originating from the appendix, involving the abdominal wall, without signs of ascites or metastasis. A right hemi-colectomy, lymphadenectomy and resection of the skin fistula was performed. The histological findings revealed moderately differentiated mucinous cystadenocarcinoma of the appendix. The postoperative period was uneventful and the patient discharged on the 11th POD. During 12 month follow-up period the patient is free of disease recurrence. The authors present the literature review, diagnostic features and the treatment policy of this extremely rare condition.