BackgroundEmphysematous liver abscesses are defined as liver abscesses accompanied by gas formation. The fatality rate is extremely high at 27%, necessitating prompt intensive care.Case presentationThe patient was a 69-year-old Japanese man with type 2 diabetes. He visited the emergency outpatient department for fever and general malaise that had been ongoing for 2 weeks. Abdominal computed tomography revealed an abscess 5 cm in diameter accompanied by gas formation in the right hepatic lobe. Markedly impaired glucose tolerance was observed with a blood sugar level of 571 mg/dL and a glycated hemoglobin level of 14.6%. The patient underwent emergency percutaneous abscess drainage, and intensive care was subsequently initiated. Klebsiella pneumoniae was detected in both the abscess cavity and blood cultures. The drain was removed 3 weeks later, and the patient was discharged.ConclusionEmphysematous liver abscesses are often observed in patients with poorly controlled diabetes, and the fatality rate is extremely high. Fever and malaise occasionally mask life-threatening infections in diabetic patients, necessitating careful examination.
Background: Recurrent biliary obstruction (RBO) is a possible complication of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) in patients with malignant distal biliary obstruction (MDBO). Therefore, adding antegrade stenting across MDBO, followed by EUS-HGS (EUS-HGAS), may prolong the time to RBO (TRBO). We aimed to compare the outcomes of EUS-HGS and HGAS.
Methods:We retrospectively evaluated consecutive patients who underwent EUS-HGS or HGAS between July 2016 and November 2020. The TRBO, overall survival (OS), and adverse event (AE) rate were compared between the groups.The risk factors for RBO were determined using a multivariable Cox proportional hazards model.
Results: This study included 96 patients (EUS-HGS, n = 58; HGAS, n = 38).There was a significant difference in the cause of endoscopic retrograde cholangiopancreatography failure and the HGS stent type between the groups. A significant difference was found in TRBO (234 days vs not reached, P = .036), whereas no significant difference was found in the OS (123 vs 126 days, P = .76). The AE rate was not significantly different. Multivariable analysis revealed that EUS-HGS was an independent risk factor for RBO (hazard ratio: 4.01, 95% confidence interval: 1.16-13.9).Conclusions: Endoscopic ultrasound-guided hepaticogastrostomy prolonged the TRBO compared with EUS-HGS for biliary drainage in patients with MDBO.
We present the case of an 86-year-old man who had undergone left nephrectomy for renal cell carcinoma (clear cell carcinoma) 22 years ago. He visited the emergency department complaining of right hypochondrial pain and fever. He was eventually diagnosed with acute cholangitis. Abdominal contrast-enhanced computed tomography showed multiple tumors in the pancreas. The tumor in the pancreatic head obstructed the distal bile duct. Endoscopic retrograde cholangiopancreatography detected bloody bile juice flowing from the papilla of Vater. Therefore, he was diagnosed with hemobilia. Cholangiography showed extrinsic compression of the distal bile duct; a 6 Fr endoscopic nasobiliary drainage tube was placed. Endoscopic ultrasound showed that the pancreas contained multiple well-defined hypoechoic masses. Endoscopic ultrasound-guided fine-needle aspiration was performed using a 22 G needle. Pathological examination revealed clear cell carcinoma, and the final diagnosis was pancreatic metastasis of renal cell carcinoma (RCC) causing hemobilia. A partially covered metallic stent was placed in the distal bile duct. Consequently, hemobilia and cholangitis were resolved.
Background and AimOptimal tumor samples are crucial for successful analysis using commercially available comprehensive genomic profiling (CACGP). However, samples acquired by endoscopic ultrasound‐guided tissue acquisition (EUS‐TA) are occasionally insufficient, and no consensus on the optimal number of needle passes required for CACGP exists. This study aimed to explore the optimal number of needle passes required for EUS‐TA to procure an ideal sample fulfilling the prerequisite criteria of CACGPs.MethodsPatients who underwent EUS‐TA for solid masses between November 2019 and July 2021 were retrospectively studied. The correlation between the acquisition rate of an ideal sample and the number of needle passes mounted on a microscope slide was evaluated. Additionally, the factors predicting a successful analysis were investigated in patients scheduled for CACGP using EUS‐TA‐obtained samples during the same period.ResultsEUS‐TAs using 22‐ and 19‐gauge (G) needles were performed in 336 and 57 patients, respectively. There was a positive correlation between the acquisition rate and the number of passes using a 22‐G needle (38.9%, 45.0%, 83.7%, and 100% for 1, 2, 3, and 4 passes, respectively), while no correlation was found with a 19‐G needle (84.2%, 83.3%, and 85.0% for 1, 2, and 3 passes, respectively). The analysis success rate in patients with scheduled CACGP was significantly higher with ideal samples than with suboptimal samples (94.1% vs 55.0%, P < 0.01).ConclusionsThe optimal estimated number of needle passes was 4 and 1–2 for 22‐ and 19‐G needles, respectively.
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