Pancreas transplantation is an effective treatment for type 1 diabetes mellitus and is being increasingly performed worldwide. Early recognition of graft-related complications is fundamental for graft survival; thus, radiologists must be aware of the transplantation technique, pancreas-graft imaging and postoperative complications. We present normal pancreas-graft imaging appearances and the imaging features of postoperative complications.
Blue rubber bleb nevus syndrome (BRBNS) is a rare condition that consists of multiple venous malformations involving several organ systems, particularly the skin and the gastrointestinal tract, but any part of the body may be affected. Less than 250 cases have been reported in the literature. The authors describe the thoracic, abdominal, and pelvic imaging characteristics at computed tomography (CT) in a 50-year-old man with BRBNS.
Gastrointestinal lipomas are benign, slow-growing tumors that are typically diagnosed incidentally during endoscopy [1, 2]. They are more commonly located in the right colon; rectal involvement is uncommon [2-5]. Lipomas are characteristically asymptomatic but depending on their location and size [1], they can cause symptoms such as bleeding, obstruction, intussusception or prolapse [1, 2, 4]. Only three cases of rectal lipomas presenting with prolapse have been reported in the literature, and they are usually treated surgically. We present the case of a 65-year-old woman who was referred to the Gastroenterology Department because of symptomatic intermittent rectal prolapse. The patient reported the need to manually reinsert the prolapse. Colonoscopy revealed a large subepithelial lesion in the distal rectum, adjacent to the upper margin of the anal canal (▶ Fig. 1). Axial contrast-enhanced pelvic computed tomography scan suggested a lipomatous lesion in the rectum. An echoendoscopy, using a dedicated anal probe (7.5 MHz), revealed a well-demarcated, hyperechogenic, homogeneous lesion in the submucosa (▶ Fig. 2), suggesting a lipoma [5]. The patient was proposed for endoscopic resection. ▶ Fig. 3 Endoscopic submucosal dissection (ESD) of the lipoma. a Endoscopic view of the lipoma. b Ligation of the vascular pedicle with a hemostatic clip; forward traction using forceps. c Endoscopic view of the lesion and the mucosal defect after ESD.
An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis.
BackgroundThe implementation of an organized screening strategy should include a cost-effectiveness analysis for the governments to take decisions that promote health and better allocate resources which does not happen most of the times. This study aimed to evaluate the most cost-effective strategy for CRC screening in a European Country.
MethodsA cost-effectiveness (CE) probabilistic Markov model was developed to compare the costs and the quality-adjusted life expectancy of 50-year-old average-risk individuals submitted to ve alternative screening strategies based on colonoscopy, computed tomography (CT) and FIT, as well as no screening. We calculated the costs from the perspective of a third payer (Portuguese National Health Service) and populated the model with data from published literature. Probability of being costeffective was estimated for different thresholds of willingness-to-pay.
ResultsColonoscopy 3/10 years is the most cost-effective strategy for colorectal screening in Portugal, with an estimated ICER of 802 €/ QALY when compared with colonoscopy every 10 years. The FIT and CT colonography based strategies are dominated by colonoscopy-based strategies. Biennial FIT, the strategy currently being used in Portugal, showed the smallest gains in life years gained (498.3 days) the smallest reduction in the incidence of CRC (-37%) and the smallest reduction in CRC mortality (-57%) between all the screening strategies. The ndings were robust to probabilistic sensitivity analysis.
ConclusionsColonoscopy based strategies offer the best value for the money in Portugal. Biennial FIT, the screening strategy in Portugal should be replaced by a colonoscopy-based strategy.
Introduction: Endoscopic retrograde cholangiopancreatography is the method of choice for biliary drainage, although in some cases standard biliary access is difficult or even impossible. Endoscopic ultrasound (EUS)-guided endoluminal procedures are an alternative in these cases, although experience with these techniques is still limited. Clinical Case: We present two cases of successful EUS-guided biliary drainage. In the first case, a hepaticogastrostomy was performed in a patient with stage IV gastric adenocarcinoma with obstructive jaundice due to compression of the hilum, where malignant gastric stenosis and previous palliative gastrojejunostomy precluded access to the second part of the duodenum. In the second case, a patient with a pancreatic head adenocarcinoma with duodenal invasion that precluded major papillae identification was submitted to a choledochoduodenostomy. Both procedures occurred without immediate or delayed adverse events, with technical and clinical success. Discussion: Although experience with EUS-guided biliary drainage is still limited, its efficacy and safety is favorable when compared with percutaneous and surgical drainage, and should be considered an alternative to these techniques where sufficient expertise exists.
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