Figure 1. A) CT image showing ill-defined cystic/necrotic upper abdominal lymphadenopathy with mass effect and possible invasion of the adjacent liver B) Endoscopic ultrasound imaging showing peripancreatic mass C) Hematoxylin and Eosin cellblock at 40X magnification showing abundant neutrophils and necrotic debris D) Grocott's Methenamine Silver stain showing fungal yeast with narrow base budding E) Significant reduction of the mesenteric lymphadenopathy after antifungal therapy initiation.
Duodenal hematoma is a previously described rare complication of pancreatitis. Endoscopic evacuation was a safe and effective means of relieving the duodenal obstruction in this patient. This minimally invasive option resulted in immediate resolution and can be considered when conservative management fails.[2825] Figure 1. 10 cm duodenal wall hematoma on CT scan (a) and endoscopy (b). Endoscopic drainage via cystduodenostomy with a lumen-apposing metal stent (c). Resolution of the duodenal wall hematoma (d).
Conclusion:For assessing deeper invasion (T2, T3 and T4), EUS has been substantiated as a significantly effective tool. In staging T1b lesions, EUS was reasonably specific in ruling out sub-mucosal invasion; however, it had relatively poor sensitivity in identifying sub-mucosal invasion. Additionally, data validated endoscopic features suggesting superficial cancers including a tumor size , 2cm and the presence of Barrett's morphology. In patients with these findings suggesting superficial cancer, EUS rarely identified a deep cancer that warranted a change in management.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.