We propose that these MIPs enhance endometrial cell invasiveness and contribute to the establishment of ectopic endometriotic deposits after retrograde menstruation.

Biliary papillomatosis is a rare condition usually detected on imaging or postoperative histopathology. It may be asymptomatic or present with features of cholangitis. We report the management of a patient presenting with haemobilia.We report a rare case of benign biliary papillomatosis (BP) in a choledochal cyst. Papillomatosis arising from the intrahepatic portion of a choledochal cyst presenting with haemobilia has not been reported before. Case historyA 57-year-old woman presented initially with periumbilical pain that had lasted for a week. She also complained of tiredness but did not have loss of weight or appetite. Imaging in another hospital had revealed common bile duct thickening with intrahepatic biliary radicle dilatation and biliary sludge. She was suspected of having cholangiocarcinoma and underwent endoscopic retrograde cholangiopancreaticography (ERCP) with stent placement.General and systemic examination and blood tests were non-contributory. Magnetic resonance cholangiopancreaticography with computed tomography of the abdomen (MRCT) showed dilatation of the common bile duct and left hepatic duct (LHD). There were multiple hyperdense lesions in the LHD suggestive of intrahepatic stones (Figs 1 and 2).The patient was offered cholecystectomy, cholangioscopy, extraction of the hepatolithiasis and hepaticojejunostomy. She came back for the operation four months later. She was pale with a history of two episodes of melaena. Her haemoglobin was 5.7g% and her blood picture was consistent with iron deficiency anaemia. The coagulation profile was normal. Oesophagogastroduodenoscopy, colonoscopy and review of MRCT of the abdomen did not reveal the source of bleeding. She was diagnosed with obscure gastrointestinal bleeding and on-table enteroscopy was added to the plan of operation.

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Immune thrombocytopaenia (ITP) was referred to previously as idiopathic thrombocytopaenic purpura and is usually of autoimmune or viral aetiology. Colorectal cancer liver metastasis with concomitant ITP is rare and only three cases have been reported in the English literature. Adverse effects of adjuvant chemotherapy may aggravate ITP. The sequencing of chemotherapy, operation for the primary and liver metastasis, and a decision on splenectomy is important. We present our experience in the management of a 52-year-old man who, having undergone anterior resection one year earlier for carcinoma of the rectum, presented with liver metastasis and ITP. He underwent splenectomy with hepatectomy prior to chemotherapy.