BACKGROUND Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea,vomiting,and postprandial fullness.The treatment for this disease is mostly surgical.Endoscopic treatment techniqu...BACKGROUND Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea,vomiting,and postprandial fullness.The treatment for this disease is mostly surgical.Endoscopic treatment techniques have been developed and attempted for this disease.Endoscopic radial incision and cutting(RIC)techniques are reportedly very effective in benign anastomotic stricture.This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs.CASE SUMMARY A 23-year-old female patient with indigestion was referred to a tertiary hospital.The patient complained of postprandial fullness in the epigastric region.Previous physical examinations or blood tests indicated no abnormalities.Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum.Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb;a very small hole was observed in the distal part of the second portion,and scope passage was not possible.Gastrografin upper gastrointestinal series was performed,revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim,a typical"windsock"sign.Endoscopic RIC was performed on the duodenal web.The patient recovered uneventfully.Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis.The patient reported complete resolution of symptoms at the 18-month follow-up.CONCLUSION Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is difficult to treat and has a high mortality rate,emphasizing the importance of early diagnosis and treatment.If characteristic radiologic findings and underlying liver diseas...BACKGROUND Hepatocellular carcinoma(HCC)is difficult to treat and has a high mortality rate,emphasizing the importance of early diagnosis and treatment.If characteristic radiologic findings and underlying liver disease are present,a diagnosis can be made without a biopsy.However,when HCC is accompanied by a liver abscess,diagnosis might be delayed by atypical radiologic findings.This case report aims to assist in the diagnosis of HCC,which can manifest in various forms.CASE SUMMARY A 75-year-old male presented to the Emergency Department with worsening fever and mental changes.He was diagnosed with liver cirrhosis six months earlier.Abdominal computed tomography(CT)raised our suspicion of an organized liver abscess.A follow-up CT scan after four weeks of antibiotic treatment showed a decrease in the liver lesion size.However,high fever recurred,and C-reactive protein increased to 14 mg/L.Aspiration of the liver lesion was performed,but no bacteria were identified.Blood culture revealed the presence of fungi.The patient received an additional four weeks of antibiotics and antifungal agents before being discharged.Approximately 10 mo later,a CT scan showed an increase in the lesion size,and biopsy was performed.The biopsy revealed an organized abscess with focal carcinomatous changes,for which surgery was performed.Postoperative histopathological examination revealed HCC,clear-cell variant.The nontumor liver tissue showed cirrhosis and an organized abscess.CONCLUSION Even if a liver abscess is suspected in a patient with cirrhosis,the possibility of HCC should be considered.展开更多
文摘BACKGROUND Congenital duodenal webs are rare in adults and can lead to various symptoms such as nausea,vomiting,and postprandial fullness.The treatment for this disease is mostly surgical.Endoscopic treatment techniques have been developed and attempted for this disease.Endoscopic radial incision and cutting(RIC)techniques are reportedly very effective in benign anastomotic stricture.This case report highlights the effectiveness and safety of endoscopic RIC as a minimally invasive treatment for adult congenital duodenal webs.CASE SUMMARY A 23-year-old female patient with indigestion was referred to a tertiary hospital.The patient complained of postprandial fullness in the epigastric region.Previous physical examinations or blood tests indicated no abnormalities.Computed tomography revealed an eccentric broad-based delayed-enhancing mass-like lesion in the second portion of the duodenum.Endoscopy showed an enlarged gastric cavity and a significantly dilated duodenal bulb;a very small hole was observed in the distal part of the second portion,and scope passage was not possible.Gastrografin upper gastrointestinal series was performed,revealing an intraduodenal barium contrast-filled sac with a curvilinear narrow radiolucent rim,a typical"windsock"sign.Endoscopic RIC was performed on the duodenal web.The patient recovered uneventfully.Follow-up endoscopy showed a patent duodenal lumen without any residual stenosis.The patient reported complete resolution of symptoms at the 18-month follow-up.CONCLUSION Endoscopic RIC may be an effective treatment for congenital duodenal webs in adults.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is difficult to treat and has a high mortality rate,emphasizing the importance of early diagnosis and treatment.If characteristic radiologic findings and underlying liver disease are present,a diagnosis can be made without a biopsy.However,when HCC is accompanied by a liver abscess,diagnosis might be delayed by atypical radiologic findings.This case report aims to assist in the diagnosis of HCC,which can manifest in various forms.CASE SUMMARY A 75-year-old male presented to the Emergency Department with worsening fever and mental changes.He was diagnosed with liver cirrhosis six months earlier.Abdominal computed tomography(CT)raised our suspicion of an organized liver abscess.A follow-up CT scan after four weeks of antibiotic treatment showed a decrease in the liver lesion size.However,high fever recurred,and C-reactive protein increased to 14 mg/L.Aspiration of the liver lesion was performed,but no bacteria were identified.Blood culture revealed the presence of fungi.The patient received an additional four weeks of antibiotics and antifungal agents before being discharged.Approximately 10 mo later,a CT scan showed an increase in the lesion size,and biopsy was performed.The biopsy revealed an organized abscess with focal carcinomatous changes,for which surgery was performed.Postoperative histopathological examination revealed HCC,clear-cell variant.The nontumor liver tissue showed cirrhosis and an organized abscess.CONCLUSION Even if a liver abscess is suspected in a patient with cirrhosis,the possibility of HCC should be considered.
