WHEN NEEDLES ARE NOT ENOUGH, FORCEPS DELIVERS!
Francisco Baldaque-Silva; João Pedro Pereira; José Soares
Gastroenterology Department, ULS Matosinhos, Portugal
A 67-year-old woman with a 5 cm cystic retroperitoneal lesion detected on
a CT in the context of a pulmonary embolism was referred for EUS. EUS
revealed an anechoic, well-encapsulated, heterogeneous lesion with
regular contour and 73x45mm in transverse diameters. EUS FNA was
performed and the cystic fluid analysis showed normal values of amylase,
CEA and CA 19-9. To clarify the diagnosis, a new EUS was scheduled and biopsies were performed using a Moray forceps through a 19G needle. The
anatomopathological evaluation revealed a Schwannoma with no signs of
malignancy. The patient remains asymptomatic and the lesion shows stable
size on CT follow-up. Decision for surveillance with CT was made after
multidisciplinary team conference. This case highlights the potential role of
EUS through-the-needle biopsy forceps, as an easy to use and safe device
in the diagnosis workout of cystic lesions, enabling full histological
characterization without need for resection.
AN UNUSUAL CAUSE OF OBSTRUCTIVE JAUNDICE
Diana Ramos, Marisa Linhares, Inês Pestana, Marco Pereira, Ana Caldeira, Eduardo Pereira, António Banhudo
Serviço de Gastroenterologia da ULS Castelo Branco
A 23-year-old woman presented with jaundice (BT 10mg/dL) and increased liver tests (AST/ALT 431/544;FA 526 and GGT 308 U/L). Abdominal ultrasound revealed a homogeneous and globally enlarged pancreas(A), an enlarged main bile duct (8 mm) with retro-pancreatic distal tapering and gallbladder distended with thick bile (B). EUS (C) described the same findings. Abdominal MRI showed a “sausage-like pancreas”, that suggested autoimmune pancreatitis (AIP). EUS-FNB was performed and confirmed the diagnosis of type 2 AIP(D). Serum IgG4 was normal. The patient started corticosteroids with good clinical/imaging/analytical response. AIP is a rare entity, with type 2 being the least frequent subtype. The typical presentation of type 2 AIP is acute pancreatitis, being rare the presentation in the form of obstructive jaundice. Given the absence of specific serological markers, the definitive diagnosis requires histology. Due to the risk of chronic pancreatitis and the possibility of pancreatic cancer, careful monitoring of these patients is important.
USEFULNESS OF ENDOSCOPIC ULTRASOUND (EUS) IN THE RESOLUTION OF PELVIC ABSCESS
Diana Ramos, Marisa Linhares, Inês Pestana, Marco Pereira, Ana Caldeira, Eduardo Pereira, Rui Sousa, António Banhudo
Serviço de Gastroenterologia da ULS Castelo Branco
A 67-year-old man with adenocarcinoma of the rectum underwent an anterior resection of the rectum. In the postoperative period he developed fever and abdominal pain. CT scan revealed a pre-sacred abscess. Abdominal ultrasound with contrast identified, adjacent to the intestinal wall, a lesion with air inside, without filling with contrast(A). EUS was performed and revealed, at 9cm from the anal margin, adjacent to the intestinal wall, a well-defined collection, with 7x5cm, filled with homogeneous echogenic content, with air inside (aspects compatible with abscess)(B). EUS drainage of the rectal abscess was performed with a hot axios® stent. The distal phalanx was released inside the collection followed by the release of the proximal phalanx (anchored in the intestinal wall) with purulent drainage at the end of the procedure(C). In the following days, rectosigmoidoscopies were performed to wash the abscess cavity. Stent was removed after 10 days, with resolution of the pelvic abscess(D).
