Advances in Digestive Medicine最新文献

{"title":"Direct-acting antiviral therapy for chronic hepatitis C among incarcerated people who inject drugs","authors":"Yuan-Chih Mao,&nbsp;I-I Chen,&nbsp;Lein-Ray Mo","doi":"10.1002/aid2.13338","DOIUrl":"10.1002/aid2.13338","url":null,"abstract":"<p>Hepatitis C virus (HCV) infection is an important public health problem, causing significant morbidity and mortality worldwide. The prevalence of HCV infections is especially high among people who inject drugs (PWID). The efficacy of direct-acting antiviral (DAA) therapy was evaluated herein. During 2019-2021, a total of 321 cases who received a full course of DAA therapy and completed a 12-week follow-up observation were studied. The most frequent genotype (GT) was GT6 (34.9%), followed by GT1a (23.4%), GT1b (14.6%), GT2 (12.1%), and GT3 (11.8%). Increase was observed in GT6 (from 29.8% in 2019 to 44.9% in 2021) and GT3 (from 9.9% in 2019 to 16.3% in 2021) over the study years. GT2 was more likely found in patients &gt;50 years old, while GT3 was more in younger patients (both <i>P</i> &lt; .05). GT3 was also more frequently associated with moderate scores of fibrosis-4 index (FIB-4) (1.45 ≤ FIB-4 ≤ 3.25, 13/38 vs 49/283; <i>P</i> &lt; .05). High viral loads (&gt;1 500 000 IU/mL) were found in 65.7% of the patients, including 21.5% showing a very high level (&gt;6 000 000 IU/mL). Compared to other genotypes, viral loads were significantly higher in GT6 (<i>P</i> &lt; .005) and lower in GT1b (<i>P</i> &lt; .01). The end of treatment virologic response rate and the sustained virologic response rate at 12 weeks (SVR12) post-treatment were both 100%. Two recurrent infections with GT6 and GT2 were noted at 16-month and 3-month, respectively, after achieving SVR12. The present report provides a solid evidence for the effectiveness of DAA therapy in the treatment of hepatitis C among incarcerated PWID. We believe that appropriate DAA therapy, when incorporated with active universal screening, can achieve micro-elimination of chronic hepatitis C in incarcerated persons. Hence, the strategies should be applied to all custodial settings, especially for PWID, as an important step to eliminate hepatitis C by 2025, a goal set by the Taiwan government.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42089792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic papillary balloon dilation for revision of a symptomatic post-sphincterotomy stricture","authors":"Vincent Zimmer","doi":"10.1002/aid2.13335","DOIUrl":"10.1002/aid2.13335","url":null,"abstract":"<p>Post-sphincterotomy stricture is among the more uncommon long-term complications of preceeding endoscopic retrograde cholangiopancreatography (ERCP) including endoscopic sphincterotomy.<span>¹</span> Overall, its incidence is estimated at up to 5% in long-term follow-up, warranting revision ERCP. In lack of a standard revision procedure, endoscopic treatment warrants individualization according to patient- (anatomy-directed) and operator-related (experience, etc.) factors to appropriately choose for example, among re-do papillotomy, balloon dilation and/or temporary metal or multiple plastic stenting.<span>^{2, 3}</span> Specifically, re-do cutting translates into higher risks of bleeding and/or perforation, while stenting and/or dilation is associated with higher post-ERCP pancreatitis (PEP) risks, such that intensified PEP prophylaxis is indicated, as was the case in this 45-year-old female with a symptomatic post-sphincterotomy stricture.<span>⁴</span> The distinct selection of the revision procedure has to be taken into account aspects of duodenal anatomy (qualifying or not for a safe re-do papillotomy), severity and length of stricture (implying candidacy for stent treatment) as well as individual and institutional experience. The current patient had undergone index ERCP 3 years earlier elsewhere including endoscopic papillotomy to allow for extraction of bile duct stones. The recent ERCP was indicated due to biliary type-pain and elevated cholestasis parameters in association with common bile duct (CBD) dilation on abdominal ultrasound. Duodenoscopy indicated an excentric and severely shrunken biliary orifice post-sphincterotomy without adequate safety plane for re-do papillotomy (no intraduodenal bile duct segment) (Figure 1). After deep-biliary cannulation, a cholangiogram was performed with CBD diameter up to 14 mm with reduced contrast media clearance. After insertion of a 35″ hydrophilic-tip guidewire, endoscopic papillary balloon dilation (EPBD) up to 10 mm was performed (Supplementary  Video). The post-interventional course was uncomplicated with complete pain and cholestasis resolution, which was maintained throughout the follow-up period of 1 year.</p><p>The author declares no conflict of interest.</p><p>Ethical approval was waived (clinical routine case); informed consent has been obtained.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48668208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A bleeding duodenal lesion","authors":"Jhih-Jie Lin,&nbsp;Ming-Jen Chen","doi":"10.1002/aid2.13334","DOIUrl":"10.1002/aid2.13334","url":null,"abstract":"<p>A 40-year-old man with no known underlying diseases developed epigastric pain and passed tarry stools for 2 weeks. There was no noted coffee-ground vomitus. Upon arriving at the hospital, he had a hemoglobin level of 9 mg/dL. Esophagogastroduodenoscopy revealed oozing of the duodenal mucosa (Figure 1) The patient underwent blood transfusion with six units of packed red blood cells. Another episode of severe diarrhea with tarry stools and hemodynamic instability occurred after admission. However, no definite extravasation was detected on computed tomography angiography. On repeated esophagogastroduodenoscopy, the previously identified duodenal lesion kept oozing.</p><p>The oozing duodenal mucosa on the opposite side of superior duodenal angle, detected on repeated esophagogastroduodenoscopy, was classified as a Dieulafoy's lesion. Dieulafoy's lesion is a small mucosal erosion into a caliber-persistent and abnormally large submucosal artery. The lesion most commonly affects elderly men, and is typically located in the proximal stomach.<span>¹</span></p><p>For the uncommon bleeder with no easily defined feeding vessels, endoscopic band ligation (EBL) was performed using the Multiple Band Ligator (Boston Scientific, The Speedband Superview Super 7, Boston, USA) (Figure 2A) to suction the bleeding target lesion into the cap, occupying the endoscopic view. The rubber band was placed around the bleeding site (Figure 2B). Twenty-seven days after the patient's discharge, repeat esophagogastroduodenoscopy showed a healing scar (Figure 2C).</p><p>Dieulafoy's lesions cause 2% of gastrointestinal hemorrhages, and only 15% of cases involved the duodenum.<span>¹</span> For Dieulafoy's lesions, there is no definite consensus on the treatment and the options are dependent on the site of the lesion and available expertise. Several endoscopic techniques have been developed. Some studies have suggested that endoscopic mechanical hemostatic methods were more effective in achieving hemostasis than injection or thermal treatment.<span>²</span> EBL for Dieulafoy's lesions has gained increasing acceptance than hemoclipping because of favorable clinical outcome.<span>^{3, 4}</span> Hemoclipping is sometimes not easy to apply in duodenum when the angle of approach is tangential or when the location has no space to deploy the clip. Delayed bleeding of a residual vessel within a necrotic ulcer is problematic. In one study, about 3% of patients experienced delayed bleeding at the previous EBL site after EBL treatment.<span>⁵</span></p><p>The authors declare no conflict of interest.</p><p>The study participant provided informed consent, and the study design was approved by the appropriate ethics review board.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42773748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in renal function in patients with chronic hepatitis C treated with sofosbuvir-velpatasvir","authors":"Pei-Kai Su,&nbsp;Te-Sheng Chang,&nbsp;Shui-Yi Tung,&nbsp;Kuo-Liang Wei,&nbsp;Chien-Heng Shen,&nbsp;Yung-Yu Hsieh,&nbsp;Wei-Ming Chen,&nbsp;Yi-Hsing Chen,&nbsp;Chun-Hsien Chen,&nbsp;Chih-Wei Yen,&nbsp;Huang-Wei Xu,&nbsp;Wei-Ling Tung,&nbsp;Kao-Chi Chang","doi":"10.1002/aid2.13336","DOIUrl":"10.1002/aid2.13336","url":null,"abstract":"<p>Direct-acting antivirals (DAAs) have become an effective first-line treatment for chronic hepatitis C (CHC), and the fixed-dose combination of sofosbuvir (SOF) and velpatasvir (VEL) is one of the most important pangenotypic DAA regimen according to present treatment guideline. The association between SOF-based regimens and renal toxicity remains controversial. A total of 953 patients including 130 with estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73m² and 823 with eGFR &gt; 60 mL/min/1.73m² receiving SOF/VEL therapy for 12 weeks were enrolled in this study. The eGFR was assessed at baseline, end of treatment (EOT), and 12 weeks after completion of the therapy (end of follow-up, EOF). The eGFR in patients with eGFR ≤ 60 mL/min/1.73m² increased from baseline (47.89 ± 10.25 mL/min/1.73m²) to EOT (51.65 ± 15.92; <i>P</i> &lt; .001) and EOF (51.51 ± 14.46 mL/min/1.73m²; <i>P</i> &lt; .05). The eGFR in patients with eGFR &gt; 60 mL/min/1.73m² at baseline (91.52 ± 22.06 mL/min/1.73m²) was lower at EOT (90.37 ± 22.3; <i>P</i> &lt; .05), with no difference between EOT and EOF (<i>P</i> = .06). Multivariable analysis showed that a higher serum albumin level was associated with a lower risk of eGFR decrease at EOT, and the patients with baseline eGFR &gt; 60 mL/min/1.73m² were associated with a higher risk of eGFR decrease at EOF. The rates of sustained virologic response 12 weeks after treatment cessation (SVR12) were 99.2% in per-protocol analysis, and the most common adverse events were fatigue (4.7%), abdominal discomfort (4.5%), and skin itching (3.7%). In conclusion, renal function improved after the SOF/VEL treatment in patients with CHC and chronic kidney disease. Thus, SOF/VEL was safe, effective, and tolerable in these patients.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13336","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49151103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hormone replacement therapy and risk of hepatocellular carcinoma","authors":"Teng-Yu Lee","doi":"10.1002/aid2.13333","DOIUrl":"10.1002/aid2.13333","url":null,"abstract":"<p>Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer burden globally; therefore, the prevention of HCC is a critical issue in public health.<span>¹</span> In general, the most effective way to prevent HCC development is based on the major etiology in the carinogenesis of HCC; for example, antiviral treatment for chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection.<span>^{2, 3}</span> However, although antiviral treatment can significantly reduce HCC risk amongst patients with chronic viral hepatitis, the risk is not completely eliminated. Therefore, other methods which can further lower HCC risk remain highly expected. For example, due to its anti-inflammatory properties, aspirin has been previously investigated for its possible chemopreventive effect in HBV- or HCV-related HCC,<span>^{4, 5}</span> even though antiviral treatment remains the first consideration for HCC prevention. In addition, some etiologies of HCC remain lacking effective therapies; for example, non-alcoholic fatty liver disease.<span>⁶</span> In general, discovering another new way to prevent HCC development should be encouraged.</p><p>The epidemiological investigations of HCC disclose that the rates of both incidence and mortality are two to three times higher among men than among women in most regions.<span>¹</span> With an obvious gender disparity, sex hormone may play an important role in the pathogenesis of HCC, therefore whether hormone replacement therapy (HRT) can reduce HCC risk in females has been highly discussed.<span>^{7, 8}</span> In cell and animal experiments, some genetic, biochemical, or immunological mechanisms have been explored to explain the possible HCC chemoprevention effect of HRT.<span>⁹</span> For example, in HBV-related HCC, the HBV X protein and estrogen receptor-alpha complex could downregulate the mechanisms of HCC initiation or progression.<span>¹⁰</span> In HCV-related HCC, estrogen was found to inhibit mature HCV production through estrogen receptor-alpha,<span>¹¹</span> and the risk of HCC development may thus be reduced. However, even though experimental studies support the preventive effect of HRT, the clinical study results are not always consistent in the prevention of HCC.<span>^{7, 12}</span> Importantly, current clinical evidence mainly comes from observational studies, and the study findings cannot be directly deferred to a causal relationship.</p><p>In this issue of <i>Advances in Digestive Medicine</i>, Chang et al<span>¹³</span> aimed to investigate the chemoprevention effect of HRT on HCC risk and overall survival in women with chronic hepatitis C, and some interesting findings were disclosed after a long period of follow-up. In this retrospective population-based cohort study using data from Taiwan's National Health Insurance Research Database, 1022 patients who received HRT and 10","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44030583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Through-the-esophageal-stent diagnostics and intervention of pancreaticolithiasis complicated by high-grade esophageal stricture","authors":"Vincent Zimmer","doi":"10.1002/aid2.13325","DOIUrl":"10.1002/aid2.13325","url":null,"abstract":"<p>Luminal strictures along the endoscopic retrograde cholangiopancreatography (ERCP) route to the papilla to allow for biliopancreatic endoscopy may be encountered in individual patients, precluding scope advancement. Stent implantation to allow for scope passage followed by successful through-the-scope ERCP has rarely been reported in such setting, however, to the best of our knowledge neither in terms of pancreatic indications and/or as same-session endoscopic ultrasound-ERCP, which is pioneered in this report.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42135553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare etiology of esophageal perforation","authors":"Chih-Chi Tsai,&nbsp;Yen-Chun Peng,&nbsp;Chia-Chang Chen","doi":"10.1002/aid2.13323","DOIUrl":"10.1002/aid2.13323","url":null,"abstract":"<p>A 74-year-old male with a history of diabetes and Parkinson's disease presented to our hospital due to progressive dysphagia for 3 months. He also had frequent choking and been admitted to another hospital due to pneumonia before visiting our hospital. He had a surgery of anterior cervical discectomy and fusion (ACDF) 16 years ago due to osteomyelitis with myeloradiculopathy. Cervical roentgenograms showed migrated plate-locking screws, indicating malposition of fixation screw over C7-T1 (Figure 1A). Esophagogastroduodenoscopy was performed to assess the progressive dysphagia (Figure 2).</p><p>What is the diagnosis of this patient?</p><p>The esophagogastroduodenoscopy revealed a screw head had eroded into the esophageal lumen. The exam was stopped promptly to avoid possible complications due to air inflation. Computed tomography of the neck disclosed focal gas accumulation in the esophagus at the C7 level just anterior to the plate. The screw had penetrated through to the esophageal lumen (Figure 1B).</p><p>The incidence of esophageal perforation after ACDF was low (&lt;1%).<span>¹</span> The symptoms of esophageal perforation after ACDF includes dysphagia (57%), neck swelling and/or discharge (21%), pneumonia (11%), odynophagia, sore throat (7%), hoarseness, and breathing difficulty (7%).<span>²</span> The diagnosis of esophageal perforation related to ACDF is based on esophagogastroduodenoscopy, upper gastrointestinal series, or esophagogram.</p><p>Most delayed pharyngoesophageal perforations occurred less than 1 year from the time of ACDF. Vrouenraets reported a case of esophageal perforation 9 years post-ACDF with a background of chronic esophagitis.<span>³</span> Our patient experienced this complication 16 years after the surgery. This time frame is the longest ever reported in the literature. Clinicians should consider this differential diagnosis when managing patients with dysphagia and a history of ACDF. Computer tomography or upper GI series should be performed before esophagogastroduodenoscopy if cervical roentgenograms showed malposition of plate-locking screws.</p><p><b>Chia-Chang Chen:</b> The endoscopist who performed the esophagogastroduodenoscopy, final approval and drafting of the manuscript. <b>Chih-Chi Tsai:</b> Final approval and drafting of the manuscript. <b>Yen-Chun Peng:</b> Final approval of the manuscript.</p><p>The authors declare no conflict of interest.</p><p>Written informed consent was obtained from the patient.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43501917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenosquamous carcinoma of gallbladder associated with biliopancreatic maljunction and Todani 1c choledochal cyst: A case report","authors":"Anisse Tidjane,&nbsp;Nabil Boudjenan-Serradj,&nbsp;Samia Khalifa,&nbsp;Nacim Ikhlef,&nbsp;Aicha Bengueddach,&nbsp;Hakim Larbi,&nbsp;Sif el islam Meharzi,&nbsp;Benali Tabeti","doi":"10.1002/aid2.13327","DOIUrl":"10.1002/aid2.13327","url":null,"abstract":"<p>Gallbladder cancer is the fifth most frequent women cancer in Algeria. Squamous-cell and adenosquamous carcinomas are the rarest histological type of this cancer and represent less than 7%. Malformation of the bile ducts such as a choledochal cyst or a biliopancreatic maljunction are risk factors for this cancer. This manuscript reports a rare case of an 82-year-old woman operated on for an adenosquamous carcinoma of the gallbladder associated with a bile duct cyst and a biliopancreatic junction abnormality. Aggressive surgery was performed combined with adjuvant oral chemotherapy. Twenty-nine months of recurrence-free survival was achieved by this patient suffering from this aggressive and rare form of gallbladder cancer.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13327","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46262436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glasgow coma scale score and albumin level are associated with patient survival after emergent colonoscopy in the intensive care unit","authors":"Tung-Lung Wu,&nbsp;Hsu-Heng Yen,&nbsp;Siou-Ping Huang,&nbsp;Yang-Yuan Chen","doi":"10.1002/aid2.13326","DOIUrl":"10.1002/aid2.13326","url":null,"abstract":"<p>Due to poor patient condition and the high risk associated with the procedure, colonoscopy is rarely performed in the intensive care unit (ICU). It is indicated for ICU patients with suspected ischemic colitis, decompression of colonic distension, or lower gastrointestinal hemorrhage. ICU patients usually have more co-morbidities and higher mortality rates than other inpatient patients. Data in the literature regarding the outcomes of ICU patients after colonoscopy are limited. The aim of this study was to identify factors that are predictive of outcomes following colonoscopy in ICU patients. We retrospectively analyzed the medical records and imaging findings of patients who underwent colonoscopy in an ICU setting between January 2018 and June 2020. A total of 79 patients were identified and enrolled for analysis. The median age of the patients was 78 years. The colonoscopy findings included angiodysplasia (n = 3, 3.8%), colitis (n = 17, 21.5%), colonic ulcer (n = 2, 2.5%), diverticulosis (n = 3, 3.8%), hemorrhoid (n = 10, 12.7%), rectal ulcer (n = 16, 20.3%), tumor (n = 10, 12.7%), volvulus (n = 1, 1.3%), bleeding of unknown origin (n = 4, 5.1%), and no diagnosis (n = 13, 16.5%). A total of 46 patients (58%) survived to discharge. Patients who survived had statistically significantly higher Glasgow coma scale (GCS) scores (<i>P</i> = .009) and albumin levels (<i>P</i> = .002) than patients who did not survive. Patient survival is associated with GCS score and albumin level, but not with colonoscopy findings.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45771020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Splenic artery pseudoaneurysm as a fatal complication of acute pancreatitis","authors":"Yu-Hsuan Tseng,&nbsp;Chuen-Huei Liu,&nbsp;Chun-Yang Lee,&nbsp;Nai-Chi Chiu,&nbsp;Chien-Wei Su","doi":"10.1002/aid2.13328","DOIUrl":"10.1002/aid2.13328","url":null,"abstract":"<p>Splenic artery pseudoaneurysm (SAP) is a rare but potentially fatal complication of acute pancreatitis. We present a 67-year-old female with ruptured SAP as a complication of acute pancreatitis. The patient had mild clinical symptoms on admission, thus was difficult to identify for severe complications. However, she had experienced two episodes of hypovolemic shock on the 10th day after admission. Abdominal computer tomography scan and angiography revealed evidence of splenic artery injury possibly due to acute pancreatitis. The patient underwent transcatheter embolization of splenic artery and total spleen. However, she was still hemodynamically unstable and eventually expired due to severe sepsis. This case raised our clinical awareness of SAP as a rare but life-threatening complication of acute pancreatitis even in patients with short clinical courses and initially mild symptoms. SAP should be kept in mind during image study or in hemodynamically unstable cases of acute pancreatitis.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13328","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48199716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}