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Ma X, Gao J, Li Y, Xie J, Feng Z, Jia X, Chen W. Transplantation of splenic tissue after splenectomy: A case report. Exp Ther Med 2022; 24:612. [PMID: 36160907 PMCID: PMC9468849 DOI: 10.3892/etm.2022.11549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/01/2022] [Indexed: 11/06/2022] Open
Abstract
Transplantation of splenic tissue is a rare condition that usually occurs after splenic trauma and splenectomy. It usually requires surgery for diagnosis and treatment. A 38-year-old Asian male with familial hemolytic disease underwent laparoscopic splenectomy for a traumatic rupture of the spleen one year prior. The patient developed middle-upper abdominal pain without any obvious cause, radiating to the back and chest seven months prior to presentation. The condition improved with conservative treatment but the patient experienced recurrent episodes. Abdominal CT suggested multiple gallstones in the gallbladder that changed after splenectomy and multiple nodules in the original splenic area; thus, transplantation of splenic tissue was considered. MRI suggested thick gall bladder bile, multiple stones and cholecystitis, and the spleen was not observed (the patient underwent laparoscopic splenectomy at our hospital one year previously due to traumatic splenic rupture); furthermore, there were multiple abnormal signal foci in the splenic area, so the possibility of spleen implantation was considered. Considering the patient's family history of a hereditary hemolytic disease, laparoscopic cholecystectomy was performed simultaneously with laparoscopic accessory splenectomy. The final pathological report revealed chronic cholecystitis, mixed calculi, red pulp dilation, hyperemia and bleeding in round tissue with blood clot formation and acute and chronic inflammatory cell infiltration. Clinicians must bear in mind the possibility of splenosis after splenic trauma and its image variations.
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Affiliation(s)
- Xiaoming Ma
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Souzhou, Jiangsu 215004, P.R. China
| | - Jiawei Gao
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Souzhou, Jiangsu 215004, P.R. China
| | - Yecheng Li
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Souzhou, Jiangsu 215004, P.R. China
| | - Jiaming Xie
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Souzhou, Jiangsu 215004, P.R. China
| | - Zhenyu Feng
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Souzhou, Jiangsu 215004, P.R. China
| | - Xin Jia
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Souzhou, Jiangsu 215004, P.R. China
| | - Wei Chen
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Souzhou, Jiangsu 215004, P.R. China
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Tang X, Gu P, Lu W. A rare case of adult colocolic intussusception secondary to splenosis. J Int Med Res 2022; 50:3000605221115386. [PMID: 36036154 PMCID: PMC9527533 DOI: 10.1177/03000605221115386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intussusception is the invagination of a segment of bowel
(intussusceptum) into the lumen of an adjacent segment
(intussuscipiens). Adult intussusception is rare and typically
asymptomatic, although bowel obstruction can be a predominant symptom,
making it difficult to diagnose. Splenosis is an uncommon and benign
disease, arising from the self-implantation of splenic tissue
elsewhere in the body after splenectomy or splenic trauma. Colocolic
intussusception secondary to splenosis is rare. We report a case of
colon intussusception with a mass in the intussusception detected by
ultrasound. Abdominal ultrasound identified the intussusception
location but failed to distinguish its pathological properties.
Colonoscopy revealed the exudation of necrotic and fibrous tissue.
Surgery was performed because of suspicions of a malignant tumor.
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Affiliation(s)
- Xuemei Tang
- Department of Ultrasound, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, People's Republic of China
| | - Peng Gu
- Department of Ultrasound, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, People's Republic of China
| | - Wenming Lu
- Department of Ultrasound, Huzhou First People's Hospital, Huzhou 313000, People's Republic of China
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Smoot T, Revels J, Soliman M, Liu P, Menias CO, Hussain HH, Savas H, Gaballah AH. Abdominal and pelvic splenosis: atypical findings, pitfalls, and mimics. Abdom Radiol (NY) 2022; 47:923-947. [PMID: 35076742 DOI: 10.1007/s00261-021-03402-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 01/28/2023]
Abstract
Splenosis is an acquired form of ectopic splenic tissue that typically arises after trauma or splenectomy. It is often an incidental image finding in an otherwise asymptomatic patient, but the spectrum of symptoms varies based on the site of implantation. Radiologists should be familiar with the imaging features of splenosis to avoid mistaking it for malignancy. Splenosis has identical imaging features to that of the native spleen on US, CT, MRI, and nuclear medicine examinations. Therefore, when the radiologic findings support the diagnosis of splenosis, the patient can be spared invasive procedures for tissue sampling.
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Affiliation(s)
- Travis Smoot
- Department of Diagnostic Radiology, University of Missouri, One Hospital Dr. Columbia, Columbia, MO, 65212, USA
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Moataz Soliman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 48109, USA
| | - Peter Liu
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Hero H Hussain
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hatice Savas
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 48109, USA
| | - Ayman H Gaballah
- Department of Diagnostic Radiology, University of Missouri, One Hospital Dr. Columbia, Columbia, MO, 65212, USA.
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Alberto RG, Eliana LZ, Mauricio TM, Eduardo GH. Cecal splenosis mimicking gastrointestinal stroma tumor. Case report and review of the literature. Int J Surg Case Rep 2021; 83:105992. [PMID: 34062360 PMCID: PMC8178097 DOI: 10.1016/j.ijscr.2021.105992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 01/31/2023] Open
Abstract
Introduction Abdominal splenosis is a rare condition where autotransplanted ectopic spleen tissue is found in the abdominal cavity after spleen injury or splenectomy. While abdominal splenosis is mostly described as asymptomatic, bowel splenosis can present with abdominal pain, obstipation or gastrointestinal (GI) bleeding. Scarce information on bowel splenosis exists and high index of suspicion is needed for diagnosis. We present the case of a patient with abdominal pain and a cecal mass mimicking gastrointestinal stroma tumor (GIST) found to have bowel splenosis after laparoscopic resection. Presentation of case A 45-year-old female was evaluated for a 6-month history of abdominal pain in right-lower quadrant. She had past medical history of blunt abdominal trauma and splenectomy 35 years before symptoms. An abdominal contrast-enhanced computed tomography (CT) reported a 4.2 × 4.6 × 4.6 cm solid mass located in the antimesenteric border of the cecum, with calcifications and arterial enhancement. Colonoscopy found no epithelial lesions. A diagnostic laparoscopy was done, and resection of the mass achieved. Transoperative histopathological diagnosis revealed ectopic spleen tissue. Discussion It is difficult to know whether abdominal pain in bowel splenosis is actually triggered by splenosis itself or by an unrelated cause, making diagnosis incidental. There are no particular imaging findings suggestive of splenosis, and surgical resection is often done under uncertain diagnosis. Conclusion Bowel splenosis could present as abdominal pain variable time after spleen injury or splenectomy. Clinical features and imaging characteristics are nonspecific and similar to those of GIST. Most cases of splenosis are diagnosed after surgery. Bowel splenosis is a rare entity scarcely reported in the literature. 2nd case with more years from risk factor reported. We expose a review of the literature analyzing common findings.
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Affiliation(s)
- Riojas-Garza Alberto
- Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Nuevo León, México.
| | - López-Zamora Eliana
- Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Nuevo León, México
| | | | - Guzmán-Huerta Eduardo
- Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Nuevo León, México.
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Splenosis: An underappreciated cause of gastrointestinal bleeding in splenectomized patients. Case report and literature review. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:369-373. [PMID: 33172692 DOI: 10.1016/j.gastrohep.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/14/2020] [Accepted: 08/25/2020] [Indexed: 11/24/2022]
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Isopi C, Vitali G, Pieri F, Solaini L, Ercolani G. Gastric splenosis mimicking a gastrointestinal stromal tumor: A case report. World J Gastrointest Surg 2020; 12:435-441. [PMID: 33194092 PMCID: PMC7642345 DOI: 10.4240/wjgs.v12.i10.435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mass lesions located in the wall of the stomach (and also of the bowel) are referred to as “intramural.” The differential diagnosis of such lesions can be challenging in some cases. As such, it may occur that an inconclusive fine needle aspiration (FNA) result give way to an unexpected diagnosis upon final surgical pathology. Herein, we present a case of an intramural gastric nodule mimicking a gastric gastrointestinal stromal tumor (GIST).
CASE SUMMARY A 47-year-old Caucasian woman, who had undergone splenectomy for trauma at the age of 16, underwent gastroscopy for long-lasting epigastric pain and dyspepsia. It revealed a 15 mm submucosal nodule bulging into the gastric lumen with smooth margins and normal overlying mucosa. A thoraco-abdominal computed tomography scan showed in the gastric fundus a rounded mass (30 mm in diameter) with an exophytic growth and intense enhancement after administration of intravenous contrast. Endoscopic ultrasound scan showed a hypoechoic nodule, and fine needle FNA was inconclusive. Gastric GIST was considered the most probable diagnosis, and surgical resection was proposed due to symptoms. A laparoscopic gastric wedge resection was performed. The postoperative course was uneventful, and the patient was discharged on the seventh postoperative day. The final pathology report described a rounded encapsulated accumulation of lymphoid tissue of about 4 cm in diameter consistent with spleen parenchyma implanted during the previous splenectomy.
CONCLUSION Splenosis is a rare condition that should always be considered as a possible diagnosis in splenectomized patients who present with an intramural gastric nodule.
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Affiliation(s)
- Claudio Isopi
- Department of Surgery, Morgagni-Pierantoni Hospital, Forli 47121, Italy
| | - Giulia Vitali
- Department of Surgery, Morgagni-Pierantoni Hospital, Forli 47121, Italy
| | - Federica Pieri
- Pathology Unit, Morgagni-Pierantoni Hospital, Forli 47121, Italy
| | - Leonardo Solaini
- Department of Surgery, Morgagni-Pierantoni Hospital, Forli 47121, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 47100, Italy
| | - Giorgio Ercolani
- Department of Surgery, Morgagni-Pierantoni Hospital, Forli 47121, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 47100, Italy
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El-Kheir A, Abdelnour M, Boutros JG. Simultaneous small bowel and colon obstruction due to splenosis. A case report and review of literature. Int J Surg Case Rep 2019; 58:63-66. [PMID: 31009896 PMCID: PMC6479103 DOI: 10.1016/j.ijscr.2019.03.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/19/2019] [Accepted: 03/22/2019] [Indexed: 12/14/2022] Open
Abstract
Splenosis is an autotransplantation of splenic tissues throughout the body post splenic rupture or splenectomy. Symptomatic when hematological diseases have recurred. Abdominal splenosis may rarely be associated with abdominal pain and/or gastrointestinal symptoms. Further evaluation and treatment is mandatory when bowel obstruction is present. Treatment consists of resection of problematic splenic nodules.
Introduction Splenosis, an autotransplantation of splenic tissues in another compartment of the body, is only symptomatic when hematologic diseases have recurred or compression of other adjacent structures have occurred. Therefore, we report a clinical case of a patient with bowel obstruction due to splenosis. Case presentation A patient with a history of splenectomy, presented to the emergency room for abdominal pain and obstipation, suggesting intestinal obstruction which is also seen on CT scan. During laparotomy, multiple splenic nodules were seen on the mesentery of the small bowel and colon, with vascular bridges between them, resulting in bowel obstruction. Resection of splenic nodules was performed. The post-operative course was uneventful and the patient was discharged a week after. Discussion Although very rare, gastrointestinal symptoms may sometimes be described in patients with splenosis. Bleeding or obstruction can occur because of intramural grow or external compression, respectively. Treatment consists of resection of these nodules. Conclusion Splenosis should always be thought in patients with previous splenic rupture and presenting with incidental nodules seen on imaging, with further investigations when symptoms are present.
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Affiliation(s)
- Alaa El-Kheir
- Department of General and Digestive Surgery, Nini Hospital, Tripoli, Lebanon.
| | - M Abdelnour
- Department of Gastroenterology and Hepatology, Maritime Hospital, Jbeil, Lebanon
| | - Jihad G Boutros
- Department of General and Digestive Surgery, Maritime Hospital, Jbeil, Lebanon
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Famà F, Giacobbe G, Cintolo M, Gioffré-Florio M, Pallio S, Consolo P. A Lower Gastrointestinal Bleeding Due to a Post-Traumatic Splenosis: "Wait and See" Represents a Feasible Attitude: A Case Report. Medicine (Baltimore) 2016; 95:e3555. [PMID: 27124065 PMCID: PMC4998728 DOI: 10.1097/md.0000000000003555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Splenosis represents a benign condition due to an ectopic localization of splenic tissue caused by pathologic or traumatic spleen rupture. Generally, it is asymptomatic and incidentally diagnosed during imaging performed for other reasons. Occult gastrointestinal bleeding due to an extraperitoneal localization is a rare occurrence. Differential diagnosis may be very hard and includes benign and malignant neoplasms.We describe the case of a 68-year-old Caucasian man that was admitted for an increasing lower gastrointestinal bleeding associated to a vague abdominal pain.He was assessed by means of laboratory tests, as well as by endoscopic and radiological examinations, and successfully treated with an exclusive medical approach.The patient was discharged on the ninth day and currently he is doing well.This case shows that wait and see could prove a feasible attitude for the management of clinically stable patients.
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Affiliation(s)
- Fausto Famà
- From the Department of Human Pathology, University Hospital of Messina, Messina, Italy
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9
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Splenosis: A Rare Etiology for Bowel Obstruction-A Case Report and Review of the Literature. Case Rep Surg 2015; 2015:890602. [PMID: 26543660 PMCID: PMC4620401 DOI: 10.1155/2015/890602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/27/2015] [Indexed: 01/31/2023] Open
Abstract
Splenosis is a historically uncommon etiology for bowel obstruction. Autotransplanted splenic tissues following surgery or trauma of the spleen are known to occur in multiple locations of the abdominal cavity and pelvis. The small bowel mesentery is a blood vessel-rich environment for growth of splenic fragments. We present a case of a 36-year-old male patient who sustained a gunshot wound to his left abdomen requiring a splenectomy and bowel resection fifteen years prior to his presentation with small bowel obstruction requiring exploration, adhesiolysis, and resection of the mesenteric splenic deposit. Our aim in this report is to provide awareness of splenosis as an etiology for bowel obstruction, especially with increased incidence and survival following abdominal traumas requiring splenectomies. We also stress on the importance of history and physical examination to include splenosis on the list of differential diagnoses for bowel obstruction.
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Maki T, Omi M, Ishii D, Kaneko H, Misu K, Inomata H, Tateno M, Nihei K. Spontaneous hemorrhage from splenic tissue 13 years after total splenectomy: report of a case. Surg Case Rep 2015; 1:91. [PMID: 26943415 PMCID: PMC4593983 DOI: 10.1186/s40792-015-0099-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/01/2015] [Indexed: 11/10/2022] Open
Abstract
A 33-year-old man suffered sudden abdominal distension without traumatic episodes. He had undergone total splenectomy for hereditary spherocytosis 13 years ago. He was in shock, and his hemoglobin level was 10.5 g/dl. Contrast enhanced computed tomography revealed a giant mass in the left upper abdomen and extravasation of the contrast material into the mass. Excision of the mass was performed, and microscopic examination showed a giant hematoma surrounded by normal splenic tissue. We speculated that an accessory spleen or splenosis had enlarged for the 13 years and ruptured. The patient remained asymptomatic 4 months after the surgery. Spontaneous hemorrhage from accessory spleens or splenosis is extremely rare, and relevant case reports suggest that surgical resection of bleeding sites yields favorable prognosis although preoperative qualitative diagnosis seems to be difficult.
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Affiliation(s)
- Takehiro Maki
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Makoto Omi
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Daisuke Ishii
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Hiroyuki Kaneko
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Kenjiro Misu
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Hitoshi Inomata
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Masatoshi Tateno
- Department of Pathology, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Kazuyoshi Nihei
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
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Splenosis: a rare cause of gastrointestinal bleeding successfully treated with transarterial embolization. Clin J Gastroenterol 2015; 8:126-9. [PMID: 25860663 DOI: 10.1007/s12328-015-0567-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/29/2015] [Indexed: 10/23/2022]
Abstract
Splenosis, the ectopic implantation of splenic tissue, most commonly occurs in the peritoneal cavity following traumatic splenic injury with subsequent splenectomy. This entity is asymptomatic in a vast majority of patients. Occult gastrointestinal (GI) bleeding is a relatively rare presentation of splenosis. Previous cases of splenosis resulting in refractory GI bleeding have been treated with surgical excision of the ectopic splenic implant. We report a case of splenosis presenting as occult GI bleeding that was eventually treated with transarterial embolization. This presents an alternative minimally invasive approach to treating a patient with refractory GI bleeding secondary to splenosis.
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12
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[Upper gastrointestinal bleeding due to gastric splenosis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 36:59-61. [PMID: 23218771 DOI: 10.1016/j.gastrohep.2012.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/16/2012] [Accepted: 07/24/2012] [Indexed: 11/23/2022]
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