Upper-gastrointestinal bleeding from angiodysplasia of the minor papilla

Angiodysplasia of the Gallbladder: An Unknown Risk Factor for Cholecystolithiasis

Angiodysplasia is a common type of lesion characterized by malformed submucosal and mucosal blood vessels. Angiodysplasia of the gallbladder is extremely rare, usually an incidental finding, with only two cases reported. Laparoscopic cholecystectomy is a curative treatment for angiodysplasia of the gallbladder. Our report describes a case of angiodysplasia of the gallbladder in a patient who underwent elective laparoscopic cholecystectomy for biliary colic because of gallstones, and a systematic literature review. We surmise that angiodysplasia of the gallbladder could be a risk factor for gallstones in younger female patients.

Successful treatment of severe spontaneous periampullary bleeding with argon plasma coagulation

Periampullary bleeding is an uncommon cause of upper gastrointestinal (GI) hemorrhage, which is typically iatrogenic in origin occurring as the result of endoscopic intervention of the papilla. Spontaneous, non-iatrogenic periampullary bleeding is extraordinarily rare with only a few cases reported in the literature to date. Vascular malformations, including angiodysplasia and Dieulafoy’s lesions, have been implicated in several reports as the etiology but endoscopic intervention is often unsuccessful in achieving durable hemostasis with surgery being required for definitive management in many cases. Herein is reported the case of a 67-year-old male on anticoagulation for atrial fibrillation who presented with severe upper GI bleeding determined to be arising from underneath the hood of the major papilla. No distinct lesion was seen endoscopically but the presumed etiology was an unidentified vascular malformation. Successful treatment was achieved with argon plasma coagulation (APC) applied circumferentially around the papilla. No subsequent endoscopic or surgical intervention was required for durable hemostasis and the patient was able to resume anticoagulation shortly after the procedure. This is the first reported case of spontaneous periampullary bleeding successfully treated with APC.

Angiodysplasia of the gallbladder

INTRODUCTION

Angiodysplasia is a term used to describe distinct mucosal vascular ectasias found mainly in the gastrointestinal tract. Angiodysplasia of the gallbladder is exceedingly rare.

PRESENTATION OF CASE

We encountered a patient who presented with biliary colic and subsequently underwent an elective laparoscopic cholecystectomy. The angiodysplasia of the gallbladder was found incidentally on histopathological examination of the excised gallbladder.

DISCUSSION

Review of the literature showed only one other reported case of angiodysplasia of the gallbladder. The condition may be found incidentally after histopathological examination of the gallbladder removed for gallstone; or it may present with haemobilia.

CONCLUSION

We presented an extremely rare case of angiodysplasia of the gallbladder, which was found incidentally after histopathological examination of the gallbladder removed for gallstone. Angiodysplasia of the gallbladder has the potential to bleed. Laparoscopic cholecystectomy is effective in providing a definitive cure.

Relationship between papillary fibrosis and patency of the accessory pancreatic duct

A study of structure and function of the minor duodenal papilla was carried out on 36 autopsy specimens of the human duodenopancreas. An original perfusion method with manometric control was developed for testing the minor papilla patency, i.e. resistency to intraductal pressure. According to this test, all the specimens were classified as: Type I: non-patent (45%); Type II: patent under normal, physiological pressure (36%); and Type III: patent under increased pressure (19%). After that, the whole minor papilla specimens underwent longitudinal sectioning with HE staining. Light microscopy showed various degrees of fibrosis (mild-45%, moderate-29%, and severe-26%). The correlation between the fibrosis and the patency was significant: papillae with lower degrees of fibrosis were more patent and vice versa. Further, the pancreatic tissue in the Santorini segment of the pancreatic head followed the same manner. No apparent sphincter of the minor papilla was found in any of the specimens analyzed.