A Case of a Mass of the Pancreatic Head Presenting as Mixed Hemorrhagic and Septic Shock

Acute cholangitis is a biliary tract infection secondary to the obstruction, which causes biliary stasis and bacterial overgrowth. Typically, it presents with the Charcot triad of right upper quadrant abdominal pain, jaundice, and fever. Most acute cholangitis cases are secondary to choledocholithiasis. There are rare cases resulting from pancreatic neoplasm. We report the case of a 43-year-old Caucasian male who was found unresponsive at home with hypotension, anemia, and severe jaundice. Initial imaging studies were notable for a periampullary mass lesion causing intrahepatic biliary ductal dilation. Endoscopic retrograde cholangiopancreatography (ERCP) revealed an actively oozing periampullary fungating mass. In this case, acute cholangitis and hemorrhagic shock secondary to bleeding periampullary lesions are atypical. This case presents an effective treatment plan for this condition.

Migration of Over-the-scope Clip Resulting in Anal Pain and Obstructed Defecation

Iatrogenic perforation is a known and feared complication of diagnostic and therapeutic colonoscopy. Specific locations in the gastrointestinal tract, such as the jejunum, have a higher risk of perforation owing to its difficult anatomical position. Over-the-scope clips have recently been used for the management of these perforations. We present the case of a 40-year-old male patient treated with over-the-scope (Ovesco^®, Ovesco Endoscopy AG, Tübingen, Germany) clips for an iatrogenic postpolypectomy perforation with subsequent anal pain and inability to evacuate stool occurring as a result of the migration of the clip, followed by a review of the literature.

Aggressive lymphoma presenting as dysphagia: A rare cause of dysphagia

Diffuse large B-cell lymphoma (DLBCL) can involve the esophagus from local spread, distant metastasis and very rarely can also be the primary site. Once DLBCL is diagnosed, caution should be exercised in further evaluation for local treatments of sites like adnexal masses as was seen in this case; sometimes it is DLBCL at atypical sites.

Rectal Mass in a Pregnant Patient: How Come?

A 23-year-old pregnant Native American woman was initially evaluated at the onset of labor with the additional complaint of severe constipation and the finding of iron deficiency anemia. Immediately following manual disimpaction of feces, her rectum prolapsed revealing a 4 cm 9 4 cm bleeding mass. Following a successful Cesarean section, colonoscopy later revealed a 10 cm circumferential, necrotic mass with histologic characteristics of a moderately differentiated, invasive adenocarcinoma with IHC staining characteristic of LS. She left without resolving this problem. Because LS is a common cause of hereditary CRC, screening for LS and MSI is now increasingly being advocated. Early identification of those affected can reduce mortality from colon and a number of other cancers, particularly in females. Awareness of the issue is particularly important in Native American communities where screening rates are low and death rates from CRC are high, particularly in the western USA and in Alaska.