BACKGROUND Ventriculoperitoneal(VP)shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebrospinal fluid(CSF)into the peritoneum.Abdominal pseudocysts con...BACKGROUND Ventriculoperitoneal(VP)shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebrospinal fluid(CSF)into the peritoneum.Abdominal pseudocysts containing CSF are the common long-term complication of this frequently performed procedure,mainly because VP shunts have significantly prolonged survival.Of these,liver CSF pseudocysts are rare entities that may cause shunt dysfunction,affect normal organ function,and therefore pose therapeutic challenges.CASE SUMMARY A 49-year-old man with history of congenital hydrocephalus status post bilateral VP shunt placement presented with progressively worsening dyspnea on exertion,abdominal discomfort/distention.Abdominal computed tomography(CT)scan revealed a large CSF pseudocyst in the right hepatic lobe with the tip of VP shunt catheter into the hepatic cyst cavity.Patient underwent robotic laparoscopic cyst fenestration with a partial hepatectomy,and repositioning of VP shunt catheter to the right lower quadrant of the abdomen.Follow-up CT demonstrated a significant reduction in hepatic CSF pseudocyst.CONCLUSION A high index of clinical suspicion is required for early detection of liver CSF pseudocysts since their presentation is often asymptomatic and cunning early in the course.Late-stage liver CSF pseudocysts could have adverse outcomes on the treatment course of hydrocephalus as well as on hepatobiliary dysfunction.There is paucity of data to define the management of liver CSF pseudocyst in current guidelines due to rare nature of this entity.The reported occurrences have been managed by laparotomy with debridement,paracentesis,radiological imaging guided fluid aspiration and laparoscopic-associated cyst fenestration.Robotic surgery is an additional minimally invasive option in the management of hepatic CSF pseudocyst;however,its use is limited by lack of widespread availability and cost of surgery.展开更多
Pancreatic cancer is the leading cause of cancer-related morbidity and mortality with an overall five-year survival of less than 9%in the United States.At presentation,the majority of patients have painless jaundice,p...Pancreatic cancer is the leading cause of cancer-related morbidity and mortality with an overall five-year survival of less than 9%in the United States.At presentation,the majority of patients have painless jaundice,pruritis,and malaise,a triad that develops secondary to obstruction,which often occurs late in the course of the disease process.The technical advancements in radiological imaging and endoscopic interventions have played a crucial role in the diagnosis,staging,and management of patients with pancreatic cancer.Endoscopic retrograde cholangiopancreatography(ERCP)-guided diagnosis(with brush cytology,serial pancreatic juice aspiration cytologic examination technique,or biliary biopsy)and therapeutic interventions such as pancreatobiliary decompression,intraductal and relief of gastric outlet obstruction play a pivotal role in the management of advanced pancreatic cancer and are increasingly used due to improved morbidity and complication rates compared to surgical management.In this review,we highlight various ERCP-guided diagnostic and therapeutic interventions for the management of pancreatic cancer.展开更多
BACKGROUND Herbal supplements(HS)for weight loss are perceived to be“safe”and“natural”,as advertised in ads,however,hepatotoxicity can be associated with consumption of some HS.Use of HS may be missed,as the patie...BACKGROUND Herbal supplements(HS)for weight loss are perceived to be“safe”and“natural”,as advertised in ads,however,hepatotoxicity can be associated with consumption of some HS.Use of HS may be missed,as the patient may not report these unless specifically asked about these products,since they are often not thought of as medications with potential side effects or interaction potential.CASE SUMMARY We reported a case of a 21-year-old female with morbid obesity who presented with abdominal pain for 1 wk associated with nausea,vomiting,anorexia and myalgias.She denied smoking tobacco,drinking alcohol,usage of illicit drugs,hormonal contraceptives,or energy drinks.There was no significant past medical or family illnesses.Her laboratory workup revealed acute liver failure.The workup for possible etiologies of acute liver failure was unremarkable.She was using a weight loss herbal supplement“Garcinia cambogia”for 4 wks.This case demonstrates the association of acute liver failure with Garcinia cambogia.CONCLUSION Medical reconciliation of HS should be performed in patients with suspected acute liver failure and early discontinuation of HS can prevent further progression of drug induced hepatoxicity.展开更多
文摘BACKGROUND Ventriculoperitoneal(VP)shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebrospinal fluid(CSF)into the peritoneum.Abdominal pseudocysts containing CSF are the common long-term complication of this frequently performed procedure,mainly because VP shunts have significantly prolonged survival.Of these,liver CSF pseudocysts are rare entities that may cause shunt dysfunction,affect normal organ function,and therefore pose therapeutic challenges.CASE SUMMARY A 49-year-old man with history of congenital hydrocephalus status post bilateral VP shunt placement presented with progressively worsening dyspnea on exertion,abdominal discomfort/distention.Abdominal computed tomography(CT)scan revealed a large CSF pseudocyst in the right hepatic lobe with the tip of VP shunt catheter into the hepatic cyst cavity.Patient underwent robotic laparoscopic cyst fenestration with a partial hepatectomy,and repositioning of VP shunt catheter to the right lower quadrant of the abdomen.Follow-up CT demonstrated a significant reduction in hepatic CSF pseudocyst.CONCLUSION A high index of clinical suspicion is required for early detection of liver CSF pseudocysts since their presentation is often asymptomatic and cunning early in the course.Late-stage liver CSF pseudocysts could have adverse outcomes on the treatment course of hydrocephalus as well as on hepatobiliary dysfunction.There is paucity of data to define the management of liver CSF pseudocyst in current guidelines due to rare nature of this entity.The reported occurrences have been managed by laparotomy with debridement,paracentesis,radiological imaging guided fluid aspiration and laparoscopic-associated cyst fenestration.Robotic surgery is an additional minimally invasive option in the management of hepatic CSF pseudocyst;however,its use is limited by lack of widespread availability and cost of surgery.
文摘Pancreatic cancer is the leading cause of cancer-related morbidity and mortality with an overall five-year survival of less than 9%in the United States.At presentation,the majority of patients have painless jaundice,pruritis,and malaise,a triad that develops secondary to obstruction,which often occurs late in the course of the disease process.The technical advancements in radiological imaging and endoscopic interventions have played a crucial role in the diagnosis,staging,and management of patients with pancreatic cancer.Endoscopic retrograde cholangiopancreatography(ERCP)-guided diagnosis(with brush cytology,serial pancreatic juice aspiration cytologic examination technique,or biliary biopsy)and therapeutic interventions such as pancreatobiliary decompression,intraductal and relief of gastric outlet obstruction play a pivotal role in the management of advanced pancreatic cancer and are increasingly used due to improved morbidity and complication rates compared to surgical management.In this review,we highlight various ERCP-guided diagnostic and therapeutic interventions for the management of pancreatic cancer.
文摘BACKGROUND Herbal supplements(HS)for weight loss are perceived to be“safe”and“natural”,as advertised in ads,however,hepatotoxicity can be associated with consumption of some HS.Use of HS may be missed,as the patient may not report these unless specifically asked about these products,since they are often not thought of as medications with potential side effects or interaction potential.CASE SUMMARY We reported a case of a 21-year-old female with morbid obesity who presented with abdominal pain for 1 wk associated with nausea,vomiting,anorexia and myalgias.She denied smoking tobacco,drinking alcohol,usage of illicit drugs,hormonal contraceptives,or energy drinks.There was no significant past medical or family illnesses.Her laboratory workup revealed acute liver failure.The workup for possible etiologies of acute liver failure was unremarkable.She was using a weight loss herbal supplement“Garcinia cambogia”for 4 wks.This case demonstrates the association of acute liver failure with Garcinia cambogia.CONCLUSION Medical reconciliation of HS should be performed in patients with suspected acute liver failure and early discontinuation of HS can prevent further progression of drug induced hepatoxicity.
