Case 1• 82 y.o. female82 y.o. female

• Retrosternal burningRetrosternal burning

• Long standing dysphagiaLong standing dysphagia

Upper esophagusUpper esophagus

Larynx

Upper esophagus

Lower esophagus

• Diverticulum Diverticulum

• Duplication of esophagusDuplication of esophagus

• Congenital double lumen esophagusCongenital double lumen esophagus

• FistulaFistula

• None of the aboveNone of the above

Case 2• 49 y.o. woman

• Chronic idiopathic pancreatitis

• Severe pain – on narcotics

• ERCP X 2: failed cannulation of Wirsung due to severe stricture

EUSEUS

Head

Calcifications

Wirsung 11mm

??

EUS guided pancreaticogastrostomy

AA BB

CC DD

EUS – guided pancreaticogastrostomy

Francois et al. Gastrointestinal Endoscopy 2002

• 4 patients

• 3 of 4 had satisfactory pain relief

• 1 year follow-up

Case 3

• 51 y.o. woman with mild RUQ pain

• No relevant medical history • No medications

• Normal physical examination

CT

Hepatic artery phase PVPLate phase

MRI

T1Contr hepatic artery phase

Differential diagnosis• Atypical hemangioma

• Hemangiosarcoma • Necrotic tumor

• Peliosis hepatis

• Other

Liver biopsy

Peliosis hepatis - Black and Blue Liver

Etiology• Wasting illness

• Carcinomatosis

• Drugs (anabolics, steroids, oral contraceptives, azathioprine) • Immunosuppressed patients

• AIDS – bacillary angiomatosis peliosis • Idiopathic

Case 4• 51 y.o. man

• Diabetes mellitus type II, target organ damage, no prior abdominal operations

• Abdominal pain, vomiting, weight loss

• Palpable mass at the right upper quadrant

Differential diagnosis

- Partial pseudoobstruction- Partial pseudoobstruction

- Retroperitoneal fibrosis- Retroperitoneal fibrosis

- Sclerosing peritonitis- Sclerosing peritonitis

- Paraduodenal hernia- Paraduodenal hernia

- Amyloidosis- Amyloidosis

Cocoon syndrome

Cocoon syndrome

• First described in 1978• Idiopathic , sclerosing , encapsulating peritonitis

• - congenital- idiopathic- secondary (peritoneal dialysis, peritoneovenous shunts,

beta-blockers, peritoneal TB, GI malignancy)