Fluid Collection Research Articles

S1556 Outcomes for Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections in Patients With and Without Cirrhosis in a Propensity-Matched National Cohort

S1556 Outcomes for Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections in Patients With and Without Cirrhosis in a Propensity-Matched National Cohort

S2820 A Case of Encapsulating Peritoneal Sclerosis Complicated by a Large Loculated Fluid Collection

S2820 A Case of Encapsulating Peritoneal Sclerosis Complicated by a Large Loculated Fluid Collection

S148 The Utility of Lumen-Apposing Metal Stents Combined With Coaxial Double-Pigtail Plastic Stents for Endoscopic Ultrasound-Guided Transluminal Drainage of Pancreatic Fluid Collections

S148 The Utility of Lumen-Apposing Metal Stents Combined With Coaxial Double-Pigtail Plastic Stents for Endoscopic Ultrasound-Guided Transluminal Drainage of Pancreatic Fluid Collections

S4089 Endoscopic Ultrasound-Guided Cystocystostomy (EUS-CC) for Management of Non-communicating Peripancreatic Fluid Collections

S4089 Endoscopic Ultrasound-Guided Cystocystostomy (EUS-CC) for Management of Non-communicating Peripancreatic Fluid Collections

Role of Multidetector Computed Tomography Urography in Evaluating Obstructive Uropathy in a Tertiary Hospital in Rural India.

This study aims to evaluate the role of multidetector computed tomography (MDCT) urography in cases of obstructive uropathy to determine the cause, side, site, and level of obstruction and to differentiate between acute and chronic cases of obstructive uropathy based on imaging features. Using Cochran's formula, a sample sizeof 121 patients was calculated. The patients underwent computed tomography (CT) urography to assess the obstructing agents causing obstructive uropathy. The conducted scan had four phases: the non-contrast phase, corticomedullary phase, nephrographic phase, and excretory phase. We assessed the obstructive agents and the changes they caused in the urinary tract. A total of 74 patients (61.16%) had calculus as their obstructive agent, followed by stricture (14.88%). The obstructive agents were intraluminal in 102 patients (84.3%) and extraluminal in 19 patients (15.7%). The ureter was the most common site of obstruction, accounting for 41.32%. The acute cases were 66 (54.55%), and the chronic cases were 55 (45.45%). A statistically significant (p<0.05) association was found using the chi-square test in the comparison of the enhancement and excretion of the kidneys and the type of case (acute or chronic). A statistically significant (p<0.05) association was found using the chi-square test in the comparison of the distribution of the secondary findings, such as perinephric fat stranding and perinephric fluid collection, and thetype of case (acute or chronic). MDCT urography is a highly reliable method of imaging the cause of obstructing agents in cases of obstructive uropathy and the damage caused by them. The type of enhancement and excretion and the secondary findings play an important role in determining the acuteness or the chronicity of the obstructive agent.

Timing of lumen-apposing metal stents removal in pancreatic fluid collections: Could we go beyond?

Background and aimsLumen-apposing metal stents (LAMS) are the mainstay treatment for pancreatic fluid collections (PFC). A 4-weeks interval for LAMS removal has been suggested to avoid adverse events (AEs). Primary aim is to evaluate the AEs rate in patients with LAMS removal <4 and >4 weeks from placement and possible associated factors. MethodsRetrospective study on patients underwent EUS-guided drainage of PFC with LAMS at two Italian centers between January 2017 and November 2023. PFC and LAMS features were collected. AEs were defined as bleeding, obstruction and buried LAMS. Results108 patients were enrolled (62.9 % males; mean age 61 ± 14 years old). In 38 % PFC was in pancreatic head.In 64.8 % of patients LAMS ≥15 mm was used. Mean time of LAMS indwelling was 71 ± 87 days and in 73.1 % of patients the LAMS was removed after 4 weeks. AE occurred in 8.3 % of patients and the most common (77.8 %) was bleeding.There was no association between LAMS indwelling >4 weeks (8/9 vs 65/93 p = 0.44) and the rate of AE. A comparable mean time of LAMS persistence (108 ± 96 vs 67 ± 86 p = 0.18) between patients with and without AE was observed. PFC in the head (7/9 vs 33/93 p = 0.02) and LAMS ≥15 mm (9/9 vs 58/93 p = 0.03) were associated with a higher rate of AE. ConclusionWhen needed, LAMS removal >4 weeks appears to be as safe as LAMS removal within 4 weeks. LAMS ≥15 mm and Head location were associated with higher rate of AE and thus should arouse more caution.

S1502 Postoperative Abdominal Fluid Collections Management with EUS-Guided Transmural Drainage: Timing, Efficacy, and Safety Profile

S1502 Postoperative Abdominal Fluid Collections Management with EUS-Guided Transmural Drainage: Timing, Efficacy, and Safety Profile

Presentation and management of post-esophagectomy or Gastrectomy Hiatal Hernia.

Hiatal hernia may development after esophagectomy or Gastrectomy. Post- esophago-gastric hiatal hernia is a rare but challenging condition. Nearly half of reported cases involve emergent situations, underscoring the urgency of addressing this condition. However, there is currently no consensus on the optimal treatment approach for this type of hernia. All consecutive patients who underwent repair for Post- esophago-gastric hiatal hernia over the past five years were retrospectively reviewed. Patient characteristics and perioperative data were collected. The primary outcomes, repair methods, and surgical results following post-esophago-gastric hiatal repair were analyzed. A total of eight patients with post-esophago-gastric hiatal hernia were included in this study. All patients presented with emergent conditions, specifically bowel obstruction. Laparoscopic repair was successful in four cases, with a conversion rate to open surgery of 50% (4 out of 8). Primary suture was performed in three cases, while biological mesh repair was carried out in four cases, and one case was left unrepaired. Bowel gangrene and perforation occurred in one case. The most notable postoperative complications included wound infection and pleural fluid collection. Importantly, there were no instances of hernia recurrence during the follow-up period, which ranged from 2 to 55 months, with a 100% follow-up rate observed. Post-esophago-gastric hiatal hernia is a rare yet significant condition, often presenting emergently and linked to higher morbidity and mortality rates. Therefore, symptomatic patients warrant surgical repair, and immediate intervention should be provided to those with acute-onset symptoms and clinical signs of bowel obstruction. Primary suture repair, with or without biological mesh, appears to be a durable method of repair.

Outcomes of lumen apposing metal stent placement in patients with surgically altered anatomy: Multicenter international experience.

Background and study aims Although outcomes of lumen-apposing metal stents (LAMS) placement in native anatomy have been reported, data on LAMS placement in surgically altered anatomy (SAA) are sparse. We aimed to assess outcomes of LAMS placement in patients with SAA for different indications. Patients and methods This was an international, multicenter, retrospective, observational study at 25 tertiary care centers through November 2023. Consecutive patients with SAA who underwent LAMS placement were included. The primary outcome was technical success defined as correct placement of LAMS. Secondary outcomes were clinical success and safety. Results Two hundred and seventy patients (125 males; average age 61 ± 15 years) underwent LAMS placement with SAA. Procedures included EUS-directed transgastric ERCP (EDGE) and EUS-directed transenteric ERCP (EDEE) (n = 82), EUS-guided entero-enterostomy (n = 81), EUS-guided biliary drainage (n = 57), EUS-guided drainage of peri-pancreatic fluid collections (n = 48), and EUS-guided pancreaticogastrostomy (n = 2). Most cases utilized AXIOS stents (n = 255) compared with SPAXUS stents (n = 15). Overall, technical success was 98%, clinical success was 97%, and the adverse event (AE) rate was 12%. Using AGREE classification, five events were rated as Grade II, 21 events as Grade IIIa, and six events as IIIb. No difference in AEs were noted among stent types ( P = 0.52). Conclusions This study shows that placement of LAMS is associated with high technical and clinical success rates in patients with SAA. However, the rate of AEs is noteworthy, and thus, these procedures should be performed by expert endoscopists at tertiary centers.

Early versus Delayed Cholecystectomy in Mild Gallstone Pancreatitis (Prospective Comparative Study)

Abstract Background Gallstone pancreatitis is the most common etiology of acute pancreatitis accounting for up to sixty percent of all cases. In patients with mild gallstone pancreatitis – characterized by the absence of organ failure, peripancreatic fluid collections or necrosis, and typical resolution within one week – cholecystectomy is the definitive treatment. Aim of the Work To determine the feasibility of early cholecystectomy during index admission as long as the symptoms and laboratory values are improving for patients with gallstone pancreatitis predicted to be mild on admission and to obtain unbiased estimates of the effect of early cholecystectomy on hospital LOS, complications, and patient-reported outcomes (PROs) in order to determine the need for further evaluation. Patients and Methods This Prospective comparative study was conducted at tertiary care hospitals at Ain Shams University hospitals and Nasser institute for medical research and treatment from May 2022 till December 2022 and performed on a total of 20 adult patients who aged 18 years old and over with mild pancreatitis and without cholangitis. Results Patients treated with early or late procedure experienced approximately the same intra operative bleeding (30 vs 50%), conversion to open (10 vs 10%), biliary injury (0 vs 0%), and operation time (50 vs 50 minutes) with no statistically significant differences between them (p value= 1.00, 0.65, 0.912) respectively. Conclusion Early cholecystectomy after gallstone pancreatitis is more advantageous than late cholecystectomy after gallstone pancreatitis because it is associated with less rate of recurrence of biliary pancreatitis, less complication of pancreatitis, less perioperative complication (adhesions, blood loss, biliary events, infection, postoperative pain) and shorter duration of postoperative hospital stay.

Lumen-apposing metal stents and their emerging role in therapeutic endoscopic ultrasound

The field of therapeutic endoscopic ultrasound (EUS) has expanded significantly in the past 2 decades, thanks in part to the invention and wide use of lumen-apposing metal stents (LAMS). LAMS are used as alternatives to surgical or interventional radiological procedures, and yield excellent outcomes. Initially, their use was limited to management of various types of pancreatic fluid collections, including walled-off necrosis or pseudocysts. In recent years, the indications have expanded to biliary drainage, particularly in cases of malignant bile duct obstruction. LAMS are also used in gastric outlet obstruction and to access bile duct in patients with surgically altered anatomy. This clinical review aims to briefly expand on these indications and discuss the supporting literature for use of LAMS.

A Preliminary Phenomenological Exploration of Experiences of the Empty Pelvis Syndrome Derived From a Modified-Delphi: The Price of Survival Following Pelvic Exenteration for Advanced Pelvic Cancer.

The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health-related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived-experiences of EPS complications. Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified-Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes. Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were 'Out of Options', depicting patients forced to accept complications or limited survival; 'The New Normal', with EPS potentially delaying adaptation to post-PE HrQoL; 'Information Influencing Adaptation,' emphasising the significance of patients understanding EPS to cope with its effects; and 'Symptoms,' reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves. EPS may influence patient decision-making, regret, adaptation, and information-seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes.

EXPLORING THE STREPTOZOTOCIN-NICOTINAMIDE MOUSE MODEL IN BALB/C MICE: GAINING INSIGHTS INTO DIABETIC PNEUMOPATHY

Background: Diabetic pneumopathy has been a topic of interest in the present era, and it caught the eye during the COVID-19 pandemic. Extensive research provides compelling data supporting the association between diabetes and lung injury, establishing the lung as a principal organ affected by diabetes. However, the understanding of diabetic lung has always remained under shadow. For this purpose, we aimed to search for diabetic lung conditions by using a type 2 diabetic model in BALB/c mice. Methods: The study spanned from May to June 2023 at Ziauddin University. Nicotinamide, followed by streptozotocin, was injected into the mice. Mice were confirmed diabetic on the 7th day and housed for the onset of diabetic lung complications. After 28 days, mice underwent an oral glucose tolerance test and were then sacrificed, followed by the collection of bronchoalveolar lavage fluid and the extraction of the lungs. Lungs were fixed for histological analysis. Results: The presence of increased glycaemic levels, further verified by abnormal glucose tolerance, confirmed the establishment of the type 2 diabetic model. Additionally, the diabetic group showed lung fibrotic changes. Conclusion: The foundation of a type 2 diabetic model with the target of generating pneumopathy was accomplished successfully. Pak J Physiol 2024;20(3):31?6, DOI: https://doi.org/10.69656/pjp.v20i3.1673

Role of empirical antitubercular therapy for chronic mastitis—A prospective study

Objectives Chronic mastitis (CM) is an uncommon inflammatory condition of the breast, clinically mimicking malignancy with variable etiological factors. It often recurs, causing cosmetic disfigurement and hampering the quality of life of affected females. Limited literature reveals underlying bacterial infection as causative agents in a few cases, while the majority belong to idiopathic entities. CM can be seen as two histological types—chronic granulomatous mastitis (CGM) and chronic nonspecific inflammatory infiltrates (NGM). Etiological and ethnic variations exist globally, and there is lack of information from India. Understanding this entity is important for undertaking etiology-based therapy and preventing unnecessary mismanagement. Materials and Methods We evaluated the demographic, imaging profile and management protocol of CM patients presenting to a tertiary care center in India. Clinically suspected CM patients were prospectively evaluated by mammography and ultrasound (USG). USG-guided biopsy was performed for histopathological and microbiological analysis and treatment was administered accordingly. Response assessment was conducted at six months through USG and clinical evaluation. Results Out of the 53 clinically suspected CM patients, 48 biopsy-proven CM patients were enrolled (five breast carcinoma cases were excluded). All 48 patients were females, with a mean age of 36 ± 9 years. The most common symptom was a unilateral painful lump with skin discoloration. The etiology was idiopathic in 58.3% of cases, tuberculosis in 29%, and bacterial in 4%. Mammography revealed focal asymmetry, architectural distortion, and trabecular thickening. USG showed tracking fluid collections, microlobulated hypoechoic masses, and skin thickening. Etiology-based treatment was administered, and all patients showed 90–100% resolution between four and six months. Conclusion Mammography and USG are important for raising the suspicion while histopathology and microbiological analysis are mandatory for accurate treatment of CM. In India, idiopathic and tubercular etiology of CM is encountered and patients respond well to therapy.

The Ghost Of Hip Arthroplasties Past: It Takes A Geriatrician To Mine For Metal

Abstract Background An 84-year-old female presented to Geriatric Medicine out-patient clinic with many years of persistent right hip pain, generalised myalgia; and several months of constipation, weight loss and persistent elevation of C-reactive protein and Erythrocyte Sedimentation Rate. The General Practitioner's concern was occult neoplasm. History of right hip arthroplasty in 2011. 6 years prior, she had wide local excision and adjuvant radiotherapy for a grade 3, “triple negative”, invasive ductal carcinoma of the right breast. Serial imaging identified a right parasternal, internal mammary chain neurofibroma. A Rheumatologist had administered intra-articular steroid to both glenohumeral joints for plain X-ray confirmed osteoarthritis, in the absence of serological vasculitic or autoimmune rheumatological disease. Benefit was transient. Her Oncologist had arranged MRI spine for “sciatica” demonstrating L3/4 and L4/5 stenosis and a large right adnexal cyst. Subsequently, the Gynaecology team assessed and planned interval MRI pelvis as initial MRI suggested a right partial hydrosalpinx, left internal chain lymphadenopathy and nodule adjacent to sacroiliac joint. Methods History, examination and imaging results were checked against the Medical Device Alert number 18 from the Medicines and Healthcare products Regulatory Agency (UK) in 2017. Oxford Hip Score Assessment was 29. Lymphatic drainage from medial hip joint is towards right iliac chain. Results In the absence of Gadolinium based contrast agents within 96hours, metal testing demonstrated: Serum Cobalt was 232nmol/L or 13.7 ug/L; Serum Chromium was 78.8nmol/L or 4.1ug/L; Chromium Urine: Creatinine Urine Ratio was 24.54nmol/mmol; and Cobalt Urine: Creatinine Urine Ratio73.96nmol/mmol. These elevated blood and urine results confirmed metal-on-metal hip disease. Conclusion Consider symptomatic metal-on-metal hip disease with soft-tissue involvement in patients presenting with post-hip arthroplasty joint pain, generalised myalgia and raised inflammatory markers; particularly if there is unexplained ipsilateral internal iliac chain lymphadenopathy and pelvic fluid collections. If confirmed, metalwork explanation is the treatment.

Prenatal Sonographic Features of Noonan Syndrome: Case Series and Literature Review.

Noonan syndro me is a rare autosomal dominant congenital abnormality associated with a gene defect located on the short arm of chromosome 12. It is characterized by dysmorphic facies, webbed neck, short stature, lymphatic obstruction, cardiac anomalies, and intellectual disability. Prenatal diagnosis of Noonan syndrome is rare because there are no pathognomonic sonographic signs. Studies on the prenatal sonographic features of Noonan syndrome have been reported in very limited numbers. This case series of severe fetal Noonan syndrome, together with a literature review, was conducted to establish prenatal sonographic features highly suggestive of Noonan syndrome to facilitate early detection by clinicians. This study reveals that Noonan syndrome has a relatively specific pattern, which facilitates prenatal molecular genetic diagnosis. Increased nuchal translucency (NT) in the late first trimester and fluid collection in the early second trimester could be warning signs for follow-up, prompting further investigation to detect late-onset features and leading to molecular genetic confirmation. Most structural abnormalities appear in the second trimester, with progressive changes noted throughout gestation. This review better characterizes the sonographic features of fetal Noonan syndrome based on a larger sample size, illustrating a wider spectrum of prenatal phenotypes, including lymphatic drainage disorders, cardiac abnormalities, polyhydramnios, and absent ductus venosus.

Comorbidity burden and outcomes of endoscopic ultrasound-guided treatment of pancreatic fluid collections:Multicenter study with nationwide data-based validation.

The appropriate holistic management is mandatory for successful endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs). However, comorbidity status has not been fully examined in relation to clinical outcomes of this treatment. Using a multi-institutional cohort of 406 patients receiving EUS-guided treatment of PFCs in 2010-2020, we examined the associations of Charlson Comorbidity Index (CCI) with in-hospital mortality and other clinical outcomes. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. The findings were validated using a Japanese nationwide inpatient database including 4053 patients treated at 486 hospitals in 2010-2020. In the clinical multi-institutional cohort, CCI was positively associated with the risk of in-hospital mortality (Ptrend < 0.001). Compared to patients with CCI = 0, patients with CCI of 1-2, 3-5, and ≥6 had adjusted odds ratios (95% confidence intervals) of 0.76 (0.22-2.54), 5.39 (1.74-16.7), and 8.77 (2.36-32.6), respectively. In the nationwide validation cohort, a similar positive association was observed; the corresponding odds ratios (95% confidence interval) were 1.21 (0.90-1.64), 1.52 (0.92-2.49), and 4.84 (2.63-8.88), respectively (Ptrend < 0.001). The association of higher CCI with longer length of stay was observed in the nationwide cohort (Ptrend < 0.001), but not in the clinical cohort (Ptrend = 0.18). CCI was not associated with the risk of procedure-related adverse events. Higher levels of CCI were associated with a higher risk of in-hospital mortality among patients receiving EUS-guided treatment of PFCs, suggesting the potential of CCI in stratifying the periprocedural mortality risk. The research based on the clinical data from the WONDERFULcohort was registered with UMIN-CTR (registration number UMIN000044130).

Bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient: a case report

BackgroundWorldwide, there is an increase in the frequency of reports of psoas abscesses due to advances in imaging technology, which has led to early diagnosis and treatment. A bilateral psoas abscess is rare and, when it occurs, is usually secondary and in immunocompromised patients. We present a case of a bilateral tuberculosis psoas abscess in a human immunodeficiency virus-positive patient.Case presentationA 21-year-old Ugandan female undergraduate who contracted human immunodeficiency virus through vertical transmission and has been on highly active antiretroviral drugs presented with bilateral lower abdominal pain with associated fever and headache. Clinical examination revealed abdominal tenderness in both iliac fossae with palpable masses. Ultrasonography revealed fluid collection in both psoas muscles confirming bilateral abscesses. The aspirate was acid-fast bacilli positive. A diagnosis of bilateral tuberculosis psoas abscess was made. Open drainage was performed and antituberculosis drugs were commenced.ConclusionsBilateral tuberculosis psoas abscesses occurring in human immunodeficiency virus-positive patients, although uncommon, is not unexpected. It is a form of secondary psoas abscess in immunocompromised patients. Here, the outcome was successful with a combination of early surgical drainage and appropriate medical therapy.

Ocular tear fluid biomarkers collected by contact lenses

PurposeTo collect tear fluid biomarkers from contact lenses (CLs) and determine the impact of CL wear duration. MethodsRabbits were fitted with commercial etafilcon A CLs, which were collected after 1 min, 4 and 8 h (n = 4/time point). Tear fluid proteins and cytokines were extracted from the CLs and quantified. An exploratory comparison was performed between CLs and Schirmer Strips (SS) for a 1 min duration. ResultsThe concentration of MUC5AC was significantly higher after 4 h of CL wear. The expression of all investigated cytokines (IL-1α, IL-1β, IL-8, IL-17A, IL-21, Leptin, MIP-1β, MMP-9, NCAM-1, and TNF-α) was detectable after 1 min of CL wear, and over time, all showed significant variations throughout the 8-h CL wear period. Notably, IL-1α significantly increased by 8 h of CL wear, while MMP-9 decreased. Albumin and lysozyme did not show significant variations with CL wear. Differences between CLs and SS after 1 min were statistically significant for albumin, Leptin, TNF-α, IL-1α, IL-1β, and IL-8. ConclusionsThe duration of CL wear significantly affects the collection of some tear fluid biomarkers. Albumin, MUC5AC, and cytokines may have individual and synergistic diagnostic or prognostic potential. CLs and SS were similar for lysozyme and MUC5AC but differed in the collection of albumin and some cytokines. CLs are a viable tear fluid collection method for biomarker analyses and can be immediately added as a routine clinical test by being FDA-approved medical devices.

Atraumatic Hepatic Laceration with Hemoperitoneum.

Introduction: A rare case of atraumatic liver laceration associated with hemoperitoneum is presented in a patient with amyloidosis who came to the hospital for abdominal pain. Case Presentation: The imaging findings reveal significant hepatomegaly with finely heterogeneous hepatic density and subcapsular hypo-dense streaks in segments VI and VII, likely representing lesions. Post-contrast enhancement shows a punctiform contrast medium extravasation within the subhepatic fluid collection, visible from the arterial phase and intensifying in subsequent study phases. Discussion: These imaging findings suggest an atraumatic hepatic laceration, a diagnosis confirmed by the presence of hemoperitoneum distributed bilaterally under the diaphragm, in the paracolic gutters, along the mesentery root, and predominantly in the peri-hepatic region. Conclusion: The detailed imaging analysis provided critical insights into the diagnosis and management of this rare clinical presentation.