Acute pancreatitis (AP) is a disease with significant morbidity and mortality. The aim of this study was to evaluate the prognostic role of inflammatory markers, particularly interleukins (ILs), in the course of AP and to determine the frequency of etiologic factors of AP. We included patients with AP who were treated at our institution from May 1, 2012 to January 31, 2015. Different laboratory parameters, including ILs, and the severity scoring systems Ranson’s criteria and Bedside Index of Severity in Acute Pancreatitis (BISAP) were analyzed. AP was classified into mild and severe, and independent parameters were compared between these groups. The predictive performance of each parameter was evaluated using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC). A binomial logistic regression was performed to evaluate Ranson’s criteria and IL6, IL8, and IL10 (at admission and after 48 hours) in the course of AP. Overall, 96 patients were treated, 59 (61.5%) males and 37 (38.5%) females, average age 62.5 ± 16.8 years (range 22–91 years). The best predictor for the severity of AP was IL6, measured 48 hours after admission (AUC = 0.84). Other useful predictors of the severity of AP were lactate dehydrogenase (p < 0.001), serum glucose (p < 0.006), and difference in the platelet count (p < 0.001) between admission and after 48 hours (p < 0.001), hemoglobin (p < 0.027) and erythrocytes (p < 0.029). The major causes of AP were gallstones and alcohol consumption. According to our results, IL6 and Ranson score are important predictors of the severity of AP.

Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidence of bariatric operations and coherently possible complications after such procedures, which modify patient's anatomy and physiology. Key words: Roux-en-Y gastric bypass; Duodenal ulcer; Bleeding; Endoscopy; Emergency surgery Core tip: Bleeding duodenal ulcer after Roux-en-Y gastric bypass for morbid obesity is a rare, but life threatening situation. Anatomic rearrangement after bariatric operation prevents upper endoscopy from displaying stomach remnant, duodenum, and proximal jejunum. The bleeding duodenal ulcer was identified at emergency laparotomy by intraoperative endoscopy through gastrotomy. After surgical hemostasis, duodenal ulcer excision and completion of the remnant gastrectomy the postoperative course was uneventful.

Presented is a patient with a rare form of primary amyloidosis and fatal complication, spleenic rupture.

Purpose: Foreign bodies in the upper gastrointestinal tract (GIT) rarely cause urgent problems in gastroenterology. The purpose of the study was to assess the percentage of patients in whom urgent endoscopic investigation revealed true foreign bodies in the upper GIT and to evaluate the success of emergency endoscopic procedures. Methods: The study includes patients in whom urgent endoscopic investigations of the upper GIT were performed in the period 1 January 1994 to 1 May 2008. Results: 8552 patients were investigated, average age 60.6 years (SD±17.1 years, range 1–106 years), with 3276 (38 %) females and 5276 males (62 %). In 69 patients (0.8 %), “true” foreign bodies were detected in the esophagus or stomach. In these patients a total of 90 endoscopic investigations were performed: in 65/69 patients (94.2%) the foreign bodies were removed endoscopically; in 4 (5.8 %) cases the endoscopic procedures were unsuccessful. Among the foreign bodies removed were a variety metal or plastic objects, such as coins, keys, screws, hooks, batteries, razor blades, needles, lighters, buttons, and parts of kitchen, toilet or writing utensils. In patients with successful endoscopic removal of the objects, no significant complications were noted. In 4 patients (4/69, 5.8 %) mild hemorrhages from the region of the esophagogastric junction were observed. Conclusion: Endoscopic technologies allow successful removal of a variety of types of foreign bodies from the upper GIT.

BACKGROUND Aorto-esophageal fistula is an extremely rare cause of acute upper gastrointestinal bleeding (UGIB). CASE SUMMARY We present a case of an 80-year-old woman with esophageal cancer who was admitted to our department with hemorrhagic shock due to UGIB. During the diagnostic procedure, emergency computed tomography angiography was performed and confirmed aorto-esophageal fistula. Interventional radiologists inserted a stent graft into the aorta, successfully closing the fistula. Unfortunately, the patient later died of heart failure following irreversible hemorrhagic shock. Autopsy confirmed the aorto-esophageal fistula, which formed 1 cm below the distal edge of the stent previously inserted into the esophagus for a malignant stricture. CONCLUSION There are very rare causes of UGIB. Although clinical decisions are made during the diagnostic workup of these patients, we must be aware of the limitations of various therapeutic options, even the most contemporary.