Endoscopic duodenal polypectomy is a routine procedure particularly useful for obtaining histological diagnosis but it is not without serious complications. This is a case report of severe necrotising pancreatitis after duodenal polypectomy. We suggest that experienced endoscopists should carry out polypectomies and that clear guidelines for the management of duodenal polyps are required. Patients undergoing endoscopic duodenal polypectomies should be placed at the beginning of the endoscopy list and observed for at least 4 h.

INTRODUCTION: Ceftriaxone has been shown to cause transient biliary and cholecystic sludge evident on imaging in asymptomatic subjects. This sludge may result in obstruction, and hence, acute pancreatitis and cholecystitis. Here we report a case of acute pancreatitis presenting three days following treatment with ceftriaxone which may be attributed to this phenomenon. No other risk factors could be identified. CASE DESCRIPTION/METHODS: A 34-year-old male patient with no past medical history presented to the hospital with the complaint of stabbing epigastric abdominal pain radiating to the back with associated nausea and vomiting of one day duration. He was seen by his primary care doctor three days prior to presentation for urethral discharge and was given an intramuscular injection of 250 mg ceftriaxone in addition to 1 g oral azithromycin with complete resolution of symptoms. Physical examination was notable for epigastric tenderness without rebound tenderness or guarding and was otherwise normal. Laboratory work up was remarkable for WBC 15200 per microliter and lipase 1961 U/L. Liver function test, serum calcium, triglycerides, and IgG4 were all within normal limit. Computed tomography (CT) scan of the abdomen confirmed findings of acute pancreatitis with well-defined pancreatic borders. This was followed by a right upper quadrant ultrasound which showed biliary and cholecystic sludge. Upon further questioning the patient denied alcohol and tobacco use, recent travel, or any prior history of mumps and herpes simplex virus infections. Furthermore, no family history of acute pancreatitis was reported. The time frame of symptoms and the absence of other risk factors point towards a drug adverse reaction. The patient was managed conservatively and discharged the following day with significant clinical improvement. DISCUSSION: Younger patients, patients receiving a prolonged or larger dose and patients with impaired gallbladder emptying are at a greater risk for developing sludge secondary to ceftriaxone use. This is often asymptomatic with discontinuation of the drug usually resulting in resolution of this phenomenon. This case highlights the fact that ceftriaxone induced biliary sludge may rarely result in potentially serious adverse events including acute cholecystitis and pancreatitis.

INTRODUCTION: Multiple studies have attempted to evaluate the risk obstructive sleep apnea (OSA) imposes on certain malignancies. Particularly the association between OSA and colorectal cancer and cancer-related mortality have been scarcely studied with contradicting results. This study aims to review the literature on OSA and its association with colorectal cancer. METHODS: A systematic review was conducted in Pubmed, MEDLINE, EMBASE, and Cochrane databases from inception through May 2019 to identify the studies which explored the association between OSA and colorectal cancer. Effect estimates from the individual studies were extracted and combined using the random effect, generic inverse variance method of DerSimonian and Laird and a pooled odds ratio (OR) was calculated. Forest plots were generated, and publication bias was assessed for using conventional techniques. RESULTS: Three studies with a total of 1,705,003 patients with OSA were included in this analysis. Of them, 3,835 patients had an incident colorectal cancer diagnosis. The pooled OR for colorectal cancer in patients with OSA was 0.968 (95% CI: 0.940 - 0.997, P = 0.029) compared to the control group. CONCLUSION: Our meta-analysis found that OSA is not associated with an increase incidence of colorectal cancer. Further studies might be needed to explore this association and its effect on the disease course mortality.