Eosinophilic ascites is a rare feature of eosinophilic gastroenteritis. We would like to highlight this increasingly recognised diagnosis in a case of unexplained ascites. We present a challenging case of a woman aged 25 years who presented with nausea, vomiting, diarrhoea, generalised abdominal pain and swelling 8-week following delivery of her first baby. Her symptoms were primarily aggravated by eating, and she had also noticed postprandial itching and self-limiting generalised rash. She had a strong history of atopy. Physical examination revealed abdominal tenderness and distension with shifting dullness. Urticarial skin rash was noted on the face, neck, chest and abdomen. Routine biochemistry was normal apart from peripheral eosinophilia. Imaging confirmed moderate ascites. Diagnostic paracentesis showed exudative ascites with numerous eosinophils. Histology of the upper and lower gastrointestinal tract showed infiltration of the oesophageogastroduodenal and rectosigmoid mucosa with eosinophils. The patient significantly improved following a course of steroids and six-food elimination diet.

The Swedish National Inpatient Register (NPR) has near‐complete coverage of in‐hospital admissions and ICD codes in Sweden. Acute pulmonary embolism (PE) is a serious condition presenting challenges regarding diagnosis, treatment, and follow‐up. Here we aimed to validate the accuracy of acute PE diagnosis in the NPR, investigational findings, antithrombotic treatment, and follow‐up of PE patients in Sweden. From a nation‐wide cohort of all patients with in‐hospital diagnoses of acute PE (ICD‐10‐SE codes I26.0–I26.9) in 2005 (n = 5793), we selected those from two Swedish regions for thorough manual review of hospital records. We identified 599 patients with PE diagnoses according to the ICD‐10 coding system. We excluded 58 patients with admissions related to previous PE (47; 8%) or incorrect ICD codes (11; 2%), leaving 501 patients with probable PE diagnoses. We confirmed the diagnosis in 441 (79%) cases, which was based on imaging (435 patients; 73%) or autopsy (6; 1%). In the remaining 60 (11%) cases, the PE diagnosis was based on clinical findings and can therefore not be confirmed. Of the surviving patients with PE, 231 (47%) were offered follow‐up within 6 months after the acute event. At follow‐up, 67 patients (29%) had symptoms requiring clinical attention (dyspnoea or reduced general condition). The Swedish NPR showed acceptable accuracy for PE diagnosis, and could be reliably used for register‐based research regarding acute PE.

conscious sedation: average midazolam dose was 7 mg; fentanyl 141 mcg; buscopan 24 mg.Macroscopic assessment of strictures and indeterminate lesions correlating with malignancy had a sensitivity, specificity and accuracy of 90% (95%CI 79-97), 83% ((95% CI 71-96) and 86% (78.5%-92%) respectively. Histological correlation with final diagnosis increased over the study, from 77% in 2015 to 87% in 2017. Complete stone clearance rose from 50% in 2014 to 85% by 2017. 70% of patients had complete stone clearance at 1 st attempt. 4.3% of patients developed complications post SOC. Post-ERCP pancreatitis (PEP) was the commonest adverse event (2.4%; n=5/206). Conclusions The role of SOC in tertiary centres for identification of biliary lesions and management of difficult choledocholithiasis continues to grow. The South West service is centralised to one centre with a clear improvement in diagnostic accuracy for malignancy and stone clearance rates. Diagnostic accuracy rates mirror figures quoted in literature, most recently Japanese data in 2017. 1 2 Adverse events were lower than those widely reported, but PEP remains the commonest cause. SOC under conscious sedation is both safe and effective.

Background Ferric Carboxymaltose (Ferinject) is a commonly used intravenous iron preparation. Varying degrees of hypophosphataemia have been reported with Ferinject. This is thought to be due to FGF23 mediated renal phosphate wasting, which has been associated with osteomalacia. With only 2 case reports of symptomatic osteomalacia and insufficiency fractures, clinical significance of Ferinject related hypophosphatemia in the overall population receiving it is unclear. Alternative intravenous iron preparation Iron III Isomaltoside (Monofer), has been reported to have a lower incidence of hypophosphatemia compared to Ferinject (Detlie, et. al., 2019) but some case series have reported a higher rate of hypersensitivity reactions (Mulder, et. al., 2018) Aim To investigate the incidence of clinically significant hypophosphataemia in patients receiving Ferinject therapy based at daycase unit at Nottingham University Hospitals. Methods Electronic and paper medical records, including prescription charts, of patients receiving parenteral Ferinject between January 2017 and September 2019 were reviewed. Patients were identified from the local admission database. Data was collected including age, sex, and race, number of Ferinject infusions, Ferinject dose, eGFR, Vitamin D, parathyroid hormone (PTH) and phosphate levels before and after Ferinject infusion. Hospital admissions, symptoms related to hypophosphataemia and need for phosphate replacement was recorded. Normal lab phosphate levels were 0.80-1.50 mmol/ L. Hypophosphatemia was defined as mild (0.65-0.79 mmol/ L), moderate (0.32 to 0.64 mmol/L), and severe (<0.32 mmol/L). Results We identified 400 (251 female and 149 male), patients who had received Ferinject during the study period. 56 (14%) and 51 (13%) patients had phosphate levels tested within 1 year before and after receiving Ferinject respectively. Of these patients, 4 (7%) had hypophosphataemia prior to and, 17 (33%) {3 mild, 13 moderate and 1 severe} after Ferinject therapy. None of the 17 patients had symptoms related to hypophosphataemia. 2 patients with moderate hypophosphataemia incidentally found on routine bloods were admitted for phosphate replacement. 3 patients were admitted for a cause unrelated to hypophosphataemia. Conclusions Our audit demonstrates that in our practice no acute serious adverse events were recorded due to Ferinject related hypophosphatemia. The long term impact of Ferinject-related hypophosphataemia requires larger prospective studies. This is of particular relevance to patients with preexisting risk factors for bone metabolism disorders. It is our practice to correct Vitamin D deficiency where possible prior to administration of Ferinject. It has not been our practice to routinely measure serum phosphate level post infusion.