Duodenal perforation is rare and associated with a high mortality. Therapeutic strategies to address duodenal perforation include conservative, surgical, and endoscopic measures. Surgery remains the gold standard. However, endoscopic management is gaining ground mostly with the use of over-the-scope clips and vacuum-sponge therapy. A 67-year-old male patient was admitted to the emergency room for persistent epigastric pain, melena, and signs of sepsis. The physical assessment revealed reduced bowel sounds, involuntary guarding, and rebound tenderness in the upper abdominal quadrant. A contrast-enhanced computed tomography (CT) scan confirmed the suspicion of ulcer perforation. The initial laparoscopic surgical approach required conversion to laparotomy with overstitching of the perforation. In the postoperative course, the patient developed signs of increased inflammation and dyspnea. A CT scan and an endoscopy revealed a postoperative leakage and pneumonia. We placed an endoscopic duodenal intraluminal vacuum-sponge therapy with endoscopic negative pressure for 21 days. The leakage healed and the patient was discharged. Most experience in endoscopic vacuum-sponge therapy for gastrointestinal perforations has been gained in the area of esophageal and rectal transmural defects, whereas only few reports have described its use in duodenal perforations. In our case, the need for further surgical management could be avoided in a patient with multiple comorbidities and a reduced clinical status. Moreover, the pull-through technique via PEG for sponge placement reduces the intraluminal distance of the Eso-Sponge tube by shortcutting the length of the esophagus, thus decreasing the risk of dislocation and increasing the chance of successful treatment.

Objectives of the study There is little guidance regarding the impact of alcohol and cannabis on the clinical course of inflammatory bowel disease. The aim of this study was to assess the prevalence, sociodemographic characteristics and impact of alcohol and cannabis use on the clinical course of the disease. Methods We performed an analysis of prospectively collected data within the Swiss Inflammatory Bowel Disease Cohort Study with yearly follow-ups and substance-specific questionnaires. We analyzed the prevalence of use, the profile of users at risk for addiction and the impact of alcohol and cannabis on the course of the disease. ResultsWe collected data of 2828 patients included between 2006 and 2018 and analyzed it according to their completion of specific surveys on alcohol and cannabis use. The prevalence of patient-reported active use was 41.3% for alcohol and 6% for cannabis. Heavy drinkers were over-represented among retired, married smokers receiving mostly aminosalicylates and less immunosuppression. In ulcerative colitis patients, low-to-moderate drinking was associated with less extensive disease. Cannabis users were often students with ileal Crohn's disease. Conclusion A significant proportion of patients with inflammatory bowel disease consume alcohol or cannabis. Heavy alcohol consumption is most likely in male smokers >50 years, whereas young men with ileal disease rather use cannabis.

Les anomalies de l'arc aortique sont typiquement diagnostiquées au cours de la petite enfance. Le degré de gravité des symptômes dépend de l'importance de la compression de la trachée ou de l'oesophage. Les troubles respiratoires représentent le symptôme principal chez les nourrissons; par contre, la plupart des patients adultes se plaignent surtout d'une dysphagie. Une correction opératoire a été réalisée chez une patiente de 28 ans atteinte de dysphagie et présentant un double arc aortique avec compression oesophagienne. Quatre mois après l'intervention, elle s'est de nouveau plainte de dysphagie. Cette étude de cas décrit la procédure diagnostique devant exclure d'autres causes de la dysphagie avant de poser l'indication d'une nouvelle opération. Rapport de cas AnamnèseUne patiente de 28 ans, par ailleurs en bonne santé, s'est plainte depuis trois mois de vomissements récurrents et de douleurs rétrosternales. La gastroscopie a montré une compression externe de l'oesophage à 20 cm environ l'arcade dentaire. Le cliché tomodensitométrique a Ioannis Kapoglou

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After failed biliary cannulation via standard ERC-approach EUS-based rendezvous-ERC (EUS-RV-ERC) is a valid alternative. One of the challenging factors in this setting is the management of the guidewire. Here we propose a method, where a slim endoscope is used to stabilize the guidewire and optimize wire manipulation in a patient who underwent EUS-RV-ERC via a transgastric approach.