The case of a 20 year old woman is reported with Budd-Chiari

with the syndrome (13/43) had had similar symptoms in their previous pregnancy.Symptoms were considered mild if they had lasted from a few seconds to 15 minutes and occurred once a week for at least four weeks (44

Duodenal hematoma is a previously described rare complication of pancreatitis. Endoscopic evacuation was a safe and effective means of relieving the duodenal obstruction in this patient. This minimally invasive option resulted in immediate resolution and can be considered when conservative management fails.[2825] Figure 1. 10 cm duodenal wall hematoma on CT scan (a) and endoscopy (b). Endoscopic drainage via cystduodenostomy with a lumen-apposing metal stent (c). Resolution of the duodenal wall hematoma (d).

stent was passed over a wire into the gallbladder to complete the procedure (Figure c). At one month follow-up ERCP, the LAMS was removed leaving a mature gastrocholecystic fistula. No recurrence of symptoms noted at 12-month follow-up. Discussion: Laparoscopic cholecystectomy after recovery of gallstone pancreatitis is recommended to reduce risk of recurrent pancreatitis. In some patients, difficult anatomy and inflammation necessitates STC to avoid injury to the extrahepatic bile ducts and surrounding blood vessels. STC is associated with significant morbidity. Completion cholecystectomy for symptomatic complications from RBG is recommended if possible. However, our patient was deemed a poor surgical candidate. Transpapillary drainage of the RBG was also precluded by difficult anatomy with sharp angulation at the confluence of the common hepatic and cystic ducts. This case describes the novel application of EUS-guided drainage of an RBG as a safe and effective alternative to completion cholecystectomy for patients who are poor operative candidates.[2885] Figure 1. EUS used to measure dimensions of remnant gallbladder after injecting 80mL of sterile saline (A). Cholecystogastrostomy was performed using a 10 mm X 15 mm LAMS with cautery tip over a wire and dilated using a controlled radial expansion balloon (B). A double pigtail stent was placed through the lumen of the LAMS (C).

No abstract