Video capsule endoscopy (VCE) is a safe innovative tool for investigating obscure gastrointestinal bleeding, Crohn's disease and other small bowel pathologies. The capsule is usually excreted with faeces within 24-48 h. Retention of capsule rarely occurs, and it usually depends on the indication of VCE. The longest reported case of capsule retention in the literature is 2.5 years. Surgical approach is considered effective to retrieve the retained capsule. We present a case of asymptomatic retention of capsule for four and half years in a 49-yearold man who underwent VCE to explore the cause of obscure gastrointestinal bleeding. It was successfully retrieved endoscopically. We will also briefly review the literature regarding the causes, different presentations and management of capsule retention. Core tip: We present the longest case of asymptomatic video capsule retention in the literature. With our case we would like to highlight that asymptomatic video capsule retention is not an indication for surgical retrieval. Capsule can retain for long time without harm. Surgical retrieval should be reserved for those patients in whom the expectant management, medical management and endoscopic therapy fails or in patients who are symptomatic with intestinal obstruction or perforation.

The incidence of colorectal cancer (CRC) is increasing daily worldwide. Although different aspects of CRC have been studied in other parts of the world, relatively little or almost no information is available in Pakistan about different aspects of this disease at the molecular level. The present study was aimed at determining the frequency and prevalence of K ras gene mutations in Pakistani CRC patients. Tissue and blood samples of 150 CRC patients (64% male and 36% female) were used for PCR amplification of K ras and detection of mutations by denaturing gradient gel electrophoresis, restriction fragment length polymorphism analysis, and nucleotide sequencing. The K ras mutation frequency was found to be 13%, and the most prevalent mutations were found at codons 12 and 13. A novel mutation was also found at codon 31. The dominant mutation observed was a G to A transition. Female patients were more susceptible to K ras mutations, and these mutations were predominant in patients with a nonmetastatic stage of CRC. No significant differences in the prevalence of K ras mutations were observed for patient age, gender, or tumor type. It can be inferred from this study that Pakistani CRC patients have a lower frequency of K ras mutations compared to those observed in other parts of the world, and that K ras mutations seemed to be significantly associated with female patients.

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Intra-abdominal and intramural hematomas are well-known complications of pseudoaneurysms. We present a case of small bowel obstruction as a result of external mechanical compression from hematoma. Bleeding was localized to the pseudoaneurysm of the gastroduodenal artery and inferior pancreaticoduodenal artery. Angiography was used to control the bleeding with coil embolization. This rare clinical manifestation represents just one of the symptoms associated with pseudoaneurysms of the gastrointestinal tract. Therapeutic options are discussed along with a review of the literature.

Background and Aim: Walled off pancreatic necrosis (WON) is an important complication of acute necrotizing pancreatitis (ANP). There are limited data on comparison of nasocystic irrigation versus lumen apposing metal stent (LAMS) in management of WON. We compare the technical and clinical success of both the treatment strategies. Material and Methods: A randomized controlled trial conducted on patients with ANP with symptomatic WON who were randomized to nasocystic irrigation with hydrogen peroxide (group A) and LAMS placement (group B). ANP was diagnosed based on clinical features, laboratory parameters and imaging. Primary end points were clinical and technical success of both the procedures. Results: 47 patients were randomized till date to group A (nZ24, age 37.8AE27.4 years, 15 men) and group B (nZ23, age 40.9AE20.6 years, 17 men). There were no significant difference in baseline characteristics between the two groups. Most common etiology was alcohol observed in 27(57.4%) patients and most common symptom was abdominal pain seen in all patients. Technical success (100% vs 91.4%, pZ0.95) and clinical success (83.33% vs 78.3%, p Z0.9), additional procedures to get clinical success (15% vs 21.66%, pZ0.9) and complications (4 vs 5, pZ0.9) were comparable in both the groups. The duration to get clinical success (35.5AE49.1 days vs 14.9 AE24.8 days, p Z0.004) was longer in group A compared to group B. Conclusions: LAMS and nasocystic irrigation with H 2 O 2 are equally effective in the treatment of WON but duration of clinical success is longer with nasocystic irrigation.