Visceral leishmaniasis is an endemic in the southwestern region of Saudi Arabia, with a low incidence rate. Clinical presentations of visceral leishmaniasis include recurrent fever, substantial weight loss, hepatosplenomegaly and anemia. However, the clinical features may not be easily evident owing to the involvement of multiple organs. This, in turn, can cause difficulties in establishing the correct diagnosis, and subsequently, in managing the patient. Here, the authors report a case of a 42-year-old male from Jizan, southwestern Saudi Arabia, who presented with impaired renal function. After kidney biopsy, the patient was diagnosed with glomerulonephritis of unknown etiology and treated with mycophenolate and prednisone. After 3 months, the patient developed high fever with hepatomegaly and pancytopenia. Based on the investigations, a possible diagnosis of visceral leishmaniasis was considered. Accordingly, he was treated with liposomal amphotericin B, following which his condition improved significantly. This case report discusses the relationship between glomerulonephritis and visceral leishmaniasis and focuses on the potential consequences of glomerulonephritis management without investigating the etiology of the underlying diseases, especially in patients from tropical and subtropical areas.

Laparoscopy Assisted ERCPSubmit Manuscript | http://medcraveonline.com obesity trend suggests that by 2025, the prevalence of obesity worldwide will reach 18% for males and surpass 21% in women [1]. The trend of obesity in the Middle East is particularly pronounced and exceeds 50% among women in many countries in this region. Bariatric surgery has been found to be effective for weight loss and reduce the consequences of obesity.However, long term health consequences of bariatric surgery are not fully clear. The weight loss that accompanies bariatric Roux-en-Y gastric bypass (R-e-YGB) is a risk factor for cholelithiasis which in turn increases the risk of choledocholithiasis and gall stone pancreatitis. Around 7-8% of post R-e-YGB patients become symptomatic with gall stone disease that require cholecystectomy. Therefore, due to this relative low prevalence rate of gall stone disease, recommending prophylactic cholecystectomy in patients undergoing R-e-YGB might be an overkill and is not generally advocated [1]. While performing cholecystectomy in R-e-YGB patients is relatively straightforward, performing Endoscopic Retrograde Cholangiopancreatography (ERCP) with conventional scope is technically challenging in these cases.We report a case of laparoscopically-assisted ERCP with review of the literature. Case ReportA 30-year-old woman status post R-e-YGB surgery for obesity 4 years ago. She was admitted with acute gall stone pancreatitis. Biliary imaging confirmed choledocholithiasis and cholelithiasis. ERCP was attempted using a conventional colonoscope under conscious sedation using midazolam and fentanyl. However, despite entering the pancreatico-biliary limb (roux limb) of the intestine and visualizing bile, this was not successful in identifying the ampulla. This procedure took around 2 hours and had to be abandoned.She later underwent Laparoscopy with assisted ERCP and subsequent cholecystectomy. The patient had standard laparoscopy for access into the peritoneal cavity. After identification of the gastric remnant, the therapeutic duodenoscope was introduced into the abdominal cavity via left upper quadrant incision and inserted into the remnant stomach through the gastrostomy. It was passed into the duodenum with access to the ampulla without difficulties. The common bile duct was cannulated using guide wire. Cholangiogram reveled stones in the common bile duct which were extracted after sphincterotomy with balloon. It was an uncomplicated procedure. The total operative time was 100 minutes. The patient was discharged the next day with good recovery. The patient was reviewed a month later and was asymptomatic.There were no real difficulties in manipulating the duodenoscope. There were no ERCP related complications. The postoperative care was similar to conventional cholecystectomy or other laparoscopy procedures. There was close collaboration between the surgeon and the endoscopist to harmonize their timetable and to ensure optimal positioning of the endoscopic and radiological equipment during the procedur...

No abstract

No abstract