S1834 Spontaneous Bacterial Peritonitis in a Postpartum Female Secondary to Necrotizing Pancreatitis

Abstract

Case Description/Methods: A 64-year-old female with Gardner syndrome requiring colectomy and classic pancreaticoduodenectomy for an ampullary adenoma 10 years prior presented for surveillance endoscopy. She previously underwent endoscopic mucosal resection and intraductal radiofrequency ablation (RFA) of adenomatous tissue at the hepaticojejunal (HJ) anastomosis. She subsequently developed a stricture at the HJ anastomosis needing sequential dilations. A 1T scope was used and advanced to the HJ anastomosis. After balloon dilation of the HJ anastomotic stricture, cholangioscopy was performed and revealed abnormal biliary mucosa (Figure) approximately 2 cm below the hilum raising concern for intraductal extension of adenomatous tissue. Cholangioscopy directed biopsies were obtained and pathology revealed tubular adenoma without high-grade dysplasia. Intraductal RFA is planned in the future. Discussion: ERCP in patients with pancreaticoduodenectomy can be challenging. Different endoscopes have been used to overcome some challenges of ERCP in altered anatomy, each offering certain advantages and limitations. Commonly used endoscopes for ERCP in patients with pancreaticoduodenectomy include the adult and pediatric colonoscopes and single balloon enteroscope. These endoscopes do not allow for performing single operator cholangioscopy due to the length of the scope or the width of the accessory channel. Our report highlights that the 1T endoscope allows for performing single operator cholangioscopy in patients with prior pancreaticoduodenectomy when the HJ anastomosis can be reached.[1833] Figure 1. Intraductal extension of adenomatous tissue seen on cholangioscopy.

Small Bowel Obstruction in Postpartum Vaginal Delivery due to Prior Abdominal Adhesions Case Report

“…Intestinal obstruction is rarely observed after an uncomplicated vaginal delivery with an incidence of 1 in 3000 and a high mortality rate of 18–25% [ 1 ]. The differential diagnosis for acute abdominal pain in the postpartum period includes postoperative complications including hemoperitoneum, appendicitis, cholecystitis, adhesive intestinal obstruction, ileus after Cesarean section, perforated peptic ulcer, bladder rupture [ 2 ], bacterial peritonitis [ 3 ], and ovarian torsion [ 4 ]. Specifically related to postpartum is Ogilvie's syndrome, which is denervation of parasympathetic nerves causing atonic distal colon and pseudo-colonic obstructions.…”