Shounak Majumder

Sarcoidosisis amultisystemic granulomatous disease, potentially affecting any organ system of the body. Calcium metabolism disturbances occur in up to 20% of patients, of which hypercalciuria and asymptomatic hypercalcemia are most common. Ocular sarcoid typically presents with anterior chamber manifestations such as uveitis, iritis, and iridocyclitis, but can involve posterior chamber as well. We describe herein a unique presentation of sarcoidosis with retinal detachment and symptomatic hypercalcemia as its first manifestation. Prompt therapy with steroids is indicated in these cases, and an immediate ophthalmology referral cannot be overemphasized.

We report a case of postoperative bile leak originating from subvesical bile ducts. This anatomic variant of the bile duct is widely prevalent, often undiagnosed, and usually uncovered in the setting of iatrogenic biliary injury. Injury to these ducts during gallbladder surgery can be potentially averted by minimizing dissection into the hepatic parenchyma. Because of their small size, leaks originating from these ducts have good prognosis and almost never require surgical intervention. Preoperative knowledge of this uncommon variant may improve surgical technique aimed at avoiding biliary injury during cholecystectomy.

"Hepatoid" cancer refers to an extrahepatic neoplasm with hepatocellular differentiation. The stomach is the most common site and pancreatic origin is distinctly uncommon. We describe a patient with hepatoid pancreatic tumor who presented with inoperable metastatic disease. Serum levels or tissue staining with alpha-fetoprotein (AFP) may not be a reliable tumor marker in these cases and an experienced pathologist and appropriate immunohistochemical staining are essential for early diagnosis. This report incorporates a comprehensive literature review outlining the clinical presentation, diagnostic difficulties, management and outcomes associated with this rare pathological entity.

Gastroenterologists are expected to play a pivotal role in the management of the global obesity epidemic in coming years as novel endoscopic approaches become more widely available, safe, and effective. This review focuses on the recent advances in the field of endoluminal therapy as a primary approach to obesity management with the aim of providing the interventional endoscopist an overview of currently available evidence along with an insight into upcoming devices and techniques. The intragastric balloon appears to be safe and effective in the short term, especially as a bridge to bariatric surgery. Although early trials support the safety and feasibility of endoscopic gastroplasty, it is technically demanding and staple-line dehiscence continues to be a problem. Moreover, with ongoing technical innovations, most devices that have been used in published trials are no longer manufactured and results of studies using newer endoscopic suturing systems are currently awaited. The duodenojejunal bypass sleeve mimics the physiology of intestinal bypass and shares the metabolic advantages of intestinal diversion. A high rate of premature device withdrawal has been its major limiting factor. Therapeutic endoscopy may be the next paradigm of bariatric care. Combining restrictive and barrier endoscopic techniques can potentially improve efficacy and should be evaluated in the setting of appropriate clinical trials.

The association between cancer and thrombosis is well-known. Among gastrointestinal malignancies, pancreatic cancer has perhaps the strongest association with thromboembolic events. However, simultaneous arterial and venous thromboses affecting multiple organs at the time of initial diagnosis is rare, with an incidence of less than 1%. We report herein a case of a 61-year-old woman who presented with digital ischemia, a non-ST elevation myocardial infarction and an ischemic stroke, along with deep vein thromboses and pulmonary embolism. She was subsequently diagnosed with metastatic pancreatic cancer. This report highlights the intriguing association between pancreatic cancer biology, tumor metastases, and triggering of venous and arterial thromboembolic events. Current evidence points towards early thromboembolic phenomena as a harbinger of poor outcome in pancreatic cancer, and studies attempting to define the role of prophylactic anticoagulation in these patients are ongoing.