EUS-assisted rendezvous stenting of the pancreatic duct for chronic calcifying pancreatitis with multiple pseudocysts.

Introduction: The best choice of endoscopic drainage of pancreatic pseudocysts complicating chronic pancreatitis is currently unknown, with EUS-guided transmural drainage competing with ERCP transpapillary techniques. However, recent studies currently recommend the use of both techniques in complex cases.

Case Presentation: We present the case of a 60-year-old male patient with chronic calcifying pancreatitis, with severe ductal obstruction and multiple communicating pancreatic pseudocysts.

The role of imaging methods in identifying the causes of extrahepatic cholestasis.

Transabdominal ultrasonography is the first choice examination used for the etiological diagnosis of extrahepatic cholestasis because it is a noninvasive, rapid method and presently widely accessible. In this article we discuss the accuracy of transabdominal ultrasonography, computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS) in detecting the main causes of extrahepatic colestasis. Although in bile duct pathology, and especially in the evaluation of patients with jaundice, transabdominal ultrasonography is the first choice exploration, helicoidal CT, ERCP and MRCP are often required to establish the local cause of jaundice, local and distant consequences evaluation, appreciation of surgical intervention opportunity and choice of the right therapeutic method.

[External biliary fistulas selectively managed by endoscopic retrograde cholangiography with sphincterotomy and/or stent placement].

External bile duct fistulas are inherent postoperative complications that usually appear after biliary tract surgery, traumatic bile duct injuries and liver surgery for hepatic hydatid disease or liver transplant. The management is highly individualized, while the success and long-term results of endoscopic and surgical techniques are conflicting. The study included 32 cases with external bile duct fistulas managed by endoscopic retrograde cholangiography (ERC) with sphincterotomy and/or stent placement, including "rendez-vous" procedures in 2 cases.

Diagnostic particularities in primitive diffuse form hepatocellular carcinoma associated with portal vein thrombosis.

The diagnosis of primitive hepatocellular carcinoma, infiltrative form, arose on liver cirrhosis is often difficult because the imagistic investigations could not relevate the tumoral formation. We are presenting the case of a 56 years patient, diagnosed with viral B liver cirrhosis, in which the clinical symptomatology and laboratory investigations were leading to hepatocellular carcinoma, but the ultrasonography and CT scan could not confirm the malignant transformation. In these conditions we performed ultrasonographically guided biopsy from the liver parenchyma and visualized thrombus in portal vein lumen.