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Ubi pus, ibi evacua

  • Ubi pus, ibi evacua Figure 1

Question

Which of the following is true about acute cholecystitis diagnosis and management?

The absence of sonographic evidence of cholecystitis should steer clinical evaluation away from the diagnosis. The Fukuoka guidelines present a reliable framework to establish the diagnosis and severity grading of acute cholecystitis. In patients with cholecystitis and choledocholithiasis, a bridging therapy transpapillary gallbladder drainage worsens postsurgical outcomes for future surgical candidates. When endoscopic therapy is favored for cholecystitis, transgastric lumen-apposing metal stent drainage of a hot gallbladder is less favored than the transduodenal approach given the higher risk of stent migration.
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During screening colonoscopy, a 45-year-old man is found to have a rectal submucosal lesion. EUS reveals a 2.5-cm hypoechoic lesion emanating from the adventitial layer with an intact muscularis propria. EUS-guided core biopsy shows a GI stromal tumor (GIST), and the patient is referred for endoscopic adventitial dissection (Figure). Which of the following is true regarding GISTs?
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A 67-year-old patient presents with melena and shortness of breath culminating over the last few weeks. Laboratory test results show a hemoglobin level of 7 mg/dl from a baseline of 13 mg/dl and a blood urea nitrogen/creatinine ratio >40. CT scan results reveal a fundal mass with hyper-enhancing locules consistent with a GI stromal tumor. Upper endoscopy finds a 5-cm ulcerated submucosal mass diffusely bleeding in the gastric fundus. To control this bleed, hemostatic powder therapy is chosen, and the injection catheter is modified to prevent clogging of the system during deployment (Figure). After successful hemostasis, the patient undergoes definitive therapy with surgical resection. Which of the following is true regarding upper GI bleeding?
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A 70-year-old man presents with weight loss, anorexia, and nausea. A CT scan shows a significantly thickened gastric wall. Upper endoscopy and mucosal biopsies are performed from hyperemic, “angry-looking” areas, but malignancy is not discerned. A repeat endoscopy is performed, and the lumen is submerged in water. A specialized stiff cold snare is used to obtain sampling underwater. Histopathologic evaluation also is performed (Figure). Which of the following is true about this condition?
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A 73-year-old man presents with right upper quadrant pain 19 months after cholecystectomy. A CT scan shows perihepatic fluid collection extending to the gallbladder fossa suspicious for biloma. Percutaneous drainage is performed, and evidence of dropped gallstones is found during placement. After multidisciplinary discussion, cholangioscopy is completed through the percutaneous tract with removal of the dropped gallstones. Which of the following is true?
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