1. 72/M patient has come to us with c/o increased stool frequency and bleeding per rectum for last few months with some wt loss. Recent CT Scan showed a possibility of mass in the rectum with nodes.

  2. Ileo-Colonoscopic findings are suggestive of active ulcerative colitis affecting the recto sigmoid up to around 5 cms from the anal verge with large sessile lesion.
  3. Rectal EUS was then performed with a radial echo endoscope, which revealed essentially mucosal lesion limited to the muscularis mucosa.
  4. EMR (endoscopic mucosal resection) was then carried out with saline adrenaline injection followed by resection with snare and cautery. Complete resection was ensured and haemostasis was secured.
  5. Resected specimen was retrieved and sent for HPE which was diagnosed as adenocarcinoma.
Large sessile lesion was seen in the rectum

1. Large sessile lesion was seen in the rectum

Rectal EUS showed mucosal lesion limited to the muscularis mucosa

2. Rectal EUS showed mucosal lesion limited to the muscularis mucosa

Saline adrenaline injected

3. Saline adrenaline injected

EMR performed with snare and cautery

4. EMR performed with snare and cautery

Resected specimen was retrieved

5. Resected specimen was retrieved

Complete resection was ensured and haemostasis was secured

6. Complete resection was ensured an aemostasis was secured

  1. 06/M child came with a severe pain in abdomen for the last few days
  2. EUS revealed a dilated fusiform intra pancreatic portion of the CBD and MPD with large soft stones leading to dilated CBD and MPD with changes of chronic pancreatitis.
  3. ERCP was considered – Selective cannulation of MPD was achieved and pancreatogram confirmed EUS findings
  4. All the soft stones were cleared from the MPD and a 5 fr single pigtail stent was placed into the MPD
  5. In view of abnormal LFT a 7 fr stent was then placed in the CBD, patient’s symptoms subsided immediately after the procedure

 Take Home Message:

Irrespective of the age of the patient even in children, EUS-ERCP interface allowed us to provide accurate diagnosis and optimum immediate treatment. Patient will require a definitive surgical intervention once Cholangitis and Pancreatitis subsides.

Feb 2016

01. EUS showing dilated MPD with large soft stones

Feb 2016

02. Selective cannulation of MPD was achieved

Feb 2016

03. Pancreatogram showed fusiform dilatation with soft stones

04. All the soft stones were cleared from the MPD

04. All the soft stones were cleared from the MPD

Feb 2016

05. cholangiogram showed ductal anomaly

06. 5fr single pigtail stent placed in the MPD and 7fr stent was placed in the CBD

06. 5fr single pigtail stent placed in the MPD and 7fr stent was placed in the CBD