Dr. Manoj Chandrakant Kolhe

Introduction: The world is in the middle of the COVID-19 global pandemic. Case load is rising on exponential rate and we have already crossed 20 million mark. Typical presenting feature of COVID-19 is asymptomatic/mild or symptoms/acute respiratory illness and death. Gastrointestinal (GI) manifestations are common like loose stools, nausea, and abdominal pain. Case Report: A case of a 19-year-old girl without previous comorbidities presented with typical symptoms of COVID-19. During hospital stay she developed abdominal pain and diagnosed severe pancreatitis. All common causes of acute pancreatitis were ruled out by doing relevant investigations. Her pancreatitis was severe and required percutaneous drainage of necrotic material. She was discharged after prolonged hospital stay even after her negative COVID test. Conclusion: Atypical presentation of COVID-19 is increasing with increasing case load. Abdominal pain in a patient with COVID should be evaluated for acute pancreatitis and be treated accordingly to lessen morbidity and mortality.

These images are from a 13-year-old girl, who presented with odynophagia. Upper gastrointestinal (GI) endoscopy revealed longitudinal ulcer in the mid esophagus ([Fig. 1]). CT chest [Fig. 2] and endoscopic ultrasound (EUS) ([Fig. 3]) showed a node in the left paratracheal region. Cytology examination showed necrotic granulomas ([Fig. 4]), and stain for acid-fast bacillus (AFB) was positive. Midesophageal ulcers have varied etiology such as viral diseases, pill esophagitis, corrosive injury, submucosal lesions, or malignancy. In endemic places, tuberculosis should be considered as differential diagnosis. Subepithelial bulge with ulcer (summit ulcer) has been explained in tuberculosis.

Background and Aims External pancreatic fistula occurring in the setting of disconnected pancreatic duct syndrome leads to significant morbidity, often requiring surgery. The aim of this study is to report a new technique of endoscopic ultrasound (EUS)-guided rendezvous and tractogastrostomy in patients with disconnected pancreatic duct syndrome and external pancreatic fistula. Methods This study is retrospective analysis of the data of the patients with external pancreatic fistula who had undergone EUS-guided rendezvous and tractogastrostomy. Internalization of pancreatic secretions was performed by placing a stent between tract and the stomach. Technical success was defined as placement of stent between the tract and the stomach. Clinical success was defined as removal of external catheter and absence of peripancreatic fluid collection, ascites or external fistula at 3 months after the tractogastrostomy. Results Four patients, all male, with median age of 33.5 years (range: 29–45), underwent EUS-guided tractogastrostomy. Technical and clinical success was 100%, without any procedure related complication. External catheter could be removed in all the patients. During the median follow-up of 10.5 months (range: 8–12), two patients had stent migration and peripancreatic fluid collection, which were managed by EUSguided internal drainage. Conclusions EUS-guided rendezvous and tractogastrostomy are a safe and effective technique for the treatment of external pancreatic fistula.