Background & Aim: The ablation of the sphincter of Oddi causes bilioenteric reflux that could promote development of bile duct cancer. Aim of this review is to present the currently published reports on late cholangiocarcinoma development after endoscopic sphincterotomy and trans-duodenal sphincteroplasty/bilioenteric procedures Methods:An extensive search was performed in Pubmed, Google scholar databases, for publications including the title phrases “late cholangiocarcinoma (or bile duct cancer) +/- after endoscopic sphincterotomy +/- after bilioenteric procedures”. Furthermore, we reviewed the currently published studies examining the changes on biliary/choledochal epithelium after performing endoscopic or surgical sphincterotomy and bilioenteric procedures. Results: Eighteen case reports, 2 retrospective human trials and several experimental animal trials address the issue of late cholangiocarcinoma after surgical sphincteroplasty/bilioenteric procedures. Three population-based studies examine the risk of late bile duct cancer after endoscopic sphincterotomy. Several other publications studying the sphincter function and bilioenteric reflux complications were also reviewed. Conclusions:The available evidence demonstrates a clear correlation of cholangiocarcinoma and bilio-enteric procedures. On the contrary, large population-based studies failed to show a relation between ES and late bile duct malignancy.
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Lower gastrointestinal bleeding is defined as bleeding that occurs distant to the ligament of Treitz. It is less common and less severe than upper gastrointestinal bleeding and carries a mortality rate of 2%-4%, which, however, increases to 21% in cases of massive hematochezia and hemodynamic instability. The most common source of the bleeding is the colon, with diverticular disease and angiodysplasia being the most common causes. In this article we present the case of a 64-year-old male patient who suffered from massive lower gastrointestinal bleeding from the invaginated appendiceal stump twenty days after the appendectomy
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