The loin pain hematuria syndrome (LPHS) creates a considerable burden, both for patients afflicted with the disease and for those involved in medical management and diagnosis.  To date, the diagnosis of LPHS remains one of exclusion, with some speculation regarding the extent of actual pathology.  We report ureteroscopic findings in 2 cases of LPHS.  These findings provide objective confirmation of underlying pathology in a difficult-to-manage disease process.

Benjamin K. Canales

Andrew Windsperger

Stephen Lukasewycz

Manoj Monga

Endoscopic Findings in Loin Pain Hematuria Syndrome: Concentric Clot in Calyceal Fornices

<i  >Background</i>: Adequate bowel preparation is essential for
accurate colonoscopy. Both oral sodium phosphate (NaP) and
polyethylene glycol-based lavage (PEG-ELS) are used predominantly
as bowel cleansing modalities. NaP has gained popularity due to
low drinking volume and lower costs. The purpose of this
randomized multicenter observer blinded study was  to compare
three groups of cleansing (NaP, NaP + sennosides, PEG-ELS +
sennosides) in reference to tolerability, acceptance, and
cleanliness. Patient and Methods: 355 outpatients between 18 and
75 years were randomized into three groups (A, B, C) receiving NaP =
A, NaP, and sennosides = B or PEG-ELS and sennosides = C.
Gastroenterologists performing colonoscopies were blinded to the
type of preparation. All patients documented tolerance and adverse
events. Vital signs, premedication, completeness, discomfort, and
complications were recorded. A quality score (0&#x2013;4) of cleanliness
was generated. <i  >Results</i>: The three groups were similar
with regard to age, sex, BMI, indication for colonoscopy, and
comorbidity. Drinking volumes (L) (A =  4.33 + 1.2, B =  4.56 + 1.18, C = 4.93 + 1.71) were in favor of NaP
(<svg     style="vertical-align:-0.0pt;width:10.9375px;" id="M1" height="11.175" version="1.1" viewBox="0 0 10.9375 11.175" width="10.9375"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.113)"><path id="x1D443" d="M619 482q0 -69 -40.5 -119t-96 -72.5t-118.5 -26.5h-44l-70 20l-31 -151q-14 -67 0.5 -83t89.5 -22l-5 -28h-287l8 28q65 7 81.5 22t29.5 83l79 398q12 56 0.5 70.5t-78.5 20.5l7 28h255q108 0 164 -43t56 -125zM524 478q0 141 -146 141q-25 0 -47 -8q-16 -6 -20.5 -13.5&#xA;t-10.5 -39.5l-43 -241q37 -13 83 -13q67 0 125.5 45t58.5 129z" /></g>

		
	
</svg> = .005). Discomfort from
ingested fluid was recorded in  A = 39.8&#x25;  (versus C: <svg     style="vertical-align:-0.0pt;width:10.9375px;" id="M2" height="11.175" version="1.1" viewBox="0 0 10.9375 11.175" width="10.9375"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.113)"><use xlink:href="#x1D443"/></g>

		
	
</svg> = .015), 
B = 46.6&#x25;  (versus C: <svg     style="vertical-align:-0.0pt;width:10.9375px;" id="M3" height="11.175" version="1.1" viewBox="0 0 10.9375 11.175" width="10.9375"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.113)"><use xlink:href="#x1D443"/></g>

		
	
</svg> = .147), and C =  54.6&#x25;.  Differences in tolerability and acceptance between the three groups were
statistically not significant. No differences in adverse events
and the cleanliness effects occurred in the three groups (<svg     style="vertical-align:-0.0pt;width:10.9375px;" id="M4" height="11.175" version="1.1" viewBox="0 0 10.9375 11.175" width="10.9375"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.113)"><use xlink:href="#x1D443"/></g>

		
	
</svg> = .113).
The cleanliness quality scores 0&#x2013;2 were calculated in A:
77.7&#x25;, B: 86.7&#x25;, and C: 85.2&#x25;. <i  >Conclusions</i>:
These data fail to demonstrate significant differences in
tolerability, acceptance, and preparation quality between the
three types of bowel preparation for colonoscopy. Cleansing with
NaP was not superior to PEG-ELS.

S. Schanz

W. Kruis

O. Mickisch

B. Küppers

P. Berg

B. Frick

G. Heiland

D. Hüppe

B. Schenck

H. Horstkotte

A. Winkler

Bowel Preparation for Colonoscopy with Sodium Phosphate Solution versus Polyethylene Glycol-Based Lavage: A Multicenter Trial

<i>Situs inversus totalis</i> is an inherited condition characterized 
                  by a mirror-image transposition of thoracic and abdominal organs. It often coexists 
                  with other anatomical variations. Transposition of the organs imposes special demands 
                  on the diagnostic and surgical skills of the surgeon. We report a case of a 34-year-old 
                  female patient presented with left upper quadrant pain, signs of acute abdomen, and 
                  unknown <i>situs inversus totalis</i>. Severe acute cholecystitis was diagnosed, 
                  and an uneventful laparoscopic cholecystectomy was performed. A posterior cystic 
                  artery was identified and ligated. Laparoscopic cholecystectomy is feasible in patients 
                  with severe acute calculus cholecystitis and <i>situs inversus totalis</i>; however, 
                  the surgeon should be alert of possible anatomic variations.

Theodoros E. Pavlidis

Kyriakos Psarras

Apostolos Triantafyllou

Georgios N. Marakis

Athanasios K. Sakantamis

Laparoscopic Cholecystectomy for Severe Acute Cholecystitis in a Patient with Situs Inversus Totalis  and Posterior  Cystic Artery

A seventy-year-old male presented with severe myasthenia gravis and an episode of obscure bleeding. There was a history of gastric ulcer leading to Billroth II surgery twenty-five years ago. Upper endoscopy revealed no pathology. Colonoscopy showed a few solitary diverticula and traces of old blood in the terminal ileum. Capsule endoscopy pictured red smear in the upper jejunum. Diverticula were seen as well. Suspecting bleeding jejunal diverticulosis double balloon enteroscopy was performed. The complete jejunal ascending loop and about 100&#x2009;cm of the jejunum through the descending jejunal loop could be inspected. Large diverticula with fecoliths were found in both loops. Bleeding had ceased. The patient was discharged to neurology for optimizing therapy for myasthenia gravis.

I. Zuber-Jerger

E. Endlicher

F. Kullmann

Bleeding Jejunal Diverticulosis in a Patient with Myasthenia Gravis

Bouveret&#x27;s syndrome is a rare condition of gastric outlet obstruction resulting from the migration of a gallstone through a choledochoduodenal fistula.  Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery. We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb.  After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful.  We believe this to be the first case of Bouveret&#x27;s syndrome successfully treated by endoscopy alone in the United States. We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques.

Jason N. Rogart

Melissa Perkal

Anil Nagar

Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret&#x27;s Syndrome)

A 57 year old woman was presented to the emergency department with upper abdominal pain and left sided chest discomfort. No cardiac or pulmonary cause could be determined and the patient underwent upper gastrointestinal endoscopy. Inversion of the scope to the fundus and subsequent fluoroscopy revealed a diaphragmatic hernia with a large herniation of the gastric fundus. Immediate laparotomy showed a 3&#x2009;cm orifice of the diaphragm. The orifice was widened and a partial necrosis of the incarcerated fundus was resected. The patient recovered fully and was discharged 12 days after laparotomy.

Hans  B&#246;deker

Steffen  Leinung

Henning  Wittenburg

Julia  Fischer

Ingolf  Schiefke

Niels  Teich

The Hole in the Stomach

About this journal

Journal profile

Meet the editorial board

Editor spotlight

Submit your proposal

Do you think there is an emerging area of research that really needs to be highlighted? Or an existing research area that has been overlooked or would benefit from deeper investigation? Raise the profile of a research area by leading a Special Issue.

Diagnostic and Therapeutic Endoscopy