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Diagnostic imaging of jejuno-ileal neuroendocrine tumors (NETs) has been described as challenging. Follow-up requires the detection of metastatic spread as well as screening for local recurrence. Multimodal imaging concepts must often be applied.We report the case of a 45-year-old man with a history of ileal NET. At 2 points in follow-up of our patient, information provided by high-end ultrasound changed prognosis and treatment considerably: when positron emission tomography/computed tomography newly detected suspected hepatic metastases, contrast-enhanced ultrasound correctly identified the lesions as intrahepatic vascular shunts. Moreover, profound B-mode ultrasound solely detected ileal recurrence, leading to early removal of the tumor.Diagnostische Bildgebung bei jejuno-ilealen neuroendokrinen Tumoren (NETs) stellt gemeinhin eine Herausforderung dar. In der Nachsorge ist sowohl auf die Detektion möglicher Metastasen als auch auf das Auftreten von Lokalrezidiven zu achten. Oft sind hierfür multimodale bildgebende Ansätze notwendig.Wir berichten über den Fall eines 45-jährigen Patienten mit einem ilealen NET in der Vorgeschichte. An zwei Punkten in der Nachsorge des Patienten lieferte high-end Ultraschall Informationen, die sowohl die Prognose als auch das Behandlungskonzept des Patienten maßgeblich beeinflussten. Im PET/CT neu aufgetretene und als hoch metastasensuspekt beschriebene Läsionen wurden im CEUS korrekt als intrahepatische vaskuläre Shunts erkannt. Des Weiteren detektierte fundierter B-Bild-Ultraschall als einziger ein ileales Rezidiv des NET, was eine frühe Resektion des Tumors ermöglichte.

Recurrent Pyogenic Cholangitis (RPC) or Primary Hepatolithiasis is a common disease of the biliary tract in Asia, whereas it is usually not seen in Europeans. With increasing global mobility, the disease will be encountered in Europe more frequently, too. It should therefore be considered as a differential diagnosis in patients from endemic countries with recurrent symptoms of cholestasis/cholangitis and bile duct dilations, strictures and hepatolithiasis. In this case report, we present the history of a 37-year old patient from Sri Lanka and describe typical aspects of RPC. The patient presented at our hospital with scleral jaundice and pruritus. In the past she had been treated for septic cholangitis. Diagnosis in our patient was made after laboratory tests, MRT/MRCP and ERC. She was treated interventionally by ERC and is now monitored on a regular basis.

Low-grade appendiceal mucinous neoplasms (LAMNs) are neoplastic lesions with potential progression to pseudomyxoma peritonei (PMP). In most cases, diagnosis is made because of suspected acute appendicitis or incidentally by computed tomography (CT). However, incidental diagnosis during colonoscopy is rare. We present the case of a 63-year-old man with a LAMN type 1 lesion, diagnosed at routine colonoscopy for surveillance of ulcerative colitis. Because in earlier surveillance colonoscopies, this lesion was misinterpreted as fecal polution, for the first time, this case describes retrospectively a 3-year endoscopic follow-up of LAMN type 1, underlining the benign course of these kind of lesions compared to type 2 lesions with submucosal infiltration. Even though endoscopy and sonography are not accepted as method of choice to detect LAMN lesions, our case highlights their role regarding diagnosis of small lesions, as CT scan was not able to detect the lesion in our case. Even though LAMNs are rare, awareness of LAMN lesions in routine colonoscopy is favorable as potential progression to PMP can not be ruled out.

Der Over-the-scope-Clip (OTSC) wird hauptsachlich zum endoskopischen Verschluss gastrointestinaler Defekte oder zur Blutstillung verwendet. Der Einsatz bei der Resektion subepithelialer Tumoren oder gar zur endoskopischen Vollwandresektion ist bislang noch Gegenstand von Untersuchungen. Neuroendokrine Tumoren (NET) des Duodenums sind seltene Erkrankungen, bei denen bis zu einer Grose von 20 mm endoskopisch reseziert werden kann, allerdings aufgrund der subepithelialen Lage Tumorreste zur Tiefe hin verbleiben konnen. Wir berichten uber einen 60-jahrigen Patienten mit zahlreichen Vorerkrankungen, bei dem wir nach R1-Resektion (vertikal) eines duodenalen NET (G1) komplikationslos eine OTSC-assistierte tiefe Nachresektion endoskopisch durchfuhrten. Histologisch konnten so Tumorfreiheit (R0) erreicht und eine offene Resektion vermieden werden. Unser Fallbericht demonstriert, dass die OTSC-assistierte tiefe Resektion subepithelialer Tumoren eine mogliche und sichere Alternative speziell fur Patienten und Lokalisationen darstellt, bei denen eine operative Entfernung mit einem erhohten Risiko verbunden ist.

A 35-year-old Kenian lady with advanced immunodeficiency due to HIV infection started on an antiretroviral therapy. Five months later, a severe colitis was diagnosed, however, no causal pathogen could be found. In order to avoid imminent perforation, a hemicolectomy became necessary, and immediately the symptoms and inflammation markers normalized rapidly. M. tuberculosis could be proven in culture in a draining abdominal lymph node. We assume that the severe inflammation was caused by an immune restoration inflammatory syndrome (IRIS). Essentials in diagnosis, pathogenesis and therapy of IRIS are discussed.

Endoscopic retrieval of proximally migrated biliary stents is sometimes challenging. We report on the successful use of a three-prong colon polyp retrieval device in a two year old child.