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Abdominal pain is a frequent cause of consultation to doctors' offices and emergency rooms. The most common differential diagnoses can be confirmed with readily available, cost-effective, and low-risk diagnostic tools such as laboratory tests, ultrasound, or gastroscopy. Additional diagnostic tests are required to exclude rare causes such as small, solid, or hematological malignancies, metabolic disorders, or polyneuropathies of varying origin. In the following, we present the case of a patient with severe epigastric pain due to neuroborreliosis, and recapitulate the diagnostic steps for clarifying abdominal pain using this example.

Clinical Issue: Biliary diseases require fast and rational use of diagnostic tests by both gastroenterologists and radiologists., Standard Treatment: Standard diagnostic workup includes transabdominal ultrasound, endoscopic retrograde cholangiography (ERC), endoscopic ultrasound, direct cholangioscopy, magnetic resonance cholangiopancreatography (MRI/MRCP), and computed tomography (CT)., Treatment Innovations: Modular cholangioscopy is a novel diagnostic method., Diagnostic Work-Up: The goal of diagnostic examinations is the determination of the location of obstructions and differentiation of benign from malignant lesions., Achievements: Transabdominal ultrasound is risk-free and can show the gallbladder in great detail providing high diagnostic accuracy in most conditions. Endoscopic ultrasound, ERC and/or cholangioscopy are powerful tools to investigate the large bile ducts but are associated with inherent procedural risks., Practical Recommendations: Gall bladder diseases can often be diagnosed with transabdominal ultrasound alone. Bile duct disease often requires the use of endoscopic ultrasound, ERC and/or cholangioscopy.

We present the case of a 22 year old man who developed a permanent penile erection after a blunt perineal trauma. Conservative treatment in terms of cooling, compression and puncture of the cavernosal corpora with blood aspiration failed to resolve the priapism. Angiography confirmed the diagnosis of high-flow priapism caused by an arteriovenous fistula. Interventional coil embolization of the fistula was effective meaning that complete detumescence was achieved and erectile function was preserved.