Search

Sump syndrome is a rare complication of choledochoenterotomy. Patients with sump syndrome often have abdominal pain, recurrent cholangitis, pancreatitis, malabsorption, fever, an abnormal liver function test, and, rarely, hepatic abscess. Roux-en-Y choledochojejunostomy or hepaticojejunostomy has been advocated to prevent sump syndrome. We report an 80-year-old man who presented with a hepatic abscess secondary to sump syndrome 26 years after a Roux-en-Y choledochojejunostomy for recurrent cholangitis. Sump syndrome should be considered for patients who underwent biliary diversion surgery, regardless of the type of procedure or time from surgery.

Tuberculosis (TB) is a common disease worldwide affecting more than 2 billion people, including latent, pulmonary, and extrapulmonary TB. The presentation of disseminated TB is variable and dependent on the organs affected. Therefore, making the diagnosis and providing appropriate treatment can be delayed. We present a case of disseminated TB in a patient with Sjogren's syndrome on hydroxychloroquine monotherapy without traditional risk factors.

inflammation in 7% (n = 37), fibrostenotic disease in 50 % (n = 270) and penetrating disease in 43% (231/538) of the cases. Laparoscopy was used in 383 (71%) patients, while 47 patients (12%) were converted. Median hospital stay was 7 days (IQR: 5 8). Overall postoperative morbidity was reported in 122 (23%) patients. 15 patients (3%) developed an anastomotic leak, despite a low ileostomy rate. Indeed, 7% (n = 38) had an ileostomy. All but one stomas were reversed after a median time lapse of 5 months (IQR: 4 7). Specimen length (p = 0.002) and preoperative anti-TNF use (p = 0.0353) increased the risk of anastomotic leakage significantly. Median follow up was 6 years (IQR : 2 9). Clinical recurrence after 5 and 10 years were 45% and 55% respectively. Postoperative smoking (p = 0.0047) and microscopic section margin positivity (p < 0.0001) significantly influenced clinical recurrence. Surgical recurrence after 5 and 10 years were 6.5% and 19.1% respectively. Surgical recurrence was significantly influenced by smoking (p = 0.012), postoperative treatment regimen (p = 0.0008) and microscopic resection margin positivity (p = 0.0119). Conclusion: Ileocecal resection for Crohn's disease is safe and is more effectively keeping the patient in surgical remission than previously reported. Overall surgical recurrence rate is low. The risk of surgical recurrence is not a valid argument to delay surgery in Crohn's patients.