All but one failure in the EGD group was secondary to a lack of a bulge seen in the gastrointestinal (GI) tract.[54] Park et al. published the results of another randomized trial which showed similar results with eight patients with no bulge crossing over to successful EUS drainage, with all patients in the study having eventual successful drainage.[55] In a study published by Fockens et al.,

the use of EUS changed management in 37.5% of pseudocyst drainages because of a multitude of unexpected findings.[56] If there is any doubt as to whether a fluid collection represents a pseudocyst or WOPN, EUS can be particularly helpful at identifying selleck chemical whether or not necrotic debris is present within the collection. Overall results suggest that if a bulge is seen in the GI tract, then drainage can be performed with or without EUS while patients without a visible bulge should receive EUS drainage. In summary, endoscopic treatment of pancreatic pseudocysts selleck chemicals appears to be effective, with a 94% initial success rate, 20% complication rate, and a 90% cyst resolution rate. Recurrences approximate 16% and procedural mortality is less than 1%.[57] Because of the risk of adverse events, endoscopic drainage is best done in settings with significant experience and a multidisciplinary team. Alternative drainage options include surgery or percutaneous drainage. Care must be taken to ensure that a collection does not

represent WOPN before planning simple transmural drainage. Disconnected duct syndrome is a pancreatic duct leak with a complete transection of the main pancreatic duct resulting in an isolated segment of the proximal (tail) portion of the pancreas. This generally occurs as a result of severe acute pancreatitis with pancreatic necrosis and can be seen in up to 50% of these patients.[58] This results in the entire upstream portion of the pancreas being isolated and not in communication with the papilla. This isolated segment of the pancreas will continue to produce its exocrine pancreatic juices which will be secreted

freely into the abdominal cavity resulting in a significant fistula. This type of fistula is not amenable to transpapillary stenting. The isolated portion of the pancreas cannot be reached from the papilla and therefore the leak this website cannot be bridged endoscopically. Historically, DDS has required surgical excision of the isolated tail segment of the pancreas. However, several endoscopic and interventional alternatives have been developed, although treatment success remains variable.[59] Endoscopic management of DDS has been described in several series and reviews.[2, 38, 52, 58, 60, 61] This method employs transmural drainage of fluid collections as described in the previous section for treatment of pseudocysts; however, the transmural stents are left in place indefinitely. Leaving the transmural stents in place creates an outlet for the pancreatic juice from the isolated tail segment of the pancreas.

In the enrolled patients, the χ2-test illustrated that the selleck products SV was the predominant originating vein of the LGV (P < 0.001). In the 98 patients included, the mean LGV, PV and SV diameters were 6.0 ± 3.2 mm (range, 2.0–17.6), 12.9 ± 2.6 mm (range, 6.2–24.2) and 9.3 ± 2.2 mm (range, 4.7–14.9), respectively, for the first measurements. For the repeated measurements, the mean LGV, PV and SV diameters were 5.9 ± 3.1 mm (range, 2.1–17.4), 12.8 ± 2.9 mm (range, 6.4–24.9) and 9.3 ± 2.1 mm

(range, 4.5–15.2), respectively. The intraobserver concordance of LGV, PV and SV diameter measurements on MR portography was good because the rc values were 0.90, 0.92 and 0.98, respectively; and the first measurements were used as the final diameter values. The median value of LGV, SV and PV diameters were 6.0 mm, 9.3 mm and 12.9 mm, respectively. Univariate analysis showed Aloxistatin datasheet the correlations of the diameters with the presence of esophageal varices (Table 2). Patients with an LGV diameter of 6.0 mm or more and an SV diameter of 9.3 mm or more were more likely to have esophageal

varices than with an LGV diameter of less than 6.0 mm (P = 0.001) and SV diameter of less than 9.3 mm (P = 0.002), respectively; but PV diameter was not associated with the presence of the varices (P = 0.417). Before multivariate analysis, the diameters of LGV and SV were chosen as independent risk factors for the presence of the varices, which were identified by multivariate stepwise regression analysis. The diameters of LGV (P = 0.023, odds ratio [OR] = 1.583 and 95% confidence interval [CI] for OR of 0.748–3.351] and SV (P = 0.012, OR = 2.126 and 95% CI for OR of 1.818–5.523) were associated with the varices. The relationship of the LGV or SV diameters with endoscopic grades of esophageal varices is summarized in Table 3. LGV or SV diameters could discriminate patients between grades 0 and 1 (P < 0.001 or 0.007, respectively),

between grades 0 and 2 (both P < 0.001), between grades 0 and 3 (both P < 0.001), between grades 1 and 3 (P < 0.001 or P = 0.001, respectively), and between grades 2 and 3 (P = 0.002 or 0.022, respectively). However, the diameter of LGV or SV could not differentiate check details grade 1 from 2 (P = 0.182 or 0.139, respectively). Additionally, the differences in LGV or SV diameter between patients with esophageal varices grades 0–1 and 2–3, which were defined as low-risk and high-risk varices, respectively, were of statistical significance (all P < 0.001). By ROC analysis in all of the 98 patients enrolled, we found that the cut-off diameters of LGV of 5.1 mm, 5.9 mm, 6.6 mm, 7.1 mm, 7.8 mm and 5.8 mm, or the cut-off diameters of SV of 7.3 mm, 7.9 mm, 8.4 mm, 9.5 mm, 10.7 mm and 8.3 mm, could discriminate endoscopic grades 0 from 1, grades 0 from 2, grades 0 from 3, grades 1 from 3, grades 2 from 3, and grades 0–1 from 2–3 (Fig. 2), respectively.

Among the other data collected and analyzed were age, gender, age at time of migraine onset, and migraine subtype (ie, episodic vs chronic). Actively cycling females who reported menses as a trigger were questioned as to whether their menstrual migraine (MM) attacks differed from their

non-menstrual migraines and, if so, how they differed. Results.— One hundred and eighty-two patients (91%) reported at least 1 migraine trigger, and 165 (82.5%) reported multiple triggers. The most common trigger reported (59%) was “emotional stress,” followed by “too much or little sleep” (53.5%), “odors” (46.5%), and “missing meals” (39%). Females or subjects of either gender with chronic migraine were no more likely than males or subjects with episodic migraine CHIR-99021 molecular weight to report triggers or multiple triggers. Similarly, longer exposure to migraine did not correlate with a higher likelihood of reporting a trigger or multiple triggers. Fifty-three (62%) of 85 actively cycling females reported menses as a trigger, and of the 51 with menstrually related migraine, 34 (67%) reported their MM to be more severe, more refractory to symptomatic therapy or of longer duration than their non-menstrual

attacks; 13 (24.5%) of the 53 women with apparent MM reported their MM check details to be at least occasionally manifested as status migrainosus. The selleckchem prevalence and type of triggers reported by this predominantly white female population were similar to those reported by clinic-based populations in San Diego, California and Mobile, Alabama, and in a population-based sample of Hispanics in San Diego County. Conclusions.— A large majority of migraineurs report migraine attack triggers, and the triggers most commonly reported include emotional stress, a disrupted sleep pattern, and various odors. These findings do not appear to vary according to geographic

region or race/ethnicity. Among the triggers, MM appears inclined to provoke headache that is more severe, less amenable to treatment, or longer in duration than headaches that occur at other times during the cycle. (Headache 2010;50:1366-1370) “
“Objective.— This study tests the hypothesis that injury to the somatosensory cortex is associated with periorbital allodynia and increases in nociceptive neuropeptides in the brainstem in a mouse model of controlled cortical impact (CCI) injury. Methods.— Male C57BL/6 mice received either CCI or craniotomy-only followed by weekly periorbital von Frey (mechanical) sensory testing for up to 28 days post-injury. Mice receiving an incision only and naïve mice were included as control groups. Changes in calcitonin gene-related peptide (CGRP) and substance P (SP) within the brainstem were determined using enzyme-linked immunosorbent assay and immunohistochemistry, respectively.

Ian A. Rowe B.Sc., M.B., Ch.B., M.R.C.P.(UK)* † ‡, Matthew J. Armstrong M.B., Ch.B., M.R.C.P.† ‡, Diarmaid D. Houlihan M.B., Ch.B.† ‡, * Hepatitis C Virus Research Group, University of Birmingham, Birmingham, UK, † Center for Liver Research and NHR Biomedical Research Unit, University of Birmingham, Birmingham, UK, ‡ Liver and Hepatobiliary Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK. “
“Ascites

is the most common complication of cirrhosis and in adults it is associated with 50% mortality at 5 years if patients do not receive a liver transplant. The occurrence of hyponatremia in these patients has been associated with increased mortality on the waiting list. The importance of serum sodium levels and the presence of ascites in the pediatric XL765 mw setting remain to be clarified. A retrospective analysis of pediatric patients with cirrhosis on the transplant selleck chemicals list was carried out

between October 2000 and February 2012. The primary objective of this study was to evaluate the association of pretransplant variables with mortality within 90 days following the inclusion of patients on the waiting list. In all, 522 patients were included in the study; 345 (66%) patients were under 1 year of age; 208 (40%) of the children presented ascites. A multivariate Cox proportional hazards analysis was conducted and total bilirubin (P < 0.001, hazard ratio [HR] = 2.09, 95% confidence interval [CI] = 1.35-3.21), check details international normalized ratio (INR) (P < 0.001, HR = 9.83, 95% CI = 4.51-21.45), serum sodium levels (P = 0.03, HR = 0.96, 95% CI = 0.92-0.99), ascites (P = 0.001, HR = 2.59, 95% CI = 1.44-4.64), and categorized age (0-1 versus ≥1 year old) (P = 0.025, HR = 2.33, 95% CI = 1.11-4.86) were independently associated with risk of death in 90 days. Malnutrition (Z score height/age, weight/age) and serum albumin (pediatric endstage liver disease [PELD] formula) were not included in the final model.

Conclusion: The presence of ascites and serum sodium levels are important variables associated with decreased patient survival while candidates wait for a liver graft. Multicenter studies are necessary to validate these findings in order to improve current allocation policies based on the PELD score. (Hepatology 2014;59:1964–1971) “
“Based on the recently established role for the master coregulator MTA1 and MTA1-containing nuclear remodeling complexes in oncogenesis and inflammation, we explored the links between parasitism by the carcinogenic liver fluke Opisthorchis viverrini and this coregulator using both an Mta1−/− mouse model of infection and a tissue microarray of liver fluke–induced human cholangiocarcinomas (CCAs). Intense foci of inflammation and periductal fibrosis in the liver and kidneys of wild-type Mta1+/+ mice were evident at 23 days postinfection with O. viverrini. In contrast, little inflammatory response was observed in the same organs of infected Mta1−/− mice.

Ian A. Rowe B.Sc., M.B., Ch.B., M.R.C.P.(UK)* † ‡, Matthew J. Armstrong M.B., Ch.B., M.R.C.P.† ‡, Diarmaid D. Houlihan M.B., Ch.B.† ‡, * Hepatitis C Virus Research Group, University of Birmingham, Birmingham, UK, † Center for Liver Research and NHR Biomedical Research Unit, University of Birmingham, Birmingham, UK, ‡ Liver and Hepatobiliary Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK. “
“Ascites

is the most common complication of cirrhosis and in adults it is associated with 50% mortality at 5 years if patients do not receive a liver transplant. The occurrence of hyponatremia in these patients has been associated with increased mortality on the waiting list. The importance of serum sodium levels and the presence of ascites in the pediatric CB-839 ic50 setting remain to be clarified. A retrospective analysis of pediatric patients with cirrhosis on the transplant check details list was carried out

between October 2000 and February 2012. The primary objective of this study was to evaluate the association of pretransplant variables with mortality within 90 days following the inclusion of patients on the waiting list. In all, 522 patients were included in the study; 345 (66%) patients were under 1 year of age; 208 (40%) of the children presented ascites. A multivariate Cox proportional hazards analysis was conducted and total bilirubin (P < 0.001, hazard ratio [HR] = 2.09, 95% confidence interval [CI] = 1.35-3.21), selleckchem international normalized ratio (INR) (P < 0.001, HR = 9.83, 95% CI = 4.51-21.45), serum sodium levels (P = 0.03, HR = 0.96, 95% CI = 0.92-0.99), ascites (P = 0.001, HR = 2.59, 95% CI = 1.44-4.64), and categorized age (0-1 versus ≥1 year old) (P = 0.025, HR = 2.33, 95% CI = 1.11-4.86) were independently associated with risk of death in 90 days. Malnutrition (Z score height/age, weight/age) and serum albumin (pediatric endstage liver disease [PELD] formula) were not included in the final model.

Conclusion: The presence of ascites and serum sodium levels are important variables associated with decreased patient survival while candidates wait for a liver graft. Multicenter studies are necessary to validate these findings in order to improve current allocation policies based on the PELD score. (Hepatology 2014;59:1964–1971) “
“Based on the recently established role for the master coregulator MTA1 and MTA1-containing nuclear remodeling complexes in oncogenesis and inflammation, we explored the links between parasitism by the carcinogenic liver fluke Opisthorchis viverrini and this coregulator using both an Mta1−/− mouse model of infection and a tissue microarray of liver fluke–induced human cholangiocarcinomas (CCAs). Intense foci of inflammation and periductal fibrosis in the liver and kidneys of wild-type Mta1+/+ mice were evident at 23 days postinfection with O. viverrini. In contrast, little inflammatory response was observed in the same organs of infected Mta1−/− mice.

Conclusions:  Dietary FODMAPs induce prolonged hydrogen production in the intestine that is greater in IBS, influence find more the amount of methane produced, and induce gastrointestinal and systemic symptoms experienced by patients with IBS. The results offer mechanisms underlying the efficacy of the low FODMAP diet in IBS. Irritable bowel syndrome (IBS) is the most common disorder seen in gastroenterological

practice, affecting approximately 15% of the population.1 This condition is characterized by abdominal pain, bloating, wind, distension and altered bowel habit but with no abnormal pathology.2 It is often stated that diet has a major role in triggering symptoms. Dietary factors such as citrus fruits, cereals, dairy foods, some fiber, caffeine and alcohol have all been implicated3 but dietary trials have produced mixed results and in general have offered little guidance for the management of IBS. Recent work has identified a collection of short-chain carbohydrates

that are poorly absorbed in the small intestine, FODMAPs (Fermentable Oligo- Di- and Mono-saccharides And Polyols)4–6 as important triggers of functional gut symptoms. Open studies have suggested that three out of four patients with IBS will respond well symptomatically to restriction of FODMAP Alectinib intake,7 and a randomized placebo-controlled rechallenge trial confirmed that the benefit was likely to be due to reduction of FODMAP intake.8 Breath hydrogen testing helps identify which specific sugars behave as

FODMAPs in the individual.9 It has been hypothesized that FODMAPs trigger gastrointestinal symptoms in people with visceral hypersensitivity or abnormal motility responses10,11 largely by inducing luminal distension via a combination of osmotic effects and gas production related to their rapid fermentation by bacteria in the small and proximal large intestine.6 Indeed, a recent study in ileostomates showed that a diet high in FODMAPs increased the volume of liquid and fermentable load likely to be delivered to the proximal colon as postulated.12 The fate of the fermentable load is, however, less selleck products clearly defined. Fermentation will generate the gases hydrogen and carbon dioxide, but the rate and time course at which that occurs in response to FODMAPs, and the fate of the hydrogen liberated are not known. Hydrogen can diffuse in to the circulation to be excreted via the lungs, may be used to form methane by methanogens, and may be incorporated into volatile end-products such as acetate or sulfides.13,14 The amount of luminal distension induced will therefore depend at least in part on the disposal mechanisms of hydrogen atoms liberated during fermentation.

Conclusions:  Dietary FODMAPs induce prolonged hydrogen production in the intestine that is greater in IBS, influence selleck screening library the amount of methane produced, and induce gastrointestinal and systemic symptoms experienced by patients with IBS. The results offer mechanisms underlying the efficacy of the low FODMAP diet in IBS. Irritable bowel syndrome (IBS) is the most common disorder seen in gastroenterological

practice, affecting approximately 15% of the population.1 This condition is characterized by abdominal pain, bloating, wind, distension and altered bowel habit but with no abnormal pathology.2 It is often stated that diet has a major role in triggering symptoms. Dietary factors such as citrus fruits, cereals, dairy foods, some fiber, caffeine and alcohol have all been implicated3 but dietary trials have produced mixed results and in general have offered little guidance for the management of IBS. Recent work has identified a collection of short-chain carbohydrates

that are poorly absorbed in the small intestine, FODMAPs (Fermentable Oligo- Di- and Mono-saccharides And Polyols)4–6 as important triggers of functional gut symptoms. Open studies have suggested that three out of four patients with IBS will respond well symptomatically to restriction of FODMAP www.selleckchem.com/products/VX-809.html intake,7 and a randomized placebo-controlled rechallenge trial confirmed that the benefit was likely to be due to reduction of FODMAP intake.8 Breath hydrogen testing helps identify which specific sugars behave as

FODMAPs in the individual.9 It has been hypothesized that FODMAPs trigger gastrointestinal symptoms in people with visceral hypersensitivity or abnormal motility responses10,11 largely by inducing luminal distension via a combination of osmotic effects and gas production related to their rapid fermentation by bacteria in the small and proximal large intestine.6 Indeed, a recent study in ileostomates showed that a diet high in FODMAPs increased the volume of liquid and fermentable load likely to be delivered to the proximal colon as postulated.12 The fate of the fermentable load is, however, less selleck clearly defined. Fermentation will generate the gases hydrogen and carbon dioxide, but the rate and time course at which that occurs in response to FODMAPs, and the fate of the hydrogen liberated are not known. Hydrogen can diffuse in to the circulation to be excreted via the lungs, may be used to form methane by methanogens, and may be incorporated into volatile end-products such as acetate or sulfides.13,14 The amount of luminal distension induced will therefore depend at least in part on the disposal mechanisms of hydrogen atoms liberated during fermentation.

FD on individual probably turn out in different age, and recurrent of FD and unstable ‘Gut-Brain’ will impair the learning ability beyond school years.

In the interaction between gut and brain in adult brain takes a more dominant role, whereas in PI3K inhibitor infants and children often gut is dominating brain. Therefore, in the early development stage, a good gastrointestinal system is more important than a good brain. Key Word(s): 1. Children; 2. Functional Dyspepsia; 3. tossing and turning; 4. restless sleep; Presenting Author: JING TANG Additional Authors: JUN CHEN, YAN TAN Corresponding Author: JING TANG Affiliations: Affiliated to hospital of Hainan medical college; Affiliated hospital of Hainan medical college Objective: To study

the relationship between irritable bowel syndrome (IBS) and mental health. Methods: Selected cases were based on Rome III IBS criteria, all patients with disease duration of more than six months. The investigation group selected 65 cases of IBS from department of Gastroenterology in May to December 2012: 33 males and 38 females, aged 35.6 ± 19.0 years, including 41 cases of diarrhea-predominant, 11 cases of constipation, 13 cases of mixed. The control group of 60 healthy DAPT cases were from the region in the same period: 28 males, 32 females, aged 34.2 ± 14.2 years. The age, gender, education level in two groups were matched (p > 0.05). All cases were tested blood count, erythrocyte sedimentation rate, blood chemistry, stool routing, abdominal B ultrasound, barium meal or

colonoscopy examination, exclusion of organic disease, and no significant neurological history of mental illness and drug abuse history, willing to accepte psychological testing. 65 patients with IBS and 60 healthy controls were carried out Self-Rating Depression Scale (SDS), Self-Rating Anxiety, cale (SAS). Results: Most IBS patients suffered from psychological disorders. SDS, SAS scores in IBS patients were significantly higher (P < 0.05). The IBS cases somatization, obsessive-compulsive symptoms, depression, anxiety, paranoid ideation integral selleck chemicals and total scores were higher than the healthy control group. The difference between the groups was statistically significant (P < 0.05), and the other factor score was no significant difference. Conclusion: There is a certain degree of abnormal psychology in those IBS patients, so, psychological factors play an important role in the pathogenesis of IBS process. Severe anxiety, depression also indicates a poor prognosis and poor response to treatment in patients with IBS. Key Word(s): 1. IBS; 2. SAS; 3. SDS; Presenting Author: DONG YANYAN Additional Authors: LI YANQING Corresponding Author: LI YANQING Affiliations: Qilu Hospital Objective: Functional gastrointestinal disorders, including functional dyspepsia, irritable bowel syndrome and functional constipation are very common worldwide.

Antonius, Pontianak between January 2009 and December 2013. We evaluated 5912 patients undergoing endoscopic examination of the upper gastrointestinal tract for five years. Results: There were 988 eligible patients consisting of 589 (59, 62%) males and 399 females (40, 38%) ranged from 16–83 years old. The greatest occurrence was at the age group 40–49 (22, 87%). The endoscopy result showed that the most common cause of bleeding was erosive gastritis, which occurred in 675 (68, 31%)

cases, the other findings were 181 (18, 31%) cases of click here gastric ulcer, 46 (4, 65%) cases of duodenal ulcer, 33 (3, 34%) cases of portal hypertensive gastropathy, 21 (2, 12%) erosive esophagitis, 9 (0, 91%) cases of esophageal varices, 12 (1, 21%) cases of esophageal neoplasm and 11 (1, 111%) cases of gastric neoplasm. Conclusion: The greatest occurrence of upper gastrointestinal bleeding between January 2009 and December 2013 in St. Antonius General Hospital was at the age group 40–49 years. Male and erosive gastritis w ere the most common cause in this study, this finding is different compared with the etiology in Indonesian literature

which esophageal varices or gastropathy were the most common cause. Key Word(s): 1. endoscopic finding; 2. upper gastrointestinal bleeding; 3. erosive gastritis Presenting Author: MARGARET ELAINE J VILLAMAYOR Additional Authors: JOHN PAUL OLIVEROS, JASON CASTRO, MARK ANTHONY DE LUSONG, Src inhibitor WILMA BALTAZAR Corresponding Author: MARGARET ELAINE J VILLAMAYOR Affiliations: Philippine General Hospital, Philippine General Hospital, Philippine General Hospital, Philippine General Hospital Objective: This aims to present selleck chemicals llc a 17 year old Filipino male who presented for intermittent hematochezia for 2 years. Workups such as upper endoscopy, colonoscopy, Meckel’s scan, RBC tagging and CT angiography were all unremarkable. He was referred to our service for double balloon enteroscopy. Methods: There was a 2 × 2 cm pedunculated mass

with a 0.3 cm clean based ulcer was seen on its base located approximately in the distal jejunum. Exploratory laparotomy with resection of the mass was planned. Results: Intraop, findings showed a 4 cm outpouching in the antimesenteric border of the ileum about 115 cm from the ileocecal valve. There were no other palpable lesions on bowel run. On histopath, it was compatible with Meckel’s diverticulum, the specimen contained gastric and pancreatic tissues. Conclusion: Meckel’s diverticulum may contain ectopic tissues with gastric and pancreatic tissue occurring 60 and 6 percent at a time. It is usually located on the antimesenteric border of the ileum located within 100 cm from the ileocecal valve, although reports up to 180 cm have occurred. Hemorrhage is the most frequent complication.

Antonius, Pontianak between January 2009 and December 2013. We evaluated 5912 patients undergoing endoscopic examination of the upper gastrointestinal tract for five years. Results: There were 988 eligible patients consisting of 589 (59, 62%) males and 399 females (40, 38%) ranged from 16–83 years old. The greatest occurrence was at the age group 40–49 (22, 87%). The endoscopy result showed that the most common cause of bleeding was erosive gastritis, which occurred in 675 (68, 31%)

cases, the other findings were 181 (18, 31%) cases of selleck chemical gastric ulcer, 46 (4, 65%) cases of duodenal ulcer, 33 (3, 34%) cases of portal hypertensive gastropathy, 21 (2, 12%) erosive esophagitis, 9 (0, 91%) cases of esophageal varices, 12 (1, 21%) cases of esophageal neoplasm and 11 (1, 111%) cases of gastric neoplasm. Conclusion: The greatest occurrence of upper gastrointestinal bleeding between January 2009 and December 2013 in St. Antonius General Hospital was at the age group 40–49 years. Male and erosive gastritis w ere the most common cause in this study, this finding is different compared with the etiology in Indonesian literature

which esophageal varices or gastropathy were the most common cause. Key Word(s): 1. endoscopic finding; 2. upper gastrointestinal bleeding; 3. erosive gastritis Presenting Author: MARGARET ELAINE J VILLAMAYOR Additional Authors: JOHN PAUL OLIVEROS, JASON CASTRO, MARK ANTHONY DE LUSONG, p38 MAPK inhibitor WILMA BALTAZAR Corresponding Author: MARGARET ELAINE J VILLAMAYOR Affiliations: Philippine General Hospital, Philippine General Hospital, Philippine General Hospital, Philippine General Hospital Objective: This aims to present selleck screening library a 17 year old Filipino male who presented for intermittent hematochezia for 2 years. Workups such as upper endoscopy, colonoscopy, Meckel’s scan, RBC tagging and CT angiography were all unremarkable. He was referred to our service for double balloon enteroscopy. Methods: There was a 2 × 2 cm pedunculated mass

with a 0.3 cm clean based ulcer was seen on its base located approximately in the distal jejunum. Exploratory laparotomy with resection of the mass was planned. Results: Intraop, findings showed a 4 cm outpouching in the antimesenteric border of the ileum about 115 cm from the ileocecal valve. There were no other palpable lesions on bowel run. On histopath, it was compatible with Meckel’s diverticulum, the specimen contained gastric and pancreatic tissues. Conclusion: Meckel’s diverticulum may contain ectopic tissues with gastric and pancreatic tissue occurring 60 and 6 percent at a time. It is usually located on the antimesenteric border of the ileum located within 100 cm from the ileocecal valve, although reports up to 180 cm have occurred. Hemorrhage is the most frequent complication.