A 67-year-old man with complaints of dark red stools was admitted to the hospital. Capsule endoscopy, computed tomography enterography (CTE) with amidotrizoic acid meglumine solution (AM), and transanal double-balloon enteroscopy revealed a diverticulum in the ileum, which was accompanied by an ulcer in the vicinity. A partial ileal resection was performed laparoscopically, and the intraoperative and pathological findings indicated that the patient had a duplicated intestinal tract. Intriguingly, we identified a few reports on preoperative diagnosis of ileal duplication;however, we experienced such a case wherein the combination of capsule endoscopy and CTE using AM aided in its diagnosis.

A 72-year-old male patient with jaundice and hilar bile duct stenosis, initially suspected to have cholangiocarcinoma, was referred to our hospital. Subsequent cholangiography revealed bile duct stenosis improvement, and intraductal ultrasonography demonstrated homogeneous bile duct wall thickening. The increased serum immunoglobulin G4 (IgG4) levels and the presence of other organ lesions possibly indicated to IgG4-related sclerosing cholangitis (IgG4-SC). After 2 months, the patient developed acute cholecystitis. Endoscopic ultrasonography revealed circumferential wall thickening that extended from the common bile duct to the cystic duct. Cholangiography demonstrated cholecystic duct stenosis. The cholecystitis might have originated from bile stasis caused by cystic duct stenosis associated with IgG4-SC. Consequently, both IgG4-SC and the cholecystitis improved with steroid treatment.

A 74-year-old male patient with upper abdominal pain visited the outpatient clinic. A computed tomography scan revealed pancreatic enlargement, increased density of the surrounding fatty tissue, and retroperitoneal emphysema, which collectively indicated to emphysematous pancreatitis. Upper gastrointestinal endoscopy revealed no gastrointestinal perforation. His treatment regimen included fasting, fluid replacement, antibiotics, and total parenteral nutrition. Temporary encapsulation was observed, but eventually improved. A common bile duct stone was later discovered, and thus endoscopic lithotripsy was performed. Acute pancreatitis-induced retroperitoneal emphysema is referred to as emphysematous pancreatitis and is considered a subtype of necrotizing pancreatitis. Emphysematous pancreatitis is a rare disease with a poor prognosis;nonetheless, early diagnosis including confirmation of gastrointestinal perforation, and antibiotic administration along with drainage are required.