Congenital portosystemic shunts (CPSS) are rare vascular anomalies with portal blood bypassing hepatic filtration and subsequent various metabolic and developmental complications. Early diagnosis and timely intervention are crucial to prevent severe complications. We describe a 3-month-old boy with persistent jaundice and developmental delays. Laboratory tests revealed hyperbilirubinemia and elevated transaminases. Doppler ultrasound and contrast-enhanced computed tomography revealed a large intrahepatic PSS up to 25 mm in diameter with hypoplasia of the right liver lobe. Endovascular embolization was performed via transjugular approach. Postoperative migration of one coil into pulmonary artery required endovascular procedure. Gradual normalization of liver function tests, restoration of portal blood flow, regeneration of liver parenchyma and age-appropriate development were achieved. This case demonstrates technical feasibility and effectiveness of endovascular closure of large intrahepatic CPSS, even in infants. Key factors for successful outcomes include careful anatomical assessment, individual treatment plan and meticulous postoperative monitoring.

Current clinical evidence on biliary drainage predominantly focuses on intraoperative outcomes and single-point laboratory assessments, lacking comprehensive longitudinal functional curves and mechanistic insight into the pathways of complications. This study compares endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) with percutaneous transhepatic cholangial drainage (PTCD) in terms of hepatobiliary biochemical decline kinetics during days 0-7, drainage efficiency parameters, inflammatory-endotoxin temporal profiles, and 28-day stent patency-survival endpoints. Twenty-four pigs with surgically induced malignant obstructive jaundice were randomized to the EUS-HGS group (n = 12) or the PTCD group (n = 12). Daily monitoring included total bilirubin (TB), direct bilirubin, alkaline phosphatase, and γ-glutamyltransferase. Drainage volume and bile bilirubin concentrations were recorded daily. C-reactive protein (CRP), interleukin-6 (IL-6), and lipopolysaccharide levels were measured on days 0, 1, 3, 5, and 7, with bile cultures performed on days 0, 3, and 7. The EUS-HGS method demonstrated superior TB half-life (2.3 ± 0.4 vs 3.8 ± 0.6 days; β = -0.42; 95% CI: -0.68 to -0.16; P < 0.001) and a higher drainage efficiency index (5.2 ± 1.1 vs 3.1 ± 0.8 µmol/L/mL; P < 0.001). The 28-day stent patency rate was 91.7% for EUS-HGS and 58.3% for PTCD (hazard ratio = 0.31; 95% CI: 0.12-0.78; P = 0.013). The area under the curve for CRP was significantly lower in the EUS-HGS group (420 ± 95 vs 680 ± 120 mg·day/L; P < 0.001); IL-6 peaked earlier but resolved faster in the EUS-HGS group. Bacterial colonization occurred in 25% of EUS-HGS cases versus 50% of PTCD cases (P = 0.041). The EUS-HGS approach demonstrates superior bilirubin clearance kinetics, enhanced drainage efficiency, reduced inflammatory burden, and improved 28-day patency compared with PTCD, supporting the mechanistic advantages of the transgastric approach.

The coexistence of autoimmune pancreatitis and pancreatic adenocarcinoma represents a rare but clinically significant diagnostic dilemma. Elevated IgG4 levels and imaging features suggestive of autoimmune pancreatitis may mask an underlying malignancy, leading to potential delays in definitive diagnosis and treatment. This overlap highlights the limitations of relying solely on clinical, serologic, and radiologic findings in the absence of histopathologic confirmation. We report a case of pancreatic ductal adenocarcinoma occurring in the setting of suspected autoimmune pancreatitis (AIP), highlighting the diagnostic challenge of overlapping imaging and biochemical features and the potential coexistence of both entities. A 51-year-old patient presented with progressive jaundice and unintentional weight loss. Laboratory evaluation revealed cholestasis, elevated tumor markers including CA 19-9, and markedly increased serum IgG4 levels (340 mg/dL; reference range 4.8-105 mg/dL). Contrast-enhanced computed tomography revealed a diffusely enlarged, sausage-shaped pancreas, associated with a focal hypoattenuating lesion in the uncinate process, regional lymphadenopathy, and peritoneal nodularity with ascites. Assessment of the pancreatic ductal system using gadolinium-enhanced MRI and MRCP demonstrated irregular narrowing of the main pancreatic duct without significant upstream dilatation. Histopathologic examination confirmed pancreatic ductal adenocarcinoma. This case emphasizes that pancreatic malignancy may coexist with AIP, and should not be excluded despite characteristic imaging and biochemical findings.

Sickle cell-beta thalassemia, a compound heterozygous hemoglobinopathy, can be difficult to diagnose because clinical features and laboratory findings often overlap with other hematological disorders. We report a 26-year-old man from Assam who presented with eight days of progressive jaundice. Further evaluation revealed chronic hemolysis that had gone undiagnosed for years. He also reported one week of abdominal distension and generalized weakness. Clinical examination revealed pallor, icterus, and moderate splenomegaly. Laboratory evaluation demonstrated anemia (hemoglobin 6.3-7.9 g/dL), microcytosis, elevated lactate dehydrogenase, indirect hyperbilirubinemia, low serum haptoglobin, moderate splenomegaly and reticulocytosis, consistent with ongoing hemolysis. The direct Coombs test was negative, ruling out immune-mediated hemolysis. Infectious causes, including chronic malaria, were excluded, and serological tests for HIV, hepatitis B, and hepatitis C were negative. Blood and urine cultures showed no growth. Glucose-6-phosphate dehydrogenase (G6PD) levels and iron studies were within normal limits, excluding enzymopathy and iron deficiency. Hemoglobin analysis revealed hemoglobin S (HbS) 73.1%, fetal hemoglobin (HbF) 15%, hemoglobin A2 (HbA2) 6.3%, and reduced hemoglobin A (HbA), consistent with compound heterozygous sickle cell-beta thalassemia. Echocardiography demonstrated prominent left ventricular apical trabeculations, likely representing adaptive cardiac remodeling in response to a chronic high-output state. This case illustrates how systematic workup can identify compound hemoglobinopathies in patients with atypical presentations. The finding of HbS-β thalassemia in a patient from Assam is epidemiologically significant, as this compound hemoglobinopathy is extremely rare in this region, where HbE variants predominate. The cardiac findings might reflect cardiovascular changes from chronic, untreated anemia.

Leptospirosis is a zoonotic disease caused by Leptospira spirochetes. It is widespread worldwide, but remains uncommon in European countries. People who come into contact with water, soil, and animals, especially wild rodents, are at risk of infection. The course of the disease is usually mild, but severe cases presenting with multiorgan dysfunction are potentially fatal. When leptospirosis is suspected, rapid treatment is essential for avoiding life-threatening complications. This report discusses the case of a 51-year-old man who was admitted to the hospital with a history of several days of fever, weakness, vomiting, abdominal pain, and jaundice. His condition quickly deteriorated. Initial test results indicated acute liver and kidney injury and thrombocytopenia. Leptospirosis was considered when, upon further questioning, the patient reported the presence of rats in the kitchen where he worked. Serological tests supported the diagnosis of probable leptospirosis. Empirical treatment with ceftriaxone was effective as the patient's condition improved significantly. This case describes the dynamic course of severe leptospirosis, a disease that is very rare in Poland.

Cholestasis beyond infancy is uncommon and presents a diagnostic challenge. We report an 11-year-old girl presenting with severe pruritus followed by jaundice and a cholestatic biochemical profile with normal gamma-glutamyl transferase levels. Extensive evaluation excluded infectious, autoimmune, metabolic, and obstructive causes. Liver biopsy demonstrated bland cholestasis with preserved hepatic architecture. The patient showed complete clinical and biochemical recovery following supportive therapy with ursodeoxycholic acid. Although this represents a first documented episode, the findings are most consistent with a benign recurrent intrahepatic cholestasis-like phenotype. This case highlights the importance of considering inherited cholestatic disorders in older children with unexplained GGT-normal cholestasis.

Caroli-like disease is a rare congenital ductal plate malformation characterized by intrahepatic bile duct dilatation and has only rarely been reported in veterinary medicine. A 2-year-old castrated male small-breed dog (5.4 kg) was presented with jaundice, weight loss, and lethargy. Laboratory tests revealed elevated liver enzyme activities, hyperbilirubinemia, and coagulopathy. Radiography showed two mineralized opacities superimposed on the hepatic silhouette. Ultrasonography revealed cholecystolithiasis, gallbladder wall thickening, and biliary dilatation with choledocholithiasis, suggesting extrahepatic biliary obstruction. Computed tomography confirmed choledocholithiasis, diffuse biliary dilatation, and a 2- to 3-cm intrahepatic cystic structure containing calcified material and communicating with the intrahepatic bile ducts. Histopathological analysis revealed cholangiohepatitis with ductal proliferation, and immunohistochemical analysis confirmed the biliary epithelial origin of the lesion and supported a congenital ductal plate malformation. Despite surgical management, the patient died postoperatively. This case represents the first veterinary description of Caroli-like disease complicated by extrahepatic biliary obstruction in a young dog and highlights the fact that intrahepatic saccular dilatation may resemble gallbladder anomalies on ultrasonography, while computed tomography provides crucial diagnostic clarity. Recognition of such rare conditions may improve diagnostic accuracy and clinical decision-making in veterinary hepatobiliary disorders.

Fasciola hepatica is a trematode that is easily visible to the naked eye. It infects sheep and cattle, but can sometimes be an accidental host in humans. This review was carried out to review the published studies on human Fasciola hepatica in Türkiye and to systematically examine the data obtained from the studies. Literature search was conducted using keywords such as "Fasciola hepatica, Fascioliasis, Türkiye (Turkey)" from "Pubmed, Google Scholar, Google" databases. In addition, poster presentations presented at congresses of national infectious disease societies on the subject were also included in the study. Eighty-four studies published in Türkiye between 1993-2022 and 183 cases examined in these studies were included in the evaluation. In this review, it was found that Fasciola hepatica infection is not rare in Türkiye, but clinicians were not aware of this and did not consider this infection in the differential diagnosis. It is seen that diagnostic methods such as serological and stool microscopy are not used adequately due to the fact that Fasciola hepatica infection is not considered in the differential diagnosis and the diagnosis methods is not available in every center. As Fasciola hepatica infection is not considered in the preliminary diagnosis and these diagnostic methods are not used sufficiently, we see that cases are often confused with primary or metastatic liver tumors in abdominal imaging, and therefore unnecessary invasive procedures are performed. In regions where Fasciola hepatica infection is endemic, Fasciola hepatica infection should be considered before performing a major surgical procedure in patients with typical clinical findings, elevated liver and cholestasis enzymes, and eosinophilia, and characteristic computed tomography or ultrasonography findings, and noninvasive diagnostic methods should be used first.