An 86-year-old man was diagnosed with obstructive jaundice due to extrahepatic bile duct tumor. Percutaneous transhepatic biliary drainage (PTBD) was performed following failed transpapillary biliary drainage. The next day, a biliary metal stent was placed by rendezvous endoscopic retrograde cholangiopancreatography (ERCP) and a tube was also placed via the PTBD route. Two days later, a computed tomography scan showed emphysema in the abdominal wall where the PTBD tube was inserted. He was diagnosed with cellulitis. The PTBD tube was removed and incisional drainage was performed. Klebsiella oxytoca was cultured from the pus. He subsequently improved and was discharged 22 days after the rendezvous ERCP.

Tuberculous valvular endocarditis is rare and diagnosis before death is seldom achieved. A case of severe aortic regurgitation due to tuberculous endocarditis in a 56-year-old man is presented. Replacement of the aortic valve in emergency and administration of anti-tuberculuos medication permitted an uneventful recovery. This is a rare case report of successful surgical treatment of tuberculous valvular disorder.

A 77-year-old woman was referred to our hospital because of general malaise and appetite loss for 3 months. Contrast-enhanced computed tomography showed a gallbladder tumor and multiple tumors in the liver. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed for the gallbladder tumor. Histopathologically, the tumor was diagnosed as poorly differentiated adenocarcinoma. There were no complications of EUS-FNA. While waiting for the histopathological results of EUS-FNA, her appetite loss gradually became severe, so she declined systemic chemotherapy. She was discharged from the hospital 15 days after EUS-FNA. EUS-FNA for gallbladder lesions is useful when pathological diagnosis is required.

An 85-year-old man who developed sudden neck pain after ingesting walnuts visited our hospital. Computed tomography showed food impaction in the cervical esophagus. Upper gastrointestinal endoscopy revealed a walnut half that was not chewed at all in the cervical esophagus. The walnut half was pushed into the stomach with the endoscope and removed using a retrieval net. No strictures, neoplastic lesions, or ulcerations were found in the esophagus. The neck pain improved after the procedure.

An 83-year-old woman who vomited blood was taken to our hospital by ambulance. She was taking oral ticlopidine for chronic arterial occlusion of the lower extremities. Emergency upper gastrointestinal endoscopy revealed bleeding from a gastric polyp. Following endoscopic mucosal resection, the clinical course was uneventful and she was discharged 7 days after admission. Histopathology revealed that the resected gastric polyp was a hyperplastic polyp with no malignant findings.

An 86-year-old man diagnosed with distal cholangiocarcinoma was treated with uncovered biliary metal stent placement. The metal stent was occluded due to growth of the tumor into the stent. Although he underwent placement of two additional plastic stents in the metal stent, the plastic stents were also rapidly occluded. He was admitted and underwent transpapillary exchange of the plastic stents. Five days later, endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) was performed using a plastic stent. The patient had no recurrence of cholangitis thereafter and was discharged 42 days after EUS-HGS.

A man in his 80’s presented with sudden onset chest pain in the outpatient waiting room at our hospital and was diagnosed with acute myocardial infarction. Emergency coronary angiography was performed, and a drug-eluting stent was placed in the occluded right coronary artery. After the procedure, the patient developed high-grade fever (40°) with chills. Computed tomography revealed retroperitoneal and iliopsoas abscesses. The patient’s condition did not improve with the administration of antibiotics, so a drainage procedure was deemed necessary. Because of the stent, he was prescribed dual antiplatelet therapy (DAPT) with aspirin and prasugrel. Two days after stent placement, percutaneous abscess drainage was performed with the patient continuing DAPT. No bleeding occurred when a drainage tube was placed. The tube was withdrawn 19 days after insertion. He was then discharged 11 days after removal of the tube.

A man in his 50's was referred to our hospital for hematemesis and hematochezia. He had previously presented to another hospital for ulcerative colitis that was in remission with a prescription of 11 mg prednisolone and adalimumab. He also had a history of partial gastrectomy. Although detailed information on the gastrectomy was unavailable upon arrival at our hospital, contrast-enhanced computed tomography scan suggested that he had undergone a distal gastrectomy with Billroth II reconstruction. Emergency upper gastrointestinal endoscopy revealed an ulcer with an exposed blood vessel at the Braun anastomosis; thus, clipping hemostasis was performed. However, hematemesis occurred 3 days later, and another emergency upper gastrointestinal endoscopy revealed that the clips at the Braun anastomosis had deviated from the original position; therefore, clipping hemostasis was repeated to stop the bleeding from the exposed blood vessels. Subsequently, he was provided intravenous hyperalimentation, after which he resumed oral intake 14 days after the second clipping. No bleeding was observed after the second clipping, and he was discharged 22 days after admission.

Case 1: An 82-year-old man presented with fever and right hypochondralgia, and he was diagnosed with acute cholecystitis. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed on the day of admission. On hospital day 16, endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) was performed. The percutaneous drainage tube was removed on hospital day 22. Recovery was uneventful, and he was discharged on day 35. Case 2: A 72-yearold woman presented with fever and right hypochondralgia, and she was diagnosed with acute cholecystitis. PTGBD was performed the next day, and her general condition improved thereafter. She was diagnosed as having rectal cancer with liver metastasis, and we determined that invasion evaluated at cholecystectomy would possibly shorten survival time. We performed EUS-GBD on hospital day 10. The percutaneous drainage tube was removed on day 18 and her recovery was uneventful. She was discharged on day 39.

An 87-year-old woman developed anorexia and jaundice. Contrast-enhanced computed tomography revealed a tumor of the duodenal papillae. Percutaneous transhepatic biliary drainage was performed instead of transpapillary biliary drainage due to stenosis of the duodenum. She complained of pain at the insertion site of the percutaneous drainage tube, and endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CDS) was performed. A duodenal stent was placed 3 days later. The percutaneous biliary drainage tube was removed, and her recovery was uneventful. She was subsequently discharged. No further treatment for biliary or gastrointestinal tract system was needed. She died 146 days after EUS-CDS.