Consequently, the approach for neoadjuvant chemoradiation therapy prior to pancreaticoduodenectomy is gaining wider acceptance and more patients with pancreatic cancer will require pre-operative biliary drainage in the future. Current data unequivocally supports the use of SEMS for patients presenting with malignant biliary obstruction due to potentially resectable pancreatic cancer

undergoing neoadjuvant chemoradiation therapy. On the other hand, for patients who have Inhibitors,research,lifescience,medical resectable pancreatic cancer, many centers may consider to proceed with curative surgery upfront. In such cases where patients may be undergoing curative surgery without neoadjuvant therapy, SEMS or any other stents may not be warranted. Lastly, when the stage of disease Inhibitors,research,lifescience,medical and treatment plan are not completely defined at the time of diagnosis, the vast majority of patients with symptomatic malignant distal

bile duct obstruction may be best served by placement of SEMS rather than a plastic stent at the initial endoscopic intervention, due to the superior patency, lower rate of Inhibitors,research,lifescience,medical complications, and cost-effectiveness of SEMS. Acknowledgements Disclosure: The authors declare no conflict of interest.
A 27 year-old Hispanic female G1P0202 presented to the emergency room with severe abdominal pain. She described a 2 day history of worsening intermittent “crampy” pain located in the periumbilical region that was exacerbated with touch. She also reported 3 episode of non-bloody vomiting earlier that day. Review of systems was unremarkable. Past medical and surgical histories revealed a caesarean section of twins one month prior for premature rupture of membranes at 35 weeks. She denied any social or family histories. Vitals were within normal Inhibitors,research,lifescience,medical limits. The abdomen was soft with normal bowel sounds and focal tenderness BX795 elicited on palpation

of the right lower quadrant. On deep palpation a 3 cm hardened mass was found in the right periumbilical area. Laboratory findings revealed leukocytosis Inhibitors,research,lifescience,medical of 11.9 K (4.5-11.0 k/mm3). Complete blood count, coagulation profile, urine pregnancy, and basic (-)-p-Bromotetramisole Oxalate metabolic panel were unremarkable. Liver related tests were mildly elevated: ALT-113 (0-31 U/L), AST-76 (0-32 U/L), alkaline phosphatase of 124 (39-117 U/L), total bilirubin of 1.2 (0.0-1.0 mg/dL). A CT of the abdomen/pelvis with oral and IV contrast revealed possible volvulus. A repeat CT of the abdomen/pelvis with rectal contrast was then ordered for further characterization demonstrating a suspicious rounded area of low attenuation with peripheral high density (appendix) as a lead point consistent with an intussusception (Figures 1,​,2).2). The patient was taken to the operating room where an exploratory laparotomy was performed urgently to relieve the intussusception. A midline excision was made extending from the xiphoid to the pubic symphysis. The uterus, fallopian tubes, and ovaries appeared grossly normal.