A Case of Appendiceal Perforation Caused by Fishbone

On rare occasions, ingested foreign bodies make their way into the appendix, which can cause an inflammatory reaction with or without perforation. In addition, perforation of the appendix by a foreign body is relatively rare, however, it should be considered in atypical cases of peritonitis, intra-abdominal abscess, or mass, and intestinal obstruction. We experienced a case of appendiceal perforation caused by a fishbone, which presented as chronic abdominal pain and intra-abdominal abscess. A 57-year-old man presented with ambiguous lower right-side abdominal pain with fever for approximately one week. Abdominal computed tomography showed a foreign body in the appendix with abscess formation. Subsequently, a laparoscopic appendectomy was performed and histopathological examination confirmed perforated appendicitis with severe inflammation secondary to a foreign body.

Acute cholecystitis associated with Clonorchis sinensis infection

Clonorchis sinensis is one of the most common causes of trematodiasis that is caused by the ingestion of raw fish contaminated with infective cysts. The adult flukes are predominantly present in the intrahepatic bile ducts, but occasionally they may be found in the pancreatic duct and extrahepatic bile ducts. The clinical manifestations depend on the number of flukes, the period of infestation, and complications such as pericholangitic abscess, cholangitis, bile duct stones, and cholangiocarcinoma. However, primary acute cholecystitis associated with C. sinensis infection is extremely rare. Herein, we report on a case of primary acute cholecystitis associated with C. sinensis infection.

Regional Differences in Chronic Stress-induced Alterations in Mast Cell and Protease-activated Receptor-2-positive Cell Numbers in the Colon of Ws/Ws Rats

BACKGROUND/AIMS: There have been no reports on the effect of chronic psychological stress on colonic immune cells or the regional differences. We aimed to investigate the effect of chronic psychological stress on the number of mast cells and protease-activated receptor (PAR)-2-positive cells in the rat colonic mucosa. METHODS: Six-week-old and 14-week-old Ws/Ws rats, which lack mast cells after 10 weeks, were used as control and mast cell-deficient groups, respectively. The rats were divided into stress and sham-treated groups. Rats in the stressed group were exposed to water avoidance stress (WAS, 1 hour/day) for 13 days. Fecal pellet output and the number of mast cells and PAR-2-positive cells in colonic mucosa were compared between the WAS and sham groups. RESULTS: In 6-week-old rats, the WAS group showed a significantly higher number of mast cells compared to the sham group. In 14-week-old rats, mast cells were nearly absent in the colonic mucosa. WAS significantly increased PAR-2-positive cells in 14-week-old rats, but not in 6-week-old rats. Indirect estimation of PAR-2-positive mast cells in 6-week-old rats suggested that the majority of increased mast cells following WAS did not express PAR-2. WAS increased mast cells and PAR-2-positive cells mainly in the proximal colon. Fecal pellet output was continuously higher in the WAS group than in the sham group, and the difference was significant for both 6-week-old and 14-week-old rats. CONCLUSIONS: Chronic psychological stress increased the number of mast cells and PAR-2-positive cells in rat colonic mucosa, and these increases were more prominent in the proximal colon.

Effect of quercetin on apoptosis of PANC-1 cells / 대한외과학회지

PURPOSE: To investigate the chemotherapeutic effect of quercetin against cancer cells, signaling pathway of apoptosis was explored in human pancreatic cells. METHODS: Various anticancer drugs including adriamycin, cisplatin, 5-fluorouracil (5-FU) and gemcitabine were used. Cell viability was measured by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphe-nyltetra zolium bromide assay. Apoptosis was determined by 4'-6-diamidino-2-phenylindole nuclei staining and flow cytometry in PANC-1 cells treated with 50 microg/mL quercetin for 24 hours. Expression of endoplas mic reticulum (ER) stress mediators including, Grp78/Bip, p-PERK, PERK, ATF4, ATF6 and GADD153/CHOP proteins were measured by Western blot analysis. Mitochondrial membrane potential was measured by fluorescence staining with JC-1, rhodamine 123. Quercetin induced the apoptosis of PANC-1, which was characterized as nucleic acid and genomic DNA fragmentation, chromatin condensation, and sub-G0/G1 fraction of cell cycle increase. But not adriamycin, cisplatin, gemcitabine, and 5-FU. PANC-1 cells were markedly sensitive to quercetin. RESULTS: Treatment with quercetin resulted in the increased accumulation of intracellular Ca2+ ion. Treatment with quercetin also increased the expression of Grp78/Bip and GADD153/CHOP protein and induced mitochondrial dysfunction. Quercetin exerted cytotoxicity against human pancreatic cancer cells via ER stress-mediated apoptotic signaling including reactive oxygen species production and mitochondrial dysfunction. CONCLUSION: These data suggest that quercetin may be an important modulator of chemosensitivity of cancer cells against anticancer chemotherapeutic agents.

Application of single incision laparoscopic surgery for appendectomy in children / 대한외과학회지

PURPOSE: Recently, single incision laparoscopic surgery (SILS) has been popular in use with its progress studied for more minimally invasive surgery and cosmetic improvement. We investigated the feasibility and efficacy of SILS for appendectomy (SILS-A) in children and compare it with conventional laparoscopic appendectomy (C-LA). METHODS: We studied, retrospectively, adolescent patients who underwent C-LA or SILS-A. There were 25 patients in the C-LA group and 30 patients in the SILS-A group. The clinical outcomes were compared between the groups. RESULTS: The SILS-A procedures were performed successfully in adolescent patients . There were no significant difference between the C-LA and SILS-A group with respect to demographic data and post-operative outcomes. There was one complication (4%) in the C-LA group and two complications (6.6%) in the SILS-A group, but there was no significant difference. CONCLUSION: SILS-A was technically feasible and safe in children. Considering little postoperative scar and no difference in post-operative outcomes compared to C-LA, SILA could be applicable in adolescent patients. Larger studies and further technical implements will be necessary to assess the true benefit of this approach.

Comparison of Clinical Result between Early Laparoscopic Cholecystectomy and Delayed Laparoscopic Cholecystectomy after Percutaneous Transhepatic Gallbladder Drainage (PTGBFD) in more than 70 Years Old Patients with Acute Cholecystitis

PURPOSE: Operative management of acute cholecystitis in aged patients has been shown to have relatively higher morbidity and mortality. The aim of this study was to determine appropriate management protocols for acute cholecystitis in those more than 70 years old. METHODS: From May 2003 to Dec 2009, we performed this study of patients over 70 years old that were diagnosed with acute cholecystitis (n=257). We excluded patients that had a hepatobilliary malignancy, a previous laparotomy history, secondary cholecystitis, or a high operative risk factor (n=78). Eligible participants were divided into two groups according to the first management of acute cholecystitis. One hundred two of the 179 (group A) had undergone a laparoscopic cholecystectomy (LC) or open cholecystectomy (OC) within 48 hr after arriving at the emergency room; 77 of the 179 (group 2) had PTGBD done as the first management protocol. We divided group 2 into group C (n=47) and D (n=30) according to cholecystectomy or not. We compared clinical outcomes of the two groups. RESULTS: The mean age of patients was 77.5 years old (102 for Group A and 77 for Group B. Univariant analysis of pre-operative clinical findings between groups A and B showed a significant difference only in age and in type of acute cholecystitis, However, the pre-operative co-morbidity of group B was significantly higher than that for group A. Comparing postoperative results between groups A and C, postoperative complications, open conversion rate, and mortality after cholecystectomy were not significantly different. CONCLUSION: PTGBD could be considered as appropriate management in aged patients with acute cholecystitis. Moreover, PTGBD can reduce unnecessary cholecytectomies.

Changes in the Muscarinic Receptors on the Colonic Smooth Muscles of Rats with Spinal Cord Injury

OBJECTIVE: To investigate changes in (1) the colonic response to acetylcholine (Ach), (2) the muscarinic (M) receptors in the colon, and (3) the levels of colonic contraction-related proteins after a spinal cord injury (SCI). METHOD: We divided 16 Sprague-Dawley rats into 2 groups: the control group and the SCI group. A spinal cord transection was performed surgically at the T10 vertebral level. After 1 week, the entire colon was divided into 2 segments, the proximal and distal colon. Each segment was mounted in a longitudinal or circular muscle direction in a 10-ml organ bath. We determined the intergroup differences as percentage changes in contractility after Ach treatment alone, Ach treatment with M2 receptor antagonist (AQ-RA741) pretreatment, and Ach treatment with M3 receptor antagonist (4-DAMP) pretreatment. Western blot analyses were performed to determine the expression level of RhoA, and heat shock protein 27 (HSP27). RESULTS: Compared to the control rats, the SCI rats showed an increased response to Ach along both the directions in the proximal colon (p<0.05). Compared to the control group, in the SCI group, the Ach response was significantly different in the proximal segment under AQ-RA741 pretreatment (p<0.05) and in the distal segment under 4-DAMP pretreatment (p<0.05). Findings of the western blot analyses showed a significant decrease in the level of protein gene product 9.5 in the proximal and distal colon and a significant increase in the level of RhoA and HSP27 in the proximal colon of the SCI rats. CONCLUSION: Our results suggest that changes in colonic contractility after SCI are partly attributable to changes in the M receptor subtypes.

Primary adenosquamous carcinoma of the colon / 대한외과학회지

Adenosquamous cell carcinoma (Ad-SCC) of the colon is rare. The pathogenesis of Ad-SCC is unclear, however, several hypotheses have been suggested. The clinical presentation and gross findings of Ad-SCC of the colon are similar to those of adenocarcinoma of the colon, but Ad-SCC has a more aggressive clinical course and a poorer prognosis. We report on two cases of Ad-SCC of the colon with obstruction; a collision-type Ad-SCC that has not only obstruction but also numerous hepatic metastases, and a composite-type Ad-SCC treated with left hemicolectomy followed by an adjuvant chemotherapy.

Retrograde Jejunojejunal Intussusception Presenting as Hematemesis

Retrograde jejunal intussusception is a rare complication following gastric surgery. Unless this complication is suspected, diagnosis is very difficult. Early diagnosis is very important in preventing avoidable morbidity and mortality. Awareness of this rare complication would help in early diagnosis and appropriate management. We present a case of an 84-year-old woman who visited the emergency department with hematemesis. Endoscopy and a computed tomography scan revealed a retrograde jejunojejunal intussusception, which was treated by surgical manual reduction.

Change of Tetrodotoxin Sensitive Inhibitory Neural System of the Colon in Spinal Cord Injured Rats

OBJECTIVE: To investigate the effect of spinal cord injury (SCI) on contractions of whole colonic preparation isolated from rats under the inhibition of nitrergic inhibitory neural system using tetrodotoxin (TTX). METHOD: Twenty Sprague-Dawley rats were used. A complete spinal cord transection was performed surgically at the T10 cord level in spinal cord injured group. After 1 week of operation, sensory and motor functions were assessed and colon was removed under anesthesia for in vitro motility study. Whole colon was divided into four segments: proximal, two mid colon and distal colon. Each segment of colon was mounted with longitudinal direction in a 10 ml organ bath. After 1 hour of equilibration, frequency, area under the curve of spontaneous contraction and the response to acetylcholine (Ach), KCl and TTX were measured in each segment. Also the responses to Ach and KCl response under TTX pretreatment were measured. RESULTS: Enhanced contractile response to KCl solution (40 mM), TTX (1 micrometer) and Ach (10(-6) M) was observed in both group. There was no statistical difference in spontaneous, Ach and KCl induced contraction between control and SCI rats, but TTX induced contraction was decreased in SCI group than control group (p<0.05). In addtion, the Ach and KCl responses under the TTX pretreatment were significantly decreased in SCI group than control group (p<0.05). CONCLUSION: These results suggest that the change of colonic contractility after the SCI is caused by at least partly from the change of TTX related inhibitory neural system.

A Case of Asymptomatic Appendiceal Intussusception by Mucinous Cystadenoma / 대한소화기내시경학회지

Appendiceal intussusception has rarely been reported, and this has an incidence of 0.01% when performing appendectomy. It develops due to anatomical or pathological conditions such as polyps, worms, carcinomas, mucoceles or fecaliths. Patients with appendiceal intussusception present with various clinical symptoms from no symptoms to acute or chronic lower abdominal pain like that in appendicitis. Yet making the accurate preoperative diagnosis is sometimes difficult. Advanced colonoscopy has recently made it possible to arrive at the preoperative diagnosis and colonoscopy provides the optimal management of appendiceal intussusceptions that show various clinical symptoms. We report here on a 62-year-old woman who has no clinical symptoms of appendiceal intussusception, and the patient was preoperatively diagnosed by colonoscopy and managed with laparoscopic partial cecectomy. The final diagnosis was mucinous cystadenoma-induced appendiceal intussusception.

Small Bowel Obstruction Caused by Acute Invasive Enteric Anisakiasis / 대한소화기학회지

Anisakiasis usually occurs in the stomach and can easily be diagnosed by digestive tract endoscopy as opposed to enteric anisakiasis which is very rare and difficult to be diagnosed definitively. The most important and useful tool in diagnosing enteric anisakiasis is obtaining an accurate patient history of having eaten raw fish before the onset of symptoms. We report a case of small bowel obstruction caused by acute invasive enteric anisakiasis. A 60-year-old woman visited the emergency room suffering from sudden abdominal pain. She had eaten raw fish 1 day before the onset of symptom. Radiologic studies showed small bowel obstruction. However, no definitive cause could be found. An emergency laparotomy revealed edematous and dilated proximal jejunum and a focal stenosis of the distal jejunum. Segmental resection of the jejunum was performed, and histopathological examination revealed enteric anisakiasis. The patient was discharged on the 7th day after surgery following an uneventful course of recovery.

Application of Single Incision Laparoscopic Surgery for Appendectomies in Patients with Complicated Appendicitis

PURPOSE: Recently, single incision laparoscopic surgery (SILS) has been studied for its being less invasive surgery and having cosmetic improvement. We investigated the application of SILS for an appendectomy (SILS-A) in cases of complicated appendicitis and compare it with a conventional laparoscopic appendectomy (C-LA). METHODS: This study involved a total of 40 patients who underwent C-LA or SILS-A in patients with complicated appendicitis; 25 patients received a C-LA, and the other 15 patients received a SILS-A. The clinical outcomes and cosmetic results were compared between the groups. RESULTS: The SILS-A procedures were performed successfully in patients with complicated appendicitis, but 6 patients who underwent SILS-A needed an additional port for dissection and drainage. Clinical outcomes and postoperative complications were similar in both study groups. The SILS-A group showed significantly higher numbers of pain control than the C-LA group, and the one port SLLS-A group showed significantly better cosmetic result than the C-LA group. CONCLUSION: SILS-A is technically feasible and safe in patients with complicated appendicitis. However, SILS-A has more postoperative pain than C-LA, and more active pain control should be considered for patients undergoing SILS-A.

Laparoscopic Management of Appendiceal Intussusception Caused by Fecaliths

Appendiceal intussusception is a rare condition of abdominal pain. It develops as a result of various anatomic or pathologic conditions, such as polyps, worms, carcinomas, mucoceles, or fecaliths. Furthermore, an accurate preoperative diagnosis of appendiceal intussusception may be difficult. However, recently developed radiologic modalities, such as multidetector CT and laparoscopy, can considerably aid preoperative diagnosis and provide a means of adopting optimal minimally invasive surgery. Here, the authors describe the case of a 30-yr-old woman with the clinical features of acute appendicitis, who was preoperatively diagnosed as having appendiceal intussusception with fecaliths and who was managed by using a laparoscopic partial cecectomy.

Metastatic Small Bowel Perforation Caused by Intrahepatic Cholangiocarcinoma in a Patient with Combined Hepatocellular-cholangiocarcinoma

Advances in chemotherapy and radiation therapies for malignant tumors have resulted in the identifications of various novel features of intestinal metastasis. The common causes of small bowel metastasis are malignant melanoma and lung cancer, and this has also been rarely reported to uterine cervical cancer, malignant lymphoma of the larynx, malignant lymphoma of soft palate, and hepatocellular carcinoma (HCC). The Combined HCC-cholangiocarcinoma (HCC-CC) is a rare primary liver malignancy, and is composed of cells with the histopathological features of both HCC and CC, but metastatic small bowel perforation by CC in a patient with combined HCC-CC has not been reported previously. The authors describe the case of a 51-year-old man with a metastatic small bowel perforation caused by an intrahepatic CC in combined HCC-CC with a review of the literature.

Pelvic mass caused by gossypiboma / 대한산부인과학회지

Gossypiboma is referred to as surgical gauze or sponge left in the body of a patient inadvertently following surgery. There are two types of foreign body reaction in the body. The first type is exudative, with the resultant formation of an abscess with or without bacterial invasion and usually causes related clinical symptoms shortly after surgery. The second type is aseptic with extensive adhesions and encapsulating in a foreign body granuloma. Gossypiboma typically have an inconsistent radiologic appearance determined by the time, the type of material and the anatomical location. Furthermore, radio-opque markers are sometimes disintegrated or fragmented over times and ultrasound or CT may be indistinguishable from intra-abdominal abscess or tumor. We report 71-year-old woman in whom gossypiboma is severely adherent with ileal loop caused by pelvic mass.

Cystic Lesions in the Greater Tuberosity of the Humerus: The Relation to Rotator Cuff Tears and Age

PURPOSE: This study was designed to investigate the location of cystic lesions in the greater tuberosity of the humerus and the relationship to rotator cuff tears and age. MATERIALS AND METHODS: A total of 78 patients (age range, 19-82 years; mean age, 51 years) who underwent arthroscopy or open surgery after MR arthrography (MRA) for a painful shoulder were enrolled in the study. The location of the cystic lesions were classified as 'A' for a supraspinatus insertion site, as 'C' for an infraspinatus insertion site, as 'B' for both a supraspinatus and infraspinatus insertion site, as 'BG' for a site posterior to the bicipital groove and as 'P' for a site at the bare area of the humeral head. The location of cystic lesions and supraspinatus and infraspinatus tears were evaluated on MRA. Statistical analyses used the chi-squared test and logistic regression. RESULTS: 'BG' and 'A' cystic lesions were related to the presence of a supraspinatus tear, 'C' cystic lesions were related to the presence of an infraspinatus tear and 'B' cystic lesions were related to the presence of both supraspinatus and infraspinatus tears (p < 0.05). 'P' cystic lesions were not related to the presence of rotator cuff tears. The incidence of cystic lesions increased with age, but with no statistical correlation. CONCLUSION: Cystic lesions at the supraspinatus and infraspinatus insertion sites are useful to predict the presence of a rotator cuff tear, but cystic lesions were not age related.

A Case of Successful Laparoscopic Management on Appendiceal Bleeding Diagnosed by Colonoscopy / 대한소화기내시경학회지

Appendiceal causes of lower gastrointestinal bleeding are rare, and identification of the bleeding site is critical. Identification of the bleeding site can be difficult. The differential diagnosis of bleeding in the appendix includes diverticulum, appendicitis, angiodysplasia, Crohn's disease, and appendiceal intussusception, which leads to mucosal erosion and vascular exposure by underlying inflammation. Laparoscopic surgery is commonly performed as a therapeutic procedure for the appendix, also can be a valuable tool in the diagnosis and treatment of hemorrhaging from the appendix. Appendiceal bleeding is rare, and laparoscopic management cases are not widely reported. Herein, we report a case of successful laparoscopic management of appendiceal bleeding diagnosed by colonoscopy with a review of the literature.

16-Slice MDCT Arthrography of the Shoulder: Accuracy for Detection of Glenoid Labral and Rotator Cuff Tears

PURPOSE: We wanted to determine the diagnostic accuracy of 16-slice MDCT arthrography (CTA) for glenoid labral and rotator cuff tears of the shoulder. MATERIALS AND METHODS: We enrolled forty-five patients who underwent arthroscopy after CTA for pain or instability of the shoulder joint. The CTA images were analyzed for the existence, sites and types of glenoid labral tears and the presence and severity of rotator cuff tears. We determined the sensitivity, specificity and accuracy of CTA for detecting glenoid labral and rotator cuff tears on the basis of the arthroscopy findings. RESULTS: At arthroscopy, there were 33 SLAP lesions (9 type I, 23 type II and 1 type III), 6 Bankart lesions and 31 rotator cuff lesions (21 supraspinatus, 9 infraspinatus and 1 subscapularis). On CTA, the sensitivity, specificity and accuracy for detecting 24 SLAP lesions, excluding the type I lesions, were 83%, 100% and 91%, the total rotator cuff tears were 90%, 100% and 98%, the full thickness supraspinatus tendon tears were 100%, 94% and 96%, and the partial thickness supraspinatus tendon tears were 29%, 100% and 89%, respectively. CONCLUSION: 16-slice MDCT arthrography has high accuracy for the diagnosis of abnormality of the glenoid labrum or rotator cuff tears and it can be a useful alternative to MRI or US.

Fine Needle Aspiration Cytological Findings of Burkitt lymphoma: A Brief Case Report / 대한세포병리학회지

A case of Burkitt lymphoma diagnosed through fine needle aspiration cytology is described. A 66-year-old man presented with lymphadenopathy on the right cervical neck and axillary area. An ultrasonogram and CT scan for the cervical neck showed a multiple variable sized lymphadenopathy with pericapsular invasion and necrotic foci. Fine needle aspiration cytology (FNAC) of the cervical lymph nodes revealed very cellular and necrotic smears consisting of diffusely scattered intermediate monotonous round cells, tingible body macrophages and many mitotic figures. Histological features of the excised lymph nodes showed the classic morphological features of Burkitt lymphoma. Recognition of the characteristic cytological features can suggest the possibility of Burkitt lymphoma.