ABSTRACT
Endoscopic variceal ligation is the preferred endoscopic treatment method for esophageal variceal bleeding. The incidence of complications such as chest pain, bleeding, stricture formation, and aspiration pneumonia is low. We report a case wherein a malfunctioning multiple-band ligator could have potentially caused damage to the esophageal varices and massive bleeding. The equipment was safely removed using scissors and forceps. To the best of our knowledge, this is the first published report detailing the management of a case of esophageal variceal bleeding.
ABSTRACT
Endoscopic ultrasound-guided fine-needle aspiration is used for the diagnosis and evaluation of rectal and pelvic lesions in lower gastrointestinal tract disease. However, it is not used widely in proximal and transverse colon disease because of the limited visual field and technical problems related to an oblique-viewing echoendoscope. Here, we report a case of recurrent signet-ring-cell gastric adenocarcinoma involving the transverse colon not diagnosed by repeated colonoscopic biopsies that was eventually diagnosed using a forward-viewing echoendoscope with fine-needle aspiration biopsy.
Subject(s)
Adenocarcinoma , Biopsy , Biopsy, Fine-Needle , Carcinoma, Signet Ring Cell , Colon, Transverse , Diagnosis , Lower Gastrointestinal Tract , Neoplasm Metastasis , Visual FieldsABSTRACT
Endoscopic ultrasound-guided fine-needle aspiration is used for the diagnosis and evaluation of rectal and pelvic lesions in lower gastrointestinal tract disease. However, it is not used widely in proximal and transverse colon disease because of the limited visual field and technical problems related to an oblique-viewing echoendoscope. Here, we report a case of recurrent signet-ring-cell gastric adenocarcinoma involving the transverse colon not diagnosed by repeated colonoscopic biopsies that was eventually diagnosed using a forward-viewing echoendoscope with fine-needle aspiration biopsy.
Subject(s)
Adenocarcinoma , Biopsy , Biopsy, Fine-Needle , Carcinoma, Signet Ring Cell , Colon, Transverse , Diagnosis , Lower Gastrointestinal Tract , Neoplasm Metastasis , Visual FieldsABSTRACT
BACKGROUND/AIMS: Autoimmune pancreatitis (AIP) often occurs with obstructive jaundice in old age in cases of weight loss, mimicking pancreatobiliary cancer. This study aimed to determine the sensitivity and specificity serum IgG, IgG4 and CEA, CA 19-9 levels for the diagnosis of AIP and their ability to distinguish AIP from pancreatobiliary cancer. METHODS: The level of serums IgG, IgG4 and CEA, CA 19-9 were measured in 413 patients including 125 with AIP, 201 with pancreatic cancer, and 87 with cholangiocarcinoma. RESULTS: Among AIP patients, 43.2% (54/125) showed elevated IgG levels (> or =1,800 mg/dL) and 52% (65/125) showed elevated IgG4 levels (> or =135 mg/dL). Sensitivity and specificity of elevated serum IgG for diagnosis AIP were 43% and 88% respectively, and 52% and 97%, respectively for elevated serum IgG4. When the cut-off value of serum IgG4 was raised to 270 mg/dL (twice the upper limit of normal), the specificity improved to 100%. About 25% of the AIP patients showed an increased level of CA 19-9 at >37 U/mL and about 12.2% of them showed an increased level of CA 19-9 at >100 U/mL. On the contrary, only 1.8% of the AIP patients showed an increased level of CEA at >6.0 ng/mL. CONCLUSIONS: To avoid unnecessary surgeries resulting from a misdiagnosed pancreatobiliary cancer as opposed to AIP, it is necessary to consider both serum immunoglobulin and tumor marker. In particular, because high level of IgG4 (> or =270 mg/dL) and CA19-9 (>100 U/mL) are relatively rare in pancreatobiliary cancer and AIP, respectively, they will be helpful in differential diagnosis.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Autoimmune Diseases/blood , CA-19-9 Antigen/blood , Carcinoembryonic Antigen/blood , Cholangiocarcinoma/blood , Diagnostic Errors , Immunoglobulin G/blood , Pancreatic Neoplasms/blood , Pancreatitis, Chronic/blood , ROC Curve , Biomarkers, Tumor/bloodABSTRACT
Bleeding is the most common and serious complication of thrombolysis in ST elevation myocardial infarction. Most bleeding cases are associated with an intervention or operation, but spontaneous bleeding such as gastro-intestinal bleeding or intracranial hemorrhage can happen. This is a report on the case of a 76-year-old female patient with retroperitoneal hemorrhage due to spontaneous right colic artery branch bleeding after thrombolysis in ST elevation myocardial infarction.