A Case of Acute Appendicitis Diagnosed by Colonoscopy / 대한소화기내시경학회지

Most patients with acute appendicitis have typical symptoms and physical examination findings, yet some patients may have an atypical clinical presentation that is indistinguishable from other alternative conditions that are included in the differential diagnosis. The clinical role of colonoscopy for the diagnosis of acute appendicitis in these patients has not been investigated. Here, we describe the case of a 44-year-old man with acute appendicitis that was diagnosed with colonoscopy, which was performed 8 days after the development of abdominal pain, and colonoscopy demonstrated the frank pus drainage from the appendiceal orifice. An emergency laparoscopic partial cecectomy with an appendectomy was performed based on the colonoscopy findings. The microscopic findings were consistent with an acute suppurative appendicitis with periappendiceal adhesions, dense fibrosis and inflamed granulation tissue. This case highlights that timely colonoscopy may be helpful for the confirmation or exclusion of appendicitis when the clinical presentation is atypical.

A Case of Esophageal Tuberculosis as the Cause of a Fever of an Unknown Origin / 대한소화기내시경학회지

Fever of an unknown origin (FUO) means a fever that does not resolve spontaneously, and the cause remains elusive after an extensive diagnostic workup. The most common cause of FUO is infectious disease, and the most common infectious cause documented in Korea is tuberculosis, and particularly extrapulmonary or miliary tuberculosis. Among the extrapulmonary tuberculosis, esophageal tuberculosis is a very rare form of adult tuberculosis, and even in Korea with its high prevalence of tuberculosis. Esophageal tuberculosis can present as systemic symptoms such as weight loss, fever, chills and general weakness, or as local symptoms such as chest pain, dysphagia, cough and hematemesis. However, it can present as a prolonged fever of an unknown origin without any other symptoms. In this report, we describe a patient with esophageal tuberculosis, and the patient presented with a fever of unknown origin for 1 month. The patient was diagnosed by esophagogastroduodenoscopy with biopsy and he responded well to antituberculosis therapy.

A Case of Crohn's Disease with an Initial Presentation of Granulomatous Appendicitis / 대한소화기내시경학회지

Crohn's disease is a condition of chronic inflammation that potentially involves any location the in gastrointestinal tract; however, Crohn's disease with the primary lesion confined to just the appendix is very rare through out the world. Physicians may not be able the clinically differentiate Crohn's disease confined to the appendix from acute appendicitis, and it may not be distinguishable from granulomatous appendicitis of other causes, according to the histopathology. Therefore, clinical follow-up for assessing additional manifestations and sometimes further investigations are the only means of differentiating between granulomatous appendicitis of other causes and early Crohn's disease of the appendix. We experienced 26-year-old man who underwent ileocecectomy for a presumed diagnosis of an acute appendicitis, which pathologically resulted in a granulomatous appendicitis. The cause of the granulomatous appendicitis might have been Crohn's disease because the patient subsequently developed other manifestations of Crohn's disease, according to the follow-up colonoscopy findings.

A Case of a Myxoid Variant of a Pedunculated Extraluminal Gastrointestinal Stromal Tumor (GIST) in the Stomach / 대한소화기내시경학회지

Gastointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. They are frequently identified as incidental lesions found by routine endoscopy or in resection specimens that are removed for other reasons. The macroscopic morphology of GISTs may be classified as the intraluminal type, extraluminal type, mixed type and intramural type. The extraluminal type is the second most frequent tumor encountered, but a GIST pedunculated externally from the stomach is very rare. In addition, the myxoid epithelioid variant, which is characterized by an unusually myxoid stroma and epithelioid histology, is also a rare distinct subtype of a GIST that is closely correlated with negative immunoreactivity for c-kit. We report a case of a myxoid epithelioid variant of a pedunculated extraluminal GIST in a 62-year-old man that presented with an abdominal mass.

A Case of Colon Cancer Coexisting with Colonic Tuberculosis / 대한소화기내시경학회지

Patients with chronic inflammatory bowel disease have a potential risk for developing colorectal cancer. Simultaneous occurrence of tuberculosis and colon cancer at the same segment of the colon has been reported; however, there is little causal relationship between the two disorders. The occurrence of tuberculosis and an adenocarcinoma at the same segment of the colon may lead to a histological misdiagnosis of either lesion. Furthermore, it may be difficult to determine the correct radiological cancer staging before surgery, as tuberculous lymphadenitis may be misinterpreted as a lymph node metastasis of colon cancer. We report here a rare case of colon cancer coexisting with colonic tuberculosis at the same segment of the colon. In addition, we review the clinical characteristics of reported patients with similar conditions following a computerized search of KoreaMed and PubMed.