A Case of Gastric Candidiasis Presented with Massive Gastric Bleeding / 대한소화기내시경학회지

Candida albicans is a saprophytic organism that frequently resides in the mouth, skin, gastrointestinal and vaginal mucosa. It is also an opportunistic pathogen in immune compromised individuals, alcoholics, and debilitated subjects treated with antibiotics, steroids, or antineoplastic drugs. Although the most common site of gastrointestinal involvement is the esophagus, gastric candidiasis may occur in immune suppressed patients and is rarely apparent in healthy individuals. Symptoms are nonspecific; indigestion, abdominal pain, fever and weight loss have been described. The diagnosis can usually be established by visualizing yeast and/or mycelial forms in endoscopic biopsy or in mucosal brushings of the lesions. A case of gastric candidiasis presented with bleeding was experienced in a 69-year-old female with chronic renal failure due to diabetic nephropathy. She underwent orthopedic surgery because of intertrochanteric fracture of her femur. On the 6th day of the postoperative period, the patient began suffering from a large amount of melena. Endoscopic findings revealed multiple whitish or central necrotic plaques in the body and antrum of the stomach. Endoscopic biopsy revealed budding yeast and pseudohyphae infiltrating through the ulcerated stomach wall. After the patient was treated with mycostatin for 7 days, endoscopic and pathologic findings did not show any evidence of the candidiasis. The case is herein reported of gastric candidiasis presented with gastric bleeding, along with a review of corresponding literature.

A Case of Atypical Ulcerative Colitis Initially Presented as the Appendiceal Lesion / 대한소화기내시경학회지

Ulcerative colitis (UC) is an inflammatory disease primarily involving the colonic mucosa. The extension of classic UC is uniform and continuous with no intervening areas of normal mucosa. The rectum is usually involved and the inflammation extends proximally in a continuous fashion for a variable distance. However, as more patients get colonoscoped, it had been reported that there is a wide spectrum to what is called UC. There appear to be a few patients with otherwise typical UC but with rectal sparing. And also there are patients with classic distal UC who have an isolated area of cecal disease and segmental UC with skipped area. We have experienced a case of atypical UC initially presented as a isolated lesion around the appendiceal orifice with the segmental distribution of inflammatory change without an active inflammatory lesion in the rectum. It was considered that understanding of the significance of an isolated lesion in the appendix would contribute to the elucidation of the pathogenesis of UC.

A Case of Hemobilia Associated with Spontaneous Gallbladder Hemorrhage / 대한소화기내시경학회지

Hemobilia is a hemorrhage into the biliary tract that may follow trauma (including surgical and percutaneous techniques in hepatobiliary system), aneurysms of the hepatic artery (and its branch), tumors of the biliary tract, hepatoma, inflammation, liver abscess, and gallstone disease. But, a case has not been reported involving of hemobilia associated with gallbladder hemorrhage without obvious predisposing factors or causes. A 62-year-old woman was admitted to Kyunghee Medical Center due to intermittent nausea, and right upper quadrant pain for 2 days before admission. She had no history of abdominal trauma. On the second and third day of her stay, she experienced melena of which the amount was about 300 ml. Abdominal ultrasonography revealed a gallbladder with a 8 mm sized cystic lesion attached to the fundus. Computed tomographic (CT) evaluation of the abdomen demonstrated a highly enhanced 7~8 mm sized nodular mass in the lumen of the gallbladder. The gallbladder, cystic duct, and CBD were dilated due to the filling of blood clots or sludge material. An ERCP was performed and bleeding from the papilla of Vater was confirmed. Subsequently, emergent laparoscopic cholecystectomy was conducted. Pathologic evaluation revealed a grayish-red gallbladder that had a ruptured vessel. The ruptured vessel showed a severe hypertrophic state but there was no evidence of vasculitis, aneurysm, arterio-venous malformation, or malignancy. The case is here in reported of hemobilia associated with spontaneous gallbladder hemorrhage.