A Case of Bleeding Meckel's Diverticulum in a Patient with Crohn's Disease

Meckel's diverticulum is the most common congenital anomaly of the intestine. The association between Meckel's diverticulum and Crohn's disease is unclear. Meckel's diverticulum has previously been reported to be present in patients with Crohn's disease. However, the finding is typically incidental, and a bleeding Meckel's diverticulum in a patient with Crohn's disease is uncommon. Recently, we managed a 27-year-old man with known Crohn's disease who presented with hematochezia thought to be due to an ileal ulcer of Crohn's disease. At the time of intra-operative small bowel endoscopy, the hematochezia was shown to be due to bleeding from Meckel's diverticulum. Although the patient had already been diagnosed with Crohn's disease, we need to consider the possibility of other causes of bleeding.

A Case of Bleeding Meckel's Diverticulum in a Patient with Crohn's Disease

Meckel's diverticulum is the most common congenital anomaly of the intestine. The association between Meckel's diverticulum and Crohn's disease is unclear. Meckel's diverticulum has previously been reported to be present in patients with Crohn's disease. However, the finding is typically incidental, and a bleeding Meckel's diverticulum in a patient with Crohn's disease is uncommon. Recently, we managed a 27-year-old man with known Crohn's disease who presented with hematochezia thought to be due to an ileal ulcer of Crohn's disease. At the time of intra-operative small bowel endoscopy, the hematochezia was shown to be due to bleeding from Meckel's diverticulum. Although the patient had already been diagnosed with Crohn's disease, we need to consider the possibility of other causes of bleeding.

A Matched Case-Control Study Using the Propensity Score on Differences in the Characteristics of Colorectal Polyps between Younger and Older Koreans: Proximal Shift in the Distribution of Colorectal Polyps among Older Koreans

BACKGROUND/AIMS: Several studies have found that the frequency of colorectal polyps increases significantly from the age of 50 years. The goal of this study was to determine the differences in the clinical characteristics of colorectal polyps between patients aged 50 years and older, and younger patients. METHODS: The colonoscopy database of 3,304 patients at the Yeungnam University Medical Center between January 2009 and December 2009 was reviewed retrospectively. In total, 679 patients were divided into the younger group (n=170) and the older group (aged > or =50 years) (n=509). A matched case-control study was performed using propensity scores and 117 patients selected from each group. RESULTS: Compared to the younger group, the older group had a significantly higher proportion of female patients, and patients with hypertension, a smoking history, and a history of taking medications. After performing the matched case-control study, 234 patients and 679 colon polyps were included in the analysis. Compared to the younger patients, the older patients had a significantly higher proportion of multiple lesions (57.3% vs 25.6%, p<0.001), left- and right-side distribution (35.9% vs 12.0%, p<0.001), and larger polyps (mean 9.1 mm vs 6.3 mm, p<0.001). A left-sided distribution was less common in the older group than in the younger group (35.0% vs 51.3%, p=0.025). CONCLUSIONS: The methods used to screen for colorectal cancer in older patients should include colonoscopy due to the shift to the right side as a common location for colorectal polyps in that age group.

A Case of Peritoneal Seeding from a Ruptured Hepatocellular Carcinoma with Direct Invasion into the Stomach Causing Gastrointestinal Hemorrhage / 대한소화기학회지

Hepatocellular carcinoma (HCC) rarely invades the gastrointestinal (GI) tract. It occurs in 0.7% to 2% of clinical HCC cases. Moreover, gastric invasion with GI hemorrhage via peritoneal seeding is very rare. We report the case of 67-year-old woman who had a history of HCC rupture and was admitted due to left upper quadrant abdominal pain. The patient was diagnosed with three omental metastatic masses and underwent hepatic segmentectomy and omental tumorectomy. Two months later, the patient had massive melena, and an esophagogastroduodenoscopy showed very large ulcerated friable mass on the gastric body. The histology was consistent with the diagnosis of metastatic HCC. The patient died from persistent GI hemorrhage 93 days after the admission. This case illustrates the very rare event of peritoneal seeding of a ruptured HCC causing direct invasion of the stomach, followed by GI hemorrhage.

Spontaneous submucosal dissection of the entire esophagus in a healthy man / 대한내과학회지

Esophageal submucosal dissection can be caused by foreign bodies and endoscopic procedures. It rarely develops spontaneously. If a submucosal hematoma and false lumen are observed at esophagogastroduodenoscopy, the lesion will heal after 7 to 10 days of conservative treatment. A 71-year-old man with sudden-onset chest pain, dyspnea, and a small amount of hematemesis was examined using chest computed tomography (CT) and esophagogastroduodenoscopy. He was diagnosed with submucosal dissection of the esophagus. After 13 days of conservative treatment, esophagogastroduodenoscopy showed mucosal exfoliation and a healing ulcer, and he was discharged without complications.

A Case of Biliary Ascariasis Associated with a Common Bile Duct Stone / 대한소화기내시경학회지

Ascaris lumbricoides is the commonest intestinal parasite. The parasites are the most numerous intestinal parasites in less-developed countries and in areas with poor sanitation. However, it's prevalence is very low in Korea recently. A. lumbricoides produces no symptoms in most patients but sometimes it may give rise to intestinal obstruction or pancreatobiliary disease. Highly motile mature worms may enter the ampulla of Vater and migrate into the bile or pancreatic ducts and can cause cholangitis, biliary stone, cholecystitis, pancreatitis and liver abscess. The cases of biliary ascariasis are rare in Korea. We report a 59-year-old female, who presented with intermittent epigastic pain, diagnosed as biliary ascariasis associated with common bile duct stone after endoscopic retrograde cholangiopancreatography (ERCP). The common bile duct (CBD) stone was removed by sphincterotomy and lithotripsy, and then we directly removed ascaris with a basket without any complication.

Clinical Characteristics of Pancreatic Cancer According to the Presence of Diabetes Mellitus / 대한소화기학회지

BACKGROUND/AIMS: Pancreatic cancer is fatal with a dismal 6-month median survival from diagnosis. Diabetes mellitus is reported to be present up to 33.3 percent of patients with pancreatic cancer. The reason for the high frequency of diabetes is unknown. We studied the prevalence and duration of diabetes in patients with pancreatic cancer and the relationship between the two diseases. METHODS: A total of 152 patients with pancreatic cancer diagnosed at Yeungnam University Hospital from January 1999 to December 2001 were enrolled in this study. Clinical features, family history, smoking history, and characteristics of the tumor were compared between diabetic and non-diabetic groups. RESULTS: Among 152 patients with pancreatic cancer, 43 patients (28.3%) had diabetes. In diabetic group, mean age of diagnosis was significantly younger than non- diabetic group (62.0 +/- 7.2 vs. 65.0 +/- 8.8, p<0.05). Most of the patients with diabetes had non-insulin dependent diabetes mellitus (NIDDM) and did not have family history. Diabetes was diagnosed within 2 years after the diagnosis of pancreatic cancer in 35 patients (74.3%) of the diabetic group. There were no differences in the location and stage of tumor, chief complaints, presence of weight loss, and body mass index between the two groups. CONCLUSIONS: Diabetes mellitus occurs frequently in patients with pancreatic cancer and does not influence clinical features of pancreatic cancer. Pancreatic cancer should be suspected in patients with recent onset diabetes, especially in patients without family history of diabetes and with type of NIDDM.

Is Routine Second-Look Endoscopy Necessary for All Bleeding Peptic Ulcers? / 대한소화기내시경학회지

BACKGROUND/AIMS: Second-look endoscopy is generally performed to prevent rebleeding in patients with bleeding peptic ulcers. However, considering recent technologic advances of endoscopic hemostasis and decreasing rate of rebleeding, a small benefit with second-look endoscopy is suggested. Prospective study was carried out to evaluate the efficacy of second-look endoscopic examinations. METHODS AND RESULTS: One hundred thirty six patients with bleeding from peptic ulcer were included. Emergency endoscopic treatments consisting of the injection of hypertonic saline-epinephrine (HSE), band ligation and/or clipping were performed in patients with Forrest class I-IIb. They were scheduled to receive second-look endoscopy in 48 hours after initial endoscopy. Nine patients (6.6%) received endoscopic retreatment during second-look endoscopy and emergency endoscopic retreatment was required before scheduled endoscopy in six patients (4.4%) because of the evidence of rebleeding. Factors influencing retreatment were Forrest classification of initial endoscopy and methods of hemostasis. None of the patients with Forrest class IIb-III and the patients receiving endoscopic band ligation or clipping on initial endoscopy required retreatment during follow-up endoscopy. CONCLUSION: Routine second-look endoscopy may not be recommended after initial successful endoscopic treatment of peptic ulcer bleeding, especially in case of Forrest class IIb, IIc or III and in the patients treated with band ligation or clipping.

Ulcer healing effect of Helicobacter pylori eradication in patients with Helicobacter pylori-associated peptic ulcer / 대한내과학회지

BACKGROUND: Proton pump inhibitor-based triple therapy is effective first line treatment for Helicobacter pylori (H. pylori) infection. However, it is unclear that additional acid-suppression therapy should be continued for ulcer healing after eradication of H. pylori in patients with peptic ulcer diseases. We evaluated the effect of H. pylori eradication in the treatment of H. pylori-associated peptic ulcer diseases. METHODS: Eighty patients with endoscopically proven active peptic ulcers with H. pylori infection were randomized to receive either 1 week therapy of omeprazole 20 mg bid plus clarithromycin 500 mg bid plus amoxicillin 1000 mg bid alone (OCA group) or same regimen followed by 3 weeks of ranitidine 150 mg bid (OCAR group). Endoscopy, clinical assessments and urea breath test were performed after treatment. RESULTS: Overall healing rates of peptic ulcer after 4 weeks and 8 weeks of treatment were 89.7% and 97.4% in OCA group and 85.5% and 97.6% in OCAR group, respectively (p>0.05). The H. pylori eradication rates in OCA and OCAR group were 84.6% and 82.9%, respectively (p>0.05). Symptomatic relief rate after 4 weeks of treatment was 89.2% in OCA group and 92.5% in OCAR group (p>0.05). CONCLUSION: One-week OCA therapy without additional acid suppressing therapy seemed to be effective for the treatment of non-complicated H. pylori-associated peptic ulcer diseases. Further study will be necessary to evaluate the effect of H. pylori eradication in the treatment of peptic ulcer disease and factors affecting healing of the ulcer.