Autoamputation of a Giant Colonic Lipoma

Most colonic lipomas are asymptomatic and need no treatment, whereas lesions larger than 2 cm can cause acute abdominal pain, changes in bowel habits, gastrointestinal bleeding, intussusception or bowel obstruction. Autoamputation of polypoid lesions in the gastrointestinal tract is indeed a rare phenomenon, and its precise mechanism remains unknown. It presumably occurs due to ischemic necrosis of the polyp by peristalsis-induced torsion or tension. Here, we report a case of autoamputation of a giant colonic lipoma in a 48-year-old man. In our case, colonoscopic examination showed a huge autoamputated mass in the rectum and a remnant long stalk in the transverse colon. The autoamputated mass in the rectum was completely removed after fragmentation using an electrosurgical snare, and the remnant long stalk located in the transverse colon was also resected safely by endoscopic snare polypectomy. To our knowledge, these endoscopic treatments for removal of an autoamputated mass and a remnant long stalk of colonic lipoma have not been reported previously.

A Case of Recurrent Infection Caused by a Pancreaticoduodenal Fistula Associated with a Pancreatic Arteriovenous Malformation

Although arteriovenous malformations (AVM) occur frequently in digestive organs, pancreatic AVM is rare. The clinical symptoms of pancreatic AVM are variable and include gastrointestinal bleeding, abdominal pain, jaundice, portal hypertension, pancreatitis, and duodenal ulcer. However, choledochoduodenal or pancreaticoduodenal fistulas complicated with ascending infection and pancreatitis is extremely rare. Herein, we report a case of pancreaticoduodenal fistula associated with a pancreatic AVM that induced recurrent anemia and ascending infection.

A Comparison of Clinical Characteristics between Medically-treated Patients and Surgically-treated Patients with Ischemic Colitis

BACKGROUND/AIMS: Ischemic colitis (IC) is usually a self-limiting disease. But, it can cause necrosis that requires urgent surgical treatment. We sought to evaluate clinical difference in IC patients between medical and surgical treatment groups, and to identify prognostic factors for adverse outcomes. METHODS: We conducted a retrospective analysis of clinical characteristics in patients with IC treated in Chonnam National University Hospital between May 2001 and April 2010. A total of 81 patients with IC were enrolled. We classified the patients into two groups-a medical treatment group and a surgical treatment group-and evaluated their clinical features, treatment outcomes and mortality. RESULTS: Absence of hematochezia, vomiting, abdominal tenderness, abdominal rebound tenderness, heart rate over 90 beats/min, systolic blood pressure less than 100 mm Hg, hyponatremia and increased LDH or serum creatinine level were observed more frequently in surgically-treated patients (p<0.05). Most cases in the medically-treated group resolved without complications (98.3%). But, about half of the cases (52.4%) of the surgically-treated group resolved and the mortality rate was 47.6%. CONCLUSIONS: In patients with ischemic colitis, several clinical factors are associated with surgical treatment. Although IC is often selflimited, our data suggests that special attention and aggressive therapy is warranted in treating these patients.

A Comparison of Clinical Characteristics between Medically-treated Patients and Surgically-treated Patients with Ischemic Colitis

BACKGROUND/AIMS: Ischemic colitis (IC) is usually a self-limiting disease. But, it can cause necrosis that requires urgent surgical treatment. We sought to evaluate clinical difference in IC patients between medical and surgical treatment groups, and to identify prognostic factors for adverse outcomes. METHODS: We conducted a retrospective analysis of clinical characteristics in patients with IC treated in Chonnam National University Hospital between May 2001 and April 2010. A total of 81 patients with IC were enrolled. We classified the patients into two groups-a medical treatment group and a surgical treatment group-and evaluated their clinical features, treatment outcomes and mortality. RESULTS: Absence of hematochezia, vomiting, abdominal tenderness, abdominal rebound tenderness, heart rate over 90 beats/min, systolic blood pressure less than 100 mm Hg, hyponatremia and increased LDH or serum creatinine level were observed more frequently in surgically-treated patients (p<0.05). Most cases in the medically-treated group resolved without complications (98.3%). But, about half of the cases (52.4%) of the surgically-treated group resolved and the mortality rate was 47.6%. CONCLUSIONS: In patients with ischemic colitis, several clinical factors are associated with surgical treatment. Although IC is often selflimited, our data suggests that special attention and aggressive therapy is warranted in treating these patients.

Gastric Candidiasis in an Immunocompromised Host: A Case Report and Review of the Literature / 대한소화기내시경학회지

Candida albicans frequently inhabits the gastrointestinal tract of humans and this can lead to gastrointestinal candidiasis. Candida albicans infection of the gastrointestinal tract in normal or immunocompromised patients invariably involves the esophagus, with the typical finding of mucosal plaques. In contrast, gastric candidiasis is an uncommon phenomenon that usually occurs in immunocompromised hosts, andonly such eight cases have currently been documented in Korea. We report here on an additional case of gastric candidiasis in a 39-year old woman who had undergone craniotomy and chemotherapy for glioblastoma, and we review the medical literature related to this condition.

A Case of Large Retroperitoneal Lipoma Mimicking Liposarcoma / 대한소화기학회지

Lipomas are the most common benign tumors of adipose tissue among adults. Lipomas can occur almost anywhere in the trunk, extremities, mediastinum, and pelvis, but retroperitoneal lipomas are extremely rare. It should be distinguished from well differentiated liposarcoma in order to provide the appropriate treatment and follow up. We experienced a case of 60-year-old patient with large retroperitoneal lipoma mimicking liposarcoma causing palpable abdominal mass and pain. Abdominal computerized tomography (CT) showed 33x22 cm sized bulky fat-containing mass with contrast enhanced solid portion in right retroperitoneum. Positron emission tomograpgy (PET) revealed increased 18F-FDG uptake at solid portion shown in abdominal CT. Imaging studies confirmed a high index of suspicion on liposarcoma. Laparotomy showed a large encapsulating tumor arising from retroperitoneum with fat necrosis. Pathologic examination of resected specimen revealed normal mature adipocytes without atypical cells, compatible with lipoma.

A Clinical Study On Liver Abscess For Recent 15 Years In Gwangju-Chonnam Province / 대한내과학회지

BACKGROUND: The mortality of liver abscess markedly decreased because of the improvement of diagnosis and treatment modalities, however, the incidence is still high and various complications have been developed. Our study was to clarify the clinical features, complications, changing patterns of causative organisms and predicting parameters for development of complications in liver abscess. METHODS: We reviewed 197 cases of pyogenic and amebic liver abscesses treated at Chonnam University Hospital from January 1989 to March 2003. These cases were divided into subgroups by time of occurrence, and the data was reviewed comparatively. Predicting parameters for development of complications in recent 5 years were also analyzed. RESULTS: The male to female ratio was 1.59 : 1 and the peak incidence age of liver abscess was in the 7th decade. There were no significant interval changes in incidence of pyogenic liver abscess (96.4%) and amebic liver abscess (3.6%) from January 1989 to March 2003. The most common infection route in pyogenic liver abscess was biliary tract (45.8%), followed by cryptogenic cause (44.2%), pulmonary disease (2.6%), hematogenous (2.1%) and abdominal trauma (1.5%). The pus culture came out positive in 50.4% of pyogenic liver abscess. Klebsiella pneumoniae was the most commonly isolated organism in pyogenic liver abscess (32.9%). The significant predicting parameters for development of complications were age (>or=60), systemic inflammatory response syndrome (SIRS, >or=2 factors), C-reactive protein (CRP, >or=8 mg/dL), bilirubin (>or=2 mg/dL), albumin (or=200 IU/L, p<0.05). CONCLUSION: There were no significant interval changes in etiologies and predisposing conditions of liver abscess in Gwangju-Chonnam Province from January 1989 to March 2003. Age, SIRS, CRP, bilirubin, albumin and AST were considered as significant predicting parameters for development of complications in liver abscess.