A Case of Sigmoid Intussusception Diagnosed by Sigmoidoscopy / 대한소화기내시경학회지

Intussusception most commonly occurs in children, and in more than 90% of cases, no cause is found. In contrast, intussusception in adults is relatively rare but over 90% of patients have an organic lesion as the cause. Only 5% of cases of intussusception occur in adults and most involve the small intestine and are benign, whereas colonic intussusceptions are usually malignant. We report here a case of a 70-year-old man with intussusception who was referred with a one-day history of hematochezia and abdominal pain. The intussusception was caused by a sigmoid colonic tumor. The CT findings suggested that we could reasonably proceed to a sigmoidoscopy to confirm the site of obstruction. We speculated that the sigmoid colon tumor induced the anterograde intussusception. As with our patient, it is important to recognize the need to diagnose the primary lesion exactly and promptly.

Detection of Liver Metastases and Recurrence Using PET-CT Scan in a Patient with Rectal Cancer / 대한소화기학회지

No abstract availble.

Hemolytic Uremic Syndrome Following a Severe Colitis

The hemolytic uremic syndrome consists of microangiopathic hemolytic anemia, acute renal failure, and thrombocytopenia following a prodromal illness of gastroenteritis or upper respiratory infection. Sometimes, the syndrome can present in a dramatic fashion with severe abdominal pain and signs of intestinal obstruction, suggesting an intussusception or acute surgical crisis. A 2-year-old girl with a 3-day history of several episodes of bloody-mucoid diarrhea and severe abdominal pain was admitted under suspicion of intussusception. Her symptoms started 4 days after eating a pork and X-ray revealed the distended small bowel without a large bowel gas pattern. Colitis without perforation was found by abdominal ultrasonogram and sigmoidoscope. Unfortunately, she became pallor, puffy, and oliguric 7 days later. Clues to the diagnosis of hemolytic uremic syndrome in the early stages of the acute illness were oliguria, abnormal peripheral blood smear, anemia despite dehydration, and proteinuria. The onset is usually preceded by symptoms of gastroenteritis, such as fever, vomiting, abdominal pain, and bloody diarrhea. This is followed in 5 to 10 days by a sudden onset of pallor, irritability, weakness, lethargy, and oliguria. The majority of patients recover normal renal function with aggressive management of the acute renal failure. Careful medical management of the hematologic and renal manifestations, in conjunction with early and frequent peritoneal dialysis, offers the best chance of recovery from the acute phase. The present patient was recovered by apropriate fluid and electrolyte management, transfusions of packed RBCs, fresh frozen plasma, and early application of peritoneal dialysis.

A Case of Pseudomembraneous Colitis by Clostridium Perfringens / 대한소화기내시경학회지

A 62-year-old female was adrnitted to the Catholic University Hospital of Taegu-Hyosung with an intracerebral hemorrhage. She was operated on successfully, but developed bacterial pneumonia. She was then treated with sulperazone, tobramycin, and metronidazole for 1 month. After the antibiotic treatment, she suffered from a fever and bloody, mucoid diarrhea for 3 days, and was examined with a sigmoidoscope. The sigmoidoscopic examination revealed yellow patches of ulcerations and swelling covered with thick sero- sanguinous exudate in the distal transverse colon and sigmoid colon. A latex agglutination test for C. was performed on her stool, whereby difficile cytotoxin was negative, however, metronidazole resistant C. perfringens was isolated from anaerobic culture of the biopsied colon tissue. She recovered with 15 days using oral vancomycin treatment. The possibility of C. perfringens as a causative organism of pseuclomernbraneous colitis was discussed.

Do We Have a Good Patient's Position for Sigmoidoscopy?

Sigmoidscopy is thought to be one of the basest and most essential tools for evaluation of colorectal patient because it could be performed in an out patient clinic with only minimal bowel preparation. AIM: The aim of this study was to assess the patient's best position for sigmoidoscopy. MATERIALS AND METHODS: Between March 4, 1997 and April 18, 1997, all patients who visited the colorectal clinic at the Dept. of Surgery, Korea Veterans Hospital were alternately underwent sigmoidoscopy in these four different positions: supine(S), left lateral(L), right lateral(R), and jack-knife(J). Sigmoidocopy was routinely performed for all patients who had lower gastrointestinal problems and was done by two well traind surgeons who had performed more than 100 sigmoidoscopies previously to this study, The patients who could not be tolerate insertion of the total length (60 cm) of the sigmoidoscope due to poor bowel preparation and/or complete obstruction by a mass were excluded. We evaluated the patient's complaints according to minimal, moderate, and severe discomfort and time between start and complete insertion of the 60 cm length of the sigmoidoscope. Statistical analysis was performed by an appropriate Anova test and Fisher's exact test. RESULTS: There were no differences among these four groups relative to age(5; 58.0+/-12.7, L; 64.3+/-10.0, R; 62.0+/-10.1, J; 56.0+/-12.9), gender(5; 76%, L; 70%, R; 72%, J, 83%,male ratio), degree of discomfort (mild: 42.9% (5), 50% (L), 33.3%(R), 66.7%(J), moderate: 42.9%(5), 34.6%(L),25%(R), 13.3%(J), severe: 14.3%(5), 15.4%(L), 41.7%(R), 20%(J)) and duration of insertion of the sigmoidoscope(5; 264.4 +/-192.9, L; 226.5 +/-267, R; 301.6+/-361.3, J; 202.5 +/-117.8 seconds). Also, there were no statistical significances between the two groups according to the surgeon who performed the procedure. CONCLUSION: The best position for sigmoidoscopy does not depend on the patient's position. Therefore, allowing the patient to change his position during the procedure would be the best way for an easy and comfortable sigmoidscopy.