Clinical Significance of Extraluminal Compressions according to the Site of the Duodenum

BACKGROUND/AIMS: Differentiating extraluminal compressions from true subepithelial tumors in the duodenum by endoscopy alone is difficult. Endoscopic ultrasonography (EUS) is one of the most useful diagnostic modalities for this purpose. Extraluminal compression in the duodenum is occasionally observed, but its clinical significance has not been reported. Therefore, the aim of this study was to evaluate the clinical significance of extraluminal compression in the duodenum according to lesion location. MATERIALS AND METHODS: We retrospectively evaluated 22 patients diagnosed as having extraluminal compression in the duodenum based on EUS findings between January 2006 and December 2017. Some patients underwent abdominal computed tomography for accurate diagnosis. RESULTS: The location of the extraluminal compression was the duodenal bulb in 10 cases, the superior duodenal angle in 10 cases, and the second portion of the duodenum in 2 cases. Of the 22 cases, 12 were caused by normal structures, including vessels, the right kidney, the gallbladder, and the pancreas, and 10 were caused by pathological lesions, including the hepatic cyst, remnant cystic duct and dilated common bile duct after cholecystectomy; gallstones, gallbladder polyps, remnant cystic duct cancer, and pseudomyxoma peritoneii. The anterior wall of the duodenum was the most frequent location of extraluminal compression. However, the lesions in the anterior wall of the duodenal bulb and superior duodenal angle showed a high frequency of pathologic lesions, including malignancy. CONCLUSIONS: If the extraluminal compression is found in the anterior wall of the duodenum, EUS is needed because of the high frequency of pathological lesions.

A Case of Duodenal Ganglioneuroma Manifesting as a Subepithelial Tumor

Ganglioneuroma of the gastrointestinal tract is a rare tumor that consists of ganglion cells, nerve fibers, and supporting cells of the enteric nervous system. Ganglioneuromas are usually associated with genetic disorders such as the multiple endocrine neoplasia syndrome or neurofibromatosis. Ganglioneuromas of the gastrointestinal tract predominantly involve the colon and rectum, and reports about duodenal ganglioneuromas are few. Herein, we report a case of duodenal ganglioneuroma treated with endoscopic resection. A 56-year-old female patient visited our hospital because of a subepithelial tumor in the second portion of the duodenum. She had no remarkable medical or family history and revealed no history of genetic disorders. Endoscopic ultrasonography and abdominal computed tomography revealed a tumor located mainly in the submucosal layer, without any regional lymph node involvement. Endoscopic resection of the lesion was performed, and the pathological examination confirmed a duodenal ganglioneuroma.

A Case of Gastric Mucormycosis Induced Necrotic Gastric Ulcer in Patients with Diabetic Ketoacidosis

Mucormycosis is a rare invasive disease with high mortality rates caused by fungi of the zygomycetes class and Mucorales order. Mucormycosis is manifested by a variety of clinical presentations according to the involved site and occurs in immunocompromised conditions such as diabetes mellitus and other conditions. Rhino-orbital-cerebral and pulmonary infection is known as commonly involved areas. Primary gastrointestinal mucormycosis is a very rare and life-threatening invasive fungal infection. Gastrointestinal mucormycosis may occur in any alimentary tract, with the stomach being most involved part. The early diagnosis and appropriate treatment including surgical debridement of involved tissues and antifungal agents is needed to improve survival rates. We report a case of gastric mucormycosis successfully treated with radical debridement and antifungal agents in a 45-year-old man with diabetic ketoacidosis.

A Case of Non ST Elevation Myocardial Infarction by Coronary Artery Focal Spasm in a Patient with Autosomal Dominant Polycystic Kidney Disease

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease. The main causes of death in ADPKD are cardiovascular disease as well as infections and neurological reasons. ADPKD is causing vasculopathy including aortic root dilation, cerebral artery aneurysm, coronary aneurysm, and aortic dissection. In this case report, we describe a 37-year-old female ADPKD patient with non-ST elevation MI (NSTEMI) caused by coronary artery focal spasm.

Perforation of Gastrointestinal Stromal Tumor in Small Bowel on an Elderly Patient Presenting Acute Abdominal Pain

Acute abdominal pain as a common complaint in elderly patients may differ from that in younger patients. In elderly patients, the diagnostic accuracy of acute abdominal pain is lower compared to that in younger patients. On the other hand, the mortality in elderly patients with acute abdominal pain is far higher than that in the younger patients. Therefore, early and correct diagnosis of acute abdominal pain for the elderly patients could significantly influence the outcome. In this report, we describe a case of a 84-year-old man with a ruptured small bowel gastrointestinal stromal tumor who presented at the Emergency Department with acute abdominal pain. Laparotomy was performed because perforation of a tumor in the jejunum was found by computed tomography. Diagnosis was confirmed by histopathology and immunohistochemistry. Therefore, small bowel disease should be considered when exploring the cause of acute abdominal pain in elderly patients.