A Case of Gastric and Colonic Submucosal Tumors after the Removal of 51 Anisakis Larvae / 대한내과학회지

A 60-year-old man visited the outpatient clinic complaining of spasmodic abdominal pain. The symptoms had started 4 days previously, within 1 hour of eating sliced raw flatfish (sashimi) and a piece of flatfish gut. Gastroscopy revealed generalized mucosal edema, erythema, multiple erosions, and numerous worms penetrating the gastric mucosa at the greater and lesser curvatures of the middle and lower corpora. Fifty-one worms, 0.5-3 cm in length, were successfully removed with biopsy forceps. Three weeks later, a normal mucosa-covered, 3.5-cm round submucosal tumor (SMT) was found on the greater curvature of the lower corpus and four yellowish, 1-cm SMTs were found on the hepatic flexure of the colon. Histopathological examination revealed marked eosinophilic infiltration in the gastric and colonic mucosa and an eosinophilic abscess in the submucosa. Here, we report a case of eosinophilic granuloma manifesting as SMTs in the stomach and colon after the endoscopic removal of a large number of anisakids.

Clinical Outcomes of Stercoral Colitis / 대한내과학회지

BACKGROUND/AIMS: Stercoral colitis is an inflammatory condition related to increased intraluminal pressure, itself caused by impacted fecal material. Stercoral colitis is a rare condition and has a generally poor prognosis. The aims of this study were to investigate the clinical characteristics and outcomes of stercoral colitis according to management strategy. METHODS: From January 2004 to August 2009, 11 patients were diagnosed with stercoral colitis at our center. The medical records of these individuals were reviewed retrospectively with regard to the clinical characteristics, management strategy, and clinical outcomes. We defined severe stercoral colitis as stercoral colitis complicated by systemic inflammatory response syndrome, sepsis, or septic shock. RESULTS: Eleven patients (three men and eight women) with a mean age of 70+/-8 years were included. Ten patients were elderly with constipation as a predisposing factor. Nine patients had severe stercoral colitis according to out criteria. Of these, five patients underwent surgery, and the other four were treated with a conservative management strategy. One patient (20%) in the surgical group and all patients in the conservative management group (n=4) died. CONCLUSIONS: Stercoral colitis should be considered in elderly patients with predisposing factors and presents as fecal impaction with colonic wall thickening or pericolic fat stranding on CT scan. In patients with severe stercoral colitis, early surgery may be effective in reducing mortality.

A Case of Pheochromocytoma that Initially Presented as Diffuse Alveolar Hemorrhage / 결핵및호흡기질환

A pheochromocytoma is a neuroectodermal tumor that originates from the chromaffin cells of the sympathetic system. Typical symptoms or signs are periodic attacks of paroxysmal hypertension, spell, palpitation, headache and sweating. However, the clinical presentation is quite variable. Therefore, an atypical clinical presentation sometimes makes a diagnosis difficult. Hemoptysis as a presenting symptom is very rare in pheochromocytoma. We recently experienced a patient with diffuse alveolar hemorrhage due to pheochromocytoma. A chest PA showed diffuse consolidation and ground glass opacities in both lungs. A chest CT showed diffuse consolidation and ground glass opacities in the central, middle and lower portion predominance of the lungs, sparing the costophrenic angles and apices of the lungs. In Korea, a case of pheochromocytoma that presented initially as massive hemoptysis due to diffuse alveolar hemorrhage has not been previously reported. We report the case with a review of the literature.

A case of lemierre syndrome poorly responsive to medical treatment / 대한내과학회지

Lemierre syndrome is a rare clinical condition that is characterized by anaerobic oropharyngeal infections leading to septic thrombophlebitis of the internal jugular vein and frequent secondary metastatic infections. The accurate diagnosis and treatment, for early stage disease, is important because it may be associated with a high mortality rate if untreated. We present the case of a 34-year-old man who presented with a history of typical for the diagnosis of Lemierre syndrome. Supportive care with antibiotics did not improve the clinical condition. The clinical course improved after treatment with IV anticoagulant and surgical thrombectomy. In addition, he had the antiphospholipid syndrome, which is known to be a common cause of acquired arterial or venous thrombosis. Therefore, in this patient the associated antiphospholipid syndrome might precipitate an internal jugular venous thrombophlebitis after an oropharyngeal infection or might account for the poor response to medical treatment.