A Case of Phlebosclerotic Colitis in a Patient of Chronic Renal Failure / 대한소화기내시경학회지

Phlebosclerotic colitis is a rare disease sub-entity of ischemic colitis that is caused by venous obstruction due to colonic and mesenteric venous calcifications. Abdominal pain, diarrhea and hematochezia are frequent symptoms of phlebosclerotic colitis. The disease is characterized by typical dark purple mucosa on endoscopy, various venous calcifications on radiological findings, and microscopic findings showing fibrous degeneration, mucosal bleeding and venous wall thickening. A 64-year-old male who was undergoing maintenance hemodialysis was admitted to our hospital due to hematochezia. There was typical dark purple colored mucosa seen on colonoscopy, multiple abdominal calcifications were seen on radiology and diffuse necrosis and inflammatory changes were seen on the histophathology, but there was no mesenteric arterial occlusion seen on abdominal CT. On the basis of these findings, we diagnosed the patient as having phlebosclerotic colitis. To the best of our knowledge, this is the first reported case of phlebosclerotic colitis in Korea.

A Case of Primary Malignant Melanoma of the Esophagus / 대한소화기내시경학회지

Primary malignant melanoma of the esophagus is a rare, but aggressive tumor with a fatal prognosis. Hematogenous and lymphatic metastasis are common. The tumor has multiple black and pigmented lesions. Resection of the tumor with an anastomotic procedure is the treatment of choice. Despite this operation, the prognosis is quite poor with the mean life expectancy being less than 1 year. We describe here a case of a 54-year-old man with esophageal malignant melanoma, and we also include a review of the relevant literature.

A case of metronidazole induced encephalopathy in a cirrhotic patient / 대한내과학회지

Metronidazole induced encephalopathy is a rare disease caused by the antibiotic drug, metronidazole. Metronidazole is a nitroimidazole antibiotic used for anaerobic infections, Helicobacter pylori infection and spontaneous bacterial peritonitis. Metronidazole has good cellular penetration and is believed to penetrate the CSF and central nervous system. The incidence of metronidazole induced encephalopathy is unknown, though several previous studies have addressed brain changes caused by metronidazole neurotoxicity. Neurologic side effects include peripheral neuropathy, seizures, encephalopathy, dysarthria, and ataxia. We experienced a case of metronidazole induced encephalopathy, diagnosed by brain MRI in a patient with spontaneous bacterial peritonitis and performed follow-up imaging after discontinuation of metronidazole.

A Case of Pulmonary Mucormycosis Mimicking Bilateral Pulmonary Edema on Chest X-ray / 결핵

Pulmonary mucormycosis is an uncommon, but important opportunistic fungal infection associated with diabetes mellitus, leukemia, lymphoma and other immunocompromised states. Mucor species grow best in acidichigh glucose medium, which explaining the particular susceptibility of diabetic patient who are ketoacidic. Early consideration of this diagnosis, along with aggressive diagnostic evaluation, is critical to effective therapy and patient survival. We have experienced a case of pulmonary murcomycosis mimicking bilateral puimonary edema on chest X-ray that associated with diabetic ketoacidosis. A brief review of the literature was given.

A Case of Gastric Leiomyosarcoma with Bleeding / 대한소화기내시경학회지

Leiomyosarcoma accounts for 1-3% of all the gastric malignancies. The most common clinical presentation of gastric leiomyosarcoma is gastrointestinal hemorrhage due to tumor ulceration. Surgical resection is the treatment of choice for gastrointestinal sarcomas and the appropriate surgical management requires deliberate efforts for complete excision of the tumor with an adequate margin of normal tissue. A 70-year-old woman was admitted to our hospital due to a melena persisting for 7 days. A gastrofiberscopy was performed and a large normal mucosa covered lobulated mass with deep multiple round ulcers were found in the fundus. A slightly protruding vessel was visible on the base of the posterior wall of the fundus. An abdominal CT revealed a heterogenous mass with irregular multifocal necrotic portions in the fundus. During on operation, a tumorous mass was found in the fundus. The liver was free of metastasis and lymphadenopathy was not discovered. A total gastrectomy, omentectomy, and an end to end esophagojejunostomy were performed. The pathologic diagnosis determined a high grade leiomyosarcoma.