Intramural Gastric Abscess Caused by a Toothpick Presenting as a Subepithelial Tumor

In the present report, we describe an unusual case of an intramural gastric abscess caused by a foreign body, detected in the form of a subepithelial tumor. A 64-year-old woman was referred to our gastroenterology clinic for further evaluation of a gastric subepithelial tumor. The patient presented with a 1-month history of sustained dull epigastric pain. Esophagogastroduodenoscopy revealed an ill-demarcated, round, smooth, protruding lesion with a small central erosion on the great curvature of the proximal antrum. Endoscopic ultrasonography indicated the presence of an ovoid, heterogeneous, hypoechoic lesion with small echogenic foci located in the submucosa and muscularis propria layers. An abdominal computed tomography scan showed focal gastric wall thickening and regional lymph node enlargement. Endoscopic submucosal dissection was performed for definite diagnosis and management. Thus, we detected a toothpick and removed it using grasping forceps. The final diagnosis was an intramural gastric abscess caused by a toothpick.

Hypothermia-induced acute kidney injury in an elderly patient

Hypothermia, defined as an unintentional decline in the core body temperature to below 35degrees C, is a life-threatening condition. Patients with malnutrition and diabetes mellitus as well as those of advanced age are at high risk for accidental hypothermia. Due to the high mortality rates of accidental hypothermia, proper management is critical for the wellbeing of patients. Accidental hypothermia was reported to be associated with acute kidney injury (AKI) in over 40% of cases. Although the pathogenesis remains to be elucidated, vasoconstriction and ischemia in the kidney were considered to be the main mechanisms involved. Cases of AKI associated with hypothermia have been reported worldwide, but there have been few reports of hypothermia-induced AKI in Korea. Here, we present a case of hypothermia-induced AKI that was treated successfully with rewarming and supportive care.

A Case of Duodenal Obstruction Due to Intestinal Malrotation Diagnosed in Middle-aged Man

Intestinal malrotation occurs because of an arrest of normal rotation of the embryonic gut. It is often diagnosed in first month of life because of acute complications and requires surgical management. If it is not detected at a young age, it is diagnosed incidentally in advanced age. It is very rarely reported at advanced age with symptoms. In Korea in the last 30 years only about 10 such cases have been reported. In 2010, intestinal malrotation was reported at advanced age in only one case who had acute duodenal obstruction due to non-rotation of the pre-arterial segment of mid-gut. Therefore, we report a case of a 45-year-old man with non-rotation of pre-arterial segment with duodenal obstruction who had complained chronic and mild epigastric discomfort from a year ago.