Cecal fecaloma due to intestinal tuberculosis: endoscopic treatment.

Colorectal fecaloma is a mass of accumulated feces that is much harder in consistency than a fecal impactation. The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site. Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, endoscopic procedures or a surgical intervention may be needed. We report here that a cecal fecaloma caused by intestinal tuberculosis scar was successfully removed by endoscopic procedures.

An effective instillation method for water-assisted colonoscopy as performed by in-training endoscopists in terms of volume and temperature.

BACKGROUND AND STUDY AIMS: There is general consensus that water instillation helps insert a colonoscope. However, the most effective method for water instillation has not yet been established, especially for endoscopists-in-training. The aim of this study was to determine volume and temperature for effective water instillation colonoscopy. PATIENTS AND METHODS: This is a prospective, randomized, controlled trial that was carried out at a single center, and a total of 207 consecutive subjects who underwent colonoscopic examination for health checkup were included in the study. Water instillation of supplied water was conducted under four different conditions: 100 and 300 ml at room temperature, 300 ml at 30 °C and no use of water instillation. The following parameters were recorded and analyzed: intubation success rate, independent predictors of successful intubation and intubation time to reach the cecum. RESULTS: The intubation success rate was not significantly different between individual groups. Independent predictors of successful intubation were younger age (P = 0.004) and later examined subjects (P = 0.016). The 300-ml warm water instillation during colonoscopy significantly reduced intubation time over the conventional method without water instillation (P = 0.034). CONCLUSIONS: Instillation of 300-ml warm (30 °C) water during colonoscopy can reduce cecal intubation time for in-training endoscopists without improving the intubation success rate.

[Endoscopic findings and clinical significance of portal hypertensive colopathy].

BACKGROUND/AIMS: The endoscopic findings and clinical relevance of portal hypertensive colopathy are not well described in Korea. We aimed to do a retrospective study of mucosal changes in the colon of patients with liver cirrhosis and to find their association with clinical characteristics. METHODS: We reviewed the clinical data and endoscopic findings of 48 patients with liver cirrhosis and 48 patients, matched for age and sex, with irritable bowel disease (IBS) who underwent colonoscopy over a 5 year span. RESULTS: Patients with liver cirrhosis were more likely to have colitis-like lesions and vascular abnormalities than IBS patients. Low platelet count (p=0.005) and severe esophageal varices (p=0.011) were associated with portal hypertensive colopathy, whereas the etiologies and severity of cirrhosis were not associated with these findings. CONCLUSIONS: Portal hypertensive colopathy can be defined with colitis-like lesions or vascular lesions. These lesions are more frequently present in patients with more severe esophageal varices and thrombocytopenia.

[Clinical aspects of intraabdominal cystic lymphangioma in Korea].

BACKGROUND/AIMS: cystic lymphangioma is an uncommon disease, and rarely develops in the intraabdomen. The aim of this article was to discuss about clinical characteristics of intraabdominal cystic lymphangioma developed in Korea. METHODS: age, sex, symptoms, locations and size of the lesions, diagnostic methods, treatments, complications and recurrence were analyzed in 13 pathologically confirmed cases of intraabdominal cystic lymphangioma and 18 cases of literature consideration reported in Korea. RESULTS: intraabdominal cystic lymphangioma commonly developed in adults compared to the other lymphangioma, and frequently located in the mesentery. Abdominal pain was the most common symptom, but it was a non-specific finding. Tenderness and abdominal mass were not significantly associated. The size of mass was diverse. Abdominal ultrasonography and abdominal CT were diagnostic tools most commonly used, but preoperative diagnosis was possible only in 22.6%. All patients were discharged without any complications, and no recurrence was reported. CONCLUSIONS: preoperative diagnosis of intraabdominal cystic lymphangioma is difficult and symptoms and signs are not specific. Intraabdominal cystic lymphangioma should be suspected in patients with non specific abdominal pain and intraabdominal mass and active diagnostic evaluation is mandatory.

[Clinical features of pyogenic liver abscess according to age group].

BACKGROUND/AIMS: Pyogenic liver abscess remains a major diagnostic and therapeutic challenge, despite advances in diagnostic technology and new strategies for treatment. This study was conducted to compare the differences in clinical features and outcomes of pyogenic liver abscess according to age. METHODS: In total, 166 patients were enrolled and included 63 (<65 years old, group I), 62 (65-74 years old, group II), 41 (>75 years old, group III) patients in each group. We reviewed the medical records retrospectively including etiology, underlying diseases, characteristics of the liver abscess, laboratory and microbiologic findings, treatment, and outcome of the patients. RESULTS: Group I had higher prevalence rates of male patients and chronic alcoholics, but lower prevalence rates of biliary disease, hypertension, and malignancy. In laboratory findings, group II had higher incidence of thrombocytopenia, elevated blood urea nitrogen and creatinine. There were no differences in symptoms and microbiologic findings in blood and pus among the three groups. Liver abscesses were more common in right liver in Group I. The lengths of stay and the treatment modalities were similar in three groups. CONCLUSIONS: Although there were differences in sex ratio, etiology, underlying disease among the different age groups, they did not cause difference in treatment and clinical outcome of pyogenic liver abscess. Thus, we recommend active treatments in patients of all age.

Spontaneous rupture of the lateral thoracic artery in patients with liver cirrhosis.

Bleeding in patients with liver cirrhosis is primarily caused by gastroesophageal varix in association with extensive collateral circulation, portal hypertensive gastropathy, a Mallory-Weiss tear and peptic ulcer disease. The spontaneous rupture of an artery, as a result of coagulopathy, is extremely rare in patients with liver cirrhosis; however, we recently observed a case of a spontaneous rupture of the lateral thoracic artery in a 47 year-old male patient with alcoholic liver cirrhosis. The patient expired despite repeated transcatheter arterial embolization of the lateral thoracic artery and best supportive care. This is, to our knowledge, the first documented case of the spontaneous rupture of the lateral thoracic artery in a patient with liver cirrhosis.

[Two cases of acute renal failure associated with nonfulminant acute hepatitis A].

We report two cases of acute renal failure in patients with nonfulminant acute hepatitis A. First case is a healthy 25 year-old man complained of myalgia and jaundice. Initial laboratory results showed BUN 40 mg/dL, creatinine 5.23 mg/dL, AST 2,220 IU/L, ALT 3,530 IU/L, total bilirubin 6.26 mg/dL, and positive anti-HAV IgM antibody. Supportive treatments including fluid therapy were started. Serum creatinine and total bilirubin levels were 7.98 mg/dL and 7.66 mg/dL respectively on the 5th hospital day, and decreased gradually. He was discharged on the 12th hospital day, and was being followed up in outpatient department. Second case is a 33 year-old woman who admitted for bilateral flank pain, high fever, nausea, and vomiting. She was diagnosed as acute pyelonephritis and acute hepatitis A. On admission, BUN 13 mg/dL, creatinine 0.74 mg/dL, AST 3,720 IU/L, ALT 2,280 IU/L, total bilirubin 0.9 mg/dL were noted, and acute renal failure developed next day. Fluid therapy with antibiotics administration were started, and maximal BUN and creatinine was 41.7 and 8.09 mg/dL respectively on the 8th day. She recovered without dialysis and was discharged on the 19th hospital day. Proper and prompt comprehensive supportive measures would decrease the need for dialysis in patient of acute renal failue associated with acute hepatitis A.

Hepatic abscess that formed secondary to fish bone and had a fistula with the ascending colon.

We present the case of a liver abscess that formed secondary to foreign bodies and formed a fistula the ascending colon and was successfully treated with percutaneous abscess drainage and colonoscopic removal of foreign bodies. A 64-year-old man presented with right upper and lower quadrant pain of 2 weeks' duration. Abdominal computed tomography was performed, demonstrating a single 3.5 x 1.9-cm abscess of the liver's right lobe and eccentric thickening of the colon wall at hepatic flexure. A percutaneous hepatic drainage catheter was placed under ultrasound guidance. Colonoscopic examination revealed multiple diverticula of the ascending colon and two 1.5-cm long fish bones at the ascending colon near the hepatic flexure. One end of each fish bone had impacted the edematous colonic mucosa and was surrounded by exudate polypoid inflammatory tissue. The fish bones were extracted with forceps. The patient was feeling well and was discharged after 12 days of treatment.

[A case of Henoch-Schönlein purpura with psoas muscle abscess and full-blown gastrointestinal complications].

Henoch-Schönlein purpura (HSP) is a vasculitis involving small vessels of skin, joints, gastrointestinal (GI) tract, and kidneys. The patients typically show palpable purpura with one or more characteristic manifestations including abdominal pain, hematuria or arthritis. HSP shows gastrointestinal symptoms in 50~85% of patients, and in 14~40% of patients GI symptoms precede purpuric rash which makes the diagnosis of HSP difficult. We present a case of Henoch-Schonlein purpura with GI bleeding, septic shock by ileal microperforation, small bowel obstruction as a result of ileal stricture and psoas muscle abscess.

Pancreatic metastasis and obstructive jaundice in small cell lung carcinoma.

Primary lung cancer frequently metastasizes to distant organs. The pancreas is a relatively infrequent site of metastasis. Furthermore, obstructive jaundice resulting from pancreatic metastasis is extremely rare. This paper examines the case of a 65-year-old woman with small cell lung cancer initially presenting with extrahepatic biliary obstruction. The patient underwent percutaneous transhepatic biliary drainage. The obstruction was relieved with a stent placement, then the woman was treated with combination chemotherapy (irinotecan, cisplatin) and a complete remission achieved in six months.

[Clinical features of acute hepatitis A in the Western part of Daejeon and Chungnam province: single center experience].

BACKGROUND/AIMS: There was an outbreak of hepatitis A in the western part of Daejeon with adjacent Chungnam province in the late 1990's. The aim of this study was to characterize the clinical features and courses of acute hepatitis A in this area. METHODS: A total of 177 cases, who were diagnosed as acute hepatitis A between June 2000 and December 2004, were reviewed retrospectively. RESULTS: The mean age was 26 and 96% of the cases were under 40 years old. The ratio of male to female was 1.2:1. There were two hospitalized cases in 2000, 3 in 2001, 73 in 2002, 60 in 2003, and 39 in 2004, respectively. The number of diagnosis was most prevalent in June (20.3%). Common occupations were students (62 cases) and homekeepers (21 cases). It was found that 51 patients experienced consumption history of raw fish or shellfish, and that 18 cases had history of exposure to contaminated underground water. Eighteen cases were infected by family members or friends. A history of travel to domestic areas was noted in 31 cases, and to overseas areas in 6 cases (especially Southeast Asia). Only four cases were vaccinated against hepatitis A. HBsAg was positive in 10 cases, and anti-HCV in 2 cases, but none of these had active diseases. The common symptoms were anorexia, jaundice and fatigue. The common ultrasonographic findings were fatty liver (68/157) and acute hepatitis (39/157). In most cases, ALT and total bilirubin level normalized within 8 weeks. No cases of fulminant hepatitis or death were observed. CONCLUSIONS: The majority of cases with acute hepatitis A were completely recovered without sequelae. It is necessary to investigate specific indications for hepatitis A vaccination either in this area or throughout Korea.

[Familial infestation of Paragonimus westermani with peritonitis and pleurisy].

Human paragonimiasis was endemic in Korea until the 1960's, and nowadays, the prevalence is decreasing. However, it is still one of the important helminthic diseases. Though it is essentially a pulmonary disorder, it may involve brain, muscle, mesentery, genital tract, pleura, peritoneum, spinal cord, spleen, and liver. We experienced two cases of paragonimiasis in a family who had ingested raw crabs together for 7 months. A 57-year-old female patient was admitted due to abdominal pain, diarrhea and tenesmus for 6 months. And, her 35-year-old son complained of cough, chest discomfort and dyspnea. The definite diagnosis for paragonimiasis could be made by the detection of the egg and adult worm from stool, sputum and involved lesion. Neither an egg or worm was detected. However, they were diagnosed based on the food history, laboratory data including serum eosinophilia, ELISA for specific IgG, pleural and peritoneal fluid examination, radiological findings, and intradermal tests. They were treated with praziquantel and their symptoms improved rapidly over 2 days. Both patients were asymptomatic at a follow-up visit 2 months later.