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Volume 43(1); July 2011
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Esophageal Perforation after Change of a Percutaneous Endoscopic Gastrostomy Tube
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Seong Wook Heo, M.D., Joong Goo Kwon, M.D., Kyoung Chan Park, M.D., Jung Il Ryu, M.D., Dong Uk Ju, M.D., Kyung Ho Ha, M.D., Jin Tae Jung, M.D. and Ho Gak Kim, M.D.
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Korean J Gastrointest Endosc 2011;43(1):1-4. Published online July 28, 2011
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- Percutaneous endoscopic gastrostomy (PEG) has become a widely used and safe method for long-term enteral feeding in patients who are unable to tolerate oral feeding. Although a number of complications can occur following PEG placement, most of these complications are not life threatening. Serious complications occur rarely after this procedure and they include peritonitis, visceral perforation, major gastrointestinal bleeding, and necrotizing fasciitis. An esophageal perforation following PEG placement is very rare and predisposing factors include Zenker's or epiphrenic esophageal diverticuli, esophageal strictures, and mass lesions. We recently experienced a case of distal esophageal perforation following a PEG tube change. The predisposing esophageal perforation factor in this case was uncertain, and we successfully treated the patient with surgical intervention. (Korean J Gastrointest Endosc 2011;43:1-4)
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A Case of a Spontaneous Hemoperitoneum as the Presentation of a Gastric Arteriovenous Malformation
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Chang Hyun Cho, M.D., Jae Young Jang, M.D., Jun-Hyung Cho, M.D., Jaejun Shim, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D. and Young Woon Chang, M.D.
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Korean J Gastrointest Endosc 2011;43(1):5-8. Published online July 28, 2011
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- Spontaneous hemoperitoneum is rare. The most common etiologies are gynecologic, splenic, and hepatic. Gastric arteriovenous malformations are commonly associated with intraluminal bleeding, but gastric arteriovenous malformations are an unusual cause of spontaneous intraperitoneal hemorrhage. A 54-year-old man presented with acute onset of epigastric pain. The patient was given an operation and pathology confirmed that it was a gastric arteriovenous malformation. (Korean J Gastrointest Endosc 2011;43:5-8)
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A Case of Duodenal Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Refractory Ulcer
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Min Keun Song, M.D., Hyoun Woo Kang, M.D., Jae Hak Kim, M.D., Jun Kyu Lee, M.D., Yun Jeong Lim, M.D., Moon Soo Koh, M.D., Jin Ho Lee, M.D. and Eo Jin Kim, M.D.*
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Korean J Gastrointest Endosc 2011;43(1):9-12. Published online July 28, 2011
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- Mucosa-associated-lymphoid-tissue (MALT) lymphomas are the most common primary gastrointestinal lymphomas. The stomach is the most common site of involvement in the GI tract. However, MALT lymphoma of the duodenum is rare. The differential diagnosis in a refractory peptic ulcer are current smoking, NSAID use, hypersecretory conditions (gastrinoma and Zollinger-Ellison syndrome), neoplasms, infection (cytomegalovirus, syphilis, and tuberculosis), and Crohn's disease. Endoscopic findings of duodenal MALT lymphoma are classified as ulcerative, polypoid, and diffuse types. The ulcerative type is the most common type of duodenal MALT lymphoma. Here, we report a case of a 64-year-old male with a history of a refractory duodenal ulcer who was diagnosed with a duodenal MALT lymphoma by immunohistochemical staining. (Korean J Gastrointest Endosc 2011;43:9-12)
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A Case of Gastric Intramural Hematoma after an Epinephrine Injection for Gastric Ulcer Bleeding in a Patient Medicated with Aspirin
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Hyung Min Noh, M.D., Young Ho Seo, M.D., Nam Hun Lee, M.D., Bong Kyu Lee, M.D., Sang Hyun Park, M.D., Yeon Hwa Kim, M.D., Chur Hoan Lim, M.D. and Sung Hwan Song, M.D.*
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Korean J Gastrointest Endosc 2011;43(1):13-16. Published online July 28, 2011
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- An intramural hematoma of the stomach usually results from trauma. Gastric intramural hematomas may also occur in patients with bleeding disorders who are receiving anticoagulation therapy or after an endoscopic procedure. Here, we describe a case of a gastric intramural hematoma after endoscopic hemostasis for gastric ulcer bleeding in a patient medicated with aspirin. (Korean J Gastrointest Endosc 2011;43:13-16)
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A Case of Peripheral T-cell Lymphoma of the Duodenum and Jejunum
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Hsueh Chen Yueh, M.D., Chi Sung Hwang, M.D., Jae Won Choi, M.D., Seung Keun Park, M.D., Hee Ug Park, M.D. and Hye Sook Kim, M.D.*
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Korean J Gastrointest Endosc 2011;43(1):17-20. Published online July 28, 2011
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- Primary T-cell lymphoma of the duodenum is uncommon, and peripheral T-cell lymphoma of the duodenum is extremely rare. Approximately 90% of primary gastrointestinal lymphomas originate from B-cells and fewer than 10% originate from T-cells. A peripheral T-cell lymphoma involved in the small intestine is usually detected by complications such as gastrointestinal bleeding, perforation, or obstruction. A 57-year-old man complained of postprandial discomfort and weight loss of 5 kg for 1 month. An esophagogastroduodenoscopy showed a deep ulcer with blood clots and whitish exudates. We conducted a Whipple's operation because of the high risk of ulcer perforation and difficulty in distinguishing the ulcer from malignancy. The resected tissue was confirmed as a peripheral T-cell lymphoma. We reported a case of peripheral T-cell lymphoma of the duodenum and jejunum that extended to the pancreatic head where a diffuse lesion was found without any complications or specific symptoms. (Korean J Gastrointest Endosc 2011;43:17-20)
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CMV Gastric Ulcers Healed by Supportive Therapy
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Hyoung Don Lee, M.D., Nam-Hoon Kim, M.D., Ki Jun Lee, M.D., Hyuk Lee, M.D., Jin Ho Jun, M.D., Won Ki Bae, M.D., Kyung-Ah Kim, M.D. and June Sung Lee, M.D.
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Korean J Gastrointest Endosc 2011;43(1):21-24. Published online July 28, 2011
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- Cytomegalovirus (CMV) is a potentially important pathogen in an immunocompromised host. CMV infection usually occurs in patients with severe immune deficiency, such as acquired immunodeficiency syndrome, organ transplantation, malignant disease, or immunosuppressive therapy. CMV can cause ulcerations anywhere in the GI tract ranging from the esophagus to the rectum, but the colon is the most susceptible organ in the GI tract. CMV infection rarely occurs but generally causes an asymptomatic or mildly symptomatic acute illness in immunocompetent patients. Some patients with gastrointestinal CMV disease do not require antiviral treatment such as ganciclovir and frequently recover with supportive therapy. Although in immunocompetent patients, antiviral therapy may be needed based on age, chronic illness, or treatment response. We experienced a case of CMV-induced multiple gastric ulcers with severe epigastric pain in an immunocompetent patient who fully recovered with supportive therapy including a proton pump inhibitor. (Korean J Gastrointest Endosc 2011;43:21-24)
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A Case of Gastric Low-grade MALT Lymphoma Induced by a Helicobacter heilmannii-like Organism
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Dong-Hoon Oh, M.D., Nam-Hoon Kim, M.D., Yu-Jung Cho, M.D., Tae Jun Song, M.D., Won Ki Bae, M.D., Kyung-Ah Kim, M.D., June Sung Lee, M.D. and Mee Joo, M.D.*
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Korean J Gastrointest Endosc 2011;43(1):25-29. Published online July 28, 2011
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- Helicobacter heilmannii is a Gram negative, long spiral-shaped organism associated with zoonotic infections acquired from primates including cats and dogs. Infection with H. heilmannii leads to gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. We experienced a 54-year-old man with dyspepsia who was diagnosed with primary gastric MALT lymphoma (stage IE1) associated with a H. heilmannii-like organism. Upper gastrointestinal endoscopy revealed only microvascular dilatation and mucosal granularity without elevated or ulcerative lesions at the stomach angle. He was probably infected by a pet dog. The man was treated with eradication therapy for 2 weeks including lansoprazole, amoxicillin, and clarithromycin. Four weeks after eradication of the H. heilmannii-like organism, follow-up endoscopy and pathological biopsy findings showed complete remission of the gastric MALT lymphoma. (Korean J Gastrointest Endosc 2011;43:25-29)
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A Case of Corrosive Esophagogastritis after Copper Sulfate Ingestion
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Hee Rin Joo, M.D., Jongha Park, M.D., Tae Gyoon Kim, M.D., Eun Hee Seo, M.D., Seung Ha Park, M.D., Tae Oh Kim, M.D., Sung Yeon Yang, M.D. and Young Soo Moon, M.D.
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Korean J Gastrointest Endosc 2011;43(1):30-32. Published online July 28, 2011
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- Copper sulfate ingestion is a rare cause of corrosive gastrointestinal injury in the Republic of Korea. In developing countries, copper sulfate is chiefly used for agricultural purposes as a pesticide and in the leather industry. It is also used in school science classes in the form of bright blue crystals. Copper sulfate is a powerful oxidizing agent that is corrosive to mucous membranes. Concentrated solutions are acidic, with a pH of 4. We report a case of corrosive gastritis and esophagitis due to accidental copper sulfate ingestion in a 12-year-old boy. (Korean J Gastrointest Endosc 2011;43:30-32)
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Huge Gastric Schwannoma Characterized by a Gastric Ulcer During Endoscopy
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Chang Jung Lee, M.D., Suk Joon Park, M.D., Seong Yong Woo, M.D., Hyun Jong Oh, M.D., Mi Kyung Sung, M.D., Byeong Ho Lee, M.D., Sung Bae An, M.D. and Hyun Ju Yoo, M.D.*
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Korean J Gastrointest Endosc 2011;43(1):33-37. Published online July 28, 2011
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- Gastric schwannomas are very rare mesenchymal tumors that can occur throughout the gastrointestinal tract, but are most commonly found in the stomach. The majority of patients have no symptoms, while others may complain of epigastric pain or upper gastrointestinal ulcer bleeding. Endoscopic examination of a gastric schwannoma commonly reveals a protrusive mass, but, as in this case, many types of ulceration can be observed with central necrosis. We report on a 62-year-old woman with endoscopic findings of 1 cm sized necrotizing ulceration and an 11 cm sized submucosal mass on radiological examinations. The patient underwent a wedge-shaped resection of the stomach and segmental resection of the transverse colon. Both histological and immunohistochemical staining revealed a gastric schwannoma. (Korean J Gastrointest Endosc 2011;43:33-37)
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A Case of Barium Appendicitis after a Small Bowel Series
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Ki Ho Yun, M.D., Hyeon Woong Yang, M.D., Se Young Park, M.D., Young Wook Yoo, M.D., Seung Yeon Na, M.D., Young Woo Lee, M.D. and Sang Woo Cha, M.D.
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Korean J Gastrointest Endosc 2011;43(1):38-41. Published online July 28, 2011
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- Barium appendicitis is a rare complication that occurs due to barium retention in the appendix after a barium study. It is believed that retained barium in the appendix forms a barium-coated fecalith and causes barium appendicitis. A 19-year-old man visited the hospital due to melena. He underwent an endoscopy and a colonoscopy but no bleeding focus was discovered. Next, a small bowel series was performed to confirm the absence of small bowel bleeding. Two weeks later, he felt right lower quadrant pain in his abdomen and developed a fever. A blood test revealed an elevated white blood cell count. A plain abdominal radiograph indicated retained barium in the appendix. A computed tomography scan revealed a dilated barium filled appendix. Thus, the pain was thought to caused by barium retention in the appendix that precipitated acute appendicitis. He underwent an appendectomy and healed well without complications. (Korean J Gastrointest Endosc 2011;43:38-41)
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A Case of Steroid Treated Amebic Colitis Misdiagnosed as Eosinophilic Colitis
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Eun Sun Cheong, M.D., Yun Ju Jo, M.D., Sang Bong An, M.D., Seong Hwan Kim, M.D., Young Sook Park, M.D., Won Mi Lee, M.D.* and Young Ok Hong, M.D.*
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Korean J Gastrointest Endosc 2011;43(1):42-46. Published online July 28, 2011
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- Some cases have reported that amebic colitis leads to serious complications that are caused by a misdiagnosis of an inflammatory bowel disease and consequential ill-managed steroid therapy. Therefore, it should be stressed that the differential diagnosis on such a case is very important. Eosinophilic colitis may reveal its presence as diarrhea, abdominal pain, ascites, and eosinophilic deposits in tissues. Therefore, it is highly necessary to make a differential diagnosis to distinguish eosinophilic colitis from other infectious or inflammatory bowel diseases. We report a case of amebic colitis, which was mistakenly diagnosed as eosinophilic colitis and a liver eosinophilic abscess in a young male who complained of bloody diarrhea and right upper quadrant pain. However, the misdiagnosed steroid therapy did not aggravate the progress of the amebic infection. (Korean J Gastrointest Endosc 2011;43:42-46)
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A Case of Churg-Strauss Syndrome Manifesting as Colonic Aphthous Ulcers with Granuloma
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Jun Sup Park, M.D., Nam-Hoon Kim, M.D., Joo Hyun Park, M.D., Won Ki Bae, M.D., Jae Won Jeong, M.D., June Sung Lee, M.D., Young Soo Moon, M.D. and Mee Joo, M.D.*
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Korean J Gastrointest Endosc 2011;43(1):47-51. Published online July 28, 2011
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- Churg-Strauss syndrome is characterized by asthma, peripheral and tissue eosinophilia, extravascular granuloma formation, and vasculitis of multiple organ systems. The gastrointestinal tract may be involved in 20% to 50% of patients, mainly with abdominal pain, diarrhea and GI bleeding. Ulcers in the small and large bowel are an uncommon manifestation, usually detected during laparotomy performed in the setting of bowel perforation. Endoscopically proven segmental colonic aphthous ulcers with typical pathologic findings such as extravascular granuloma formation, eosinophilic infiltration, or vasculitis are a rarer manifestation. We present a patient with Churg-Strauss syndrome and two aphthous ulcers in the sigmoid colon that healed after treatment with high dose steroids and cyclophosphamide. (Korean J Gastrointest Endosc 2011;43:47-51)
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A Case of a Colon Perforation Due to a Soft Rectal Foreign Body
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Jeong Hwa Lee, M.D., Sang Bum Kang, M.D., Dong Cheon Ha, M.D., Ki Huyn Kwon, M.D., Seung Woo Lee, M.D., Yeon Soo Kim, M.D., Dong Soo Lee, M.D. and Soon Woo Nam, M.D.
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Korean J Gastrointest Endosc 2011;43(1):52-55. Published online July 28, 2011
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- Numerous foreign bodies in the rectum have been reported in the literature. Their removal can be challenging depending on the size and shape of the objects and their anatomical location in the rectum. A 64-year-old man presented to the emergency department after inserting a sausage into his rectum. He had some rectal discomfort and lower abdominal pain. There were no signs of bowel perforation. We attempted to extract the sausage impacted in the recto-sigmoid junction by colonoscopy using a snare and grasping forceps but failed to extract the foreign body. Unfortunately, a colon perforation had occurred, and the sausage was eventually extracted by performing a colostomy at the recto-sigmoid junction with primary repair. We report this case of a soft rectal foreign body impacted in the recto-sigmoid colon complicated by a colon perforation with a literature review. (Korean J Gastrointest Endosc 2011;43:52-55)
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Ill-defined Granulomas Demonstrated in Ulcers of the Terminal Ileum and Transverse Colon in a Patient with Typhoid Fever
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Sang Gu Yun, M.D., Nam-Hoon Kim, M.D., Min Hwan Kim, M.D., Joo Hyun Park, M.D., Won Ki Bae, M.D., Kyung-Ah Kim, M.D., June Sung Lee, M.D. and Han Sung Kim, M.D.*
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Korean J Gastrointest Endosc 2011;43(1):56-59. Published online July 28, 2011
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- Typhoid fever, the most serious human salmonellosis, is a systemic infectious disease caused by Salmonella enterica serovar Typhi and is characterized by prolonged fever, bacteremia, and multiplication of the organism within mononuclear phagocytic cells of the liver, spleen, lymph nodes, and Peyer's patches. The characteristic lesion of typhoid fever is an ulceration of the small intestinal lymphoid tissue, particularly the Peyer's patches. The usual histological findings of typhoid ulcer are necrosis and histiocytic proliferation that phagocytizes erythrocytes and degenerated lymphocytes. A granuloma is an unusual histopathological presentation of a typhoid lesion. Even if granulomas have been reported in the bone marrow, liver, and spleen in cases of typhoid fever, granulomas in primary ulcers of the ileum and transverse colon have been reported very rarely. We experienced a case of typhoid fever in which ill-defined granulomas were seen in ulcers of the terminal ileum and transverse colon. (Korean J Gastrointest Endosc 2011;43:56-59)
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A Case of B-Lymphoblastic Leukemia/Lymphoma Detected as a Laterally Spreading Tumor
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Sang Wook Park, M.D., Chan Woo Park, M.D., Gun Woo Kim, M.D., Jong Hoon Lee, M.D., Seung Ho Choi, M.D., Du Jin Kim, M.D., Hyung Chul Moon, M.D. and Kun Young Hong, M.D.
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Korean J Gastrointest Endosc 2011;43(1):60-63. Published online July 1, 2011
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- Acute lymphoblastic leukemia is a cancer of blood cells. It is known as lymphoblastic lymphoma when it involves lymph nodes rather than the blood and bone marrow. The gastrointestinal tract is a predominant site for extra-nodal lymphomas. But, B-lymphoblastic leukemia/lymphoma more frequently presents in the leukemic form than in the lymphomatous form. We herein report a case of B-lymphoblastic leukemia/lymphoma detected as a laterally spreading tumor in the colon. A 54-year-old man was referred to our hospital for removal of multiple colonic polyps. A colonoscopy revealed multiple colonic polyps and several colonic laterally spreading tumors. An esophagogastroduodenoscopy revealed several raised erosive lesions on the fundus and several variable sized sessile polypoid lesions on the duodenum. We diagnosed B-lymphoblastic leukemia/lymphoma following biopsies of the lesions. (Korean J Gastrointest Endosc 2011;43:60-63)
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Esosinophilic Gastroenteritis with Clostridium difficile-associated Colitis: A Case Report
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Tae Gyoon Kim, M.D., Jongha Park, M.D., Eun Hee Seo, M.D., Hee Rin Joo, M.D., Seung Ha Park, M.D., Tae Oh Kim, M.D., Sung Yeon Yang, M.D. and Young Soo Moon, M.D.
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Korean J Gastrointest Endosc 2011;43(1):64-68. Published online July 28, 2011
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- Eosinophilic gastroenteritis is an uncommon disease characterized by eosinophilic infiltration in the bowel wall and presents various symptoms depending on the affected site and bowel layer. Pseudomembranous colitis is an antibiotic-associated infection caused by abnormal overgrowth of the toxin-producing Clostridium difficile in the large bowel. A 16-year-old boy was admitted with abdominal pain for 6 days. On admission, we performed an endoscopy and diagnosed gastroduodenitis. Then, we prescribed gastritis medication but he still presented with diffuse abdominal pain and fever above 38.0oC after admission. We considered infectious enterocolitis, so we prescribed an antibiotic. The next day, he presented with bloody diarrhea. A diagnosis of pseudomembranous colitis was confirmed by a colonoscopic examination with a biopsy. We also obtained a diagnosis of eosinophilic gastroenteritis through a histological diagnosis. This is the first case of the simultaneous occurrence of eosinophilic gastroenteritis and pseudomembranous colitis in the Korean medical literature. We report this case with a brief review of the literature. (Korean J Gastrointest Endosc 2011;43:64-68)
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