The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 267
Poster Session
PS 1098 Gastroenterology (Gastrointestinal Tract) A Rare Case of Hepatoid Carcinoma Detected on Colo- noscopy for Colon Cancer Work Up
Hyun-Suk Lee1, Jang-Eon Kim1, Chul-Hee Park1, Tae-Hee Lee1, Jun-Ho Lee1, Yong-seok Lim1, Eui-Chang Kim1
Seoul Medical Center, Korea1
Background: We described a rare case of an alpha-fetoprotein-producing carcinoma originated in the Ascending colon of a 76-year old man.
Methods: The patient was reported an abdominal mass and tenderness on RLQ area.
He was diagnosed with colon cancer in CT. But the result of colonoscopy performed at other hospital was acute colitis. On our hospital’s examination, partial obstruction was noticed on the proximal A -colon and hepatic fl exure and found a tumor of the ascending colon and 1.7cm sized osteolytic metastatic lesion with cortical destruction in L4 body. The serum alpha-fetoprotein level was 12.42 ng/ml.The patient was per- formed endoscopic biopsy via colonoscopy examination.
Results: Histologically, the colon cancer was hapatoid carcinoma.It’s composed of large polygonal tumor cells with sheet formation and distinct cell borders. Unfortu- nately, the patient had been suffer from massive hematochezia and died due to dis- seminated intravascular coagulation in a week.
Conclusion: We reported a rare case of hepatoid carcinoma was generally associated with a poor prognosis because of the high angioinvasiveness.
PS 1099 Gastroenterology (Gastrointestinal Tract) A Case of Asymptomatic Perforated Appendicitis Pre- sented as Subepithelial Sigmoid Colon Lesion during Screening Colonoscopy
Yu Yi Choi1, Su Jin Kim1, Dong Ku Kang1, Hyeong Seok Nam1, Young Shin Shin1, Dae Hwan Kang1
Pusan National University YangSan Hospital, Korea1
Acute appendicitis is a common disease in all age groups. Although many patients with acute appendicitis present with migrating abdominal pain, initial presentations can be atypical and nonspecifi c. Unusual manifestation can lead to diagnostic delays associ- ated with an increased morbidity and mortality. Colonoscopic fi ndings for diagnosis of asymptomatic appendicitis include hyperemia and bulging at the appendiceal orifi ce area with surrounding mucosal edema, and drainage of pus from the appendiceal orifi ce. We report a case of asymptomatic perforated appendicitis and periappendiceal abscess presented as subepithelial sigmoid colon lesion during screening colonoscopy.
Subepithelial lesion with pustular drainage and surrounded by hyperemic mucosa was seen at sigmoid colon during colonoscopy. CT revealed appendicitis and periappen- diceal abscess with adjacent sigmoid colon wall thickening. The patient underwent appendectomy and fi nally diagnosed as perforated appendicitis with periappendiceal abscess.
PS 1100 Gastroenterology (Gastrointestinal Tract) The Case of Refractory Clostridium Diffi cile Associated Diarrhea That Resolved by Fecal Transplantation via Colonoscopy
Jun Young Shin1, Eun Jung Ko1, Seung Ho Lee1, Won Seop Lee1, Byoung Wook Bang1 Inha University Hospital, Korea1
Clostridium diffi cile Associated diarrhea(CDAD, pseudomembranous colitis) is a noso- comial infection related to use of antibiotics and it’s incidence and recurrence rate is increasing. Use of metronidazole or vancomycin is effective regimen for management of CDAD but some refractory cases may result in recurrence, decreased quality of life and mortality. We experienced refractory CDAD case that was resolved by fecal transplantation, inexpensive and convenient colonoscopic method. 69-year-old wom- an was admitted to hospital with abdominal pain and diarrhea over 2 weeks. she was diagnosed as pseudomembranous colitis by colonoscopy and positive C.diffi cile toxin exam. Symptom was improved after taking oral metronidazole, but recurred 1 week later. We used oral vancomycin regimen and her symptom was temporarily improved.
10 days later, diarrhea was recurred, and there was no further effect of vancomycin.
We decided to do fecal transplantation and her daughter was chosen as donor. After screeing, 50 gram of fresh feces was obtained and mixed with 500ml of normal saline and then fi ltered. Filtred solution were injected to patient’s colon through a colonos- copy. After procedure, diarrhea was stopped and colonoscopy showed resolved pseu- domembranous colitis without recurrence over 4 months.
PS 1101 Gastroenterology (Gastrointestinal Tract) Two Cases Melanosis Ilei in Family Members Who Had Taken Charcoal for a Long Period
Hyuntaek Seo1, Yong Kyu Lee1, Se Jun Kim1, Il Eok Jo1, Hong Min Park1, Woo Hyuk Kwon1
Good Gang-An Hospital, Korea1
Introduction: Melanosis ilei is defi ned as the seen coloring of grayish-black or brown- ish-black pigments in the mucuous membrane at the end of the ileum. Melanosis occurs almost in the large intestine, and rarely in the duodenum and ileum. Cases of melanosis ilei due to the taking of charcoal have been reported rarely, but cases of melansis ilei have been not reported among family members who have taken charcoal for a long period.
Case 1: 66-year-old woman (mother) Colonoscopy was performed to detect cancers.
She didn’t have any particular medical or family history until performing colonoscopy.
Whenever she had an intermittent abdominal pain or dyspepsia, her family had taken a spoonful of powered charcoal from 1990 to 2005. With no particular diagnostic fi ndings, colonoscopy revealed multiple polyps and the coloring of the mucous mem- brane the end of the ileum.
Case 2: 38-year-old man (son) Colonoscopy was performed due to diarrhea that occurred 2 or over 3 times a day. He had been taking antihypertensive drugs, and the family had the history disease that the father died due to liver cancer. The patient has smoked for ten years, and stopped smoking since six months ago. With no particular diagnostic fi ndings, colonoscopy revealed the coloring of the mucous membrane at the end of the ileum. After histological examination of mucous membrane revealed focal black pigments, he was diagnosed as melanosis ilei .
Summary: We hereby report two cases of melanosis ilei, which was caused among a family who took charcoal for a long period.
The Korean Association of Internal Medicine
268 32nd World Congress of Internal Medicine (October 24-28, 2014) PS 1102 Gastroenterology (Gastrointestinal Tract) A Case of Perirectal Abscess Cured by Eus Guided FNA and Stent Drainage
Jajun Goo1, Hyung Wook Kim1, Peel Jung1, Sook Kyoung Oh1, Yu Yi Choi1, Su Bum Park1, Su Jin Kim1
Pusan National University YangSan Hospital, Korea1
Background: Perirectal abscess could be caused by various causes such as intraab- dominal disease or surgical complication. Without an early diagnosis and appropriate treatment, the mortality of this disease could be increased.
Case Report: An 36-year-old man was transfered our hospital for the evaluation of the abdominal pain, fever, and yellowish discharge through the drain tube after laparoscopic appendectomy. Computed tomography(CT) of abdomen demonstrated the abscess at rectovesical fossa (3x4cm) and perirectal abscess was showed by endo- scopic ultrasonography (EUS). EUS guided fi ne needle aspiration (FNA) was done and brownish pus was aspirated for about 18cc. And then, the stent(pig tail, 5cm, 7Fr) in- sertion was taken for abscess drainage. After 3days, we removed stent by endoscopic forcep due to stent migration through anus. CT of Abdomen was checked again and demonstrated that the size of abscess was decreased.
Conclusion: We present here a case of perirectal abscess treated with EUS guided FNA and transrectal stent drainage
PS 1103 Gastroenterology (Gastrointestinal Tract) A Case of Intestinal Pseudo-Obstruction as Paraneo- plastic Syndrome in Renal Cell Carcinoma
Sook Kyoung Oh1, Su Jin Kim1, Dong Ku Kang1, Hyeong Seok Nam1, Yu Yi Choi1 Pusan National University YangSan Hospital, Korea1
Background: Intestinal pseudo-obstruction is a syndrome characterized by signs and symptoms of a mechanical obstruction of the bowel without the evidence of an ana- tomic lesion that obstructs the fl ow of intestinal contents. Recently, several case re- ports have revealed an association between intestinal pseudo-obstruction and various malignancies, but it is extremely rare in renal cell carcinoma.
Case Report: A 51-year-old man was admitted because of diffuse abdominal pain, vomiting and constipation for 1 month. There was no mechanically obstructive lesion on colonoscopy. An abdominal CT scan revealed fecal stasis with distended rectosig- moid colon and left renal incidentaloma suggestive of renal cell carcinoma. Because conservative care including intensive pharmacotherapy was not effective and there was clinical suspicion for Hirschsprung’s disease, he had undergone Hartmann’s operation and left nephrectomy. Pathology revealed only chronic inflammation in rectosigmoid colon and confi rmed left-sided renal cell carcinoma. He was completely recovered from ileus and has remained clinically well. Finally he was diagnosed as in- testinal pseudo-obstruction which was attributed to a paraneoplastic manifestation of an occult renal cell carcinoma.
Conclusion: In case of intestinal pseudo-obstruction without defi nite causes, parane- oplastic syndrome secondary to occult cancer should be considered. Here we report a case of intestinal pseudo-obstruction in renal cell carcinoma with a review of the literature.
PS 1104 Gastroenterology (Gastrointestinal Tract) A Case of Superior Mesenteric Artery Syndrome Treat- ed with Percutaneous Radiologic Gastrojejunostomy
Ju Young Lee1, Jeong Woo Choi1, Hyeon Geun Cho2
Sungae Hospital, Korea1, Catholic Kwandong University College of Medicine, Korea2
Superior mesenteric artery(SMA) syndrome is an uncommon, benign cause of duo- denal obstruction by compression of the third portion of the duodenum because of narrowing of the angle between the SMA and abdominal aorta. It manifests with nonspecifi c obstructive symptoms of nausea, vomiting, epigastric pain, and abdominal distension. Anorexia and weight loss can occur in chronic condition. SMA syndrome has been managed with total parenteral nutrition(TPN) or surgical intervention such as laparoscopic duodenojejunostomy. But, post operative morbidity and mortality were higher in the setting of old age, general weakness, or co-morbidities. In the majority of critically ill patients with diffi cult to surgical treatment, it can be more practical and safe to utilize enteral nutrition(EN) instead of parenteral nutrition(PN). In many studies, further benefi ts of EN are seen from signifi cant reductions in hospital length of stay, infectious morbidity, and cost of nutrition therapy. We describe the treatment of an elderly woman who improved SMA syndrome by percutaneous gastrojejunosto- my for enteral nutrition feeding.
