The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 269
Poster Session
PS 1105 Gastroenterology (Gastrointestinal Tract) Ischemic Proctitis in Patient with “Bowel Obsession Syndrome” : A Case Report
Jun Hyung Park1, Ji Young Park1, Tae Joo Jeon1, Tae Hoon Oh1, Won Chang Shin1, Tae Hwan Ha1, Mi Jin Ryu1, Seung Suk Baek1, Yena Choi1
Department of Internal Medicine, Inje University College of Medicine, Korea1
Background: Ischemic proctitis is a rare clinical entity because the rectum is supplied by an extensive arterial network. In most cases of ischemic proctitis, it occurs post- operatively and often is associated with hemodynamic instability. We report here a patient diagnosed as ischemic proctitis result from unusual cause; bowel obsession syndrome.
Case: A 49-year-old woman presented to the hospital with bloody stool and proctalgia for several months. She had psychiatric history of depression and obsessive compulsive disorder under treatment. From the age of 30, she had always felt fullness at the anal region and sense of obstruction with defecation, often resulting in excessive straining and need to digitally reduce the rectum to help push stool out of the rectum at least three times a day. Vital signs and laboratory test results were unremarkable. Rectal examination revealed palpable mass accompanied by tenderness. Colonoscopy showed large geographic ulcers covered with exudate and peripheral erythematous mucosa in the anterior rectal wall approximately 5 cm of the anal verge. The mucosa proximal to the ulcers was intact. Elective sigmoidoscopy 2 weeks later revealed a huge mass-like mucosa with edematous surface 5 cm above the anal verge. Histology of the biopsy specimen obtained from colonoscopy demonstrated focal loss of epithelial cells, super- fi cial epithelial necrosis, destructions of vessels and thrombosis of the veins consistant with chronic ischemia. The patient was diagnosed with ischemic proctitis caused by high pressure within the rectum during defecation and persistant irritation of the rec- tum by enemas and fi ngers leading to mucosal ischemia. The patient received intrave- nously antibiotic agents and psychotherapy. She is steadily improving under long-term behavioral therapy.
PS 1106 Gastroenterology (Gastrointestinal Tract) A Case of Cerebral Venous Thrombosis in a Patient with Crohn’s Disease
Young-Hak Cho1, Jae Myong Cha1, Joung Il Lee1, Kwang Ro Joo1, Hyun Phil Shin1, Il Hyun Baek1, Jung Won Jeon1, Jun Uk Lim1
Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Korea1
Patients with inflammatory bowel disease (IBD) have an elevated risk of venous thromboembolism compared with the general population. The most common sites of venous thromboembolism in IBD patients are the deep veins of the legs and pulmonary system, followed by the portal and mesenteric veins. Cerebral venous thrombosis is extremely rare in IBD-related venous thromboembolism. This report describes a case of Crohn’s disease complicated by cerebral venous thrombosis. A 17-year-old female, diagnosed with Crohn’s disease 4 years ago, hospitalized with headache, anorexia, vomiting for 6 weeks. Brain MRI& venography showed venous thrombosis in cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. The patient immediately started anticoagulation therapy with intravenous heparin infusion followed by oral rivaroxaban 10mg qd. After anticoagulation, her headache was im- proved.At 2-weeks later, Brain MRI & venography showed resolved venous thrombosis with recanalization of cortical veins, superior sagittal sinus, right transverse sinus, and right internal jugular vein. She had taken anticoagulation with rivaroxaban for 6 months, remains well during the outpatient follow-up.
PS 1107 Gastroenterology (Gastrointestinal Tract) A Case of Acute Myeloid Leukemia(M4) with Myeloid Sarcoma after Azathioprine and Infl iximab Combina- tion Therapy in a Crohn’s Disease
Seung Hwa Choi1, Sang-Bum Kang1
The Catholic University of Korea, Daejon St. Mary`s Hospital, Korea1
Crohn’s disease is a chronic infl ammatory condition with a variable clinical course of exacerbations and remissions in the short term and a chronic progressive destruc- tive course in many patients in the long term. The treatment of Crohn’s disease has changed signifi cantly due to the introduction of biologic therapy with TNF-a blocker.
Combination therapy with TNF-a blocker plus immunomodulators resulted in sig- nifi cantly higher rates of corticosteroid-free clinical remission among patients with moderate-to-severe Crohn’s disease. In our case, Crohn’s disease exacerbation was occured during was treated sulfasalazine for maintenance therapy. So authors treated with combination therapy of azathioprine and infl iximab for clinical remission. During gastrointestinal symptoms was improved, anemia was worsed and severe thrombocy- topenia was accompanied. A diagnosis of acute myeloid leukemia(M4) with myeloid sarcoma was established by biopsy of bone marrow and nasal polyp. In infl ammatory bowel disease, increased risk of hematopoietic cancers especially lymphomas, but no trends towards higher risks for myeloid leukemia in Crohn’s disease. This case presents the possibility of induced acute myeloid leukemia Crohn’s disease after a long expo- sure to azathioprine and infl iximab.
PS 1108 Gastroenterology (Gastrointestinal Tract) Distant Recurrence of Gastrointestinal Stromal Tumors to Left Brachialis Muscle
Susin Jin1, Seung woo Lee1
Division of Gastroenterology, Department of Internal Medicine, Daejon St. Mary`s Hospital, The Catholic University of Korea, Korea1
Gastrointestinal stromal tumors (GISTs) is the mesenchymal tumor of the gastroin- testinal tract. It most found in the wall of stomach and has spread usually to the liver and peritoneum, but metastasis to the skeletal muscle are very rare. Here, we report a case of distant recurrence of GISTs to left brachialis muscle.An 80-year-old woman was diagnosed a gastric GISTs with omental invasion and underwent a wedge resec- tion of stomach with omental mass in 2010. Then, she was received adjuvant imatinib 400mg once daily for 1year and confirmed the complete remission. After 3 years, she had pain and swelling of left upper arm and magnetic resonance imaging (MRI) demonstrated a 14 cm mass-like lesion in brachialis muscle of left arm. A positron emission tomography (PET) scan showed an area of increased metabolic activity in left brachialis muscle. An incisional biopsy revealed spindle cells with positivity of CD117 and CD34 and expression of actin. She was diagnosed with solitary muscle recurrence of GISTs and was treated with imatinib 400mg daily again. But, she stopped taking imatinib because of nausea and vomiting. Therefore, she was metastasized to liver and adrenal gland after 6 months. She was discharged to other healthcare facility for conservative management. Only four cases of metastatic GISTs to skeletal muscle have been reported in the English literature. However, it were concurrent skeletal mus- cle metastasis of primary GISTs or liver metastasis. Distance recurrence is when the cancer cells have metastasized to a distant part of the body after treatment. None of the above distant recurrence has previously been reported in English literature reviews to our knowledge. These diagnosis should be kept in mind in patients presenting with suggestive signs and symptoms even if it is unusual metastatic site.
