WCIM 2014 SEOUL KOREA 109
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0238 Gastroenterology
Cases of Ischemic Colitis Associated with Pseudoephed- rine
Jae Min LEE1, Seong O SUH1, Jun-Oh JUNG1, Ji Won YOO1, Jae Yeon KIM1 National Police Hospital, Korea1
Introduction: Ischemic colitis is the consequence of a sudden reduction in colon blood supply, which in turn results in the ischemic injury. The splenic fl exure and rectosig- moid junction, which are known as watershed areas, are the areas most often affect- ed. Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly and is caused by various medications and substances, and procedures. Pseudoephedrine which are usually used for nasal decongestion acts as vasoconstriction directly affecting to a-adrenal receptor of nasal mucous membrane.
Pseudoephedrine occasionally causes vascular insuffi ciency due to intense vasocon- striction, even at standard doses. Pseudoehpedrine can cause a variety of adverse events. Among of them, ischemic colitis associated with pseudoephedrine has been re- ported in other countries. But there has never been reported in Korea. In this report we describe cases of ischemic colitis after taking pseudoephedrine for nasal congestion.
Cases: We reviewed cases of two women (79-year-old, 81-year-old) with hyperten- sion and one man (53-year-old) with no signifi cant past medical history who present- ed with the sudden onset of colicky abdominal pain followed by hematochezia. Three patients were healthy, full ambulation state, and not taking other medication asso- ciated with ischemic colitis except pseudoephedrine. Two women had used medicine containing pseudoephedrine daily for approximately 14 days before admission. One man was taking pseudoephedrine daily for approximately 7 days before admission.
Their Symptoms, colonoscopy, CT exam were compatible with ischemic colitis. After discontinuation of pseudoephedrine, idchemic colitis was self resolved within 7~10 days in three cases.
Discussion: Pseudoephedrine are usually used for nasal decongestion. The vasocon- strictive action of pseudoephedrine may predispose susceptible patients to develop ischemic colitis. We recommend close observation for patients who are taking pseu- doephedrine and who have any risk factors for ischemic colitis.
PS 0239 Gastroenterology
Vitamin C Insuffi ciency Aggravates Dextran Sulfate Sodium (DSS)-Induced Colitis in Gulo(-/-) Mice
Hyemin KIM1, Jae Seung KANG1, Jong Pil IM2, Seyeon BAE1, Yejin KIM1, Hang-Rae KIM1, Joo Sung KIM2, Young-Il HWANG1, Wang Jae LEE1
Department of Anatomy, Seoul National University College of Medicine, Korea1, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea2 Background: Mucosal damage in inflammatory bowel diseases (IBDs) involves the dysfunctional immunoregulation of the gut. Among immunoregulatory factors, oxida- tive stress is abnormally high level in IBDs, and their destructive effects may contrib- ute to the initiation or propagation of the disease. Vitamin C has both anti-oxidant and immunomodulatory effects.
Methods: we investigated the effect of vitamin C on dextran sulfate sodium (DSS)-in- duced colitis in Gulo(-/-) mice which cannot synthesize vitamin C.
Results: Vitamin C-insufficient Gulo(-/-) mice showed decreased survival with in- creased oxidative stress and more severe colitis. The production of interleukin (IL)-6 was higher, and STAT3 and Akt were more activated in DSS-treated vitamin C-in- suffi cient Gulo(-/-) mice than in vitamin C-suffi cient Gulo(-/-) mice and wild-type mice. In contrast, the production of IL-22, the recruitment of NKp46(+) cells, and the activation of p38 MAPK were decreased in the vitamin C-insuffi cient Gulo(-/-) mice accompanied by decreased mucin-1 expression. Taken together, vitamin C insuffi ciency was associated with not only increased oxidative stress and IL-6 production but also decreased production of IL-22, which eventually induces severe colitis and death by DSS treatment.
Conclusions: Therefore, our results suggest that vitamin C has a protective effect on DSS-induced colitis by regulating the production of cytokine and the induction of in- fl ammation.
PS 0240 Gastroenterology
Benign Prostatic Hyperplasia Mimicking a Rectal Sube- pithelial Tumor: A Case Report
SeungWook HONG1, JaeYoung CHUN1, Jong Pil IM1, Cheol KWAK2, Kyu Joo PARK3, Joo Sung KIM1, Hyun Chae JUNG1
Seoul National University College of Medicine, Korea1, Seoul National University College of Medicine, Korea2, Seoul National University College of Medicine, Korea3
Benign prostatic hyperplasia (BPH) is the most common tumor in men, and the prevalence of BPH increases with age. BPH commonly presents with obstructive and irritative lower urinary tract symptoms including weak urinary stream, hesistancy, incomplete voiding, nocturia, urgency, and frequency. However, gastrointestinal mani- festations due to extrinsic compression of the anterior rectum are very rare in patients with BPH. We report the case of a 56-year-old man with a prostatic mass extending into the rectal mucosa. He underwent surgical ablation for a 5 cm-sized benign sube- pithelial cystic mass in the rectum, which was adjacent to a 5 cm-sized solid mass lo- cated at the prostatic gland on a computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis. At 1 year after the surgery, he had anal bleeding with dif- fi culty in defecation. The pelvis MRI scan demonstrated no signifi cant interval change in size of the heterogenous solid mass with enhancement compressing the rectum.
However, the sigmoidoscopic exam showed a 4 cm-sized mass protruding through the anterior rectal mucosa above 7 cm from anal verge. Ultra-low anterior resection with ileostomy and prostatectomy was performed for curative resection of the mass with extension into the rectum. Pathologic reports revealed massive benign prostatic hy- perplasia, not penetrating into but involving the rectum. This is the fi rst case of benign prostatic mass mimicking a rectal subepithelial mass in a patient presented with anal bleeding and constipation.
