WCIM 2014 SEOUL KOREA 119
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0272 Gastroenterology
Ogilvie Syndrome - Undiagnosed and Untreated but a Condition to Have in Mind
Joana MALHO RODRIGUES1, Débora CARDOSO1, Rita IVO1, Sofi a SERRA1, Margarida PROENÇA1, Patricia MONIZ1, Arturo BOTELLA1, Susana JESUS1, Candida FONSECA1, Ana LEITÃO1, Luís CAMPOS1
Occidental Lisbon Hospital Center (CHLO) - Hospital São Francisco Xavier, Portugal1
Introduction: Ogilvie Syndrome (OS) is an acute colonic pseudo-obstruction with no mechanical cause underlying. The diagnosis is mainly clinical and radiological. Of unknown pathophysiology but in 95% associated with other pathologies such as infectious, cardiac, neurological among others. The treatment is based on decompres- sion wih nasogastric tube(NGT), enteroclysis, laxative and procinetic therapies with neostigmine and erythromycine. In severely ill or complicated patients, endoscopic and surgical decompression may be indicated, even thought, mortality rates can be up to 40%.
Clinical Cases: 1) 82 years old woman admitted with acute heart failure. Presented with abdominal distention and hydroaeric levels without relevant hydroelectrolyte disturbances. Lack of response to laxative and procinetic therapies. Computer tomog- raphy (CT) excluded obstructive lesions. After introduction of erythromycin intestinal transit was reestablished. 2) 87 years old man, admitted with community adquired pneumonia (CAP) who developed intestinal sub-oclusion with parcial recuperation af- ter procinetics, NGT decompression and enteroclysis. CT: massive intestinal distention without obstruction. Hospitalization complicated with stroke, which lead to death.
3) 94 years old woman, admitted with CAP and acute renal lesion. Had maintained intestinal transit but, marked abdominal distention and pain. Transitory improvement after enteroclysis and NGT. CT showed transverse and sigmoid colon marked disten- tion, without occlusive lesions. Although optimized therapy the patient progressed into anuria, multiorganic failure which lead to death.
Conclusion: OS is a frequently undiagnosed clinical condition. Prompt diagnosis and treatment can predict a better outcome and are important to avoid complications such as intestinal perforation, ischaemia and peritonitis.
PS 0273 Gastroenterology
Risk Factors and Clinical Outcomes for Spontaneous Rupture of Pyogenic Liver Abscess
Jae Hyun YOON1, Chung Hwan JUN1, Sung Bum CHO1, Wan Sik LEE1, Sook In JUNG1, Chang Hwan PARK1, Young Eun JOO1, Hyun Soo KIM1, Sung Kyu CHOI1, Jong Sun REW1
Chonnam National University Hospital, Korea1
Background: To identify risk factors and clinical outcomes for spontaneous rupture of pyogenic liver abscess (SRLA).
Methods: A total of 602 patients who were diagnosed with pyogenic liver abscess were analyzed retrospectively from January 2004 to July 2013. Among the 602 pa- tients, 23 patients experienced SRLA.
Results: The incidence rate of SRLA was 3.8%. In multivariate analysis, underlying liver cirrhosis (OR: 4.65, p=0.009), gas forming abscess (OR: 3.65, p=0.026), abscess size (=6cm) (OR: 10.99, p=0.002), and other septic metastasis (OR: 1.71, p=0.047) were risk factors for SRLA in patients with pyogenic liver abscess. Regarding to the site of rup- ture, 20 patients (87%) had localized rupture; sub-phrenic abscess (13%), peri-hepatic abscess (43.5%), localized peritoneal abscess (13%), empyema (17.4%), and 3 patients (13%) had peritonitis. Ruptures resulting in peritonitis require urgent surgery, whereas localized rupture can be managed with percutaneous drainage in addition to appropri- ate antibiotics. The outcomes of SRLA (mortality rate; 4.3%) were relatively good.
Conclusions: Patients with cirrhosis, abscess size (=6cm), gas forming abscess, and other septic metastasis who have pyogenic liver abscess should need to be monitored closely and may need early intervention for spontaneous rupture of liver abscess.
PS 0274 Gastroenterology
The “Triple P” Syndrome: Panniculitis and Polyarthritis in Pancreatic Disease
Bernard Benjamin P. ALBANO1, Emmanuel PEREZ1
Department of Internal Medicine, De La Salle University Medical Center, Philippines1
Background: Panniculitis is a very rare manifestation of a pancreatic disease. This was fi rst illustrated by Mullin in 1968, who reported 1 case of 893 patients. But even more unusual is when panniculitis occurs with polyarthritis in patients with pancreatic dis- ease. Literature showed less than fi ve cases of this association. Some studies suggest- ed that elevated enzymes from the diseased pancreas, acting with trypsin, account for the rash and arthritis but this relationship is not yet scientifi cally-proven.
Objective: To present a rare case of panniculitis and polyarthritis in a patient with pancreatic tumor.
Setting: De La Salle Uiniversity Medical Center, Dasmariñas, Cavite.
Case Summary: A 57 year-old Filipino, alcoholic, complained of several painful, er- ythematous, nodular rash on both legs, associated with knee and ankle pain which started two weeks prior to admission. He also had weight loss, low-grade fever and non-productive cough. There was no abdominal pain. Work-up revealed leukocytosis, anemia, elevated transaminases, direct bilirubin levels, serum amylase and CA 19-9.
ANA & anti-SSA/SSB were negative. Abdominal CT revealed intrahepatic and pancre- atic duct dilatation. Treatment included blood transfusion, antibiotics, corticosteroids, and bowel rest. ERCP revealed common bile duct (CBD) and pancreatic duct stricture (double duct sign) which lead to the diagnosis of pancreatic head tumor. Dermato- pathologic biopsy of the nodules confi rmed the diagnosis of pancreatic panniculitis.
Join pains and rash stopped progressing after endoscopic stent placement and sphinc- terotomy. Diet was slowly resumed and he was discharged after 18 days.
Signifi cance: Awareness of the less common manifestations of diseases is useful to avoid delay in the diagnosis. Such awareness applies to panniculitis and polyarthritis in pancreatic disease. In pancreatic disease, early recognition is critical due to its high mortality when diagnosis is delayed. This awareness also prevents misdiagnosis and administration of inappropriate treatment.
120 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0275 Gastroenterology
One of the Undetectable Causes of Gastrointestinal Bleeding: Small Bowel Angiodysplasia
Yusuf HANCERLI1, Veysel OZALPER1, Muammer KARA2, Ramazan ARIKAN1, Yalçin ONEM1
GATA Haydarpasa Teaching Hospital, Turkey1, GATA Haydarpasa Teaching Hospital, Turkey2 Objective: Angiodysplasia is the major cause of the recurrent massive lower gastro- intestinal bleeding after 60 years of age and it can effect anywhere in the digestive system. This report presents a case on a 72 year old male patient; when investigating anemia etiology it was detected small bowel angiodysplasia with active bleeding.
Case Report: The patient was transferred to internal medicine clinic in order to inves- tigate anemia etiology. Labarotary fi ndings were hemoglobin: 6.19 g/dL MCV:62.6, se- rum iron <0.0, total iron binding capacity:436.30 mcg/dL, ferritin 9.1 ng/ml, folate:6.4 ng/ml, vitamin b12: 210 pg/ml, stool occult blood in Day 1 and Day 2 was negative, but Day 3 was positive. There were not any fi ndings of active bleeding in lower and upper gastrointestinal endoscopic examination in order to explain the cause for ane- mia. When applying capsule endoscopy to the patient it was found 6 mm diameter angiodysplasia in the front wall of duodenal bulb and intensive fresh blood in proximal jejunum and also about 5mm diameter angiodysplasia with active bleeding was identi- fi ed. The patient was discharged after bleeding has been treated and he was asked to come back to medical control examinations.
Conclusion: Gastrointestinal bleeding is one of the common cause of iron defi ciency anemia. In most of the cases it is possible to identify the bleeding by standard meth- ods such as gastroscopy and colonoscopy. However, if the bleeding is in small intestine it is much more diffi cult to identify. If it is not possible to determine the cause of bleeding in anemia patients, not only routine endoscopic imaging must be run but also a complete gastrointestinal scan must be done.
PS 0276 Gastroenterology
Gastrointestinal Tract Hemorrhage Due to Angiodyspla- sia in Hutchinson Gilfort Progeria Syndrome
Serife Hanife AKTAS1
Ümraniye Training and Research Hospital, Turkey1
Hutchinson Gilfort Progeria Syndrome (HGPS) is an aging disease which encounters in childhood and includes a higher risk for atherosclerosis, cerebrovascular event, stroke and coronary artery disease. Angiodysplasia in the gastrointestinal (GIS) tract can be seen as a cause of hemorrhage rarely. 15 years female Progeria patient which the diagnose was established before. The patient admitted our center with dys- peptic symtoms such as neusea, vomit, bloating and described the blackness in the stool. In the patient’s history, GIS tract hemorrhage was occured and treated in the another region hospital, two months ago. In the physical examination, decreased subcutaneous fat tissue, thin skin structure, micrognaty, thin top and bottom lip structure were inspected. Cardiovascular and respiratory system exami- nation displayed normal fi ndings. Melena was not examinated in rectal examination.
Laboratory fi ndings were normal between ranges except mild hypochromic anemia and hypothyroidism; hemoglobin:12 g/dL (12 - 18), hematocrit: 38 % (37 -48), fer- ritin: 139 ng/mL (4.6 - 204), iron: 19 μg/dL (50 - 170), TIBC:269(141-519) thyroid stimulan hormone (TSH) : 6.1 mIU/L (0.4 - 3.4), free T4: 1.0 ng/dL (0.9 - 1.5), anti thyroglobulin: 113 IU/mL (0 - 57), anti thyroid peroxidase:267 IU/mL (0 - 64), sedimen- tation:39 mm/hour. Intact and diffuse type angiodysplasia on the gastric mucosa was identifi ed by the gastroscopy. There were no any bleeding signs and medical treat- ment (proton pump inhibitor and sucralfate) was applied. Also, hypothyroidism was treated by the levo-thyroxin preparate. For the mild hypochromic and iron defi cient anemia, iron containing preparate added to the treatment after discharge. In the liter- ature, there was not coincided HGPS case with hemorrhagic angiodisplasia, commonly.
This case report was represented to emphasize HGPS associated angiodisplasia as a rare cause of anemia and GIS tract hemorrhage.
