The Korean Association of Internal Medicine
270 32nd World Congress of Internal Medicine (October 24-28, 2014) PS 1109 Gastroenterology (Gastrointestinal Tract) Fish Bone-Related Periumbilical Mesentery Abscess in an Elderly Patient
Bo Ra Kim1, Chang Yoon Ha1, Jeong Woo Hong1, Won Yong Jo1 Gyeongsang National University Hospital, Korea1
Foreign body ingestion is not an uncommon problem .The accidental ingestion of fi sh bones may sometimes lead to penetration injuries with complicating abscess forma- tion.Fish bones are usually invisible on plain X-ray. A computed tomography (CT) scan of the abdomen is helpful to determine the cause of abdominal pain.We present the case of a 78-year-old man who had periumbilical area pain and dyspepsia . The com- puted tomography (CT) demonstrated a 5cm sized cystic lesion with wall enhancement and adjacent fat infi ltration in periumbilical mesentery.An periumbilical mesentery ab- scess was diagnosed and after colonoscopy, a foreign body, which proved to be a fi sh bone, was removed. The man could not remember swallowing this fi sh bone.
PS 1110 Gastroenterology (Gastrointestinal Tract) Igg4-Ralated Sclerosing Mesenteritis Misdiagnosed as a Mucinous Cystadenocarcinoma
Young Shin Shin1, Hyung Wook Kim1, Hong Kyu Lim1, Ja Jun Goo1, Peel Jung1 Pusan National University YangSan Hospital, Korea1
Background: IgG4-related disease has been recognized as a broad-spectrum systemic disease characterized by forming the mass with an extensive IgG4-positive plasma cell and lymphocyte infi ltration and sclerosis. This disease infi ltrates various sites such as the pancreas, retroperitoneum, lung, head, and neck. However, the origin of this disease has not been known yet. Steroid therapy admittedly has a favorable effect on this disease.
Case Report : An 50-year-old woman was hospitalzed here, for evaluation of the RLQ mass found in abdominal ultrasonography without any symptoms. Abdominal computed tomography demonstrated lobulated solid mass with curvilinear calcifi- cations (4.2cm) abutting appendiceal tip, and this fi nding was positively suspected to be the mucinous cystadenocarcinoma(Fig.1). But there were no other abnormal fi ndings on the laboratory exam including tumor markers such as CA 19-9, CEA. She took right hemicolectomy. On gross, a well-defi ned yellow-whitish calcifi ed mass was showed. On section, there was sclerotic lesion with infl ammatory exudates in another side(Fig.2). Microscopically, the sclerotic lesion, in this case, has stromal fi brosis and abundant infl ammatory cells such as neutrophils, lymphocytes and plasma cells(Fig.3).
Immunohistochemically, many IgG4-positive plasma cells have been found, and the IgG4/IgG ratio was more than 40%(Fig.4). According to these fi ndings, this disease was diagnosed as IgG4-related sclerosing mesenteritis, but the serum IgG4 level on postoperation was the normal range. After operation, neither symptom nor complica- tion appears in this patient.
Conclusion: We report the case of IgG4-ralated sclerosing mesenteritis misdiagnosed as the mucinous cystadenocarcinoma. An accurate diagnosis for this disease is signifi - cantly important to make suitable treatment.
PS 1111 Gastroenterology (Gastrointestinal Tract) A Case of Benign Cystic Mesothelioma Misdiagnosed as Peritoneal Carcinomatosis
Kyu Hyung Han1
Dankook University Hospital, Korea1
Benign cystic mesothelioma (BCM) is a rare mesothelial lesion that forms multicystic masses in the upper abdomen, pelvis, and retroperitoneum. Although it is catego- rized as a benign lesion, it has a tendency to recur. It occurs predominantly in young to middle-aged women. The majority of cases were associated with a history of a abdominal or pelvic operation, a history of endometriosis, and pelvic infl ammatory disease. We experienced a case of BCM which was incidentally discovered. A 52-year- old man visited private clinic to take health medical examination. On ultrasonogram, moderate amount of ascites was founded, so he took a computed tomographic scan of the abdomen & pelvis. CT scan showed that peritoneal carcinomatosis findings with moderate amount of ascites and omental cake formation from epigastric area to lower abdomen. He was recommended to visit tertiary hospital. He did not complain any symptoms and show abnormal physical fi ndings. The patient underwent diagnostic laparoscopic operation. About 1L of yellowish ascites was observed in peritoneal cav- ity, a lot of 2~3mm sized nodular lesions seemed like peritoneal seeding masses was observed. Microscopically, the tumor consisted of a multilocular cyst containing clear serous fl uid. The cell lining the cysts ranged from fl at to low cuboid. They showed strong positive reactivity for calretinin & D2-40 and negative reactivity for epithelial membrane antigen (CD31) on immunohistochemical staining. These fi ndings suggest that the tumor was mesothelial in origin. We report a case of benign cystic mesothe- lioma without any specifi c symptoms which was misdiagnosed as peritoneal carcino- matosis.
PS 1112 Gastroenterology (Gastrointestinal Tract) Scrub Typhus Associated Hepatic Dysfunction and Ab- dominal CT Findings
Weon Jae Lee1, Sang Goon Shim1, Kil Jong Yu1, Chang Uk Jeong1, Ji Eun Oh1, Kwang Min Kim1, Hyun Jin Cho1, Dae Hyun Jo1, Hyoun Su Lee1, Man Je Park1
Samsung Changwon Hospital, Korea1
Background: This retrospective study investigated abnormal hepatic dysfunction and abdominal computed tomography (CT) fi ndings in scrub typhus, and severity of hepat- ic dysfunction according to the number of CT fi ndings.
Methods: 349 adult patients were diagnosed with scrub typhus. 94 underwent ab- dominal CT. The CT images were reviewed by the attending radiologist. Patient data of history, symptoms, signs, and results of laboratory tests were collected from the electronic medical records.
Results: In 349 patients with scrub typhus, elevation of AST (78.5%) and ALT (63.0%) were dominant compared to ALP (27.2%) and total bilirubin (16.1%) (Table 1). Ab- dominal CT fi ndings of 94 patients were, in descending order of frequency, enlarged lymphnode (53.2%), inhomogenous enhancement of liver (47.9%), splenomegaly (46.8%), ascites (28.7%), low attenuation of periportal areas (27.7%), gallbladder wall thickening (17.0%), and splenic infarct (6.4%) (Table 2) (Figure 1). Also, the level of aspartate transaminase tended to be elevated according to the number of CT fi ndings (P= 0.028).
Conclusions: When scrub typhus is suspected in an endemic area, the hepatocellular pattern of hepatic dysfunction and the aforementioned fi ndings of abdominal CT may be helpful to the accurate diagnosis and improvement the patient prognosis, such as by the appropriate selection of antibiotics.
