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.
