A 41–year–old man presented with general fatigue, tarry stool and epigastralgia. Hematological examination data showed an anemia (Hb 9.3g/dl). No abnormalities were found on upper gastrointestinal endoscopy and colonoscopy. Therefore patient was received a video capsule endoscopy. A stenosis with reddish and edematous mucosal changes was recognized at the upper jejunum. Furthermore, double–balloon enteroscopy was added to this patient. Pathological studies of the biopsy specimens diagnosed a primary small intestinal adenocarcinoma. Computed tomography showed the regional lymph node metastasis without distant metastasis. The patient was received a radical operation. Primary small intestinal adenocarcinoma is a rare malignancy ; most cases cannot be detected on routine gastrointestinal endoscopy due to their location. Therefore, it is often that diagnosis is late. Our experience suggests that double–balloon enteroscopy and video capsule endoscopy are useful for diagnosing small intestinal adenocarcinoma.
A 45–year–old woman was admitted to a local hospital because of abdominal pain, but the symptom did not resolve. Therefore, she was admitted to our hospital the next day. On admission, she had abdominal pain with muscular defense and abdominal distension. Since plain abdominal CT showed ascites and the “whirl sign”, emergency surgery was performed. At laparotomy, 300 ml of blood–tinged ascitic fluid was found. Since the right hemicolon, including a mobile cecum, was found to be twisted 360 degrees counterclockwise around the mesentery and necrotized, right hemicolectomy was performed.
A 20–year–old woman presented at the emergency department with acute right lower abdominal pain. Physical and laboratory examinations indicated acute appendicitis with periappendiceal infiltrate, and the patient underwent appendectomy. However, histological examination of the appendectomy specimen revealed carcinoid tumor with acute inflammation. Therefore, the patient underwent laparoscopic radical ileocecal resection with lymph node dissection two months after the appendectomy. Pathological examination of the resected specimen did not show any tumor in the ileocecal region, but massive metastases in 2 of 35 analyzed lymph nodes were observed. This case evidences that carcinoid tumor of the appendix can easily be missed without histological examination. Routine careful pathological examination of appendectomy specimens is warranted because further surgery and chemotherapy may be necessary.
We report a case initially diagnosed as infected pancreatic pseudocyst after acute pancreatitis and treated by repeated endoscopic drainage, in which the final diagnosis was mucinous cystadenocarcinoma. A 60–year–old woman was admitted to our hospital's gastroenterology department after developing acute pancreatitis and what seemed to be recurrent infected pseudocyst of the pancreatic tail. This was treated by endoscopic transpapillary drainage. However, because the cyst enlarged on imaging and serum carbohydrate antigen 19–9 level increased, we decided to treat the case surgically. Postoperative pathological examination revealed mucinous cystadenocarcinoma with direct invasion of the spleen and transverse colon.