An 83-year-old woman who was admitted to other hospital, was consulted us because of continuous tarry stool and abdominal fullness. On upper endoscopy, the submucosal tumor from greater curvature of gastric fornix invaginated into the duodenal bulbus, showing so-called "ball valve syndrome (BVS)". As the tumor incarcerted again on the following endoscoopy, she underwent laparoscopic partial gastrectomy. The submucosal tumor was diagnosed histologically as gastrointestinal stromal tumor (GIST) arising from the muscularis mucosae. This is the first report that GIST arising from the muscularis mucosae in gastric fornix showed a BVS.
We encountered a case of Cronkhite-Canada syndrome in which contrast radiologic examinations of the upper and lower digestive tract were performed immediately before and after the development of the clinical symptoms. These contrast radiologic images showed mainly mucosal coarseness and no polyposis of the stomach and colon. The endoscopy, performed 3 months later from the development of the clinical symptoms, revealed polyposis of the stomach and colon. So we recognized that the clinical symptoms developed before appearance of the polyposis of the digestive tract and the polyposis progressed rapidly.
TEN is a severe dermatological disorder characterized by extended epidermal necrosis. Disseminated mucosal erosions have been occasionally reported to occur in the gastrointestinal tract. We report a case of toxic epidermal necrolysis (TEN) with severe intestinal manifestation. A 52-year-old woman was admitted with high fever, skin eruption and severe diarrhea. She was diagnosed as toxic epidermal necrolysis (TEN), which was most likely due to nonsteroidal anti-inflammatory drugs (NSAIDs). After skin lesion recovered, fever and bloody diarrhea went on. Colonoscopy and X-ray revealed lead-pipe like stenotic long loops which was caused by erosion and sublation of whole mucosa of large intestinum, and severe stenosis of ileum end. The ileo-cecal region was resected on the 216th hospital day. Pathological examination showed sublation of mucoepithelium and inflammatory change in the muco-submucosal layer, but muscular layers of mucosa remained intact. Pathologically, the intestinal lesion resemble the changes in the early skin lesions and seems to be part of the systemic lesion of TEN.
A 66-year-old man patient with chronic hepatitis (CH) C and complications from ulcerative colitis (UC) was treated with interferon-beta (IFN-β). Endoscopically, the UC disease activity was moderate before IFN-β treatment but was in remission eight week after treatment. However, a few months after stopping IFN treatment, endoscopy revealed that the UC disease activity had returned to moderate levels. This result shows that UC improved with IFN treatment.
We present a 68 years old woman who was referred to our department due to impaired liver function. Hepatitis A IgM antibody and anti-nuclear antibody were positive, IgG, and γ-globulin were elevated. Percutaneous liver biopsy was performed and autoimmune hepatitis was suspected pathologically. Oral administration of ursodeoxycholic acid was started and liver function was normalized three months later. The improvement of a hepatitis image was examined by percutaneous liver biopsy one year later. Although hepatitis A IgM antibody was positive throughout the course, hepatitis A virusemia was not considered the cause of persistent positive hepatitis A. IgM antibody could not be clarified. There was a possibility of a non-specific reaction and abnormalities in antibody production control were considered possible. We present this case and discuss the previous literature.
The patients was a 54-year-old woman. In the liver, a high-echo phyma was detected. The lesion increased from 5 to 23mm over 2 years and 4 months. On CT and MRI, it was difficult to differentiate the phyma from hepatocellular carcinoma. However, angiography revealed early outflow to the hepatic vein. In the late CTHA phase of angio-CT, there was no ring-like dark staining reaction (corona), as observed in hepatocellular carcinoma patients, outside the tumor. Hepatectomy was performed, suggesting angiomyolipoma. The course of enlargement could be followed-up, and we present findings that may be useful for differentiating this tumor from hepatocellular carcinoma.
We report a case of diverticular form type of congenital choledochal dilatation with anomalous arrangement of pancreaticobiliary duct and bile duct stone. The patient was a 63-year-old woman with the chief complaint of epigastralgia. Abdominal CT showed low density area suggesting cystic lesion at the region of pancreatic head. MRCP and ERCP revealed dilatation of the common bile duct in the multiple diverticular form with anomalous arrangement of pancreaticobiliary duct. A 2.0cm sized stone was also recognized in the dilated common bile duct. The patient underwent resection of gall bladder and dilated common bile duct, followed by hepatico-jejunostomy. Histological findings did not revealed malignant changes in the mucosa of both gall bladder and dilated common bile duct.
A 52-year-old-man was admitted to our hospital for obstructive jaundice. Percutaneous transhepatic cholangio drainage (PTCD) and endscopic retrograde cholangiopancreatography (ERCP) were performed, and pointed out stenosis of lower common bile duct (CBD) and pancreatobiliary maljunction. Brushing cytology of this lesion was negative for malignancy. CT and MRI revealed chronic inflammatory change in groove lesion with no mass formation suggesting tumor. So we diagnosed groove pancreatitis (segmental form) associated with pancreatobiliary maljunction, and operation (resection of the bile duct and biliary reconstruction by Roux-en-Y) was done. Resected specimen was revealed stenosis of the bile duct formed by fibrous tissue with no malignancy compatible to groove pancreatitis pathologically. This is first reported case of groove pancreatits associated with pancreatobiliary maljunction.