A 72-year-old woman with liver cirrhosis developed spontaneous esophageal rupture due to vomiting after meals. The middle thoracic esophagus was perforated, and was, therefore, clipped endoscopically. The patient was found to have mediastinal emphysema on the chest CT image, we diagnosed as Boerhaave syndrome. The esophagus was perforated atypically. The patient was discharged in stable condition by conservative therapy. Endoscopic injection sclerotherapy may have effect that patient has not developed serious condition.
A 73-year-old woman was diagnosed as having tuberculosis of ileocecum by colonoscopy and started on medication. A month later, she admitted for ileus. Colonoscopy showed improvement of tuberculosis of ileocecum. An ileus tube was inserted on the same day, and ileus was improved once. But after removing the tube, she had ileus again. Computed tomography just after re-inserting an ileus tube with Amidotrizoic acid showed 3 stenoses of ileum. A partial resection of the small intestine was performed. Mycobacterium tuberculosis with PCR was positive. A postoperative course was uneventful and no recurrence has occurred up to now. During treatment of tuberculosis, ileus caused by intestinal tuberculosis may occur. It must be considered to examine the small intestine before beginning to treat tuberculosis of ileocecum or colon.
A 75-year-old woman complaining of sudden lower abdominal pain, fever, and bloody stool was admitted to the hospital. Abdominal CT scan showed retroperitoneal emphysema ranging from the retrorectal space to the posterior region of the kidney, and a stool-like shadow around the rectum. It suggested rectal ulcer and conservative management was started since the general condition was not critical and abdominal pain was localized. Colonoscopy revealed a solitary ulcerative lesion on the posterior wall of rectosigmoid colon, which was considered to be perforating origin. We report a case of perforating rectal ulcer with retroperitoneal emphysema successfully treated conservatively.
We report a case of emphysematous cholecystitis (EC). An 82-year-old woman was hospitalized for subarachnoidal hemorrhage. She presented with fever, vomiting, hypotension, and slight abdominal tenderness in the right upper quadrant. Abdominal computed tomography (CT) revealed the air-fluid level in the lumen of the gallbladder and gas around the wall. The patient underwent cholecystectomy. Laparotomy revealed necrotic changes in the gallbladder. A bile culture revealed Clostridium species infection. The histopathological findings were multiple arterial thromboses and gallbladder infarction. The pathogenesis of EC is controversial, but many cases of emphysematous cholecystitis were acalculous and have been reported in individuals with a history of diabetes mellitus, hypertension, cerebrovasucular accidents, or ischemic heart disease. We consider that the case presented here proves the hypothesis that ischemia and necrotic changes may occur in the gallbladder due to a primary vascular compromise, and that gas-producing bacteria grow under anaerobic conditions, resulting in the development of EC.
A 54-year-old man had repeated pancreatitis since three years after pylorus-preserving pancreatoduodenectomy (PpPD) and reconstruction by the modified Child method. Since abdominal pain appeared after meals, a pancreatic duct tube was removed endoscopically, which resulted in an improvement. It has been postulated that a pancreatic duct tube, used at the anastomosis between the pancreas and gastrointestinal tract, is spontaneously dislodged or creates a spatial gap with the wall of the main pancreatic duct enough to let the pancreatic juice outflow. However, endoscopic removal of the tube remained in place was significantly effective. We here discussed this case with reference of previous published reports.
The patient was a woman, aged 69, diagnosed with acute pancreatitis by a local physician; simultaneously, with US, a low-echo tumor was indicated in the pancreas' uncinate process. Diagnosis was made of acute pancreatitis resulting from a pancreatic IPMN, and the patient was referred. Ultrasound showed hypoechoic tumor images accompanied by posterior echo enhancement. With radiography-CT, from the pancreas parenchymal phase, the peripheral portion was densely stained, while internally, images showed densely stained dendriforms towards the equilibrium phase. With MRI T1-weighted images, there was appearance at low intensity, and with T2-weighted images, there was appearance at high intensity; with MRCP, there was depiction at relatively high intensity. In the final pathological diagnosis, there was prominent formation of mucinous nodules, and mucinous carcinoma including large quantity of mucous.
We report a 11-year-old girl who had abdominal pain, hematemesis and melena. On admission, endoscopy revealed multiple duodenal ulcers and abdominal computed tomography showed dilatation and wall thickness of the jejunum. Because she showed purpura on the lower extremities and a decreased serum level of the XIII factor, she was diagnosed as having Henoch-Schönlein purpura (HSP). On the clinical course, she had acute pancreatitis. Following administration of XIII factor, nafamostal mesilate and predonisolone, the abdominal pain disappeared. Eventually the acute pancreatitis was improved with improvement of purpura. According to this course, this acute pancreatitis was associated with HSP.
An eighty-six-year-old man was admitted to our hospital for bacterial septic shock due to splenic abscess. He had undergone percutaneous coronary intervention 3 weeks earlier. Percutaneous splenic abscess drainage was urgently performed under ultrasonography, and then the general state of the patient rapidly improved. Staphylococcus hemolyticus was isolated from the splenic abscess. We reported that percutaneous catheter drainage was effective for splenic abscess.