When performing percutaneous endoscopic gastrostomy (PEG), the associated risks must always be kept in mind. We investigated and analyzed early mortality after PEG, retrospectively. Of the 302 patients (63% males, mean age 75 years) who underwent PEG at our center from 1999 to 2008, 7 patients (2.3%) were dead within 30 days of the procedure. Only one death could be directly related to the procedure. By a logistic regression analysis, the following 3 factors were identified as independent preoperative risk factors for death within 30 days of the PEG: (1) high serum creatinine level [mg/dl, p=0.006, odds ratio (OR)=8.472]; (2) past history of ischemic heart disease [p=0.008, OR=9.985]; (3) low serum albumin level [g/dl, p=0.017, OR=0.096]. In patients with poor renal function, poor cardiac function, severe malnutrition or exhaustion, the indications for PEG need to be very carefully investigated.
A 24-year-old man presented complaining of epigastralgia and tenderness in the epigastric region. An abdominal computed tomography revealed a low density tumor, extending between the anterior wall of the stomach and the abdominal wall. Because the tumor was found to enlarge, an operation was performed to remove the tumor. During the operation, it was revealed that the tumor was connected with the lesser omentum, which suggested that it had originated from the lesser omentum. We diagnosed an inflammatory myofibroblastic tumor based on the pathological examination, which revealed infiltration of inflammatory cells, sparse proliferation of spindle cells and limited proliferation of collagen fibers, characterized by an irregular arrangement.
A 54-year-old man was referred to our hospital with an esophageal lesion. On esophagogastroduodenoscopy a pedunculated elevated lesion about 15mm in diameter was identified in the abdominal esophagus. The surface of the lesion had irregular nodules with white coating. We found no Barrett's mucosa around the lesion. A biopsy specimen of this tumor showed well-differentiated adenocarcinoma. A lower esophagus-proximal gastrectomy was performed because this tumor was suspected to invade the submucosal layer. Eventually, the histological diagnosis after resection was esophageal adenocarcinoma arising from cardiac glands, limited to the mucosal layer (M2). This origin of the esophageal adenocarcinoma is rare. Furthermore, this form of the tumor is especially unusual, and there have been few reports of similar cases.
A 78-year-old man was admitted to hour hospital because of dysphagia, and primary small cell carcinoma of the esophagus was diagnosed. Carboplatin (CBDCA) + etoposide (VP-16) combination chemotherapy and radiation therapy was performed. After this therapy, endoscopic examination and computed tomographic scan showed the disappearance of the primary esophageal tumor. Endoscopic examination with biopsy confirmed the disappearance of malignant cells. Severe adverse reactions were not observed during this therapy. This patient is alive without recurrence for 6 years and 3 months. This case seems to provide suggestions on deciding on the operative indications for small cell carcinoma of esophagus.
We encountered a rare case of liposarcoma of the ascending colon mesenterium. A 53-year-old man visited our hospital because of a mass, 12×8cm in diameter, in the right upper abdomen. On computed tomography (CT), the tumor showed irregular density with a smooth surface and was enhanced irregularly. A part of the tumor protruded into the colon in the upper portion of the ascending colon. The tumor was surgically resected by right hemicolectomy. Histological diagnosis of the tumor was well-differentiated liposarcoma, sclerosing variant. Radiological findings seemed to reflect the pathological findings well.
A 50-year-old man with von Recklinghausen's disease was admitted to our hospital for anemia. Abdominal computed tomography and small intestinal fiberscopy revealed a submucosal tumor in the third portion of the duodenum. CT during angiography showed three small tumor stains on the jejunum, which were not able to be diagnosed on contrast-enhanced CT. The operative findings showed a tumor in the third portion of the duodenum and three small tumors in the jejunum. These tumors, which were immunohistochemically positive for KIT, were diagnosed as multiple gastrointestinal stromal tumors of the duodenum and jejunum. For this case, CT during angiography was useful for localization and diagnosis of multiple lesions on the small intestines.
We describe a case of a 47-year old Japanese man with steroid-dependent, refractory ulcerative colitis complicated by non-tuberculous mycobacterial skin infection. The patient remained in remission by combination therapy of 100mg azathioprine and 27.5mg prednisolone (total dose over 25g for three years), but developed a deep genital ulcer. Mycobacterium szulgai was confirmed by skin culture, and the ulcer became turned into a scar after oral administration of isoniazid, rifampicin, and ethanbutol.
A 19-year old man was admitted for treatment of a right psoas abscess. He was first diagnosed as Crohn's disease with ileocolitis and fistula, which caused the abscess. Following the drainage of the abscess and conservative treatment including administration of antibiotics, total parenteral nutrition and medication, his symptoms were temporarily improved. After recurrence, additional therapy with infliximab successfully induced remission. He has remained free from abdominal symptoms and recurrence of the abscess. It seems that conservative treatment including infliximab administration is useful for induction as well as maintenance of remission and avoiding surgical treatment.