Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
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Volume 107, Issue 6
Displaying 1-13 of 13 articles from this issue
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Review article
Monthly report; Current status and future prospects on diagnosis and treatment of Crohn's disease
Case report
  • A case of anal cancer with rapidly rising CEA in longstanding perianal Crohn disease after infliximab administration
    Manabu SATO, Hitoshi OGAWA, Chikashi SHIBATA, Koh MIURA, Toshinori AND ...
    2010 Volume 107 Issue 6 Pages 885-892
    Published: 2010
    Released on J-STAGE: June 07, 2010
    DOIhttps://doi.org/10.11405/nisshoshi.107.885
    JOURNAL FREE ACCESS
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    Infliximab is effective in the treatment of steroid-resistant Crohn disease. However, there is clinical concern about a possible correlation between an increased risk of anorectal cancer and infliximab treatment. We report a case of anorectal cancer in long-standing perianal Crohn disease. A 34-year-old patient with a long-standing perianal lesion of Crohn disease underwent 3 sessions of infliximab therapy. After therapy, the concentration of plasma CEA was 36.5ng/ml and rose to 91.4ng/ml. We suspected anorectal cancer, so abdominoperineal resection was performed. The histological findings indicated mucinous adenocarcinoma. Monitoring of patients with long-standing perianal Crohn disease is considered essential for early diagnosis of anal cancer after obtaining biopsy samples from perianal lesions. Additionally, when infliximab is started for perianal Crohn disease, thorough examination for perianal lesion should be performed.
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  • Two cases of treatment with infliximab which replaced long-term home parenteral nutrition and maintained remission in patients with Crohn disease
    Narihiro SHIBUKAWA, Riichiro NEZU, Maiko MURATA, Masako SATO, Katsuhis ...
    2010 Volume 107 Issue 6 Pages 893-899
    Published: 2010
    Released on J-STAGE: June 07, 2010
    DOIhttps://doi.org/10.11405/nisshoshi.107.893
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    [Case 1] A 41-year-old man had undergone multiple bowel resections and consequently short bowel syndrome with high-output jejunostomy developed. In July 2008, he started infliximab (IFX) treatment and achieved remission and recovery from cholestatic liver damage following the cessation of home parenteral nutrition (HPN). [Case 2] A 29-year-old woman chose HPN over enteral nutrition because of high-output fecal fluids through a rectovaginal fistula. Treatment with IFX and dietary control reduced her perianal discomfort. In these 2 patients, treatment with IFX successfully replaced long-term HPN which maintained remission, and improved quality of life.
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  • Two cases of inflammatory bowel disease diagnosed in the course of primary biliary cirrhosis
    Osamu ARAI, Hiroshi IKEDA, Hirokazu MOURI, Kenji NOTOHARA, Kazuhiro MA ...
    2010 Volume 107 Issue 6 Pages 900-908
    Published: 2010
    Released on J-STAGE: June 07, 2010
    DOIhttps://doi.org/10.11405/nisshoshi.107.900
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    Inflammatory bowel disease (IBD), especially ulcerative colitis (UC), sometimes accompanies with primary sclerosing cirrhosis (PSC). Primary biliary cirrhosis (PBC) is also a chronic liver disease, but is attributed to an unknown immune abnormality. PBC frequently accompanies various autoimmune diseases, but rarely IBD. We report 2 rare cases of IBD which developed in the course of treatment for PBC. A 64-year-old man had blood in his stool 17 months after he was given a diagnosis of PBC. Colonoscopy revealed erosion and disappearance of the vascular network pattern in the rectum. UC (rectal type) was diagnosed and he received mesalazine, and following which his symptoms improved. A 40-year-old woman developed diarrhea, fever and arthralgia while receiving treatment for PBC. Colonoscopy revealed ileal erosion, a longitudinal ulcer in the ascending colon but only mild rectal inflammation. These findings were atypical of UC, and we therefore diagnosed indeterminate colitis. Her symptoms disappeared as a result of the administration of mesalazine.
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  • A case of acute superior mesenteric arterial occlusion with successful emergency simultaneous side-to-end anastomosis
    Yoshihiro MORIWAKI, Shinju ARATA, Kazuhisa TAKAYAMA
    2010 Volume 107 Issue 6 Pages 909-914
    Published: 2010
    Released on J-STAGE: June 07, 2010
    DOIhttps://doi.org/10.11405/nisshoshi.107.909
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    A 72-year-old woman was transferred to our critical care center because of transient loss of consciousness and aphasia. She had a history of abdominal pain, nausea, and atrial fibrillation, and reported on admission mild abdominal rebound tenderness, inflammatory response, acidosis and renal dysfunction. We suspected acute superior mesenteric arterial occlusion (SMAO) after cerebral infarction. We performed simultaneous reconstruction with side-to-end anastomosis using circular and linear staplers, rather than jejunostomy, which avoided the loss of massive intestinal contents and frequent diarrhea. A detailed history is important to make a diagnosis of acute SMAO and simultaneous reconstruction with side-to-end anastomosis is an important treatment option.
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  • A case of systemic lupus erythematosus with liver damage
    Hidenao NORITAKE, Yoshimasa KOBAYASHI, Kenichi SODA, Kinya KAWAMURA, K ...
    2010 Volume 107 Issue 6 Pages 915-922
    Published: 2010
    Released on J-STAGE: June 07, 2010
    DOIhttps://doi.org/10.11405/nisshoshi.107.915
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    A 38-year-old woman with systemic lupus erythematosus (SLE) presented with liver damage during prednisolone therapy. Because her liver damage did not improve, she was admitted to our hospital. Laboratory findings revealed liver enzyme elevation, impaired glucose tolerance, and insulin resistance. Pathological examination revealed marked diffuse macro and microvesicular fatty infiltration. Because the patient did not consume alcohol, she was given a diagnosis of nonalcoholic steatohepatitis. To improve her insulin resistance, we administered pioglitazone therapy for 1 week; however, subsequent laboratory findings did not indicate any improvement in her liver damage. Assuming that SLE might have caused liver damage, we administered high-dose prednisolone therapy; subsequent laboratory findings indicated that her serum complement titer and the level of liver enzymes improved. Abdominal computed tomography revealed that the Hounsfield number of the liver increased to normal after treatment. Fat infiltration of the liver improved after treatment, which confirmed the fact that her liver damage had been due to SLE.
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  • A case of serous cystic tumor, which recurred with severe acute pancreatitis
    Mika ORIHARA, Michio KUROKI, Keiichiro HIRAMOTO, Hirokazu SHOHJI, Yosh ...
    2010 Volume 107 Issue 6 Pages 923-929
    Published: 2010
    Released on J-STAGE: June 07, 2010
    DOIhttps://doi.org/10.11405/nisshoshi.107.923
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    A 76-year-old woman with serous cystic tumor (SCT) was admitted to our hospital with abdominal pain and was given a diagnosis of severe acute pancreatitis. Infusion of intravenous protein inhibitor and continuous hemodiafiltration (CHDF) were started and she was placed on a respirator, but she died on the 6th day after diagnosis. On autopsy, each SCT cyst showed evidence of hemorrhage. We supposed that the growth of the SCT after hemorrhage compressed the main pancreatic duct and caused severe acute pancreatitis. SCT is benign, and there are no standard treatments. During follow-up of patients with SCT, we should consider the risk of severe acute pancreatitis.
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  • A case of pancreatic glucagonoma with erythema
    Michihiro YOSHIDA, Kazuki HAYASHI, Hirotaka OHARA, Katsuyuki MIYABE, F ...
    2010 Volume 107 Issue 6 Pages 930-936
    Published: 2010
    Released on J-STAGE: June 07, 2010
    DOIhttps://doi.org/10.11405/nisshoshi.107.930
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    A 38-year-old man was admitted because of exacerbation of erythema. Full-body computed tomography (CT) scanning revealed a tumor mass in the tail of the pancreas; CT and magnetic resonance imaging (MRI) scans confirmed the presence of a spherical mass. In contrast CT scans, although the contrast was gradually increased, no strong contrast differences were observed between the tumor and the surrounding tissue. Endoscopic ultrasonography (EUS) revealed a spherical low-density mass. Blood test results revealed that the patient had a high glucagon level. We diagnosed glucagonoma syndrome on the basis of the above results and resected the tail of the pancreas. Pathological analysis revealed that the tumor cells had proliferated in ribbon-like, cord-like structures. Immunostaining results were positive for glucagon, which confirmed our diagnosis.
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  • A case of pancreatic arteriovenous malformation creating a common bile duct-duodenal fistula with the onset of hemorrhagic duodenal ulcer
    Takahisa SUZUKI, Masataka SHINODA, Hitomi TAKASHI, Mutsumi MURAYAMA, I ...
    2010 Volume 107 Issue 6 Pages 937-947
    Published: 2010
    Released on J-STAGE: June 07, 2010
    DOIhttps://doi.org/10.11405/nisshoshi.107.937
    JOURNAL FREE ACCESS
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    A 50-year-old man had been treated for hemorrhagic duodenal ulcer. Although the patient was treated by proton pump inhibitors (PPI), the ulcer did not show any sign of improvement. Therefore, we also examined the pancreas, and obtained CT findings suggestive of arteriovenous malformation (AVM) from the head to the body of the pancreas. Pancreatic AVM was diagnosed based on angiography. He was readmitted for high fever and abdominal pain. On day 2, CT demonstrated a cystic lesion containing gas at the pancreatic head, and CT showed pneumobilia on day 15. The next day, pancreaticoduodenectomy was carried out and a common bile duct-duodenal fistula was confirmed. This report describes a rare case of pancreatic AVM complicated with a common bile duct-duodenal fistula.
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