Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
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Volume 109, Issue 10
Displaying 1-14 of 14 articles from this issue
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Review article
Monthly report; Physiology of digestive organs and Japanese herbal medicine
Round-table discussion
Case report
  • Esophageal involvement in a case of eosinophilic gastroenteritis
    Yutaka KUREBAYASHI, Yasuhiko MARUYAMA, Teruyuki SHIMURA, Masanobu KAGE ...
    2012 Volume 109 Issue 10 Pages 1745-1751
    Published: 2012
    Released on J-STAGE: October 05, 2012
    DOIhttps://doi.org/10.11405/nisshoshi.109.1745
    JOURNAL FREE ACCESS
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    A 43-year-old woman presented with severe diarrhea and vomiting in addition to abdominal distension and dysphagia which had persisted for a month. Endoscopic biopsies revealed a significant eosinophilic infiltration in the mucosal layer of the esophagus, duodenum and ileum, yielding a diagnosis of eosinophilic gastroenteritis (EG) with esophageal involvement. The endoscopic examination of esophageal lesion in this case showed linear fissures and concentric rings, both of which are characteristic findings observed in eosinophilic esophagitis (EE). This suggests that these characteristic endoscopic findings in EE can also be applied to the results of endoscopic examinations for esophageal involvement in EG.
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  • A patient of the acute phase with severe ischemic enteritis accompanied by portal venous gas who survived conservative treatment
    Haruhito ATOJI, Noriko SAKAI, Yoshio TANJI
    2012 Volume 109 Issue 10 Pages 1752-1759
    Published: 2012
    Released on J-STAGE: October 05, 2012
    DOIhttps://doi.org/10.11405/nisshoshi.109.1752
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    A 90-year-old man had chest pain. Portal venous gas and ileal edema were noted on abdominal CT, and severe ischemic enteritis was diagnosed. Conservative treatment was performed because of circulatory failure. Later, ileus slowly developed, and ileal stenosis was noted on contrast imaging through an ileus tube. Laparoscopy-assisted small bowel resection was performed and achieved remission. Emergency surgery is performed for portal venous gas in acute celiopathy because it may result in intestinal necrosis, but it is also necessary to consider conservative treatment for maintaining mesenteric blood flow in cases difficult to treat by surgery.
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  • A case of intestinal obstruction occurring during anti-tuberculous therapy for tuberculous peritonitis
    Nobuhiro TAKEUCHI, Tetsuo MAEDA, Hidetoshi TADA, Yu NISHIDA, Yusuke NO ...
    2012 Volume 109 Issue 10 Pages 1760-1769
    Published: 2012
    Released on J-STAGE: October 05, 2012
    DOIhttps://doi.org/10.11405/nisshoshi.109.1760
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    We report here a case of intestinal obstruction occurring during anti-tuberculous therapy for tuberculous peritonitis. An 89-year-old woman, who had been treated for tuberculous spondylitis and operated for tuberculous mastitis and peritonitis, was transferred to our hospital with high grade fever, lower abdominal pain and vomiting. An enhanced abdominal computed tomography (CT) revealed ascites and hypertrophy of the parietal peritoneum. Puncture and drainage of ascites were performed and revealed that a smear examination of the specimen was positive for acid-fast bacilli (Gaffky 1). Treatment by rifampicin, isoniazid and ethambutol for tuberculous peritonitis was started then halted because of drug-induced liver injury. After recovery of the liver damage improved, anti-tuberculosis drugs (rifampicin and streptomycin) were restarted. However two days after recommencing administration, repeated vomiting occurred. An abdominal X-ray showed intestinal obstruction. An ileus tube was inserted and she was treated conservatively, but her symptoms did not improve. Injection of contrast medium through the ileus tube showed obstruction of the upper jejunum, so open surgery was performed. Disseminated yellowish miliary tubercles were seen on the peritoneum and severe inflammatory adhesions were found between the jejunum and the ileum. After ablation of the adhesions, partial resections of jejunum and ileum were performed. Histological examination confirmed the diagnosis of tuberculous peritonitis.
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  • A case of protein-losing gastroenteropathy accompanied by Sjögren syndrome and mixed connective tissue disease
    Kana KAKIGAO, Nobuyoshi FUKUSHIMA, Takahiro MIZUTANI, Kazuhiro HARAGUC ...
    2012 Volume 109 Issue 10 Pages 1770-1775
    Published: 2012
    Released on J-STAGE: October 05, 2012
    DOIhttps://doi.org/10.11405/nisshoshi.109.1770
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    Case reports of protein-losing gastroenteropathy (PLGE) associated with not only mixed connective tissue disease (MCTD) but also Sjögren syndrome (SjS) are very rare. We report a first case of PLGE in a patient with both MCTD and SjS. A 58-year-old Japanese woman was referred and admitted to our hospital because of abdominal fullness and lower leg edema. Her past medical history revealed SjS at age 40. Physical examination demonstrated lower leg edema and Raynaud's phenomenon. Blood chemistry data showed severe hypoproteinemia. Anti RNP antibody was positive. MCTD was diagnosed. The alpha-1 antitrypsin clearance level was high. The 99mTc-DTPA human serum albumin scintigraphy demonstrated abnormal accumulation in the intestine. PLGE associated with both MCTD and SjS was diagnosed, but she was successfully treated by prednisolone.
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  • A case of mucosal Schwann cell hamartoma
    Shintaro SAGAMI, Akira FUKUMOTO, Mio AMANO, Kentaro YAMAO, Yoshimasa H ...
    2012 Volume 109 Issue 10 Pages 1776-1783
    Published: 2012
    Released on J-STAGE: October 05, 2012
    DOIhttps://doi.org/10.11405/nisshoshi.109.1776
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    A 40-year-old man was referred to our hospital because of a positive fecal occult blood test. Colonoscopy revealed many small whitish nodules in the mucosa of the sigmoid colon. Specimens endoscopically resected from the lesions revealed spindle cell proliferation in the lamina propria. Immunohistochemical study revealed strong and diffuse positivity for S-100 protein. Results of staining for neurofilament protein and epithelial membrane antigen were negative. The neurogenic tumors were diagnosed as mucosal Schwann cell hamartoma. No clinical features of multiple endocrine neoplasia type 2B or neurofibromatosis type 1 were found in the present case.
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  • A case of primary biliary cirrhosis with systemic lymph node enlargement
    Shinsuke HIRAMATSU, Hiroko NEBIKI, Ayako UENO, Hirotsugu MARUYAMA, Tak ...
    2012 Volume 109 Issue 10 Pages 1784-1790
    Published: 2012
    Released on J-STAGE: October 05, 2012
    DOIhttps://doi.org/10.11405/nisshoshi.109.1784
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    A 40's woman was hospitalized with cervical lymph node enlargement. Laboratory examinations showed elevated serum bile duct enzymes and the presence of anti-mitochondrial antibody. Abdominal ultrasonography and computed tomography showed enlargement of not only perihepatic lymph nodes, but also axillary and cervical lymph nodes. FDG-PET showed intense uptake concordant with these lymph nodes. We performed endoscopic ultrasonographic fine-needle aspiration biopsy of a perihepatic lymph node, but detected no malignant cells. We then performed liver biopsy, and obtained a histological diagnosed primary biliary cirrhosis. Systemic lymph nodes decreased together with serum bile duct enzyme levels during treatment with ursodeoxycholic acid.
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  • A case of dermoid cyst of the pancreas
    Takahiro URATA, Yoshihiro IZUMI, Yoshi TAKEKUMA, Akira YAMASAKI, Momok ...
    2012 Volume 109 Issue 10 Pages 1791-1798
    Published: 2012
    Released on J-STAGE: October 05, 2012
    DOIhttps://doi.org/10.11405/nisshoshi.109.1791
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    A 58-year-old man visited a local clinic after experiencing epigastric and dorsal pain. A computed tomography scan revealed a hypovascular mass in the pancreatic tail. T1-weighted magnetic resonance imaging (MRI) of the tumor showed a heterogeneous isointense signal and T2-weighted MRI showed a hyperintense signal. Contrast studies revealed contrast enhancement, showing a cystic wall and parts of a septal structure and lumen. Endoscopic ultrasonography revealed a multilocular hypoechoic tumor containing large quantity of debris. We experienced difficulty arriving at a diagnosis and are reporting this case of a pancreatic dermoid cyst, which was diagnosed based on pathological findings.
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  • A case of pancreatic mucinous carcinoma invading the common bile duct with obstructive jaundice
    Noriaki NAKAMURA, Takumi IRIE, Shinji TANAKA, Kenichi TERAMOTO, Shigek ...
    2012 Volume 109 Issue 10 Pages 1799-1806
    Published: 2012
    Released on J-STAGE: October 05, 2012
    DOIhttps://doi.org/10.11405/nisshoshi.109.1799
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    A 75-year-old man was admitted to our hospital for further investigation of obstructive jaundice due to a mucin-producing bile duct tumor. ERCP revealed dilatation of the common bile duct and a filling defect in the bile duct. Because of obstructive jaundice, an EBD tube was placed and bile was drained. Contrast-enhanced CT showed a low density 2-cm mass, in the pancreatic head containing some enhanced parts in the tumor. MRI revealed the tumor to be a low-intensity mass on T2-weighted image. After recovery from the obstructive jaundice, pancreaticoduodenectomy was performed under a diagnosis of invasive mucinous carcinoma penetrating the common bile duct from the pancreatic head, resulting in obstruction of the common bile duct. Postoperatively histopathological diagnosis of the resected specimen showed mainly mucinous carcinoma originating from the pancreatic head without a component of intraductal papillary-mucinous tumor.
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