The present study investigated the long-term outcomes of restorative proctocolectomy in pediatric patients with ulcerative colitis (UC). We report a series of 25 patients who underwent total proctocolectomy with ileal pouch-anal canal anastomosis (IACA). Surgery was performed for medically intractable colitis and severe colitis in 14 and 11 patients, respectively. Early and late complications were observed in 6 (24%) and 14 (56%) patients, respectively. The long-term quality of life outcomes were satisfactory, including both bowel function and social function. Growth retardation was observed in 6 patients. Five patients exhibited catch-up growth and 3 patients overcame growth retardation. Patients with growth retardation tended to have a younger onset and longer duration of UC, as well as a longer duration and higher total dose of steroid use. In conclusion, the long-term outcomes of pediatric patients with UC undergoing IACA are satisfactory. Furthermore, to minimize the risk of growth retardation, surgery should be performed without delay.
We report a rare case of duplication of the transverse colon in an adult. A 26-year-old male presented to our hospital with upper left abdominal pain and fever. An abdominal computed tomography scan revealed an inflammatory mass in the gastrocolic ligament. Although conservative management with fasting and antibiotics ameliorated the abdominal pain, the mass remained approximately 5cm at its largest diameter. Further investigation with a Gastrografin® enema revealed a fistula in the central part of the transverse colon. A perforation of the transverse colon was intraoperatively detected; therefore, both the intra-abdominal abscess and part of the transverse colon were excised. Pathological examination revealed duplication of the transverse colon that was lined with ciliated columnar epithelium, squamous epithelium, and heterotopic glands.
A 79-year-old man presented with constipation and anal bleeding. Colonoscopy revealed a reddish submucosal tumor of the transverse colon that was 20mm in diameter. Magnified endoscopy with narrow-band imaging (NBI) of the tumor surface revealed a type I pit pattern with decreased density and dilated tree-like microvessels. Furthermore, endoscopic ultrasonography showed that the tumor was limited to the submucosa. A biopsy was subsequently performed, which suggested mucosa-associated lymphoid tissue (MALT) lymphoma. This diagnosis was confirmed by endoscopic submucosal dissection (ESD). To the best of our knowledge, this is the first case report in which magnified endoscopy with NBI was successfully used to diagnose a MALT lymphoma of the colon. In addition, this case report demonstrates the utility of ESD for the therapeutic diagnosis of relatively large lesions with evidence of invasion limited to the submucosa.
A 39-year-old female patient was referred to our hospital with a suspected esophageal motility disorder following a 4-month history of hiccup and dysphagia. Her past medical and family histories were unremarkable. Prior investigation with upper gastrointestinal endoscopy and esophagography failed to demonstrate any obvious pathology. Therefore, high-resolution manometry was performed, which showed the following: an integrated relaxation pressure (IRP) of 11.5mmHg; a distal contractile integral (DCI) of 6543mmHg-s-cm; and, a highest DCI of 9289mmHg-s-cm. A diagnosis of jackhammer esophagus was, therefore, considered. We reported on the details of this case and reviewed the relevant literature.
Gastrointestinal stromal tumor (GIST) of the duodenum is rare. Obtaining tissue samples of GIST in the duodenum is difficult, especially when the tumor is located in the distal duodenum. Thus, preoperative pathological diagnosis often becomes difficult. We performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy for two cases with submucosal tumors in the third portion of the duodenum. Tissue samples were successfully obtained and diagnosed as GIST. Partial duodenectomy was performed in the two patients. Thus, we believe that EUS-FNA is a potentially useful diagnostic aid for submucosal tumors in the third portion of the duodenum, and it should be attempted before more invasive approaches.
A 46-year-old man with cancer of the sigmoid colon with hepatic metastasis underwent sigmoidectomy, partial hepatectomy, and cholecystectomy in May 2008. He subsequently received 10 cycles of a modified 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) regimen as adjuvant chemotherapy from June 2008 to December 2008, following which he developed thrombocytopenia and splenomegaly. In May 2011, upper gastrointestinal endoscopy was performed, which revealed esophageal and gastric varices. The varices were treated endoscopically with ligation and balloon-occluded retrograde transvenous obliteration. A liver biopsy was performed to determine the cause of the portal hypertension in the absence of severe hepatic dysfunction or liver cirrhosis. The biopsy revealed obliteration of the peripheral portal veins with sinusoidal dilatation without fibrosis or inflammatory cell infiltration in the hepatic lobules. Oxaliplatin-based chemotherapy has been associated with hepatovascular injury, such as sinusoidal dilatation and fibrosis, resulting in non-cirrhotic portal hypertension as seen in this case.
A 48-year-old man with locally advanced pancreatic cancer underwent combined treatment with gemcitabine and proton radiation therapy. Because of subsequent obstruction of the common bile duct, a metallic biliary stent was placed and he received further gemcitabine chemotherapy. During chemotherapy, he developed an acute abdomen with a sudden-onset of tarry stool and jaundice. Gastroduodenoscopy revealed hemobilia from the biliary metallic stent. Contrast-enhanced abdominal computed tomography revealed the presence of a pseudoaneurysm arising from the right hepatic artery adjacent to the top of the stent. Hemostasis of the right hepatic artery pseudoaneurysm was achieved via transcatheter arterial embolization using cyanoacrylate.
We report two cases of ruptured pyogenic liver abscesses where one patient survived and the other died. We suspected that infection with gas-producing bacteria was the cause of the latter outcome, and we reviewed 47 case reports of ruptured pyogenic liver abscesses. Of the 47 cases, we determined that 77.6% included gas-producing pathogens. Moreover, the presence of gas-producing pathogens was associated with a mortality of 22.2%, whereas there were no deaths in cases with no gas-producing pathogens.