Early cholecystectomy has become the standard treatment for acute cholecystitis. However, gallbladder drainage is often performed before surgery. In the present study, we compared the clinical outcomes between patients who underwent endoscopic naso-gallbladder drainage (ENGBD) and those who underwent percutaneous transhepatic gallbladder drainage (PTGBD). PTGBD was superior to ENGBD in terms of success rate and procedure time. However, there was no significant difference in the rate of complications, improvement effect on inflammation, the length of hospitalization, the duration from drainage to operation, and operation time. Although PTGBD has become the first choice for cases requiring gallbladder drainage, ENGBD should be considered the most appropriate therapy in cases with a contraindication for PTGBD due to antithrombotic treatment, those associated with choledocholithiasis, and those suspected of gallbladder cancer. The importance of ENGBD is expected to increase in the future.
A 36-year-old woman presented with fever, diarrhea, and weight loss in April 2011. Upper GI endoscopy and colonoscopy showed a diffuse yellow-white shaggy mucosa in the second part of the duodenum and the ileum end, respectively. These lesions in these 2 locations were biopsied, and both specimens showed distended epithelial villi and massive infiltration of foamy macrophages in the lamina propria. PCR was performed to identify causative bacilli. DNA extracted from the duodenal mucosa showed a specific PCR product, confirming the diagnosis of Whipple's disease. The patient was treated with a 2-week course of ceftriaxone, followed by sulfamethoxazole/trimethoprim. After we started the treatment, the patient developed complications of infective endocarditis and meningitis. The patient was relieved of her symptoms using a combination of gentamicin, penicillin G, ampicillin, meropenem, and vancomycin.
A 79-year-old woman with a history of pyothorax was admitted with a 4-day history of abdominal distension. Physical examination revealed marked abdominal distention, absent bowel sounds, and a vesicular rash over the left Th8-10 dermatome. Abdominal radiography showed gaseous distension of the colon and ileum. Colonoscopy excluded any obstructive process of the colon. Laboratory findings yielded positive results for serum IgM and IgG against the varicella zoster virus (VZV) . Paralytic ileus associated with the VZV was therefore diagnosed. The ileus improved after conservative treatment with intravenous acyclovir. Although shingles is frequently encountered, it is a rare cause of paralytic ileus. In the future, the VZV should be considered as one of the causes of paralytic ileus, and complete resolution can be achieved with conservative management.
Intestinal polyps are a distinctive feature of Peutz-Jeghers syndrome (PJS). These hamartomas can lead to significant complications such as intussusception or gastrointestinal bleeding which necessitate multiple laparotomies and bowel resections. In an operation for intestinal intussusception, it is preferable to simultaneously resect as many polyps as possible to prevent recurrence of complications caused by intestinal polyps. We report a case of a woman in her twenties with PJS, diagnosed as small intestinal intussusception caused by an intestinal polyp. We performed not only repair of the intussusception but also endoscopic polypectomy without resection of the small intestine. We successfully resected all polyps larger than 10mm from the duodenum to the ascending colon during the operation.
We report a case of juvenile gastric polyposis associated with antiphospholipid syndrome. A 42-year-old woman was admitted with a chief complain of fatigue. Six years earlier, antiphospholipid syndrome was diagnosed and treated with aspirin. Two years earlier, gastric polyps were endoscopically observed, the number and size of which subsequently increased. Juvenile gastric polyposis was diagnosed on the basis of the pathological features of the biopsy specimens. Bleeding was repeatedly identified from the polyposis. Total gastrectomy was performed because of worsening anemia and hypoalbuminemia.
A 60-year-old man presented with fever and fatigue in a medical clinic and was given a diagnosis of cholangitis with mild cholangiectasis. The cholangiectasis remained even after treatment with an appropriate antibiotic agent. When the patient was transferred to our hospital for further examination, he was newly suffering from orthostatic hypotension and peripheral facial nerve palsy. Computed tomography (CT) scan revealed multiple low-density areas in the liver and intrahepatic bile duct dilatation. We performed percutaneous liver biopsy, and histopathological findings showed amyloid deposition around the portal vein. We diagnosed his condition as AL amyloidosis. Oral administration of melphalan and dexamethasone improved his clinical features and CT findings. We consider this case as rare in that the deposition of amyloid protein caused cholangiectasis.
A 55-year-old woman was admitted to our hospital because of diverse symptoms of portal hypertension, such as refractory ascites, diarrhea, and general malaise. Blood test revealed liver and renal dysfunction and glucose tolerance. Contrast enhancement computed tomography revealed splenic arteriovenous fistula with dilated splenic artery and vein, causing portal hypertension. The splenic arteriovenous fistula was successfully treated by percutaneous transarterial embolization, resulting in the complete recovery of the patient. Herein, we report a case of arteriovenous fistula which was successfully treated with the aid of interventional radiology.
A 65-year-old man with back pain showed a hypovascular lesion of the head of the pancreas on dynamic computed tomography and abdominal ultrasonography. The distal portion of the pancreas was not visible. Endoscopic retrograde cholangiopancreatography revealed pancreatic duct obstruction, and the duodenal minor papilla was not visible. Therefore, we diagnosed the patient's condition as stage IVa pancreatic cancer with congenital agenesis of the dorsal pancreas. The patient underwent successful chemotherapy with 3 courses of gemcitabine and S-1, which was followed by pancreaticoduodenectomy. Pathological staging revealed invasive ductal carcinoma, pT3, pN0, pM0, stage III. We report a rare case of pancreatic cancer with congenital agenesis of the dorsal pancreas.