Among 586 patients who underwent computed tomography colonography (CTC) from May 2012 to September 2017, 333 were diagnosed with colonic diverticulosis. The incidence of colonic diverticulosis increases with age. Despite a high frequency of ascending colonic diverticulosis, multiple diverticulosis (>10 in a colonic segment) were the most frequent in the sigmoid colon. In previous studies, the frequency of detection of colonic diverticulosis by CTC was higher than that by colonoscopy and barium enema. In addition, using CTC, the detection rate of colonic diverticulosis has been recently increasing, suggesting that CTC is the most sensitive procedure for detecting colonic diverticulosis.
Clinical features of 60 patients with ischemic colitis diagnosed at our hospital were analyzed. Ischemic colitis developed in 58 patients (97%) shortly after the evening meal, and in 52 patients (87%), it occurred while the patients were asleep from night to daybreak. The supine position while sleeping resulted in a decrease in the blood flow to the colonic wall and an increase in the intraluminal pressure due to a delay in excretion of the contents of the gut. In addition, increased peristalsis and intraluminal pressure after the evening meal triggered ischemic colitis. Ischemic colitis in the young adult group (<40 years) was more frequently mild because they did not experience arteriosclerosis-related diseases and constipation, and these intestinal factors were considered to contribute to the onset of the disease. In the elderly group (≥70 years), ischemic colitis was more severe than that in the young adult group because ischemic colitis in the elderly group was caused by both vascular and intestinal factors. The severity score evaluated by endoscopic findings revealed a marked correlation with age, clinical symptoms, leukocyte count, and CRP value. The final linear regression model determined leukocyte count, age, and digestive symptoms as substantial independent predictors. In several cases in our study, ischemic colitis occurred more often when exposed to a high percentage of humidity;thus, we speculated that high humidity played an essential role in the pathogenesis of ischemic colitis.
A 69-year-old Japanese man underwent successful percutaneous endoscopic gastrostomy (PEG) without any intra-procedural adverse event. However, 3 days postoperatively, he presented with melena and bloody discharge from the gastrostomy tube. Computed tomography revealed gastric emphysema, hepatic portal venous gas, portal vein thrombosis, and swelling of the ascending colon. We administered antibiotics and discontinued enteral feeding; this resulted in resolution of gastric emphysema, hepatic portal venous gas, and portal vein thrombosis and an improvement in the swelling of the ascending colon. To the best of our knowledge, till date, only three patients have been reported to develop gastric emphysema and hepatic portal venous gas after PEG. All previously reported patients were treated with antibiotics and/or discontinuation of enteral feeding, exhibiting recovery within 6-14 days. Although the occurrence of gastric emphysema and hepatic portal venous gas after a PEG procedure is rare, conservative management can ensure recovery in such patients.
An 81-year-old woman was treated with Daclatasvir (DCV) and Asunaprevir (ASV) for chronic HCV infection. Although she developed a fever 13 days after treatment initiation, the administration of these drugs was continued under careful observation. After 33 days of treatment initiation, she developed a high fever and hip joint pain that led to hospitalization. Following MRI studies and examination of her hip joint fluid, we suspected that she had developed hip joint synovitis secondary to the use of DCV and ASV. Consequently, we discontinued the administration of both DCV and ASV, resulting in an immediate improvement in her symptoms. Eventually, she attained a sustained virological response 24 despite discontinuing the administration of DCV and ASV. Hence, unexpected adverse events, such as hip joint synovitis, should be considered in the differential diagnosis, particularly in elderly patients (≥80 years) who are treated with DCV and ASV for chronic HCV infection.
A 79-year-old woman presented with a chief complaint of abdominal pain. Imaging findings suggested hepatocellular carcinoma although the serum levels of tumor markers were within the normal range. Thus, we performed hepatectomy of S5 and components separation. Histologically, the tumor was diagnosed as reactive lymphoid hyperplasia of the liver. In reactive lymphoid hyperplasia of the liver, a preoperative diagnosis of a malignant tumor was made followed by a definitive diagnosis after resection. Hence, it is imperative to consider reactive lymphoid hyperplasia as a type of liver tumor that is distinct from hepatocellular carcinoma.