A 67-year-old female was admitted to our hospital because of bloody stool and anemia. Colonoscopic findings showed an arteriovenous malformation (AVM) with circular ulcer, about 12mm in diameter in the cecum. The lesion was endoscopically performed hot biopsy and electric cauterization after injection of saline containing diluted epinephrine into the submucosa. Also colonoscopic findings showed enlargement of the ulcer but residue of the AVM after 4 days, it was performed electric cauterization again.
But colonoscopic findings showed bleeding from the lesion after 2 weeks, and ileocolic arteriogram showed collection of arterioles and early venous drainage. So ileocecal resection was performed. Microscopic view of the resected specimen showed proliferation of dilated vessels in the submucosa and mucosa.
A case of colonic AVM with ulcer has been rarely reported with only 3 cases in the literature. All ulcers of them were longitudinal, which were different from that of our case. It is supposed that the uler of colonic AVM is due to mechanical stimulation or thrombosis of the arterioles.

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A 19-year-old female visited our hospital because of severe abdominal pain and hematochezia. The symptom occurred suddenly from the evening of the previous day and disappeared two days later.
A colonoscopy performed on the second day of the disease revealed 2 longitudinal ulcers from the transverse colon to the descending colon. It was highly suggestive of ischemic colitis and the histology of the biopsied specimen was compatible with the diagnosis. There was no drug history such as antibiotics or oral contraceptives. The stool culture was negative. A barium enema performed on the sixth day of the disease showed no definite abnormality. Neither abnormal coagulopathy, nor collagen disease were detected by a bood test.
According to a survey of 5 cases of teenagers reported in Japan including our own case, it seems that juvenile cases without any background disease improves more quickly than senior type usually accompanied by atherosclerotic change.

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Benign lymphoid polyp of the rectum is an uncommon lesion. About 20 cases have been reported in Japan to date, and the same type of polyp of the transverse colon is also unusual. Only one case has so far been reported.
Case 1 : The immunological fecal occult blood test of a 50-year-old woman revealed a positive diagnosis. Colonoscopy disclosed 5-6 hemispheric polyps measuring 2-4mm near the anal verge. The polyps had disappered 6 months later. Histological examination of the specimens showed lymphoid hyperplasia with numerous lymphocyte infiltrations in the submucosa. No atypical lymphocytes were found.
Case 2 : A 65-year-old woman was admitted to our clinic complaining of right upper quadrant discomfort. Barium enema examination revealed a small polypoid lesion in the transverse colon near the hepatic flexure. Endoscopic polypectomy was performed, and the specimen was 6×8mm in size. Histological examination showed lymphoid follicular hyperplasia with germinal centers. Immunohistological staining did not show any monoclonality in the lymphocytes.

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A 19-year-old man was admitted to our hospital complaining of watery diarrhea and body weight loss. Laboratory examinations showed positive CRP and mild elevated erythrocyte sedimentation rate. Stool culture disclosed no pathogenic bacterium.
Initial barium enema showed numerous aphthoid lesions throughout the entire colon and rectum. Colonoscopy revealed aphthoid ulcers on the mucosal surface from the rectum to the descending colon. Histological examination of the biopsy specimen from rectum showed non-caseating epithelioid cell granuloma. Anal fissures were found in the rectal examination. We diagnosed the patient as suffering from Crohn's disease.
Remission was obtained by the administration of salazosulfapyridine and his clinical course was uneventful. But 2 years later, his symptoms got worse and follow-up colonoscopic examination revealed longitudinal ulcerations on the descending and the transverse colon. By treatment with elemental diet alimentation, the patient has been given relief. This case was considered important in speculating the natural course of Crohn's disease.

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A 31-year-old man was referred to our hospital because of fever, oral and genital ulcers, mild abdominal pain and diarrhea which occured 6 months before admission. Colonoscopic examination disclosed diffuse, discrete round ulcers of the colon, and the intact terminal ileum. The administration of salazosulfapyridine followed by aminosalicylic acid improved pyrexia and colonic lesions.
Relapsing oral, genital and colonic ulcers suggested the diagnosis of incomplete-type intestinal Behçet's disease. However, microscopic examination demonstrated non-caseous epithelioid cell granulomas, which are characteristic of Crohn's disease.
Therefore, the present case was considered an indeterminate one of inflammatory bowel disease and a long-term follow-up might disclose a definite diagnosis.

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A 47-year-old man visited our hospital with a complaint of abdominal mass. He did not complain any abdominal pain and disorder of defecation. A fist sized mass was palpable on his left lower abdomen.
Abdominal CT scan showed increased density of the fat tissue surrounding the sigmoid colon. Barium enema study revealed an irregular stenosis without rigidity of the sigmoid colon and scattered diverticula near this lesion. Colonoscopy showed neither rand wall nor ulceration at the stenotic lesion and biopsy specimen showed no malignancy. So this case was diagnosed as inflammatory mass and stenosis caused by colonic diverticulitis and sigmoidectomy was performed.
Sigmoid colon with dense adhesion to the abdominal wall and the remarkably thickened mesentery associated with previous inflammation were observed. Histological findings of the resected specimen showed scattered pseudo-diverticula and noticeably thickened proper musclelayer. In summary, we reported a rare case of diverticulitis of the sigmoid colon with asymptomatic mass.

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Kuni-village, located northwest of Gunma prefecture, is blessed with good natural environment. In autumn, wild Akebiae Caulis fruits ripen and are harvested in the mountains and bushes by villagers. Since the seeds of the fruit taste bitter, most people will spit it out immediately, but people who love this fruit will eat and swallow the whole fruit. This report will present two cases of hemorrhagic proctitis induced by excessive eating of this fruit.
Case 1 ; male, age 72. His first medical examination was on October 12, 1989 when he came in complaining of bloody stool and abdominal distension. He had eaten over 50 pieces of the fruit the day before. The results of endoscopic examination showed large amounts of the fruit seeds stacked in the rectum and hemorrhagic and erosive rectal mucosa were observed. The patient was administered an enema and stool extraction resulting in discharging large amount of seeds. After two weeks of treatments, the endoscopic examination showed that the mucosa was back to its normal condition.
Case 2 ; female, age 44. Her first medical examination was on October 5, 1995 when she came in complaining of bloody stool and abdominal distension. She had eaten over 20 pieces of the fruit the day before. Since the endoscopic examination showed the same results as mentioned in case 1, the patient was admitted an enema and stool extraction.
Two cases demonstrated above were acute hemorrhagic proctitis induced by some stimulation with Akebiae Caulis seeds. It is suggested that from these cases the seeds of the fruit should be spit out immediately to prevent sickness.

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We report three patients with acute hemorrhagic rectal ulcer (AHRU) in our hospital.
Case 1 : A 61-years-old male with alcoholic liver damage and acute renal failure had massive fresh bloody stool. Colonogram showed AHRU. Local injection of hypertonic saline-epinephrine (HSE) and clip ligation failed to prevent rebleeding. Surgical ligation was done.
Case 2 : A 80-years-old male with congestive heart failure was admitted because of hematochezia. We could easily inject HSE and perfom clippig ligation by the colonoscopy capped with a transparent hood.
Case 3 : A 77-years-old female with congestive heart failure and toxic epidermalnecrolysis had hematochezia. Bleeding from AHRU was treated by clipping ligation.
It is important to perform colonoscopy considering AHRU, when we find that a patient have scarlet bloody stool without abdominal pain.

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We report a case of rectal carcinoid in a patient who was undergoing remission-inducing treatment for acute lymphoblastic leukemia (ALL-L1) .
A 49-year-old male was admitted to our hospital because of ALL. He developed melena while undergoing treatment for leukemia, and colonoscopy showed a linear ulcer at the transverse colon and a polyp at the rectum measuring approximately 10mm.
Histological examination of the rectal polyp revealed carcinoid. However, no treatment for the rectal carcinoid was given in consideration of his general condition and leukemia treatment. Polypectomy was performed one year later, when he was in complete remission from leukemia.
Digestive tract cancer with acute leukemia is rarely encountered clinically, nevertheless, such cases have been reported. While the survival of leukemic patients is prolonged due to the progress in chemotherapy, the risk of a secondary cancer increases. In this respect, examination of the digestive tract and careful observation are necessary for paitients with leukemia.

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We report a case of rectal carcinoid which brought about rapid local recurrence and liver metastasis after the operation.
A 69-year-old man was admitted with a complaint of bleeding at the time of evacuation. Malignant mass (type-3) was found endoscopically. Ultrasonograpy, CT scan and MR image showed lymphatic involvement without liver metastasis. A Miles' operation (D-2) was carried out. The tumor was invaded to prostate so deep that it was hard to dissect lesser pelvic cavity.
The tumor was histologically diagnosed as rectal carcinoid, and got over muscle layer and invaded peri-rectal adipose tissue and local lymphnodes. Then he was discharged in 32nd POD in good condition. In 52nd POD, he was admitted to hospital again. At this time anal hard mass was recognized. MR image showed multiple nodular tumors in the anus part. And liver metastasis was recognized multiply in ultrasonography. He died of liver dysfunction and renal dysfunction in 61st POD.
This report implicates that Miles' operation gives no survival advantage for patients with aggressive behavior of rectal carcinoid tumors.

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We encountered one patient with hepatic sarcoidosis and conducted a clinical investigation of this patient together with 4 other patients who had so far been diagnosed as hepatic sarcoidosis by laparoscopic biopsy of the livers, based mainly on laparoscopic images and histopathological findings.
The five patients, consisting of 2 males and 3 females, were 30-59 years in age. For biochemical findings of the blood, TBil and γ-globulin levels were elevated in 2 patients and ALP rose in 3 patients. ACE was increased in 4 patients. For laparoscopic observations, the surface of the livers exhibited various levels of unevenness, ranging from smooth to highly uneven. The size and distribution of white sarcoid nodules observed on the liver surface varied from dotted nodules to map-like nodules. For histopathological findings, although uncaseous granuloma was found in 3 of the 5 patients, no granuloma was observed in deep tissues taken by liver biopsy in the remaining 2 patients.
It is considered that both laparoscopic and histological findings of the liver are important for definite diagnosis of liver sarcoidosis.

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A 58-year-old man admitted to our hospital because of epigastralgia and icterus. ERCP revealed a long stricture from the right hepatic duct to the common bile duct suggesting Mirizzi syndrome.
IDUS findings showed thickness of bile duct walls and large gall bladder stone. EST, EBD (10Fr) and ESWL were performed, followed by acute cholecystitis. GB stones were crushed and removed by PTCCSL, after PTGBD was performed. The stricture of bile duct remained mild, but the stones were completely removed.
PTCCSL is very useful in this case, although it is difficult to treat Mirizzi syndrome only by EST and ESWL. In conclusion PTCCSL is a practical procedure to treat Mirizzi syndrome without any complications.

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Laparoscopic cholecystectomy, cryptorchidectomy and hernioplasty were performed simultaneously in a patient with gall bladder polyps, cryptorchism and indirect inguinal hernia.
These operations were successfully completed with only 6 trocar ports. A good sight for all of 3 operations was obtained without increasing invasion and changing patient's position. Operation time was approximately 3 hours, 2 times longer than that of laparoscopic cholecystectomy.
We conclude that simultaneous laparoscopic operations are performed with potential benefits of minimal invasion, quick recovery and shorter hospital stay.

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A 49-year-old male with chief complaint of abdominal fullness who was pointed out massive ascites by abdominal ultrasonography admitted our hospital for further examinations and treatment on October 9th, 1996.
Anemia in palpebral conjunctiva and severe abdominal bulging was pointed out at physical examination. Laboratory data revealed elevation on serum amylase (1,031IU/l) and elastase I (1,363ng/dl) and abdominal fluid was exdate which has elevation of amylase (16,260IU/l) . About 2 cm in diameter of calcification was detected in head of the pancreas and cystic lesion was also revealed in tail of the pancreas by computer tomography. Endoscopic retrograde cholangiopancreatography (ERCP) revealed calcification (22×12mm) in head of the main pancreatic duct and cystic lesion in tail of the pancreas.
This patient was transfered to another hospital and pancreatolithiasis was successfully treated by extracorporeal shockwave lithotripsy (20KV, 2000shoots, Dornie Co, HM3) . After ESWL treatment, ascites was decreasing day by day, and ERCP and CT revealed disappearing of calcification in head of the pancreas.
We reviewed literature about ESWL for pancreatolithiasis in Japan. Averaged 39% (75-13%) of pancreatolithiasis was perfectly treated by ESWL and remainning part was also partialy disappeared without major complications. We conclude that ESWL is less invasive treatment for pancreatolithiasis without major complications, alternative to surgery.

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A 72-year-old male, who visited our hospital for diabetes mellitus, was pointed out abnormality on pancreas and admitted to our hospital for further examination. Abdominal US, CT, MRI and EUS showed a cyst 7mm in diameter in the pancreatic body and dilatation of the main pancreatic duct (MPD) in the pancreatic body and tail. ERP showed severe localized stenosis of the MPD in the pancreatic body, with proximal duct dilatation. The result of cytologic examination of the pancreatic juice was class IIIa.
Under the diagnosis of pancreatic cancer, distal pancreatectomy was performed. Histopathological study showed inflammatory cells and marked fibrosis but no tumor tissues around the stenotic part of the MPD. And it showed carcinoma in situ approximately 5mm in size mainly presented in the branch of the pancreatic duct and partially in the MPD in the distal portion. p53 staining showed diffusely positive pattern in the carcinoma.

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A 67-year-old man was admitted to our hospital for increasing abdominal fullness and high titer of anti-DNA antibody in March 1995 during treatment for systemic lupus erythematosus (SLE) .
Abdominal CT scan showed massive splenomegaly. Endoscopic examination showed neither gastric nor esophageal varices. The portal blood flow rate and blood flow volume were both normal on ultrasonic Doppler. Laparoscopic findings revealed massive splenomegaly, and well developed collateral vessels. The biopsy specimens of the liver showed chronic inactive hepatitis and mild portal hypertention. Treatment with 30mg daily of predonisolone was started ; and the hematologic findings and massive splenomegaly were improved.
As described above, the massive splenomegaly in this case appeared to have derived from the activity of SLE.

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We present an unusual case of a symptomatic intraabdominal lymphangioma in and adult.
A 38-year-old woman had experienced nonprogressive epigastric discomfort after eating for several months. Abdominal US revealed a giant multilobular cystic lesion that appeared to be contiguous with the large part of the gastric body. EUS also showed a cystic lesion with thin septa. CT with oral and intravenous contrast showed a 5×10cm cystic mass with thin septa that had no enhancement. MRI revealed a cystic lesion, as was observed with US and CT. From the above imaging findings, abdominal lymphangioma was strongly suspected. At laparotomy, a soft whitish mass (7×6×3cm) filled with clear fluid, which was attached to the mesentery, was excised as a whole. Histological diagnosis was a lymphangioma originating in the mesentery. The patient did well without recurrence.

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