Duodenal Crohn''s Disease Complicated by Common Bile Duct Obstruction: Report of a Case and Review of the Literature

A 28-year-old woman with Crohn's disease involving the duodenum and terminal ileum presented with biochemical evidence of incomplete, extrahepatic biliary obstruction. Percutaneous transhepatic cholangiography showed partial obstruction of the intramural duodenal portion of the common bile duct. Cholangiography was complicated by cholangitis. Surgical decompression of the biliary system and bypass of the affected duodenal segment were performed after intraoperative confirmation of Crohn's disease involving the ileum, duodenum, and ampulla of Vater. The patient made a complete recovery and all previously abnormal cholestatic liver function test results returned to normal.     

Intraluminal Duodenal Diverticulum: Case Report and Update of the Literature 1975–1986

Intraluminal duodenal diverticulum (IDD) is a rare congenital web of membrane causing intrinsic duodenal obstruction. We report the case of a 26-yr-old woman diagnosed by contrast study and endoscopy, who was successfully treated by surgery, and review the literature on the subject. Most patients with this obstruction are adults in their 3rd to 5th decade. The clinical presentation is nonspecific, although symptoms of gastrointestinal obstruction are frequent. A shift in the time of diagnosis, from intraoperative to preoperative contrast studies to endoscopy, has been revealed. Surgery has traditionally been an effective and safe treatment, but therapeutic endoscopy with incision or excision of the membrane may now be considered in selected patients.     

Fatal Ruptured Duodenal Varix: A Case Report and Review of Literature

The incidence of bleeding duodenal varices is exceedingly rare. We report a case of a 35-year-old chronic alcoholic who died of severe fatal upper gastrointestinal bleeding from a ruptured duodenal varix located in the second portion of duodenum. This diagnosis was suspected at endoscopy and was confirmed at autopsy. A review of literature shows 20 case reports of bleeding duodenal varices with two fatalities. While the duodenal bulb is the most common site of varices, the second portion of duodenum appears to be the next most common site. From all of the possible causes of duodenal varix, chronic liver diseases, mainly cirrhosis, remains the predominant etiological factor accounting for 30.7% of reported cases.     

Small Bowel Obstruction Due to Disease of Epiploic Appendage

Primary disease of an epiploic appendage is rare. Small bowel obstruction is an unusual complication of such disease due to bands or adhesions caused by torsion or inflammation.
A 49-year old man presented with small bowel obstruction and was found to have a band from a necrotic epiploic appendage adherent to mesentery, obstructing the ileum. The band was released and the epiploic appendage removed.     

Locked-in Syndrome Due to Meningovascular Syphilis: A Case Report and Literature Review

We herein report a 46-year-old man presenting with locked-in syndrome secondary to meningovascular syphilis. Brain magnetic resonance imaging (MRI) demonstrated multiple acute infarctions in the left ventromedial pons, right basis pontis, and left basal ganglia. His locked-in syndrome was hypothesized to have been caused by thrombosis of the small paramedian branches of the basilar artery due to syphilitic arteritis. This is a unique case of bilateral ventromedial pontine infarction caused by meningovascular syphilis that presented as locked-in syndrome. Meningovascular syphilis should be included in the differential diagnosis of uncommon stroke, particularly in young men.     

Thoracolumbar Scoliosis Due to Cryptococcal Osteomyelitis: A Case Report and Review of the Literature

Cryptococcus neoformans causes opportunistic infections in immunocompromised patients, with vertebral osteomyelitis being a very rare involvement.This study is to present a case of thoracolumbar scoliosis occurring in the setting of cryptococcal osteomyelitis.Pharmacological intervention with anticryptococcal medicine and medical management of immune hemolytic anemia were administered. After initial acute stabilization, she underwent spinal debridement and fusion on October 29, 2008. She eventually recovered fully from this episode with no subsequent mechanical instability or neurological deficits on subsequent clinic follow-ups.To the best of our knowledge, there have been no reports describing the onset of spinal cryptococcal osteomyelitis along with immune hemolytic anemia. We suggest a comprehensive algorithm for the diagnosis of vertebral cryptococcal osteomyelitis.     

A Case of Intraluminal Duodenal Diverticulum Associated with Congenital Biliary Dilatation: A Review of the Literature in Japan

A case of intraluminal duodenal diverticulum (IDD) associated with congenital biliary dilatation is reported. Patients with intraluminal duodenal diverticulum often have congenital anatomical abnormalities or acquired diseases. The treatment of the intraluminal duodenal diverticulum itself is easy, but it is important to detect and treat other disorders also present.     

Angiosarcoma of the Small Intestine: A Case Report and Literature Review

A case of primary intestinal angiosarcoma in a 59-yr-old man is reported. The patient had recurrent gastrointestinal bleeding with normal upper and lower gastrointestinal endoscopies, technetium-99m-labeled erythrocyte scan, and angiography. Barium small bowel series and abdominal computerized tomography showed an deal mass. Pathological examination was consistent with hemangiosarcoma with both solid and vasoformative patterns. Metastatic disease was also identified in the small bowel mesentery, liver, spleen, lungs, and brain. No identifiable underlying or epidemiologic factors have previously been reported to be associated with this rare type of tumor of the gastrointestinal tract. the pertinent literature on gastrointestinal angiosarcoma also is reviewed.     

Pentalogy of Cantrell with Left Ventricular Diverticulum: A Case Report and Review of Literature

Pentalogy of Cantrell is a rare congenital anomaly involving deficiency of the following structures: anterior diaphragm, supraumbilical abdominal wall, diaphragmatic pericardium, lower sternum, and associated congenital intracardiac abnormality. We describe a 3-month-old child with this syndrome having left ventricular diverticulum along with omphalocele who presented to us with a pulsating mass in the epigastrium. The defect was evaluated and defined by computed tomography scan. A team of pediatric, cardiac, and plastic surgeons successfully repaired the defects. This case report discusses the review of literature along with management options and concludes that there must be an emphasis on early repair of left ventricular diverticulum to prevent complications. Antenatal ultrasound can also detect the anomaly, and early postnatal diagnosis of the syndrome, followed by immediate surgical repair, can prevent lethal complications.     

原发性十二指肠球部溃疡型腺癌1例并文献复习

<正> 病例:患者男,74岁,因"反复黑便半年,再发5 d"于2009年1月2日入院。患者半年前无明显诱因下解柏油样稀便共3～4次,大便潜血试验阳性,伴头晕、乏力、心悸,无发热,无腹痛。至本院行胃镜检查示十二指肠球部后壁溃疡,大小约1.2 cm×1.5 cm,胃窦部活检示幽门螺杆菌(H.pylori)(+)。予泮托拉唑40 mg bid对症治疗2周,未予以H.pylori根除治疗(具体原因不详),症状完全缓解。出院后继续予泮托拉唑40 mg qd维持治疗8周。2个月前,患者欲了解溃疡愈合情况,遂于本院复查胃镜示球部溃疡未愈合,大小与第一次胃镜所见相同,胃窦部活检示H.pylori(+)。予泮托拉     

Transient Fungemia Due to Rhodotorula rubra in a Cancer Patient: Case Report and Review of the Literature

A unique case of Rhodotorula rubra transient fungemia in a post-chemotherapy, febrile neutropenic patient with colon cancer, suffering from gastrointestinal mucositis, is described. The fungus was isolated repeatedly from his blood. However, all signs and symptoms of the infection disappeared, without antifungal treatment, as soon as neutropenia and mucositis, both of short duration, resolved. Restoration of the patient's defense mechanisms was adequate for disappearance of the fungus from the patient's blood and full recovery. Received: June 7, 2000 · Revision accepted: February 28, 2001     

Hemolytic Disease of the Newborn Due to Anti-Jkb: Case Report and Review of the Literature

Although anti-Jkb is a well-defined cause of severe acute or delayed hemolytic transfusion reactions, it is rarely associated with severe Hemolytic Disease of the Newborn (HDN), even with high antibody titer. To date, only 13 cases have been reported, so the possible reasons for that still remain unclear. Most of HDN due to anti-Jkb are mild-to-moderate, and usually have a good prognosis. A 41-years-old woman, who had a positive antibody screening test in her 13th week of pregnancy, was sent to the blood bank for study before an amniocentesis. Antibody identification and red blood cell (RBC) phenotyping of the patient and his husband were performed, plus arrays study in the amniotic fluid. An anti-Jkb was identified in the patient’s serum with a titer of 1:1, and her RBC phenotype was O Rh(D) positive, C(+), c(+), E(?), e(+), K(?), Jka(+), Jkb(?). The RBC genotype of the fetus was B Rh(D) positive, Jka(+), Jkb(+). Antibody titer remained stable and the pregnancy was uneventful. At birth, there was no need of phototherapy or exchange transfusion for the newborn and her Jk(b+) typing result was confirmed in a cord blood sample. Although most of HDN cases due to anti-Jkb have a good outcome, monitoring antibody titer should be done to prevent fatal complications. Furthermore, antenatal antibody screening should be performed in every pregnant woman irrespective of her Rh(D) antigen status in order to detect red cell alloimmunization to other clinically significant blood group antigens.     

Severe Acute Cholangitis and Bacteremia Due to Campylobacter jejuni: A Case Report and Review of the Literature

Campylobacter jejuni is common cause of enteritis, but biliary infection rarely reported. An 82-year-old woman with pancreatic head cancer underwent endoscopic biliary drainage for malignant biliary obstruction. She was subsequently admitted for management of diarrhea. C. jejuni was identified in stool culture. Her symptoms resolved temporarily without antibiotics but flared up with a fever a few days later. She was diagnosed with acute cholangitis and bacteremia with C. jejuni. Endoscopic biliary drainage and antimicrobial administration improved her symptoms. As complications of C. jejuni diarrhea are rare, antibiotics are not necessarily indicated but sometimes are needed to prevent complications.     

Adenocarcinoma in Meckel''s Diverticulum: Report of a Case and Review of 30 Cases in the English and Japanese Literature

A 54-yr-old man who complained of abdominal pain was found to have an adenocarcinoma arising in Meckel's diverticulum, as preoperatively diagnosed with 99mTc-pertechnetate scintigraphy. Angiography of the superior mesenteric artery revealed multiple branched arteries and tumor stain, but the vitelline artery was not clearly identified. Surgery revealed that the tumor had invaded the urinary bladder and the ileum, including the diverticulum, and the bladder had to be partially resected. Histopathological examination of the lesion revealed a diverticulum containing normal small bowel mucosa, ectopic normal gastric tissue, and adenocarcinoma. In a review of 30 cases of adenocarcinoma in Meckel's diverticulum in the English and Japanese literature, our case was the first to be diagnosed preoperatively.     

Unusual Case of Small Cell Gastric Carcinoma: Case Report and Literature Review

Background  

Small cell carcinomas are among the most aggressive, poorly differentiated, and highly malignant of the neuroendocrine tumors (NETs). Of which, small cell gastric carcinoma is a rare small cell neuroendocrine tumor. The purpose of our study was to present this case and perform a comprehensive literature review.