Colonoscopic diagnosis of appendiceal intussusception in a patient with intermittent abdominal pain： A case report

Intussusception of the appendix is a rare condition. Most cases are diagnosed during operation of the patients suspected to have appendicitis. In this report we present a seventy one year-old man with a history of periumbilical intermittent abdominal pain for several months. None of the paraclinical tests were useful for determining the diagnosis. Colonoscopy performed during the last episode of abdominal pain revealed the prolapsed appendix in the cecum and the patient was sent to the operating room. Macroscopic appearance of the appendix was normal and microscopic examination revealed follicular hyperplasia and acute focal appendicitis. Appendiceal intussusception should be considered in differential diagnosis of intermittent abdominal pain and colonoscopic diagnosis could be very important to avoid dangerous or unnecessary decision making.     

Development of multiple myeloma in a patient with chronic hepatitis C： A case report and review of the literature

An association between chronic hepatitis C virus (HCV) infection and essential mixed cryoglobulinaemia and non-Hodgkin lymphoma (NHL) has been suggested. However, a causative role of HCV in these conditions has not been established. The authors report a case of a 50 year-old woman with chronic hepatitis C (CHC) who has been followed up since 1998 due to a high viral load, genotype 1b and moderately elevated liver function tests (LFTs). Laboratory data and liver biopsy revealed moderate activity (grade: 5/18, stage: 1/6). In April 1999, one-year interferon therapy was started. HCV-RNA became negative with normalization of LFTs. However, the patient relapsed during treatment. In September 2002, the patient was admitted for chronic back pain. A CT examination demonstrated degenerative changes. In March 2003, multiple myeloma was diagnosed (IgG-kappa, bone marrow biopsy: 50% plasma cell infiltration). MRI revealed a compression fracture of the 5th lumbar vertebral body and an abdominal mass in the right lower quadrant, infiltrating the canalis spinalis. Treatment with vincristine, adriamycin and dexamethasone (VAD) was started and bisphosphonate was administered regularly. In January 2004, after six cycles of VAD therapy, the multiple myeloma regressed. Thalidomide, as a second line treatment of refractory multiple myeloma (MM) was initiated, and followed by peginterferon-a2b and ribavirin against the HCV infection in June. In June 2005, LFTs returned to normal, while HCV-RNA was negative, demonstrating an end of treatment response. Although a pathogenic role of HCV infection in malignant lymphoproliferative disorders has not been established, NHL and possibly MM may develop in CHC patients, supporting a role of a complex follow-up in these patients.     

An unusual cause of ileal perforation： Report of a case and literature review

An ileal perforation resulting from a migrated biliary stent is a rare complication of endoscopic stent placement for benign or malignant biliary tract disease. We describe the case of a 59-year-old woman with a history of abdominal surgery in which a migrated biliary stent resulted in an ileal perforation. Patients with comorbid abdominal pathologies, including colonic diverticuli, parastomal hernia, or abdominal hernia, may be at increased risk of perforation from migrated stents.     

Heterotopic pancreas in the stomach： A case report and literature review

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathologic changes such as inflammation, bleeding, obstruction, and malignant transformation. In this report, a 40 years old woman with epigastric pain due to ectopic pancreatic tissue in the stomach is described. The difficulty of making an ac- curate diagnosis is highlighted. The patient has remained free of symptoms since she underwent wedge resection of the lesion three years ago. Frozen sections may help in deciding the extent of resection intraoperatively. Although ectopic pancreas is rare, it should be considered in the differential diagnosis of a submucosal gastric tumour.     

Clinical and therapeutic considerations of rectal lymphoma： A case report and literature review

Primary rectal lymphoma is a rare presentation of gastrointestinal lymphomas. Its clinical presentation is indistinguishable from that of rectal carcinoma. Although surgical resection is often technically feasible, optimal therapy for colorectal lymphoma has not yet been identified. We report a case of primary rectal lymphoma (non-Hodgkin's large cell lymphoma of type B) with high-grade features that disappeared completely after chemo radiotherapy. This case underlines that primary treatment with systemic chemotherapy and involved-field radiotherapy can be successful for rectal lymphoma, with surgery reserved for complications and chemotherapy failures.     

Endoscopic management of a new entity-plastobezoar： A case report and review of literature

INTRODUCTION Bezoar is adapted from Arabic “bazahr” or “badzehr” which means an antidote or counter-poison due to the fact that till the 19th century, bezoars obtained from sacrificed animals were widely used as antidote[1]. Foreign bodies and bezoars…     

Primary biliary cirrhosis and ulcerative colitis： A case report and review of literature

AIM: To summarize the characteristics of patients suffered from primary biliary cirrhosis associated with ulcerative colitis. METHODS: To report a new case and review the literature. RESULTS: There were 18 cases (including our case) of primary biliary cirrhosis complicated with ulcerative colitis reported in the literature. Compared with classical primary biliary cirrhosis, the patients were more often males and younger similar. The bowel lesions were usually mild with proctitis predominated. While ulcerative colitis was diagnosed before primary biliary cirrhosis in 13 cases, the presentation of primary biliary cirrhosis was earlier than that of ulcerative colitis in our new case reported here. The prevalence of primary biliary cirrhosis among patients of ulcerative colitis was almost 30 times higher than in general population. CONCLUSION: Association of primary biliary cirrhosis with ulcerative colitis is rare. It should be considered in the differential diagnosis of hepatobiliary disease in patients with ulcerative colitis, and vice versa.     

Gardner＇s syndrome： A case report and review of the literature

Gardner's syndrome is an autosomal dominant disease characterized by the presence of colonic polyposis, osteomas and a multitude of soft tissue tumors.The syndrome may present at any age from 2 mo to 70 years with a variety of symptoms, either colonic or extracolonic. We present a case of a 11-year-old female patient with Gardner's syndrome who presented with a lumbar area desmoid tumor and treated with resection of the desmoid, restorative proctocolectomy and ileal pouch anal anastomosis, A review of the current literature has been performed.     

Should neck pain in a patient with Hashimoto's thyroiditis be underestimated? A case and review of the literature

Hashimoto's Thyroiditis (HT) is an autoimmune disease and the most frequent cause of hypothyroidism. Subacute thyroiditis (SAT) overlapping HT is a rare entity. A 69-year-old female patient with HT and multinodular goiter has been followed on levothyroxine replacement therapy for 7 years. She presented with neck pain radiating to the right ear persisting for 2 months. She was prescribed analgesics and antibiotics by other physicians during that period, which did not work. Her vital signs were stable with no tachycardia or fever. The right lobe of the thyroid gland was tender on palpation. Her TSH level was 3.94 mIU/ml, ESR 23 mm/h, CRP 3.2 mg/l, WBC 4900/μl at presentation. Thyroid ultrasonography revealed a hypoechoic area over the tender lobe. Power Doppler imaging revealed almost no blood flow in that area. She was started on methylprednisolone 32 mg/day. At day 10 of therapy, her symptoms had completely resolved. Ultrasonography repeated showed that the hypoechoic area had disappeared. Glucocorticoid dosage was tapered and stopped. Emergence of subacute thyroiditis in a case with preexisting Hashimoto's thyroiditis is a quite rare condition, but should be kept in mind along with a painful attack of HT in the differential diagnosis.     

Fulminant ulcerative colitis despite maximal immunosuppression following liver transplantation: A case report and literature review

Inflammatory Bowel Disease (IBD) is thought to be the result of an overly aggressive immune response to ubiquitous antigens. Immuno -modulation and -suppression is therefore currently the treatment of choice. It was long anticipated that the course of pre-existing IBD should improve after orthotopic liver transplantation (OLT) due to increased immunosuppression. We report the case of a patient who developed acute fulminant colitis despite triple immunosuppression and mesalazine and review the relevant literature.     

Mucocele of the appendix due to endometriosis:A rare case report

Mucocele of the appendix due to endometriosis is extremely rare,and there are only 10 previously reported cases in the English literature.We report a case of mucocele of the appendix due to endometriosis and provide the first review of the literature.A 43-year-old woman was admitted to the hospital because of recurrent right lower abdominal pain during her menstrual periods.Colonoscopy revealed submucosal tumorlike elevations of the appendiceal orifice.Computed tomography and magnetic resonance imaging of the abdomen suggested cystic lesions near the appendix.Consequently,mucocele of the appendix was suspected preoperatively.An open ileocecal resection was performed.Multiple cystic lesions were observed around the appendix.The cystic lesions contained mucus.Histopathological examination was consistent with a mucocele of the appendix due to endometriosis.The postoperative course was uneventful.We present the first review of the literature to clarify the clinical features.     

Appendix adenocarcinoma associated with ulcerative colitis: a case report and literature review

Ulcerative colitis (UC) represents a risk factor for colorectal cancer, but the association between UC and appendix cancer is uncommon. A 60–year–old woman with a 5–year history of UC initially received medical treatment with mesalazine and prednisone with no satisfactory response; therefore surgery was indicated. The procedure was a total intersphincteric proctocolectomy with ileostomy. Histopathological analysis indicated adenocarcinoma from the cecal appendix, and chronic–active ulcerative colitis of the colon. In conclusion, surgeons and pathologists should examine every surgical specimen from patients with UC because of the possibility, although remote, of a neoplasic pathology. The appendix adenocarcinoma and ulcerative colitis may or may not be associated, same as colon cancer in patients with UC.     

TNF inhibitors to treat ulcerative colitis in a metastatic breast cancer patient:A case report and literature review

Adalimumab(ADA)is a tumor necrosis factor(TNF)inhibitor,used for the treatment of inflammatory bowel disease.Previous studies have reported an increased risk of cancer following exposure to TNF inhibitors,but little has been reported for patients with cancer receiving TNF-inhibitor treatment.We present a female patient with metastatic breast cancer and ulcerative colitis(UC)who was treated with ADA.A 54-year-old African American female with a past history of left-sided breast cancer(BC)diagnosed at age 30 was initially treated with left-breast lumpectomy,axillary dissection,followed by chemotherapy and radiation therapy.Years after initial diagnosis,she developed recurrent,bilateral BC and had bilateral mastectomy.Subsequent restaging computed tomography(CT)scan demonstrated distant metastases to the bone and lymph nodes.Three years into her treatment of metastatic breast cancer,she was diagnosed with UC by colonoscopy.Her UC was not controlled for 5 mo with 5-aminosalicylates.Subcutaneous ADA was started and resulted in dramatic improvement of UC.Four months after starting ADA,along with ongoing chemotherapy,restaging CT scan showed resolution of the previously seen metastatic lymph nodes.Bone scan and follow-up positron emission tomography/CT scans performed every 6 mo indicated the stability of healed metastatic bone lesions for the past 3 years on ADA.While TNF-αinhibitors could theoretically promote further metastases in patients with prior cancer,this is the first report of a patient with metastatic breast cancer in whom the cancer has remained stable for 3 years after ADA initiation for UC.     

A case report of the therapeutic effect of cryofiltration in a patient with glucocorticoid-resistant ulcerative colitis

Ulcerative colitis (UC) is characterized by chronic inflammation of the colon and its cause and pathogenesis have not been fully clarified. Although UC is treated with various drugs, including 5-amino-salycilate and glucocorticoids, some patients are resistant to them. It was recently reported that apheresis, such as leukocytapheresis and granulocytapheresis, improves intestinal inflammation in refractory cases of UC. On the other hand, cryofiltration, in which plasma apheresis is used to remove immunoglobulin and immune complexes, has been used for the treatment of autoimmune diseases. We herein report a case of glucocorticoid-resistant UC successfully treated with cryofiltration. Interestingly, the level of interleukin-10 (IL-10) in the patient's serum was markedly increased after eight sessions of cryofiltration. This suggests that cryofiltration suppresses intestinal inflammation, in part via up-regulation of IL-10.     

Squamous cell carcinoma of the rectum in ulcerative colitis: case report and review of the literature

The majority of colorectal carcinomas diagnosed are adenocarcinomas. Squamous cell carcinomas (SCC) of the rectum are rare tumors, and were reported as rare complication of inflammatory bowel disease. Surgery is the most effective therapy; and adjuvant chemotherapy and radiotherapy should also be considered. We report two cases of ulcerative colitis-associated SCC of the rectum. The lesions were treated with chemoradiotherapy with complete response.     

Sjogren's syndrome in a patient with ulcerative colitis and primary sclerosing cholangitis: Case report and review of the literature

Inflammatory bowel disease has been reported to co-exist with other autoimmune diseases. Sjogren's syndrome is an autoimmune disorder characterized by xerostomy and/or xerophthalmy. Sjogren's syndrome occurring in IBD has been very rarely reported.A 45-year old woman diagnosed ten years ago with ulcerative pancolitis and primary sclerosing cholangitis was referred to our outpatient IBD clinic because of xerostomy but not for xerophthalmy for the previous three months. The patient had been under azathioprine maintenance treatment (2 mg/kg) and achieved long-term disease remission for the past 4 years. Patient clinical examination and laboratory tests were unremarkable. Salivary gland biopsy and complete ophthalmologic investigation were performed and the patient was diagnosed with Sjogren's syndrome.Understanding sicca manifestations in IBD is difficult since the pathogenesis of this intestinal disorder is not yet clear. Of these complex autoimmune phenomena which occur along with IBD it is quite difficult to categorize concomitant Sjogren's syndrome as primary or secondary and literature is conflicting. The possibility of Sjogren's syndrome should always be considered and properly investigated in patients diagnosed with inflammatory bowel disease who develop a constellation of constitutional sicca symptoms.     

Appendiceal carcinoid in a pediatric patient with Peutz-Jeghers syndrome: A case report and comprehensive literature review

Rationale:Peutz-Jeghers syndrome (PJS), a rare autosomal dominant disorder, is characterized by mucocutaneous pigmentations, hamartomatous polyps in the gastrointestinal tract, and a high risk of developing various malignancies. To the best of our knowledge, only 1 case of appendiceal carcinoid associated with PJS has been previously reported in the pediatric population.Patient concerns:We report a 7-year-old girl who was admitted for severe, intermittent abdominal pain and cramps, nausea, and vomiting. Multiple brown melanotic macules on the lips, buccal mucosa, and the tongue were noted.Diagnosis:A plain abdominal X-ray in a standing position revealed dilated intestinal loops with multiple air-fluid levels. A computed tomography scan of the abdomen showing a “coffee bean” appearance of the jejunal loop with a transition point to the duodenal loop. Axial-contrast-enhanced computed tomography scan of the abdomen showing dilated jejunum loops, filled with fluid with the swirled appearance of mesentery typical for volvulus. The diagnosis of PJS was based on clinical findings along with the histopathologic confirmation of the hamartomatous polyps.Interventions:An emergency laparotomy was performed, revealing a jejunojejunal intussusception starting 40 cm from the duodenojejunal flexure. Jejunotomy revealed that a lead-point intussusception was a necrotic hamartomatous polyp. After resecting the involved jejunal necrotic segment, including the polyp, end-to-end jejuno-jejunal anastomosis was performed. Further exploration revealed the presence of a jejunal mass 80 cm from the duodenojejunal flexure identified as another hamartomatous pedunculated polyp. The polyp was resected, and the enterotomy was then closed transversely. The grossly normal appendix was also removed.Outcomes:Clinical findings along with the histopathologically confirmed hamartomatous polyps were consistent with PJS. An appendiceal carcinoid (well-differentiated neuroendocrine tumor, European Neuroendocrine Tumor Society stage pT2) was incidentally detected during histological examination of the appendix. The patient and parents were counseled accordingly, focusing on active surveillance and control of symptoms. Two additional hamartomatous polyps (gastric and jejunal) were detected endoscopically and resected in the fourth postoperative week. A regular, 1-year follow-up and surveillance revealed no complications or recurrences.Lessons:Unusual neoplasms can occasionally be encountered in well-defined syndromes such as PJS. Therefore, active follow-up and surveillance are mandatory for all patients with PJS.     

Adenocarcinoma of an ileostomy in a patient with ulcerative colitis

A case is reported of adenocarcinoma of the ileum following surgical management of ulcerative colitis. In this patient it seems likely that the carcinoma arose in a pre-existing tubulovillous adenoma of rectal origin. This case report draws attention to the need to exclude any possibility of retention of large-intestinal mucosa in the ileostomy when transecting the ileum, either at primary colectomy or when dismantling an ileorectal anastomosis.