Henoch-Schonlein purpura is the most common form of systemic vasculitis in children but occurs rarely in adults. Henoch-Schonlein purpura has characteristic features of a purpuric skin rash, abdominal pain, arthralgia, and abnormal urinary findings. Gastrointestinal tract involvement is characterized by abdominal pain and gastrointestinal bleeding. Recently, we experienced a case of Henoch-Schonlein purpura with gastrointestinal involvement mimicking colon cancer in a 41-year-old female who complained of erythematous macules, arthralgia, and abdominal pain. The initial colonoscopic findings and computed tomographs failed to rule out colon cancer, but serial endoscopic examinations and clinical manifestations revealed colonic involvement of Henoch-Schonlein purpura.
Abdominal Pain ; Adult ; Arthralgia ; Child ; Colon ; Colonic Neoplasms ; Colonoscopy ; Exanthema ; Female ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Purpura ; Purpura, Schoenlein-Henoch ; Systemic Vasculitis

The greatest advantage of endoscopic submucosal dissection (ESD) in the stomach is that it can be used to perform en bloc resection of a large gastric neoplasm. However, ESD is more technically difficult and more commonly associated with prolonged procedure time and complications than conventional endoscopic mucosal resection. Until now, only a few reports have considered aspiration pneumonia after ESD, which is rare, but can be fatal. We experienced two cases of aspiration pneumonia after ESD with a gastric neoplasm. One was treated by intensive care with mechanical ventilation, and the other by antibiotics only. Prevention is thought to be important for aspiration pneumonia after ESD; therefore, patients at high risk for aspiration pneumonia are urged to take precautions. We considered various factors contributing to aspiration under endoscopy, such as local pharyngeal anesthesia, procedural time, and bleeding.
Anesthesia ; Anti-Bacterial Agents ; Endoscopy ; Hemorrhage ; Humans ; Imidazoles ; Critical Care ; Nitro Compounds ; Pneumonia, Aspiration ; Respiration, Artificial ; Stomach ; Stomach Neoplasms

Double pylorus is a rare disease. It is described by a double communication between the gastric antrum and the duodenal bulb. The cause of double pylorus is either a congenital abnormality or an acquired condition. It is believed to be mostly a complication of peptic ulcer disease. Most reports revealed conditions only for the gastric antrum. However, case reports describing the involvement of the gastric body are extremely rare. Herein, we report a case of a double pylorus that developed on the gastric body and we present a review of the literature.
Congenital Abnormalities ; Peptic Ulcer ; Pyloric Antrum ; Pylorus ; Rare Diseases

Foreign bodies in the upper esophagus should be removed as soon as possible to avoid serious complications. These foreign bodies can penetrate the bowel wall and cause severe complications. The peristalsis of the esophagus is not strong enough to prevent it from retaining swallowed objects. Hence, perforation from a foreign body is more likely to occur in the esophagus than in the rest of the gastrointestinal tract. A razor blade is a rare foreign body of the esophagus. Its sharpness and large size make it difficult to remove. A razor blade was very firmly impacted in the esophageal wall in our case, and the razor blade had not moved from the upper esophagus. A standard overtube has limitations to remove a razor blade inside the overtube's lumen. We report here on a case of using a wedge resected overtube made it possible to successfully extract a razor blade and no serious complications occurred after extraction of the razor blade.
Esophagus ; Foreign Bodies ; Gastrointestinal Tract ; Peristalsis

BACKGROUND/AIMS: Colonoscopy is a useful method for detecting colorectal disease, but complications are on the rise due to the increasing number of colonoscopies. The aim of this study was to analyze colon perforations following diagnostic colonoscopies. METHODS: We performed retrospective reviews of all patients with colonoscopic perforations between January 2000 and June 2010. RESULTS: Of 25,883 diagnostic colonoscopies performed, seven cases of colon perforations were reported. Among those, five cases had an abdominal operation history; the site of perforation was the sigmoid colon in three cases and the rectum in four cases. The manipulation type was forward viewing in three cases and retroflexion in four cases. The time to diagnosis was immediate in six cases and delayed in one case, and treatment was conservative management in three cases and surgical management in four cases. CONCLUSIONS: Special attention is required for patients with a previous abdominal operation and retroflexion. Even after perforations occur, favorable outcomes can be obtained by conservative treatment if the patient's condition is stable, the bowel preparation is proper, and there are no signs of peritonitis.
Colon ; Colon, Sigmoid ; Colonoscopy ; Humans ; Peritonitis ; Rectum ; Retrospective Studies

BACKGROUND/AIMS: A number of studies have reported wide variability in the colonoscope insertion time among patients who had prior abdominal surgery. The aim of this study was to investigate the effect of abdominal surgery on colonoscope insertion time. METHODS: The subjects were 192 patients with prior abdominal surgery, among 3,600 patients who underwent a colonoscopy at Samsung Changwon Hospital from May 2008 to May 2010. We collected the following data: insertion time, age, gender, height, weight, BMI, waist circumference, method of abdominal surgery, and the degree of bowel cleanliness. Previous abdominal operations were divided into colectomy, non-colectomy abdominal surgery, pelvic surgery, and laparoscopic surgery groups. RESULTS: The average colonoscope insertion time in patients with prior abdominal surgery (7.73+/-5.95 min) was longer than that of the non-surgery group (6.4+/-3.88 min). Patients in the colectomy groups were older and had a shorter insertion time (5.11+/-3.32 min) than patients in the other groups. CONCLUSIONS: Insertion of a colonoscope in patients with previous abdominal surgery was more difficult than that in the control group, except the colectomy group.
Colectomy ; Colonoscopes ; Colonoscopy ; Humans ; Laparoscopy ; Waist Circumference

Obese patients have been increasing with the development of a social economy. Obesity is a disease with high mortality rates due to associated cardiovascular disease and diabetes. Diet or exercise therapy, medications, bariatric surgery are used for treating obesity. However, although bariatric surgery is safe and effective, it is expensive, and reoperation is a burden if patients fail to lose weight. Operative complications are also a problem. The recent development of endoluminal techniques may permit obesity treatment and many endoscopic procedures have been attempted. The role of endoscopy for treating obesity is treating the postoperative complications of bariatric surgery, for example, a stricture or widening of the anastomosis, fistula, or leaks. Second, endoscopic applications could be used for weight reduction to temporarily bridge surgery for high-risk patients with obesity, and for reducing weight in patients unable to undergo surgery. This article provides a brief overview of bariatric surgery and its complications and introduces several endoscopic applications to treat obesity.
Bariatric Surgery ; Cardiovascular Diseases ; Constriction, Pathologic ; Diet ; Endoscopy ; Exercise Therapy ; Fistula ; Humans ; Obesity ; Postoperative Complications ; Reoperation ; Weight Loss

Malignant melanomas have the potential to metastasize to any site in the body. They commonly invade the gastrointestinal tract. The small bowel is most commonly involved, followed by the stomach, large bowel, and esophagus. The vast majority of gastrointestinal melanomas are metastatic from a cutaneous lesion. An abdominal CT scan revealed multiple and variable sized low density lesions throughout the whole liver. Endoscopy revealed multiple black pigmentations at the distal esophagus, stomach, duodenum and rectum. The brain CT showed multiple hemorrhagic metastases in the brain. This 72-year-old man had malignant melanoma in his right thumb one year ago. It had metastasized to the liver, lung, gastrointestinal tract and brain. Here we report this case of whole body metastatic malignant melanoma and review the literature.
Aged ; Brain ; Duodenum ; Endoscopy ; Esophagus ; Gastrointestinal Tract ; Humans ; Liver ; Lung ; Melanoma ; Neoplasm Metastasis ; Pigmentation ; Rectum ; Stomach ; Thumb

Duodenal abscess is a form of phlegmonous enterocolitis and is a rarely reported disease throughout the entire world. Duodenal abscess mostly develops from complications of duodenal ulcer perforation, and may result in a clinically fatal course because it is difficult to differentiate from some diseases such as gastric ulcer, gastric cancer, hepatobiliary disorders etc.. The therapeutic gold standard is surgical intervention including abscess removal and drainage. We experienced a case of duodenal abscess that expressed non-specific symptoms, weight loss and epigastric pain, and diagnosed by gastrointestinal endoscopy, abdominal computed tomography. We successfully treated it through surgical intervention with intravenous antibiotics.
Abscess ; Anti-Bacterial Agents ; Cellulitis ; Drainage ; Duodenal Ulcer ; Endoscopy, Gastrointestinal ; Enterocolitis ; Foreign Bodies ; Stomach Neoplasms ; Stomach Ulcer ; Weight Loss

A gastric duplication cyst is a rare congenital anomaly. Among gastrointestinal duplication cysts, gastric duplication cyst account for only 3.8%. They tend to be symptomatic in early childhood, but asymptomatic during adulthood. So its diagnosis is incidental. Abdominal pain is the most common complaint in adults, and most cases are discovered incidentally by radiological examination or endoscopic gastroduodenoscopy. Preoperative diagnosis of gastric duplication cyst is difficult, and definitive diagnosis requires pathological examination of the lesion. So far, about 8 cases of gastric duplication cyst have been reported in adults in the Korean literature. We report here a case of multiple gastric duplication cysts presenting with melena in a 14-year-old man, which were detected by endoscopic gastroduodenoscopy, abdominal computed tomography and endoscopic ultrasonography. They were treated by complete excision of the multiple gastric duplication cysts by laparoscopic wedge resection.
Abdominal Pain ; Adolescent ; Adult ; Endosonography ; Humans ; Melena