Collagenous colitis (CC) has been looked upon as a rare disease in the past years. However, as we have acquired more knowledge about this disease, the cases diagnosed as CC are on the rise. Many case reports on Lansoprazole (LPZ) are available in our country, and our hospital has had three cases in the last year. Here, we present a typical example. Case 1: An 84-year-old woman who had been taking LPZ visited our outpatient clinic, complaining of chronic watery diarrhea for three months. Colonoscopy produced no abnormal findings other than a tiny capillary vascular growth in the descending colon. However, the histopathological findings secured from the entire colonic region revealed a thickened subepithelial collagen band. She was therefore diagnosed as suffering from CC. With the administration of LPZ suspended, her diarrhea improved in two weeks. The other two cases also underwent colonoscopy to check their chronic diarrhea. Their symptoms improved in a few weeks with the intake of LPZ suspended. In the differential diagnosis of chronic diarrhea, therefore, we believe it important to take possible CC into account, review the detailed history of medicine, and perform colonoscopy and mucosal biopsy.

The patient was a 63-years-old female with early gastric cancer in her upper stomach. Widely spreading on the mucous membrane, the cancer was too big to remove by endoscopical mucosal resection, although she wanted minimal invasive treatment. Therefore, we adopted total gastrectomy with hand-assisted laparoscopic surgery (HALS) after obtaining “informed consent” from her. Five small skin-incisions were necessary to perform it-one 7cm' for hand-port and four 1.2cm' for trocars.
The dissection was started from greater omentum and proceeded counterclockwise to remove primary lymphnodes. The abdominal esophagus and the duodenum were devided with a single or double application of Endo GIA stapler (linear stapler). All these steps were accomplished safely and securely with the effective support of the left hand of the operator. After extraction of the whole stomach through the 7cm-incision, Roux-en Y reconstruction was performed laparoscopically (esophago-jejunostomy) followed by hand sewing through the 7cm-incision (jejuno-jejunostomy). The anvil of 21mm circular stapler (EEA) was inserted orally in order to anastomose the esophagus to the jejunum. The patient had acceptable results intra-operatively as well as postoperatively by HALS total gastrectomy, which had been considered to be very hard to perform up to present time.