A 24-year-old lady with recurrent upper abdominal pain, underwent surgery for cholelithiasis based on imaging diagnosis by ultrasound scanning. At laparotomy, the gall bladder could not be found either in its normal or ectopic locations. The diagnosis of agenesis of the gall bladder was confirmed by operative cholangiography. Duplication cysts of the hepatic flexure were discovered in the position normally occupied by the gall bladder. The stony hard faeces in the cysts were probably interpreted as gallstones on ultrasound. This rare condition is discussed and the importance of intraoperative cholangiography is stressed.
Adult ; Cholelithiasis ; diagnosis ; Colonic Diseases ; complications ; pathology ; Cysts ; complications ; pathology ; Diagnosis, Differential ; Female ; Gallbladder ; abnormalities ; Humans

A 63-year-old woman was admitted due to right upper quadrant abdominal pain. She was going through hemodialysis due to end stage renal disease and taking calcium polystyrene sulfonate orally and rectally due to hyperkalemia. Colonoscopy showed a circular ulcerative mass on the proximal ascending colon. Biopsy specimen from the mass showed inflammation and necrotic debris. It also revealed basophilic angulated crystals which were adherent to the ulcer bed and normal mucosa. These crystals were morphologically consistent with calcium polystyrene sulfonate. She was diagnosed with calcium polystyrene phosphate induced colonic necrosis and improved with conservative treatment.
Colonic Diseases/chemically induced/complications/*pathology ; Colonoscopy ; Female ; Humans ; Kidney Failure, Chronic/complications/*diagnosis ; Middle Aged ; Necrosis ; Polystyrenes/*adverse effects

Arterio-enteric fistula is a very rare cause of massive lower gastrointestinal hemorrhage. We report here on a case of massive hematochezia caused by iliac arterio-colic fistula in a 60-year-old woman who had a recent history of spinal surgery for herniated nucleus pulposus. Abdomen computed tomography showed the extravasation of radiocontrast media from right iliac artery encased by an intraabdominal abscess into the adjacent dilatated colon. Also, diagnostic angiography revealed the active extravasation of radiocontrast media via a fistula between right iliac artery and colon. Although successful endovascular exclusion of the fistula with stent graft and coils was performed, disseminated intravascular coagulation and multi-organ failure were developed.
Colonic Diseases/complications/*diagnosis ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Iliac Artery/*radiography ; Intestinal Fistula/complications/*diagnosis ; Middle Aged ; Stents ; Tomography, X-Ray Computed ; Vascular Fistula/complications/*diagnosis

A 68-year-old woman with known severe aortic stenosis was admitted to the hospital because of hematochezia and dizziness. She had received several blood transfusions over the preceding 3 years and undergone right hemicolectomy 2 years ago for severe lower gastrointestinal bleeding. Postoperative histology revealed angiodysplasia involving the ascending colon. After the hemicolectomy, she continued to have hematochezia and anemia and required additional blood transfusions for anemia. During this admission, platelet count, activated partial-thromboplastin time, von Willebrand factor antigen, and von Willebrand factor ristocetin cofactor were normal. She had a severe deficiency of high-molecular-weight multimers of von Willebrand factor. Colonoscopy showed angiodysplasia in the transverse colon at this time. Successful coagulation of the bleeding angiodysplasia was achieved by argon plasma coagulator. No additional bleeding was observed thereafter. We report a case of Heyde's syndrome with abnormal von Willebrand factor in a patient who presented with intestinal angiodysplasia and aortic stenosis.
Aged ; Anemia/etiology/therapy ; Angiodysplasia/*complications ; Aortic Valve Stenosis/*complications ; Colonic Diseases/*complications ; English Abstract ; Female ; Gastrointestinal Hemorrhage/*etiology ; Humans ; Syndrome ; von Willebrand Disease/*complications/diagnosis

This study was done to evaluate prospectively the clinical significance of colonic diverticulosis. In the 1,030 consecutive outpatients undergoing colonoscopy, the information on the demographics, the patterns of bowel symptoms, and the prevalence of colon polyp were analyzed according to the presence of colonic diverticulosis. The mean age of 1,030 patients were 52.2 yr and 59.3% were male. The prevalence of diverticulosis was 19.7% (203/1,030). Of 203 diverticulosis patients 85.2% were in proximal group, 5.4% in distal group and 9.4% in both group. Six (3.0%) patients were found to have diverticulitis. Multivariate logistic regression analysis showed that an old age, diabetes and the presence of polyp were significant factors associated with proximal or both diverticulosis. A significant difference was demonstrated between the patients of distal diverticular group and the controls for the symptom frequency scores within the previous 4 weeks. The items, which showed difference, were hard stool, urgency, flatus, chest discomfort and frequent urination. In conclusion, old age, diabetes and the presence of colon polyp were associated with proximal diverticulosis. The temporal symptoms were more frequent in distal diverticulosis than in proximal diverticulosis in the study subjects.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Colonic Diseases/diagnosis/epidemiology ; Colonic Polyps/complications/*diagnosis ; Colonoscopy ; Diabetes Complications/complications/diagnosis ; Diverticulitis/diagnosis/epidemiology ; Diverticulosis, Colonic/complications/*diagnosis/epidemiology ; Female ; Flatulence/complications ; Humans ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Risk Factors

Adenocarcinoma ; complications ; pathology ; surgery ; Aged ; Colectomy ; methods ; Colonic Neoplasms ; complications ; pathology ; Diagnosis, Differential ; Female ; Hepatectomy ; methods ; Humans ; Liver ; pathology ; surgery ; Liver Diseases ; complications ; pathology ; surgery ; Necrosis

Posttraumatic diaphragmatic hernia is a rare cause of large bowel obstruction, and can present weeks or years after the initial trauma. Herein, we report the case of a 28-year-old man who presented with signs and symptoms of bowel obstruction nine months after he had a stab wound to his left chest. Chest radiography showed multiple air‑fluid levels in the right upper quadrant, an air-fluid level in the left thoracic cavity and significant free air under the diaphragm. Exploratory laparotomy revealed a contaminated abdomen with perforations in the caecum and proximal transverse colon, and a 4 cm × 4 cm defect in the left posterolateral (septal) aspect of the diaphragm, which was closed with a nonabsorbable suture. Posttraumatic diaphragmatic hernias should be part of the differential diagnosis for patients with bowel obstruction, especially if there is a history of trauma. Radiography is useful in facilitating a quick diagnosis.
Adult ; Colon, Transverse ; Colonic Diseases ; diagnosis ; etiology ; Diagnosis, Differential ; Hernia, Diaphragmatic, Traumatic ; complications ; diagnosis ; Humans ; Intestinal Obstruction ; diagnosis ; etiology ; Male ; Tomography, X-Ray Computed

Most common cause of brisk hematochezia is diverticular bleeding in Western countries. It occurs in 15% of patients with diverticulosis and one-third of them appear to be massive. Most of diverticulosis in Western countries occur in the left colon but the right colon is more common in Korea. Especially, the reports of diverticular bleeding on left colon are rare in Korea. We report a case presenting with multiple diverticuli complicated by recurrent massive bleeding restricted to the left colon. 75-year-old female was admitted due to hematochezia and dizziness. On past history, two years and two weeks ago respectively, she was treated of diverticular bleeding with and without diverticulitis. Hemoglobin level was 9.8 g/dL. On Colonoscopy, numerous diverticuli were seen at sigmoid colon upto splenic flexure which showed fresh blood clots in the lumen. We diagnosed her as recurrent massive diverticular bleeding on the sigmoid colon. She received elective laparoscopic left hemicolectomy.
Aged ; Colonoscopy ; Diagnosis, Differential ; Diverticulosis, Colonic/complications/*diagnosis/surgery ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology/therapy ; Humans ; Recurrence ; Sigmoid Diseases/*diagnosis/etiology/therapy ; Tomography, X-Ray Computed

In acute pancreatitis, colonic complications such as mechanical obstruction, ischemic necrosis, hemorrhage, and fistula are rare but their outcomes are fatal. It is known that colonic obstruction in acute pancreatits is more likely found in splenic flexure and transverse colon caused by severe inflammation of body and tail of pancreas leading to pressure necrosis. A 43-year-old man presented with abdominal distension lasting for 2 weeks. The patient had been admitted to our institution 6 weeks prior to the current admission, and the abdominal CT scan performed during the first admission revealed the pancreatic enlargement with peri-pancreatic fatty infiltration and fluid collection. At that time he was diagnosed as acute pancreatitis. The conservative management resulted in clinical improvent so that the patient was discharged. Upon the second admission, abdominal CT scan revealed multiple pseudocysts in the tail portion of pancreas with concominant wall thickening and narrowing of the proximal descending colon, and a dilatation of the bowel proximal to the splenic flexure. An obstruction of the descending colon as a complication of acute pancreatitis was suspected and the patient underwent left hemicolectomy. Abdominal distension was relieved after the operation and he was discharged on the 15th hospital days.
Acute Disease ; Adult ; Colectomy ; Colonic Diseases/*diagnosis/etiology/surgery ; Diagnosis, Differential ; Humans ; Intestinal Obstruction/*diagnosis/etiology/surgery ; Male ; Pancreatitis, Alcoholic/*complications/diagnosis ; Tomography, X-Ray Computed

No abstract available.
Aged ; Colonic Diseases/*diagnosis/etiology/surgery ; Colonoscopy ; Female ; Humans ; Intussusception/*diagnosis/etiology/surgery ; Lipoma/complications/*diagnosis/surgery ; Tomography, X-Ray Computed