Gastrointestinal duplication is a rare congenital anomaly which can occur anywhere along the digestive tract. The most common site is the mesenteric border of the terminal ileum. Intestinal duplication usually becomes symptomatic early in life with the severity of symptoms depending on the location and type of mucosal lining. Ectopic gastric mucosa is an associated possibility. Gastrointestinal hemorrhage is the most serious complication, which can cause severe anemia and shock. Another complication, although rare, is carcinoma in a duplicate cyst. We experienced an unusual case of a 12-years-old girl who presented with intermittent abdominal pain and hematochezia. There was no abnormality on Meckel's scan. Abdominal CT revealed a cystic mass in the pelvic cavity and subsequent transabdominal ultrasound showed the double-layered wall of the duplication. We performed laparoscopy-assisted, segmental resection of the ileum. The patient was discharged without any complication on the 7th postoperative day.
Abdominal Pain ; Anemia ; Child* ; Female* ; Gastric Mucosa ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans ; Ileum ; Shock ; Tomography, X-Ray Computed ; Ultrasonography

Child ; Cysts ; diagnostic imaging ; Endosonography ; methods ; Female ; Gastric Mucosa ; diagnostic imaging ; Humans ; Stomach ; diagnostic imaging ; Ultrasonography ; methods

PURPOSE: Intestinal duplications are rare congenital malformations that may require surgical intervention. This study attempted to elucidate the clinical characteristics and the management of this disease. METHODS: We reviewed the experience of 13 intestinal duplications confirmed with postoperative pathologic reports from January 1989 to September 2001 at Seoul National University Children's hospital. RESULTS: Nine patients were female and 4 were male. Ages ranged from a few days to 5 years (61.4% younger than 1 year). The most common symptom was a vomiting. The major diagnostic method recorded was abdominal ultrasonography. The location of the 12 cystic duplicaions was the ileum in 7 cases, the anus in 2 cases, the duodenun in 1 case, the jejunun in 1 case and the rectum in 1 case. A tubular duplication from the transverse colon to the anus with communication was found in one case. The diameter of the cystic duplications averaged 3.45 cm, and the average length of the tubular duplication was 40 cm. Treatment used was resection and anastomosis of the involved intestine in 8 cases, septostomies in 2, anoplasty in 1, marsupialization in 1 and transanal excision in 1. There were no postoperative complications or mortality experienced. Gastric mucosa was found in 3 of 7 ileal duplications, small intestinal mucosa was found in the duodenal duplication, and squamous epitheliums were found in the rectal and anal duplications. CONCLUSION: Congenital intestinal duplication presents as an intestinal obstruction or an abdominal mass in childhood. Abdominal ultrasonography is a major diagnostic method and surgical intervention is mandatory.
Anal Canal ; Colon, Transverse ; Epithelium ; Female ; Gastric Mucosa ; Humans ; Ileum ; Intestinal Mucosa ; Intestinal Obstruction ; Intestines ; Male ; Mortality ; Postoperative Complications ; Rectum ; Seoul ; Ultrasonography ; Vomiting

A gastric carcinoma with the endoscopic features resembling a submucosal tumor (SMT) is rare, and reportedly accounting for 0.1% to 0.63% of all resected gastric carcinomas in Japan. A diagnosis of a SMT-like gastric carcinoma is often difficult as the tumors are almost entirely covered with normal mucosa. Furthermore mucinous gastric adenocarcinoma is uncommon histologic subtype of gastric cancer. These tumors are detected mostly in an advanced stage and rarely in an early stage. Early mucinous gastric adenocarcinoma is characterized as an elevated lesion resembling SMT due to abundant mucin pools in the submucosa. Here we report one case of SMT-like mucinous gastric adenocarcinoma, diagnosed by the usual endoscopic biopsy and treated with surgery.
Adenocarcinoma, Mucinous/*diagnosis/pathology/ultrasonography ; Aged ; Diagnosis, Differential ; Gastric Mucosa/pathology ; Gastroscopy ; Humans ; Male ; Stomach Neoplasms/*diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed

No abstract available.
Aged ; Carcinoma, Medullary/*diagnosis/surgery/ultrasonography ; Epstein-Barr Virus Infections/diagnosis ; Gastric Mucosa/pathology/surgery ; Gastroscopy ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Male ; Stomach Neoplasms/*diagnosis/surgery/ultrasonography

PURPOSE: Intestinal duplication is a rare congenital anomaly that may be found anywhere from the mouth to the anus. The clinical presentation varies depending on the anatomic location or the size of the duplication, and the presence of the ectopic gastric tissue. The aim of this study was to analyze the clinical characteristics, the diagnostic and therapeutic methods, the location, the anatomic type and the associated anomalies of intestinal duplication. METHODS: We reviewed the medical record of eighteen patients with duplication of the alimentary tract and these patients had been treated at Kyungpook National University Hospital from July 1995 through October 2007. RESULTS: There were 9 boys and 9 girls. Their ages ranged from 3 days to 15 years. The most common symptom was abdominal pain. The duplicated segment acted as a leading point of intussusception in 3 cases. Two patients had melena. The duplications were cystic in fifteen cases and three others were tubular. In twelve cases, the lesions were located in the ileum; two other cases were located in the anal canal, one other was located in the in the transverse colon, another was located in the transverse and descending colon, one was located in the in the duodenum and one was located in the jejunum. Ultrasonography, computed tomography and barium enema were helpful as diagnostic tools. Three cases were diagnosed by prenatal ultrasonography. Associated anomalies were documented in four cases. All the patients underwent surgery. A duplicated lesion was lined with ectopic gastric mucosa in only one case. One patient still suffers from short bowel syndrome as a result of volvulus. CONCLUSION: The early operative treatment of intestinal duplication is safe and effective to prevent complications. In patients with intussusception, duplication should be considered as one of the causes of the leading point of intussusception.
Abdominal Pain ; Anal Canal ; Barium ; Colon, Descending ; Colon, Transverse ; Duodenum ; Enema ; Gastric Mucosa ; Humans ; Intestinal Volvulus ; Intussusception ; Jejunum ; Medical Records ; Melena ; Mouth ; Short Bowel Syndrome ; Ultrasonography, Prenatal

Heterotopia (of Ectopia) is defined as the occurrence of normal tissue in an abnormal location. Heterotopic gastric mucosa has been found throughout the length of the gastrointestinal tract from oral cavity to the rectum. Curiously, it is extremely rare in the gailbladder, but when it occurs, it tends to cause symptoms of acute cholecystitis in patients under 20 years of age, and chronic cholecystitis and gallstones in older patients. The heterotopic mucosa results in an intramural mass, a polyp or multiloculated gallbladder. A firm diagnosis of gastric heterotopia is based on the presence of fundic or pyrolic mucosa replete with parietal and chief cells. A clear distinction from intestinal rnetaplasia should be made, but at times may be difficult. Potential complications include mucosal ulceration, obstruction, and hemorrhage. Treatment is cholecystectomy. We report a case of gastric heterotopia in the gallbladder of a 35-year-old-man. Ultrasonography showed fatty change of liver with a 1.5 cm-sized polypoid lesion in the gallbladder. Endoscopic retrograde cholangiography showed a small filling defect, revealed by pooling of the dye in the center, in the body of gallbladder. Laparoscopic cholecystectomy was performed. A sessile polypoid leision with central umbilication was seen in the upper body of gallbladder, without gallstones. The microscopic finding of polypoid lesion consisted of gastric pyloric glands with parietal and chief cells. The surrounding mucosa revealed ordinary gallbladder epithelium without any metaplastic change. We report a case of this condition in which there was a separate loculus lined by gastric epithelium.
Cholangiography ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Cholecystitis, Acute ; Diagnosis ; Epithelium ; Gallbladder* ; Gallstones ; Gastric Mucosa ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Liver ; Mouth ; Mucous Membrane ; Polyps ; Rabeprazole ; Rectum ; Ulcer ; Ultrasonography

PURPOSE: The diagnosis of Meckel's diverticulum is difficult and delayed because it presents with various clinical symptoms. We evaluated clinical, imaging and pathologic findings of Meckel's diverticulum to facilitate detection of Meckel's diverticulum in children. METHODS: Review of clinical, imaging, surgical and pathological findings in 10 children aged 7 days to 14 years with Meckel's diverticulum during an 8-year period, 1993-2001, at Ewha Womans University Hospital was undertaken. RESULTS: The male to female ratio was 2.3 : 1. The chief complaint was painless lower gastrointestinal(GI) bleeding; others were abdominal pain, abdominal distention and vomiting, in order of frequency. The diagonsis before surgery were Meckel's diverticulum in 5 patients, non-reducible intussusception in 3 patients and intestinal obstruction in 2 patients. The diverticulum was located between 35 cm to 70 cm proximal to the ileocecal valve. The length of the diverticulum ranged from 4 cm to 12 cm and 80% of it was within 5 cm. A Meckel scan(99mTc-pertechnetate scintigraphy) after cimetidine administration was done in 6 cases. All 5 cases that presented with lower GI bleeding had ectopic gastric mucosa confirmed on pathology. Out of 5 cases of ectopic gastric mucosa, only 4 cases were positive on the Meckel's scan. CONCLUSION: In cases of unexplained GI bleeding, obstruction, or inflammation diagnostic workup should be carried out to rule out Meckel's diverticulum. Laparoscopy, high resolution ultrasonography and computed tomography of the abdomen may be indicated in the assessment of pediatric patient with lower GI bleeding, especially in patients with suspected bleeding from Meckel's diverticulum showing negative Meckel's scan.
Abdomen ; Abdominal Pain ; Child ; Cimetidine ; Diagnosis ; Diverticulum ; Female ; Gastric Mucosa ; Hemorrhage ; Humans ; Ileocecal Valve ; Inflammation ; Intestinal Obstruction ; Intussusception ; Laparoscopy ; Male ; Meckel Diverticulum* ; Pathology ; Ultrasonography ; Vomiting

An inverted hyperplastic polyp (IHP) found in stomach is rare and characterized by downward growth of hyperplastic mucosal component into the submucosa. Because of such characteristic, IHP can be misdiagnosed as subepithelial tumor or malignant tumor. In fact, adenocarcinoma was reported to have coexisted with gastric IHP in several previous reports. Because only 18 cases on gastric IHP have been reported in English and Korean literature until now, pathogenesis and clinical features of gastric IHP and correlation with adenocarcinoma have not been clearly established. Herein, we report a case of gastric IHP which was initially misdiagnosed as gastrointestinal stromal tumor and resected using endoscopic submucosal dissection. Literature review of previously published case reports on gastric IHP is also presented.
Adult ; Gastric Mucosa/pathology/surgery ; Humans ; Hyperplasia/*diagnosis/diagnostic imaging ; Male ; Polyps/pathology/surgery ; Stomach/diagnostic imaging ; Stomach Neoplasms/diagnosis/diagnostic imaging/pathology ; Tomography, X-Ray Computed ; Ultrasonography

Duplication cysts are uncommon congenital malformations that may occur anywhere throughout the alimentary tract. The stomach is an extremely rare site of occurrence. Here, we report a case of gastric duplication cyst initially presenting with a gastric submucosal tumor. A 28-year-old man complained of dyspepsia lasting 1 year and upper endoscopy revealed an ellipsoid submucosal tumor at the greater curvature of the antrum. We intended to use the injection-and-cut technique: however, after saline injection, the lesion was dented and impossible to grasp with a snare. Therefore, we decided to perform endoscopic submucosal dissection and removed the tumor without complication. Histopathology revealed a 0.6x0.6 cm-sized duplication cyst, and there has been no recurrence in 2 years.
Adult ; Cysts/congenital/*pathology/*surgery ; Dissection ; Gastric Mucosa/*pathology/*surgery ; *Gastroscopy ; Humans ; Male ; Pyloric Antrum/pathology ; Stomach Diseases/*pathology/*surgery/ultrasonography