Idiopathic chronic ulcerative enteritis (ICUE) is a rare disease with a mortality rate exceeding 75%, which manifests as an ulceration of the small bowel in the absence of a recognizable cause. It is diagnosed by biopsy. A 31-year-old man who had a 10-year history of recurrent episodes of abdominal pain was admitted with a 10-day occurrence of abdominal pain and fever. Upper endoscopy showed multiple active ulcers from duodenal second to distal portion. Colonoscopy revealed diffuse ulcerations at the terminal ileum. Colonic findings were normal. The patient was treated with intravenous antibiotics, systemic steroids, and total parenteral nutrition in the intensive care unit. Ten days after admission, the patient fell into shock due to massive hematochezia and underwent an emergency surgical resection, which revealed Meckel's diverticulum. Bleeding was uncontrolled and the following day surgical resection and intraoperative endoscopy of the highly involved jejunum revealed severe ulcerative bleeding. Microscopic examination revealed ulcerations with pseudopolyps and granulation tissue and no evidence of vasculitis, suggestive of ICUE.
Abdominal Pain ; Adult ; Anti-Bacterial Agents ; Biopsy ; Colon ; Colonoscopy ; Emergencies ; Endoscopy ; Enteritis ; Fever ; Gastrointestinal Hemorrhage ; Granulation Tissue ; Hemorrhage ; Humans ; Ileum ; Intensive Care Units ; Jejunum ; Meckel Diverticulum ; Parenteral Nutrition, Total ; Rare Diseases ; Shock ; Shock, Septic ; Steroids ; Ulcer ; Vasculitis

PURPOSE: The aim of this study was to investigate the changing pattern in the use of intravenous pyelogram (IVP), conventional computed tomography (CT), and non-contrast-enhanced computed tomography (NECT) for evaluation of patients with acute flank pain. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 2,180 patients with acute flank pain who had visited Bundang Jesaeng General Hospital between January 2008 and December 2012 and analyzed the use of IVP, conventional CT, and NECT for these patients. RESULTS: During the study period there was a significant increase in NECT use (p<0.001) and a significant decrease in IVP use (p<0.001). Conventional CT use was also increased significantly (p=0.001). During this time the proportion of patients with acute flank pain who were diagnosed with urinary calculi did not change significantly (p=0.971). CONCLUSIONS: There was a great shift in the use of imaging study from IVP to NECT between 2008 and 2012 for patients with acute flank pain.
Flank Pain ; Hospitals, General ; Humans ; Medical Records ; Retrospective Studies ; Urinary Calculi*

BACKGROUND/AIMS: Primary epiploic appendagitis (PEA) is a rare cause of focal abdominal pain in otherwise healthy patients. Patients with acute abdominal pain are often misdiagnosed clinically as acute appendicitis or diverticulitis. The purpose of this study was to describe the clinical presentation and characteristic computed tomography (CT) findings of PEA. METHODS: We reviewed the clinical records and CT images of 23 consecutive patients in Korea who presented with acute abdominal pain between January 2005 and February 2009 and had radiologic signs of PEA. RESULTS: Twenty-three patients (7 females and 16 males; average age, 42+/-14 years) were diagnosed with symptomatic PEA. Abdominal pain localized to the left (8 patients [44.5%]) and right (10 patients [55.5%]) lower quadrants as the leading symptom. CT findings specific for PEA were present in all patients except one. The symptoms resolved within 1 week (mean, 3.5 days) with or without antibiotic treatment. CONCLUSIONS: In patients with localized, sharp, acute abdominal pain not associated with other symptoms, such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of PEA should be considered and the diagnosis confirmed by CT scan.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Diverticulitis ; Female ; Fever ; Humans ; Korea ; Nausea ; Peas ; Vomiting

BACKGROUND/AIMS: This study evaluated the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hemorrhage from gastric varices (GV) in Korean patients with liver cirrhosis (LC). METHODS: We retrospectively analyzed data from 183 LC patients who underwent BRTO for GV bleeding in 6 university-based hospitals between January 2001 and December 2010. RESULTS: Of the 183 enrolled patients, 49 patients had Child-Pugh (CP) class A LC, 105 had CP class B, and 30 had CP class C at the time of BRTO. BRTO was successfully performed in 177 patients (96.7%). Procedure-related complications (e.g., pulmonary thromboembolism and renal infarction) occurred in eight patients (4.4%). Among 151 patients who underwent follow-up examinations of GV, 79 patients (52.3%) achieved eradication of GV, and 110 patients (72.8%) exhibited marked shrinkage of the treated GV to grade 0 or I. Meanwhile, new-appearance or aggravation of esophageal varices (EV) occurred in 54 out of 136 patients who underwent follow-up endoscopy (41.2%). During the 36.0+/-29.2 months (mean+/-SD) of follow-up, 39 patients rebled (hemorrhage from GV in 7, EV in 18, nonvariceal origin in 4, and unknown in 10 patients). The estimated 3-year rebleeding-free rate was 74.8%, and multivariate analysis showed that CP class C was associated with rebleeding (odds ratio, 2.404; 95% confidence-interval, 1.013-5.704; P=0.047). CONCLUSIONS: BRTO can be performed safely and effectively for the treatment of GV bleeding. However, aggravation of EV or bleeding from EV is not uncommon after BRTO; thus, periodic endoscopy to follow-up of EV with or without prophylactic treatment might be necessary in LC patients undergoing BRTO.
Adult ; Aged ; Asian Continental Ancestry Group ; *Balloon Occlusion/adverse effects ; Endoscopy, Gastrointestinal ; Esophageal and Gastric Varices/*complications ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage/etiology/prevention & control/*therapy ; Humans ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Odds Ratio ; Pulmonary Embolism/etiology ; Recurrence ; Republic of Korea ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome