Multiple jejunalgastrointestinal stromal tumors (GISTs) were found in a 52-year-old woman with a history of neurofibromatosis type 1. These tumors were composed of interlacing fascicles of uniform spindle cells with eosinophilic cytoplasm. Immunohistochemically, the tumor cells were positive for CD117, CD34 and negative for S-100, smooth muscle actin. Molecular analysis for activating mutations of KIT and PDGFRA was performed in two tumors. Contrary to sporadic GISTs, the NF1-associated GISTs are characterized by rare mutations of KIT or PDGFRA. But, one missense point mutation (Trp557Gly) was identified in KIT exon 11 of the extramural portion of the largest tumor in this case. The intramural portion of the largest tumor and the other tumor had wild type KIT and PDGFRA.
Actins ; Cytoplasm ; Eosinophils ; Exons ; Female ; Gastrointestinal Stromal Tumors ; Humans ; Middle Aged ; Muscle, Smooth ; Neurofibromatoses ; Neurofibromatosis 1 ; Point Mutation

A malignant fibrous histiocytoma (MFH) is one of the most common types of soft-tissue sarcomas. It tends to develop in elderly people and is mainly localized in skeletal muscles, the dermis, the subcutis, and the retroperitoneum. A MFH of the intestine is an exceedingly rare neoplasm. We experienced a primary inflammatory malignant fibrous histiocytoma of the colon in a 51-year-old male. A right hemicolectomy and gastro-jejunostomy were performed. Microscopically, the tumor consisted of atypical fibroblast like spindle cells, arranged in a storiform or fascicular pattern and accompanied by infiltration of acute inflammatory cells.
Aged ; Colon* ; Dermis ; Fibroblasts ; Histiocytoma, Malignant Fibrous* ; Humans ; Intestines ; Male ; Middle Aged ; Muscle, Skeletal ; Sarcoma

Although toothpick ingestion is rare, it can lead to fatal complications in the gastrointestinal tract. Diagnosing toothpick ingestion is difficult because most patients do not recall swallowing one. We report 2 cases of toothpick-ingestion-induced colon injury, mimicking diverticulitis. The first patient was a 47-year-old male who had received conservative treatment under the impression of his having diverticulitis in the cecum. Ultrasonography revealed a linear foreign body in the right lower abdomen; a subsequent laparoscopic examination revealed inflammation around the cecum, but no evidence of bowel perforation. A thorough investigation revealed a toothpick embedded in the subcutaneous fat and muscle layer of the lower abdominal wall; we removed it. The second patient was a 56-year-old male who had received conservative treatment under the impression of his having diverticulitis in the sigmoid colon. An explorative laparotomy revealed a toothpick piercing the sigmoid colon; we performed an anterior resection. Both patients were discharged without postoperative complications.
Abdomen ; Abdominal Wall ; Cecum ; Colon* ; Colon, Sigmoid ; Deglutition ; Diverticulitis ; Diverticulitis, Colonic* ; Eating ; Foreign Bodies ; Gastrointestinal Tract ; Humans ; Inflammation ; Laparotomy ; Male ; Middle Aged ; Postoperative Complications ; Subcutaneous Fat ; Ultrasonography

PURPOSE: Adult intussusception is uncommon, but an organic lesion is found to be the lead point in 75% to 90% of the cases. This study was designed to review our experience with adult intussusception and to determine if there are any preoperative predictive factors for a malignant lead point. METHODS: Thirty-three patients over 15 years of age were diagnosed with intussusceptions through operative finding over a period of 20 years. We reviewed the medical records of these patients retrospectively, and preoperative predictive factors of malignant lead points were analyzed. RESULTS: The preoperative diagnosis of intussusception had been made correctly in 86% of the cases, and computed tomography could find a lead point in 79%. A causative organic lesion was found in 29 patients (88%) pathologically; 16 cases (48%) were due to benign tumors, and 13 (39%) were due to malignant tumors. A malignant lead point was present in four of 21 enteric (20%) versus nine of 13 colonic intussusceptions (75%). The period from symptom appearance to hospital visit showed a more chronic nature in malignant neoplasm than in benign neoplasm (P = 0.006), and the location of causative organic lesion showed significant difference between benign and malignant groups (P = 0.003). CONCLUSION: Adult intussusceptions are commonly secondary to a pathologic lead point, and a computed tomography is an effective diagnostic tool for finding a lead point preoperatively. The chronic nature of the disease presentation and colonic location of the lead point may suggest a malignant neoplasm.
Adult* ; Colon ; Diagnosis ; Humans ; Intussusception* ; Medical Records ; Retrospective Studies

PURPOSE: Intussusception in adults is uncommon and constitutes approximately 5% of all intussusceptions. An organic lesion is found to be the lead point in 75 to 90% of the cases, so surgical intervention is necessary in most cases. This study was designed to review our experience with adult intussusception and to determine an appropriate method for diagnosis and management. METHODS: Thirteen (13) patients over 15 years of age were diagnosed as having on intussusception at our center between 1994 and 2003. We reviewed the medical records of these patients retrospectively. RESULTS: The preoperative diagnosis had been made correctly in 85% of patients (11 cases) by combined use of abdominal ultrasonography and a CT scan. The types of intussusceptions wene jejuno-jejunal in two cases, ileo-ileal in four, ileo-colic in three, and colo-colic in four. Causative organic lesion was found in all patients; seven cases (54%) were due to benign tumors, and six (46%) were due to malignant tumors. Surgical intervention was carried out in all cases; 11 patients underwent a surgical resection without manual reduction, and 2 patients underwent a surgical resection after manual reduction. CONCLUSIONS: Both abdominal ultrasonography and CT scan are effective and useful diagnostic tools in the diagnosis of adult intussusception. Since tumors, benign or malignant, are the most frequent cause of adult intussusception, surgical intervention is mandatory.
Adult* ; Diagnosis ; Humans ; Intussusception* ; Medical Records ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography

A rectal cancer was found in a 67-year-old man with a history of neurofibromatosis type 1. A low anterior resection was performed, and he received concurrent chemoradiation for 6 months. Twelve months after the surgery, a tumor was found at the anastomotic site by positron emission tomography-computed tomography and colonoscopy and was mistaken as anastomotic site recurrence. The tumor was confirmed as an inflammatory myofibroblastic tumor through transanal excision.
Aged ; Colonoscopy ; Colorectal Neoplasms ; Electrons ; Humans ; Myofibroblasts ; Neurofibromatoses ; Neurofibromatosis 1 ; Rectal Neoplasms ; Recurrence

An inflammatory myofibroblastic tumor (IMFT) is relatively rare pseudo-sarcomatous lesion with unknown etiology, which has a distinctive histologic appearance. An IMFT has been known as non-neoplastic aberrant inflammatory response, but some lesions are locally invasive, recurrent and distantly metastatic. We experienced a case of IMFT of the jejunum as the leading point of intussusception in a 52- year-old female. Jejunal segmental resection and anastomosis was performed and the tumor showed spindle cell proliferation with prominent inflammatory infiltrate under microscopic examination.
Adult* ; Cell Proliferation ; Female ; Humans ; Intussusception* ; Jejunum* ; Myofibroblasts*

Obstructive colitis refers to ulceroinflammatory lesions that occur in the colon proximal to an obstructing lesion. The pathogenesis is unclear, but raised intraluminal pressure, distension, and bacterial stasis are thought to play a role in the development of ischemia. The normal appearance at surgery may lead to involved segments of colon being used for anastomoses with consequent complications, so an awareness of the clinical, radiological, and endoscopic features of obstructive colitis is mandatory to prevent anastomotic complications. We experienced a case of obstructive colitis associated with a partially obstructing upper rectal cancer in a 67-year-old male. Obstructive colitis was diagnosed by using colonoscopy preoperatively, and an extended resection involving both the tumor and the colitis segment was performed without complications.
Aged ; Colitis* ; Colon ; Colonoscopy ; Humans ; Ischemia ; Male ; Rectal Neoplasms*

Purpose: To evaluate the effect of coronavirus disease 2019 (COVID-19) on out-of-hospital cardiac arrest (OHCA) outcomes in South Korea, we conducted systematic review and meta-analysis. Materials and Methods: MEDLINE, Embase, KoreaMed, and Korean Information Service System databases were searched up to June 2022. We included observational studies and letters on OHCA during the COVID-19 pandemic and compared them to those before the pandemic. Epidemiologic characteristics, including at-home OHCA, bystander cardiopulmonary resuscitation, unwitnessed arrest, use of an automated external defibrillator (AED), shockable cardiac rhythm, and airway management, were evaluated.Survival and favorable neurological outcomes were extracted. We conducted a meta-analysis of each characteristic and outcome. Results: Six studies including 4628 OHCA patients were included in this study. The incidence of at-home OHCA significantly increased and the AED use decreased during the COVID-19 pandemic compared to before the pandemic [odds ratio (OR), 1.29;95% confidence interval (CI), 1.08–1.55; I2 =0% and OR, 0.74; 95% CI, 0.57–0.97; I2 =0%, respectively]. Return of spontaneous circulation after OHCA, survival, and favorable neurological outcomes during and before the pandemic did not differ significantly (OR, 0.90; 95% CI, 0.71–1.13; I2 =37%; OR, 0.74; 95% CI, 0.43–1.26; I2 =72%; OR, 0.77; 95% CI, 0.43–1.37; I2 =70%, respectively). Conclusion During the COVID-19 pandemic in South Korea, the incidence of at-home OHCA increased and AED use decreased among OHCA patients. However, survival and favorable neurological outcomes did not significantly differ from before the pandemic. This insignificant effect of the pandemic on OHCA in South Korea could be attributed to the slow increase in patient count in the early days of the pandemic.OSF Registry (DOI: 10.17605/OSF.IO/UGE9D).