2.Rate and Predictive Factors of Rebleeding with Obscure-Overt Gastrointestinal Bleeding.
Jong Hyung KIM ; Young Ho KIM ; Sun Young LEE ; Hyun Wook JUNG ; Jun Haeng LEE ; Hee Jung SON ; Poong Lyul RHEE ; Jae J KIM ; Jong Chul RHEE
The Korean Journal of Gastroenterology 2004;44(1):19-24
BACKGROUND/AIMS: Little information is available on the rate and predictive factors of rebleeding of unknown cause, which is very important in deciding further investigations on obscure-overt gastrointestinal bleeding. The aim of this study was to evaluate the rebleeding rate and related factors in obscure-overt gastrointestinal bleeding patients who revealed normal gastroscopic and colonoscopic findings. METHODS: A total of 69 patients with negative first-line gastroscopy and colonoscopy were enrolled in this study as obscure-overt gastrointestinal bleeding cases. The relationships between rebleeding and clinical characteristics were analyzed retrospectively. RESULTS: The causes of obscure-overt gastrointestinal bleeding were confirmed in 30 cases among the 69 cases. Small bowel tumors (14 cases) were the most common cause, followed by vascular lesions (6 cases). The mean follow-up period was 28 months and rebleeding was noticed in 19 patients (27.5%). Among these rebleeding patients, 14 cases (73.7%) occurred within 6 months. The past experience of previous bleeding was significantly related with rebleeding (p=0.0009). CONCLUSIONS: Close observation and detailed investigations are needed for obscure-overt gastrointestinal bleeding patients with bleeding history, especially during 6 months follow-up.
Adult
;
Aged
;
Angiodysplasia/complications/diagnosis
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Female
;
Gastrointestinal Hemorrhage/diagnosis/*etiology
;
Gastrointestinal Neoplasms/complications/diagnosis
;
Humans
;
Intestinal Diseases/complications/diagnosis
;
Male
;
Middle Aged
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Recurrence
;
Risk Factors
3.Perforated colorectal cancer: an important differential diagnosis in all presumed diverticular abscesses.
Eugene S A YEO ; Kheng Hong NG ; Kong Weng EU
Annals of the Academy of Medicine, Singapore 2011;40(8):375-378
Abscess
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diagnosis
;
etiology
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Adenocarcinoma
;
complications
;
diagnosis
;
Colorectal Neoplasms
;
complications
;
diagnosis
;
Diagnosis, Differential
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Diverticulitis, Colonic
;
complications
;
diagnosis
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Female
;
Follow-Up Studies
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Humans
;
Intestinal Perforation
;
diagnosis
;
etiology
;
Laparotomy
;
methods
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Male
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Middle Aged
;
Sigmoid Neoplasms
;
complications
;
diagnosis
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Tomography, X-Ray Computed
;
methods
4.Phaeochromocytoma presenting with pseudo-intestinal obstruction and lactic acidosis.
Peng Chin KEK ; Emily Tse Lin HO ; Lih Ming LOH
Singapore medical journal 2015;56(8):e131-3
Phaeochromocytomas are rare neuroendocrine tumours with variable clinical signs and symptoms. Hypertension, tachycardia, sweating and headaches are cardinal manifestations. Although nausea and abdominal pain are the more common gastrointestinal features, rare gastrointestinal spectrums have been reported that can mimic abdominal emergencies. Metabolic effects of hypercatecholaminaemia are vast and one such rare presentation is lactic acidosis. We describe a case of phaeochromocytoma presenting with both intestinal pseudo-obstruction as well as lactic acidosis. This case report highlights the importance of having a high index of suspicion for and early recognition of the gastrointestinal and metabolic manifestations of phaeochromocytomas.
Abdominal Pain
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Acidosis, Lactic
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complications
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Adrenal Gland Neoplasms
;
complications
;
diagnosis
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Diabetes Mellitus, Type 2
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complications
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Dyslipidemias
;
complications
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Female
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Humans
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Hypertension
;
complications
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Intestinal Pseudo-Obstruction
;
complications
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Middle Aged
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Neuroendocrine Tumors
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complications
;
diagnosis
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Pheochromocytoma
;
complications
;
diagnosis
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Radiography, Abdominal
5.Small Bowel Obstruction Caused by Peritoneal Immunoglobulin G4-Related Disease Mimicking Carcinomatosis: Case Report.
Bruno COULIER ; Luc MONTFORT ; Gabriela BENIUGA ; Frederic PIERARD ; Isabelle GIELEN
Korean Journal of Radiology 2014;15(1):66-71
We hereby report a case of diffuse pelvic peritoneal involvement by immunoglobulin G4-related disease (IgG4-RD). Numerous pelvic masses and nodules showing delayed enhancement on enhanced abdominal CT were found to congregate in the pelvic organs of a 57-year-old female presenting with intestinal subocclusion. The differentiation between peritoneal IgG4-RD and pelvic peritoneal carcinomatosis was only made by histopathology and immunohistochemistry performed after surgical resection. Autoimmune pancreatitis represents the historical prototype of IgG4-RD, but the spectrum of manifestations involving various organs has expanded during the last decade. In this report, we shortly review this clinical entity.
Carcinoma/diagnosis
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Female
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Humans
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*Immunoglobulin G
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Immunohistochemistry
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Intestinal Obstruction/*etiology
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*Intestine, Small
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Middle Aged
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Paraproteinemias/*complications/diagnosis/pathology
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Peritoneal Diseases/*complications/diagnosis/pathology
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Peritoneal Neoplasms/diagnosis
6.A Case of Enteropathy-associated T-cell Lymphoma Presenting with Recurrent Hematochezia.
Dong Hoon YANG ; Seung Jae MYUNG ; Hye Sook CHANG ; Jin Woo SONG ; Suk Kyun YANG ; Gin Hyug LEE ; Hwoon Yong JUNG ; Weon Seon HONG ; Jin Ho KIM ; Young Il MIN ; Hee Cheol KIM ; Jooryung HUH ; Heung Bum OH
The Korean Journal of Gastroenterology 2003;42(6):527-532
Enteropathy-associated T-cell lymphoma (EATL) is an unusual primary gastrointestinal lymphoma, particularly associated with celiac sprue. This tumor usually affects the jejunum and grossly presents as multiple circumferential ulcers without the formation of definite tumor masses. Moreover, mesenteric lymph nodes are commonly involved. The patients have typically suffered from abdominal pain, diarrhea, or weight loss whereas some patients may manifest with nonspecific symptoms for a period of years or an acute emergency of perforation, obstruction, or hemorrhage. The clinical course of EATL is very unfavorable and the prognosis is poor. Both celiac sprue and EATL are very rare diseases in Asia, except India and Middle East. We report a 60-year-old male diagnosed as having EATL after segmental small bowel resection, who presented with recurrent gastrointestinal bleeding.
Celiac Disease/*complications
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Gastrointestinal Hemorrhage/*etiology
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Humans
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Intestinal Neoplasms/complications/*diagnosis/pathology
;
Intestine, Small/pathology
;
Lymphoma, T-Cell/complications/*diagnosis/pathology
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Male
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Middle Aged
;
Recurrence
8.Case of Small Bowel Perforation due to Enteropathy-Type T-Cell Lymphoma.
Yong Seok KIM ; Yoo Shin CHOI ; Jun Seok PARK ; Beom Gyu KIM ; Seong Jae CHA ; Kyong Choun CHI ; Sung Jun PARK ; In Taik CHANG ; Sung Il PARK
Yonsei Medical Journal 2009;50(6):859-861
Enteropathy-type T-cell lymphoma (ETTL) is a rare disease with a poor prognosis. According to the World Health Organization (WHO) classification, it is a subtype of the peripheral T-cell lymphomas. This disease is associated with gluten-sensitive enteropathy, has a high risk of intestinal perforation and obstruction, and is refractory to chemotherapeutic treatment. We report the case of a 73-year-old woman who was diagnosed with enteropathy-type T-cell lymphoma of the small intestine, which was positive for the markers of cytotoxic T cells, CD3, CD8, and CD56, on immunohistochemical staining after resection of the perforated terminal ileum.
Aged
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Celiac Disease/*complications/pathology
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Female
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Gastrointestinal Neoplasms/*complications/pathology
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Humans
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Intestinal Perforation/*diagnosis/*etiology/pathology
;
Lymphoma, T-Cell/*complications/pathology
9.Relaparotomy Following a Resection for Gastric Cancer.
Gi Bong CHAE ; Young Jae MOK ; Tae Jin SONG ; Jae Bok LEE ; Seoung Ju KIM ; Sang Yong CHOI ; Hong Yong MOON ; Bum Hwan KOO ; Sae Min KIM ; Chong Suk KIM
Journal of the Korean Surgical Society 1999;56(2):217-224
BACKGROUND: There has been a general feeling among surgeons that recurrence or metastasis following a curative gastric resection is a hopeless surgical proposition. This study was conducted to evaluate the clinical features and significance of relaparotomy following a gastrectomy for gastric cancer. METHODS: Fifty-six cases of relaparotomies following resection for 53 gastric cancer patients, which were performed over a nine-year period, were investigated retrospectively. On preoperative diagnosis, there were 17 cases of remnant and anastomotic recurrence, 15 cases of intestinal obstruction, 7 cases of cholecystitis, 7 cases of rectosigmoid obstruction, 5 cases of E-loop obstruction and 5 cases of other diseases. RESULTS: Of all the laparotomies eleven cases (19%) were non-recurrence, benign diseases and forty-six (81%) were recurrence. In the 17 cases of remnant and anastomotic recurrence, re-resection was possible in 13 (76%) and major postoperative complications developed in 4 cases with 2 cases of death within one month. Also 6 of 7 re-resected cases which was stage I at first operation were still alive well. In 15 cases of mechanical obstruction, 5 cases were non-recurrence and 10 cases involved recurrence, of which 6 had a bypass or enterostomy and 4 an exploration only. All cholecystitis cases had a cholecystectomy; metastasis was found in 2 cases. Rectal obstruction and E-loop obstruction all involved recurrence and a palliative resection was possible in only one case of each type of obstruction. CONCLUSIONS: In a relaparotomy of remnant and anastomotic recurrence, most of the survival-improving re-resection cases were in stage I at the first operation. In late-onset cholecystitis tumor recurrence should be suspected and a relaparotomy of the malignant obstruction, with bypass and ostomy procedure, can be justified for symptomatic relief.
Cholecystectomy
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Cholecystitis
;
Diagnosis
;
Enterostomy
;
Gastrectomy
;
Humans
;
Intestinal Obstruction
;
Laparotomy
;
Neoplasm Metastasis
;
Ostomy
;
Postoperative Complications
;
Recurrence
;
Retrospective Studies
;
Stomach Neoplasms*
10.A Case of Primary Angiosarcoma of Small Intestine Presenting as Recurrent Gastrointestinal Bleeding.
Dong Yup RYU ; Sang Youn HWANG ; Dong Won LEE ; Tae Oh KIM ; Do Youn PARK ; Gwang Ha KIM ; Jeong HEO ; Dae Hwan KANG ; Geun Am SONG ; Mong CHO
The Korean Journal of Gastroenterology 2005;46(5):404-408
Angiosarcoma is a rare malignant tumor which occurs frequently in the skin and soft subcutis. Moreover, primary gastrointestinal angiosarcomas are very rare. This tumor manifests as non-specific symptoms such as gastrointestinal bleeding, abdominal pain and nausea. The diagnosis is often made at an advanced stage. Surgery, chemotherapy and radiotherapy are the mainstay of treatment. However, the prognosis is very poor. We report a case of primary angiosarcoma of the small intestine presenting as recurrent gastrointestinal bleeding. A 54-year-old man was admitted with recurrent gastrointestinal bleeding. An abdominal CT scan revealed an ileo-ileal intussusception. Segmental resection was performed with ileo-ileal anastomosis. The ileal mass was diagnosed as angiosarcoma on immunohistochemical stain. He received 3 cycles of chemotherapy, but died 5 months after the diagnosis.
English Abstract
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Gastrointestinal Hemorrhage/*etiology
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Hemangiosarcoma/complications/*diagnosis/pathology
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Humans
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Intestinal Neoplasms/complications/*diagnosis/pathology
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*Intestine, Small/pathology
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Male
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Middle Aged
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Recurrence