Terlipressin is a vasopressin analogue that is widely used in the treatment of hepatorenal syndrome or variceal bleeding. Because it acts mainly on splanchnic vessels, terlipressin has a lower incidence of severe ischemic complications than does vasopressin. However, it can still lead to serious complications such as myocardial infarction, skin necrosis, or bowel ischemia. Herein we report a case of severe ischemic bowel necrosis in a 46-year-old cirrhotic patient treated with terlipressin. Although the patient received bowel resection, death occurred due to ongoing hypotension and metabolic acidosis. Attention should be paid to patients complaining of abdominal pain during treatment with terlipressin.
Bilirubin/blood ; Creatinine/blood ; Electrocardiography ; Fatal Outcome ; Hepatorenal Syndrome/*drug therapy ; Humans ; Intestinal Mucosa/pathology ; Intestines/surgery ; Liver Cirrhosis/diagnosis/therapy ; Lypressin/adverse effects/*analogs & derivatives/therapeutic use ; Male ; Middle Aged ; Necrosis/*chemically induced/surgery ; Tomography, X-Ray Computed ; Vasoconstrictor Agents/*adverse effects/*therapeutic use

A 35-year old male developed epigastric pain and hematemesis one week before admission. Esophagogastroduodenoscopy was performed and a communication between the esophagus and another opening was discovered. On a follow-up CT and barium esophagogram, a tubular duplication was suspected and the patient was referred to the department of cardio-thoracic surgery. A pathological diagnosis of esophageal duplication (tubular type) was established. The patient was discharged and is currently being followed up. Esophageal duplication is a rare congenital malformation. Moreover, it has not heen reported in Korea that esophageal duplication presents with hematemesis.
Adult ; Barium ; Diagnosis ; Endoscopy, Digestive System ; Esophagus ; Follow-Up Studies ; Hematemesis* ; Humans ; Korea ; Male

Schwannoma in colorectum is a rare subepithelial polyp of mesenchymal origin, which is derived from the neural sheath, and most of reported cases were removed surgically. We, herein, describe two cases of schwannoma of the cecum, which were removed by endoscopic mucosal resection. A 34-year-old man and a 62-year-old man presented with abdominal discomfort and bowel habit change. The patients were diagnosed with a subepithelial tumor in the cecum on colonoscopy and underwent endoscopic mucosal resection under a tentative impression as neuroendocrine tumor, such as carcinoid tumor. Histopathology and immunohistochemistry confirmed the colonic lesion to be a benign schwannoma.
Carcinoid Tumor ; Cecum ; Colon ; Colonoscopy ; Humans ; Immunohistochemistry ; Neurilemmoma ; Neuroendocrine Tumors ; Polyps

Ulcerative colitis is a chronic inflammatory bowel disease and may have many intestinal and extraintestinal complications. Compared with general population, patients with longstanding ulcerative colitis have an increased risk of colorectal cancer. Patients with ulcerative colitis have an increased frequency of thromboembolism too. However, hepatic vein thrombosis is a very rare extraintestinal complication. This is the first reported case of a young patient with ulcerative colitis who developed synchronous colonic neoplasm and chronic Budd-Chiari syndrome manifested as esophageal variceal bleeding. We report a case of ulcerative colitis complicated by Budd-Chiari syndrome and colon cancer in a 28-year-old female.
Adult ; Budd-Chiari Syndrome* ; Colitis, Ulcerative* ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Esophageal and Gastric Varices ; Female ; Humans ; Inflammatory Bowel Diseases ; Thromboembolism ; Ulcer*

Cicatrical pemphigoid is regarded as a chronic, autoimmune subepithelial blistering disease of mucous membranes in which lesions often heal with scar formation. Cicatrical pemphigoid typically involves the oral and/or ocular mucosa but may affect the nasal, pharyngeal, laryngeal, esophageal, anogenital regions as well. Immunopathologic studies have shown that patients with cicatrical pemphigoid typically have autoantibodies directed against basement membrane antigens and that they demonstrate continuous deposits of immunoglobulins (IgG, A), complement components and fibrin along the basement membrane. A 69-year-old female was admitted with chief complaints of hoarseness, dyspnea, multiple painful oral ulcer and vesiculobullous skin lesion on upper trunk. During admission, dysphagia and epigastric discomfort was developed. Endoscopic examination revealed multiple erosion and ulcerative lesion with scar formation. Immunopathologic studies showed that linear deposit of IgG, A, C3 along the basement membrane zone. We report a case of cicatrical pemphigoid with esophageal involvement with brief review of literature.
Aged ; Autoantibodies ; Basement Membrane ; Blister ; Cicatrix ; Complement System Proteins ; Deglutition Disorders ; Dyspnea ; Esophagus ; Female ; Fibrin ; Hoarseness ; Humans ; Immunoglobulin G ; Immunoglobulins ; Mucous Membrane ; Oral Ulcer ; Pemphigoid, Bullous* ; Skin ; Ulcer

BACKGROUND/AIMS: Antispasmodic agents have been used in the management of irritable bowel syndrome. However, systematic reviews have come to different conclusions about the efficacy in irritable bowel syndrome. Fenoverine acts as a synchronizer of smooth muscle in modulating the intracellular influx of calcium. We compared fenoverine with trimebutine for the treatment of patients with IBS. METHODS: A multicenter, randomized, double-blind, non-inferiority clinical study was conducted to compared fenoverine with trimebutine. Subjects were randomized to receive either fenoverine (100 mg three times a day) or trimebutine (150 mg three times a day) for 8 weeks. A total of 197 patients were analyzed by the intention-to-treat approach. The primary endpoint was the proportion of patients who had 30% reduction in abdominal pain or discomfort measured by bowel symptom scale (BSS) score at week 8 compared to the baseline. The secondary endpoints were changes of abdominal bloating, diarrhea, constipation, overall and total scores of BSS, and overall satisfaction. RESULTS: At week 8, fenoverine was shown to be non-inferior to trimebutine (treatment difference, 1.76%; 90% CI, -10.30-13.82; p=0.81); 69.23% (54 of 78 patients) of patients taking fenoverine and 67.47% (56 of 83 patients) of patients taking trimebutine showed 30% reduction in abdominal pain or discomfort compared to the baseline. There results of the secondary endpoints were also comparable between the fenoverine group and the trimebutine group. CONCLUSIONS: Fenoverine is non-inferior to trimebutine for treating IBS in terms of both efficacy and tolerability.
Abdominal Pain/etiology ; Adult ; Constipation/etiology ; Diarrhea/etiology ; Double-Blind Method ; Drug Administration Schedule ; Female ; Humans ; Irritable Bowel Syndrome/complications/*drug therapy ; Male ; Middle Aged ; Parasympatholytics/*therapeutic use ; Phenothiazines/*therapeutic use ; Severity of Illness Index ; Treatment Outcome ; Trimebutine/*therapeutic use

Burkitt's lymphoma is a rare disease that belongs to the aggressive non-Hodgkin's lymphomas. Burkitt's lymphoma usually occurs in children or younger persons. There is a strong association between endemic Burkitt's lymphoma and Epstein-Barr virus, whereas the association is weaker in the sporadic form occurring in Western countries. Burkitt's lymphoma of the gastrointestinal tract occurring in adults has not been reported in Korea. We herein report an unusual case of Burkitt's lymphoma presenting with a palpable abdominal mass in a 52-year-old man infected with Epstein-Barr virus. A computed tomographic scan showed marked low density wall thickening of the terminal ileum. An endoscopy revealed a narrow lumen, shallow ulcerations, and irregular nodularity of the terminal ileum. Small bowel resection and hemicolectomy were performed and a histologic examination of the resected specimen confirmed the diagnosis. Six cycles of adjuvant chemotherapy were given and the patient has been doing well without evidence of recurrence.
Adult* ; Burkitt Lymphoma* ; Chemotherapy, Adjuvant ; Child ; Diagnosis ; Endoscopy ; Gastrointestinal Tract ; Herpesvirus 4, Human ; Humans ; Ileum ; Korea ; Lymphoma, Non-Hodgkin ; Middle Aged ; Rare Diseases ; Recurrence ; Ulcer

Synovial sarcomas are malignant soft tissue neoplasms that develop from tendon and bursa near the large joints and frequently occur in the lower extremities of young male adults. They usually recur within 2 years after surgical treatment. The lung is a common metastatic site and rarely reported as the primary site of synovial sarcoma. The stomach is a very rare primary site of synovial sarcoma and recently only two cases of primary gastric synovial sarcoma were reported. We report a case of metastatic gastric synovial sarcoma in a 53-year-old male 4 years after surgical treatment of primary lung synovial sarcoma. The tumor had histologic, immunohistochemical and ultrastructural features of biphasic synovial sarcoma of the soft tissue.
Adult ; Humans ; Joints ; Lower Extremity ; Lung ; Male ; Middle Aged ; Sarcoma, Synovial* ; Soft Tissue Neoplasms ; Stomach ; Tendons

PURPOSE: Anti-tumor necrosis factor-alpha (TNF-alpha) medications represent a major advancement in the management of chronic inflammatory diseases. However, these agents are associated with increased risks of tuberculosis (TB) and other serious infections. The aim of this study was to evaluate the incidences of such disease among tertiary hospitals in Korea. MATERIALS AND METHODS: We retrospectively studied patients who received anti-TNF-alpha therapy; we reviewed serious infections including TB that developed within 6 months after initiation of anti-TNF-alpha therapy. Data concerning patient demographics, types of anti-TNF-alpha agents, concomitant immunosuppressive drugs use, and infection details were collected. RESULTS: A total 175 patients treated with infliximab (n=72) or adalimumab (n=103) with the following conditions were enrolled: Crohn's disease, 34 (19.4%); ulcerative colitis, 20 (11.4%); ankylosing spondylitis, 82 (46.9%); and rheumatoid arthritis, 39 (22.2%). There were 18 cases (6.0%) of serious infections. The most common site of serious infection was the intra-abdomen (n=6), followed by TB (n=3), skin and soft tissue (n=3), bone and joints (n=2), ocular neurons (n=2), lower respiratory tract (n=1), and urinary tract (n=1). Of the 175 patients, only 3 cases showed development of TB. Furthermore, of all those who developed TB, none had taken anti-TB chemoprophylaxis prior to treatment with an anti-TNF agent due to negative screening results. CONCLUSION: Serious infections with anti-TNF-alpha therapy were uncommon among tertiary hospitals in Korea; TB was the second most frequent infection. Nevertheless, there were no TB reactivations after anti-TB chemoprophylaxis. Accordingly, physicians should be aware of TB in subjects undergoing anti-TNF-alpha therapy, especially in countries with a high prevalence of TB.
Arthritis, Rheumatoid ; Chemoprevention ; Colitis, Ulcerative ; Crohn Disease ; Demography ; Humans ; Incidence* ; Joints ; Korea ; Mass Screening ; Methods ; Necrosis* ; Neurons ; Prevalence ; Respiratory System ; Retrospective Studies ; Skin ; Spondylitis, Ankylosing ; Tertiary Care Centers ; Tuberculosis* ; Tumor Necrosis Factor-alpha ; Urinary Tract

Meckel's diverticulum is an embryonic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract. Its incidence records about 2%. Among them, only 5% are symptomatic with complications-bleeding, intestinal obstruction, inflammation, and perforation. In particular, bleeding is a common complication and has always been caused by an ulceration of the ileal mucosa adjacent to the acid-producing ectopic mucosa in a Meckel's diverticulum. Wireless capsule endoscopy is a new method enabling non-invasive diagnostic endoscopy of the entire small intestine. We experienced a case of Meckel's diverticulum detected by wireless capsule endoscopy in a 34 year-old man who presented with chronic obscure gastrointestinal bleeding.
Adult ; Chronic Disease ; *Endoscopy, Gastrointestinal ; English Abstract ; Gastrointestinal Hemorrhage/*diagnosis/*etiology ; Humans ; Male ; Meckel Diverticulum/*complications/diagnosis