After gastrojejunostomy, a small space can occur between the jejunum at the anastomosis site, the transverse mesocolon, and retroperitoneum, which may cause an intestinal hernia. This report presents a rare case of intestinal ischemic necrosis caused by retroanastomotic hernia after subtotal gastrectomy. A 56-year-old male was admitted to Kangwon National University Hospital with melena, abdominal pain, and nausea. His only relevant medical history was gastrectomy due to stomach cancer. Endoscopic findings revealed subtotal gastrectomy with Billroth-II reconstruction and a bluish edematous mucosal change with necrotic tissue in afferent and efferent loops including the anastomosis site. Abdominopelvic CT showed strangulation of proximal small bowel loops due to mesenteric torsion and thickening of the wall of the gastric remnant. Emergency laparotomy was performed. Surgical findings revealed the internal hernia through the defect behind the anastomosis site with strangulation of the jejunum between 20 cm below the Treitz ligament and the proximal ileum. Roux-en-Y anastomosis was performed, and he was discharged without complication. Retroanastomotic hernia, also called Petersen's space hernia, is a rare complication after gastric surgery, cannot be easily recognized, and leads to strangulation.
Abdominal Pain ; Anastomosis, Roux-en-Y ; Emergencies ; Gangwon-do ; Gastrectomy ; Gastric Bypass ; Gastric Stump ; Hernia ; Humans ; Ileum ; Ischemia ; Jejunum ; Laparotomy ; Ligaments ; Male ; Melena ; Mesocolon ; Middle Aged ; Nausea ; Necrosis ; Stomach Neoplasms

Primary lymphoma of pancreatic mucosa-associated lymphoid tissue (MALT) is extremely rare. Initial suspicion of primary pancreatic lymphoma is hampered by its low incidence. However, it should always be included in a differential diagnosis of pancreatic mass with unusual features, because an accurate diagnosis can avoid unnecessary surgical intervention. A 70-year-old woman presented with melena associated with a mass on the pancreatic head. Endoscopic ultrasonography-guided core-needle biopsy of the pancreatic mass revealed MALT lymphoma. The patient is currently undergoing radiation therapy. We present a case of primary lymphoma of the pancreatic MALT with a review of the literature.
Aged ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Female ; Head ; Humans ; Incidence ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone ; Melena

We report a 12-month-old female infant who had a history of neonatal sepsis with liver micro-abscesses that resolved with intravenous antibiotics during neonatal period. During her neonatal admission period, no umbilical vein catheter was inserted. Also, she did not undergo any abdominal surgeries or had a postnatal history of necrotizing enterocolitis. However, the child developed upper gastrointestinal bleeding in form of hematemesis and melena secondary to esophageal varices at the age of 12 months with an extra-hepatic portal vein obstruction with cavernous transformation and portal hypertension subsequently. The child underwent a successful endoscopic injection sclerotherapy. She is now 20-month-old and has portal hypertension but otherwise asymptomatic. We are proposing the possibility of a delayed-onset portal hypertension as a complication of liver abscess and neonatal sepsis.
Anti-Bacterial Agents ; Catheters ; Child ; Enterocolitis, Necrotizing ; Esophageal and Gastric Varices ; Female ; Hematemesis ; Hemorrhage ; Humans ; Hypertension, Portal ; Infant ; Liver Abscess ; Liver ; Melena ; Portal Vein ; Sclerotherapy ; Sepsis ; Umbilical Veins ; Venous Thrombosis

Choriocarcinoma is an aggressively growing and widely metastasizing tumor that originates from trophoblastic cells. A primary gastric choriocarcinoma (PGC), however, is very rare. A 76-year-old female patient visited the emergency department of Wonkwang University Hospital with abdominal discomfort and melena. Esophagogastroduodenoscopy revealed a huge ulceroinfiltrative mass lesion with blood clots on the boundary between the greater curvature side and the posterior wall side of the stomach lower body. CT showed a 3-cm exophytic mass lesion with heterogeneous enhancement, an ulcer lesion at the posterior wall side of the stomach lower body, and multiple enlarged lymph nodes at the splenic artery and left gastric artery nodal stations. She underwent a radical subtotal gastrectomy with a D2 lymph node dissection. The final diagnosis was PGC coexisting with adenocarcinoma based on the pathology results. This paper reports a rare case of primary gastric choriocarcinoma coexisting with adenocarcinoma and discusses the characteristics of this neoplasm with reference to the literature.
Adenocarcinoma ; Aged ; Arteries ; Choriocarcinoma ; Chorionic Gonadotropin ; Diagnosis ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Melena ; Pathology ; Pregnancy ; Splenic Artery ; Stomach ; Trophoblasts ; Ulcer

Choriocarcinoma is an aggressively growing and widely metastasizing tumor that originates from trophoblastic cells. A primary gastric choriocarcinoma (PGC), however, is very rare. A 76-year-old female patient visited the emergency department of Wonkwang University Hospital with abdominal discomfort and melena. Esophagogastroduodenoscopy revealed a huge ulceroinfiltrative mass lesion with blood clots on the boundary between the greater curvature side and the posterior wall side of the stomach lower body. CT showed a 3-cm exophytic mass lesion with heterogeneous enhancement, an ulcer lesion at the posterior wall side of the stomach lower body, and multiple enlarged lymph nodes at the splenic artery and left gastric artery nodal stations. She underwent a radical subtotal gastrectomy with a D2 lymph node dissection. The final diagnosis was PGC coexisting with adenocarcinoma based on the pathology results. This paper reports a rare case of primary gastric choriocarcinoma coexisting with adenocarcinoma and discusses the characteristics of this neoplasm with reference to the literature.
Adenocarcinoma ; Aged ; Arteries ; Choriocarcinoma ; Chorionic Gonadotropin ; Diagnosis ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Melena ; Pathology ; Pregnancy ; Splenic Artery ; Stomach ; Trophoblasts ; Ulcer

Small bowel lymphangioma is a rare benign tumor of the lymphatic system, characterized by the presence of dilated lymphatic spaces and significant gastrointestinal bleeding. Small bowel lymphangiomas are rare in adults and case reports are few. Lymphangiomas in the jejunum or ileum are extremely rare and account for less than 1% of all lymphangiomas. The case reported herein is of an older patient (70-year-old male) with melena and chronic anemia (hemoglobin count < 5 g/dL) who had small-sized multiple lymphangiomas in his small bowel (jejunum). Surgical resection was performed after failure of treatment by gastroenteroscopy. Final pathological analysis revealed lymphangioma with thrombus and hemorrhage. After surgery, he no longer had decreased hemoglobin count, nor symptoms of anemia and melena. Also, at the last follow-up visit, the patient's hemoglobin count patient was normal and he returned to normal daily functions.
Adult ; Anemia ; Endoscopy ; Follow-Up Studies ; Hemorrhage ; Humans ; Ileum ; Jejunum ; Lymphangioma ; Lymphatic System ; Melena ; Thrombosis

We report a case of bleeding ileal varices associated with intra-abdominal adhesions after colectomy which was successfully diagnosed using capsule endoscopy. A 77-year-old woman visited the emergency department for several episodes of melena. She had a medical history of neoadjuvant chemo-radiation therapy and subsequent surgery for rectal cancer 6 years previously. Conventional diagnostic examinations including upper endoscopy, colonoscopy, and abdominal computed tomography could not detect any bleeding focus, however, following capsule endoscopy revealed venous dilatations with some fresh blood in the distal ileum, indicating bleeding ileal varices. The patient underwent exploratory laparotomy and the affected ileum was successfully resected. No further gastrointestinal bleeding occurred during the 6 months follow-up. Small intestinal varices are important differential for obscure gastrointestinal bleeding especially in patients with a history of abdominal surgery in the absence of liver cirrhosis, and capsule endoscopy can be a good option for diagnosing small intestinal varices.
Aged ; Capsule Endoscopy* ; Colectomy* ; Colonoscopy ; Dilatation ; Emergency Service, Hospital ; Endoscopy ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Ileum ; Laparotomy ; Liver Cirrhosis ; Melena ; Rectal Neoplasms ; Varicose Veins*

BACKGROUND/AIMS: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrom-botic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. METHODS: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. RESULTS: Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. CONCLUSIONS: The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
Abscess ; Asian Continental Ancestry Group ; Endoscopic Ultrasound-Guided Fine Needle Aspiration* ; Endoscopy, Gastrointestinal ; Erythrocyte Transfusion ; Fibrinolytic Agents* ; Hemorrhage* ; Hemothorax ; Humans ; Incidence ; Japan ; Male ; Melena ; Prospective Studies*

Gastric hemangiomas are rare benign vascular tumors that can cause severe gastrointestinal system bleeding. We presented the case of a neonate with fresh bleeding and melena from the orogastric tube and detected gastric hemangioma in esophagogastroduodenoscopic examination. Propranolol is widely used in treatment of cutaneous hemangiomas and non-gastric gastrointestinal system hemangiomas. However, the surgical approach is preferred for treating gastric hemangiomas, and there are few reports of gastric hemangiomas associated with non-surgical treatment. Gastric hemorrhage decreased with antacid and somatostatin treatment. Propranolol treatment was initiated before the surgery decision. After three weeks of treatment, we observed regression in the hemangioma with endoscopic evaluation. During the course of treatment, the patient's gastrointestinal system bleeding did not recur, and there were no side effects associated with propranolol.
Hemangioma* ; Hemorrhage ; Humans ; Infant, Newborn* ; Melena ; Propranolol* ; Somatostatin ; Stomach

Obesity in the United States is a medical crisis with many people attempting to lose weight with caloric restriction. Some patients choose minimally invasive weight loss solutions, such as intragastric balloon systems. These balloon systems were approved by the Federal Drug Administration (FDA) in 2015–2016 and have been considered safe, with minimal side effects. We report a patient with a two-day history of melena, abdominal pain, hypotension, and syncope which developed five months after placement of an intragastric balloon. Esophagogastroduodenoscopy with balloon removal revealed a small 8-mm gastric ulcer in the incisura. This gastric ulcer probably developed secondary to mechanical compression of the stomach mucosa by the gastric balloon which contained 900 mL of saline. The FDA is now investigating five deaths since 2016 associated with these second-generation balloons. Clinicians should be aware of these complications when evaluating patients with gastrointestinal complications, such as bleeding.
Abdominal Pain ; Caloric Restriction ; Endoscopy, Digestive System ; Gastric Balloon ; Gastrointestinal Hemorrhage ; Hemodynamics* ; Hemorrhage* ; Humans ; Hypotension ; Melena ; Mucous Membrane ; Obesity ; Stomach ; Stomach Ulcer* ; Syncope ; United States ; Weight Loss*