BACKGROUND/AIMS: Consistently defining disease activity remains a critical challenge in the follow-up of patients with Crohn's disease (CD). We investigated the potential applicability of abdominal ultrasonography with color Doppler (USCD) analysis for the detection of morphological alterations and inflammatory activity in CD. METHODS: Forty-three patients with CD ileitis/ileocolitis were evaluated using USCD analysis with measurements obtained on the terminal ileum and right colon. Sonographic parameters included wall thickening, stricture, hyperemia, presence of intra-abdominal mass, and fistulas. Patients were evaluated for the clinical activity (Harvey-Bradshaw Index [HBI]), fecal calprotectin (FC) and C-reactive protein (CRP). The USCD performance was assessed using magnetic resonance enterography (MRE) as a criterion standard. RESULTS: Most measurements obtained with USCD matched the data generated with MRE; however, the agreement improved in clinically active patients where sensitivity, positive predictive value, and accuracy were >80%, considering wall thickening and hyperemia. Complications such as intestinal wall thickening, stricture formation, and hyperemia, were detected in the USCD analysis with moderate agreement with MRE. The best agreement with the USCD analysis was obtained in regard to FC, where the sensitivity, positive predictive value, and accuracy were >70%. The overall performance of USCD was superior to that of HBI, FC and CRP levels, particularly when considering thickening, stricture, and hyperemia parameters. CONCLUSIONS: USCD represents a practical noninvasive and low-cost tool for evaluating patients with ileal or ileocolonic disease, particularly in clinically active CD. Therefore, USCD might become a useful asset in the follow-up of patients with CD.
C-Reactive Protein ; Colon ; Constriction, Pathologic ; Crohn Disease ; Fistula ; Follow-Up Studies ; Humans ; Hyperemia ; Ileitis ; Ileum ; Leukocyte L1 Antigen Complex ; Magnetic Resonance Imaging ; Ultrasonography ; Ultrasonography, Doppler, Color

BACKGROUND/AIMS: Previous studies have reported that endotoxemia is associated with pathogenesis and complications in cirrhosis. Endotoxin stimulates the secretion of inflammatory cytokines, which contributes to the development of complications. In addition, endotoxin easily invades the gut barrier system because of the increased intestinal permeability due to portal hypertensive enteropathy. In this report, we explored changes in cytokine levels and intestinal permeability and measured the thickness and elasticity of the bowel wall using ultrasonography in cirrhotic patients.METHODS: We enrolled 40 patients with cirrhosis classified as Child-Pugh B or C and 20 healthy volunteers. Abdominal ultrasonography examinations were used to evaluate bowel wall parameters in the ascending colon and terminal ileum. Intestinal permeability was measured using dual sugar absorption tests with lactulose and mannitol. Levels of tumor necrosis factor (TNF)-α and IL-10 were determined from blood samples. We compared these outcomes between cirrhotic patients and healthy controls and between Child-Pugh B and C patients. In addition, we explored the correlation between cytokine levels, intestinal permeability ratio, and bowel wall parameters in cirrhotic patients.RESULTS: In cirrhotic patients, the ascending colon wall elasticity decreased (20.4 vs. 10.9 kPa, p = 0.048) and the terminal ileum wall thickness increased (4.2 vs. 1.9 mm, p < 0.001). The intestinal permeability ratio and levels of the cytokines TNF-α and IL-10 increased (0.219 vs. 0.017, p < 0.001; 22.47 vs. 13.48 pg/mL, p < 0.001; and 14.91 vs. 8.57 pg/mL, p = 0.019, respectively) in cirrhotic patients. However, there were no significant differences between Child-Pugh classes and no significant correlations between bowel wall parameters and intestinal permeability or cytokine levels.CONCLUSIONS: Ultrasonography revealed bowel wall thickening and decreases in elasticity; in addition, intestinal permeability and cytokine levels increased in cirrhotic patients compared with healthy controls.
Absorption ; Ascites ; Colon, Ascending ; Cytokines ; Elasticity ; Endotoxemia ; Fibrosis ; Healthy Volunteers ; Humans ; Ileum ; Interleukin-10 ; Intestines ; Lactulose ; Liver Cirrhosis ; Mannitol ; Permeability ; Tumor Necrosis Factor-alpha ; Ultrasonography

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

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder caused by mutation of one of two genes, TSC1 (encoding hamartin, 9q34) and TSC2 (encoding tuberin, 16p13). It invades the central nervous system and various parts of the body, causing various symptoms. Crohn's disease (CD) is a chronic immune-mediated disease that has not been clearly elucidated. It is thought to be caused by an excessive immune response of the body to bacteria that normally exist in the digestive tract with genetic factors. No cases have been reported in which both of the above-mentioned diseases occurred simultaneously. We report a case of CD in a patient with TSC. A 12-year-old boy was brought to our hospital because of abdominal pain. Skin lesions were observed in the TSC. Fundus examination revealed a hamartoma in the right retina. Brain magnetic resonance imaging revealed a subendothelial giant cell astrocytoma (SEGA). On the basis of these findings, he was diagnosed as having TSC. Blood test results showed increased levels of inflammatory markers. On abdominal ultrasonography, his colon walls were observed to be thickened with increased vascularity of the proximal ascending colon, ileocecal valve, and terminal ileum. Colonoscopy revealed discontinuous ulcerations and inflammations of the ileum, IC valve, and cecum, similar to those found in CD. Everolimus was administered orally for the SEGA but was discontinued frequently owing to the exacerbation of CD. The possibility of CD should be kept in mind in patients with TSC considering to undergo treatment for SEGA.
Abdominal Pain ; Astrocytoma ; Bacteria ; Brain ; Cecum ; Central Nervous System ; Child ; Colon ; Colon, Ascending ; Colonoscopy ; Crohn Disease* ; Everolimus ; Gastrointestinal Tract ; Giant Cells ; Hamartoma ; Hematologic Tests ; Humans ; Ileocecal Valve ; Ileum ; Inflammation ; Magnetic Resonance Imaging ; Male ; Retina ; Skin ; Tuberous Sclerosis* ; Ulcer ; Ultrasonography

Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity. BPD is a chronic respiratory disease related to lung-injury during the primary course of critical lung disease such as respiratory distress syndrome or when abnormal development of the preterm lung occurs. Abnormal lung development not only results from primary lung injury in the first days after birth, but also secondary injury through abnormal repair resulting in arrested and abnormal alveolarization, fibrosis and pulmonary vascular dysgenesis. Chorioamnionitis is a risk factor that plays an important role in the development of BPD. Ureaplasma subspecies (spp.) are the most common isolated organisms from chorioamniotic tissue after premature births. Therefore Ureaplasma spp. appear to play an important role in the development of BPD, and treatment or prophylactic treatment of these infections or colonization may reduce the incidence, morbidity and mortality of BPD. Ureaplasma spp. infections are challenging not only to treat, but also to diagnosis in a timely manner. This review summarizes the current state of treatment and new developments in the treatment of Ureaplasma exposure in premature infants.
Azithromycin ; Bronchopulmonary Dysplasia* ; Chorioamnionitis ; Colon ; Diagnosis ; Female ; Fibrosis ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Lung ; Lung Diseases ; Lung Injury ; Mortality ; Parturition ; Pregnancy ; Premature Birth ; Risk Factors ; Ultrasonography ; Ureaplasma*

Endoscopic ultrasound (EUS)-guided management of abdominal fluid collections adjacent to the gastroduodenal lumen is a relatively new concept attracting a lot of interest in recent years. The ability of EUS to identify and drain these collections in the same session accounts for the surge of interest in these novel techniques. On the other hand, the complexity of these interventions and associated serious complications has moderated the enthusiasm of novice endoscopists to some extent and reiterated that focused research and technical innovations are needed to make EUS-guided drainage simpler and safer. Self-expandable metallic stents (SEMS) have emerged in the last decade in the endoscopic management of malignant luminal gastrointestinal strictures. The use of SEMS in the management of benign conditions (biliary, pancreatic, and colonic strictures) is also rapidly expanding. Recently, fully-covered (FC)-SEMS have been successfully used for drainage of peripancreatic and pericholecystic fluid collections. Here we will review the existing data and future directions in the use of FC-SEMS for such drainage procedures. We will also review the literature on novel “purpose-made” prostheses, such as the lumen-apposing metallic stents, which aim to address technical problems arising in EUS-guided drainage procedures when conventional SEMS are used. Further development of these and other similar devices may transform EUS-guided drainage procedures from an esoteric concept to “mainstream”, first-line intervention.
Colon ; Constriction, Pathologic ; Drainage* ; Endosonography ; Hand ; Pancreatic Pseudocyst ; Phenobarbital ; Prostheses and Implants ; Self Expandable Metallic Stents ; Stents ; Ultrasonography

Neonatal gastrointestinal mucormycosis, a rare disease with a high mortality rate, shows a rapid progressive course in premature infants with an immature immune system. We report the case of a male neonate weighing 970 g, delivered via cesarean section at 27 weeks, as one of a pair of dizygotic twins. From the 7(th) day after birth, bile was seen to drain through the orogastric tube, and paralytic ileus was noted on performing an abdominal X-ray. Thus, oral feeding was discontinued because necrotizing enterocolitis (NEC) was highly suspected. On the 9(th) day after birth, a firm mass was palpable in left upper abdominal quadrant, but no pneumatosis intestinalis was observed on performing abdominal X-ray. Small bowel intussusception was suspected on performing abdominal ultrasonography. Based on these findings, an exploratory laparotomy was performed, and although no intussusception was found intraoperatively, we performed a partial gastrectomy and hemicolectomy due to the presence of necrotic changes and perforations of the stomach and colon. Postoperatively, he was observed to have hypotension with persistence of hemorrhage at the surgical site. He died on the 11(th) day after birth. Intraoperative histopathological examination of stomach and colon showed fungal aseptate hyphae with broad branching. Gastrointestinal mucormycosis was confirmed based on findings of vascular involvement in the form of fungal hyphae and thrombosis in the transmural blood vessels. We report a case of an extremely low birth weight infant with neonatal gastrointestinal mucormycosis with an initial clinical presentation suggestive of intussusception and atypical NEC.
Bile ; Blood Vessels ; Candida ; Cesarean Section ; Colon ; Enterocolitis, Necrotizing* ; Female ; Fungi ; Gastrectomy ; Hemorrhage ; Humans ; Hyphae ; Hypotension ; Immune System ; Infant* ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Premature ; Intestinal Pseudo-Obstruction ; Intussusception* ; Laparotomy ; Male ; Mortality ; Mucormycosis* ; Parturition ; Pregnancy ; Rare Diseases ; Stomach ; Thrombosis ; Twins, Dizygotic ; Ultrasonography

PURPOSE: This study clarified the bacterial pathogens currently causing acute infectious enterocolitis (AIE) in children and evaluated the clinical characteristics and ultrasonographic findings according to the different pathogens. METHODS: Medical records regarding age, sex, clinical symptoms, laboratory data, identified enteropathogens, ultrasonographic findings, treatment, and outcome of 34 patients who were diagnosed with AIE via stool examination using multiplex polymerase chain reaction (PCR) or culture, were retrospectively reviewed. RESULTS: Twenty-four patients (70.6%) were male. The mean age of the patients was 8.5±6.2 (range, 1.1–17.1) years. Six bacterial pathogens were isolated: Salmonella species (spp.) (32.4%), Campylobacter spp. (20.6%), verotoxin-producing Escherichia coli (14.7%), Staphylococcus aureus (11.8%), Clostridium difficile (8.8%), and Shigella spp. (2.9%). Abdominal pain occurred in all patients regardless of pathogen. The patients infected with Salmonella were older than those infected with verotoxin-producing E. coli (p<0.05). C-reactive protein levels were higher in patients with Salmonella and Campylobacter infections than in those with verotoxin-producing E. coli infection (p<0.05), the other clinical and laboratory data were indistinguishable between pathogens. Ultrasonography demonstrated diverse involvement of bowel segments according to pathogen. Wall thickening of both the ileum and the entire colon was the most common lesion site regardless of pathogen. CONCLUSION: Various bacterial agents cause AIE and the symptoms are diverse symptoms, however, all most children recovered spontaneously. Use of multiplex PCR on stool samples warrants improvement of its sensitivity for diagnosis of enteropathogenic bacteria. Ultrasonographic examination is useful for diagnosis of AIE; it can also detect the disease extent and severity.
Abdominal Pain ; Bacteria ; C-Reactive Protein ; Campylobacter ; Campylobacter Infections ; Child* ; Clostridium difficile ; Colon ; Diagnosis ; Enterocolitis* ; Humans ; Ileum ; Male ; Medical Records ; Multiplex Polymerase Chain Reaction ; Retrospective Studies ; Salmonella ; Shiga-Toxigenic Escherichia coli ; Shigella ; Staphylococcus aureus ; Ultrasonography

We describe an extremely rare case of advanced pure primary ovarian squamous cell carcinoma (SCC), treated by adjuvant chemotherapy with dose-dense paclitaxel combined with carboplatin (dd-TC) plus the combination chemotherapy with irinotecan and cisplatin (CPT-P), with long-term recurrence-free survival. A 71-year-old woman complaining of lower abdominal pain was referred to our hospital and a 7-cm-diameter solid tumor was identified. She was diagnosed with a left ovarian tumor that was highly suspicious for malignancy based on ultrasonography, magnetic resonance imaging, and contrast-enhanced computed tomography. Bilateral salpingo-oophorectomy, low-anterior colon resection, and colostomy were performed. Intra- and post-operative histopathological diagnosis revealed International Federation of Gynecology and Obstetrics stage IIIc well-differentiated pure ovarian SCC. As adjuvant chemotherapy, 2 courses of dd-TC were administered, followed by 3 courses of CPT-P; the patient then underwent 4 additional courses of dd-TC. Both regimens were effective and there has been no recurrence or metastasis thus far in the 5 years since the operation.
Abdominal Pain ; Aged ; Carboplatin* ; Carcinoma, Squamous Cell* ; Chemotherapy, Adjuvant ; Cisplatin ; Colon ; Colostomy ; Diagnosis ; Drug Therapy, Combination ; Epithelial Cells* ; Female ; Gynecology ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Obstetrics ; Ovarian Neoplasms ; Paclitaxel* ; Recurrence ; Ultrasonography

Cancer is the leading cause of death in Korea. Cancer screening has become a basic health program because of the increased incidence of cancers and heightened interest. In September 2015, experts gathered at the National Cancer Institute of Korea proposed screening guidelines for seven cancers: lung, gastric, colon, breast, cervical, and thyroid cancers and hepatoma. The Korean cancer screening guidelines recommend annual screening for lung cancer with low-dose computed tomography in adults ages 55 to 74 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. For gastric cancer, endoscopy screening is recommended once every 2 years and gastrography is recommended optionally in adults ages 40 to 74 years. For hepatoma screening, alpha-fetoprotein and liver ultrasound are recommended every 6 months for patients older than 40 years old at high risk. For colon cancer screening, fecal occult blood testing is recommended with optional colonoscopy every 1-2 years in adults ages 40 to 80 years. For breast cancer screening, mammography is recommended every 2 years for all women ages 40-69 years. For cervical cancer screening, a Pap smear is recommended every 3 years for all women older than 20 years or with sexual experience. No routine screening is recommended for thyroid cancer. The author reviews the background and practices of cancer screening guidelines for seven major cancers and prostate cancer.
Adult ; alpha-Fetoproteins ; Breast ; Breast Neoplasms ; Carcinoma, Hepatocellular ; Cause of Death ; Colon ; Colonic Neoplasms ; Colonoscopy ; Early Detection of Cancer* ; Endoscopy ; Female ; Humans ; Incidence ; Korea* ; Liver ; Lung ; Lung Neoplasms ; Mammography ; Mass Screening ; National Cancer Institute (U.S.) ; Occult Blood ; Prostatic Neoplasms ; Smoke ; Smoking ; Stomach Neoplasms ; Thyroid Gland ; Thyroid Neoplasms ; Ultrasonography ; Uterine Cervical Neoplasms