Heterotopic bone formation in the gastrointestinal tract is a rare phenomenon. Most reported cases were associated with benign and malignant neoplasms, except for a case in which heterotopic bone formation was found in a patient with Barrett's esophagus. The exact pathogenesis of the disease has not yet been established. However, most heterotopic bones found in the gastrointestinal tract were associated with mucinproducing tumors of the appendix, colon, and rectum. Inflammation may also play a role in osseous metaplasia in a case with bone formation at the base of an ulcer in Barrett's esophagus. Here, we report on a patient with heterotopic bone formation in normal gastric cardiac mucosa. A 50-year-old female visited our hospital for a routine health examination. She had no gastrointestinal symptoms, and her physical examination, blood test, X-ray, urine, and stool examination results were normal. A 0.3 cm sized polypoid lesion located just below the squamocolumnar junction was observed on upper gastrointestinal endoscopy. A piece of biopsy was taken. Histologically, a lamella bone trabecula and chronic inflammatory cells were observed in the gastric cardiac mucosa. The follow-up endoscopy performed one month later showed no residual lesion.
Appendix ; Barrett Esophagus ; Biopsy ; Colon ; Endoscopy ; Endoscopy, Gastrointestinal ; Female ; Follow-Up Studies ; Gastrointestinal Tract ; Hematologic Tests ; Humans ; Inflammation ; Metaplasia ; Middle Aged ; Mucous Membrane* ; Ossification, Heterotopic ; Osteogenesis* ; Physical Examination ; Rectum ; Stomach ; Ulcer

A choledochocele is an expanded sac of the duodenal side of the distal common bile duct (CBD), and is categorized as a type III choledochal cyst. Unlike other choledochal cysts, it can be easily overlooked because of its very low prevalence, non-specific clinical symptoms, and lack of distinctive radiological findings. However, a patient having a repeated pancreaticobiliary disorder with an unknown origin, frequent abdominal pain after cholecystectomy, or repeated non-specific gastrointestinal symptoms can be suspected as having a choledochocele, and a more accurate diagnosis can be achieved via endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound. Because it rarely becomes malignant, a choledochocele can be treated via endoscopic sphincterotomy (EST) and surgical treatment. The authors were able to diagnose choledochocele accompanied by a stone in a patient admitted to the authors' hospital due to cholangitis and pancreatitis. The patient's condition was suspected to have been caused by a distal CBD stone detected via multiple detector computed tomography and ERCP, and was successfully treated via EST.
Abdominal Pain ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystectomy ; Choledochal Cyst* ; Common Bile Duct* ; Diagnosis ; Gallstones ; Humans ; Pancreatitis ; Prevalence ; Sphincterotomy, Endoscopic ; Ultrasonography

Hyperplastic gastric polyps (HPPs) are the most common type of gastric polyps. They are assumed to be caused by chronic inflammation and regenerative proliferation, although this has not been clearly investigated yet. Many studies suggested the development of fundic gland polyps and carcinoid during long-term proton pump inhibitor (PPI) therapy, but the relationship between PPIs and HPPs is still unclear. We encountered a patient who showed aggravation of HPPs after long-term use of PPIs. A 58-year-old male patient with liver cirrhosis visited our hospital because of hematemesis. We started PPI medication after confirming esophageal variceal bleeding and duodenal ulcer with blood clot in its base via emergency endoscopy. He took PPIs for three years because of an intractable duodenal ulcer. There was a marked increase in the size of the pre-existing polyps and in the development of new polyps. We presumed that the PPIs caused the aggravation of the HPPs, so we stopped their administration. After five months, the HPPs shrank and the polyps were partially degraded. More prospective studies are needed to investigate the relationship between HPPs and PPIs.
Carcinoid Tumor ; Duodenal Ulcer ; Emergencies ; Endoscopy ; Esophageal and Gastric Varices ; Hematemesis ; Humans ; Inflammation ; Liver Cirrhosis ; Male ; Middle Aged ; Polyps* ; Proton Pump Inhibitors* ; Proton Pumps* ; Protons*

Eosinophilic cholecystitis is a rare disease characterized by transmural leukocyte infiltration composed of more than 90% eosinophils. Eosinophilic cholecystitis is clinically indistinguishable from ordinary cholecystitis, and as a rule it leads to cholecystectomy. We report a case of idiopathic eosinophilic cholecystitis treated with steroids. A 75-year-old woman presented with a classic history of acute cholecystitis and a peripheral eosinophilia of 41.8%. There was no evidence of allergy or parasitic infestation. An abdominal ultrasonography and computed tomography (CT) scan showed an edematous, thickened gallbladder wall, but no gallstones. There was no evidence of eosinophilic infiltration in other organs. Cholecystectomy was not performed because the patient refused surgical management. However, fever, abdominal pain, and peripheral eosinophilia persisted despite antibiotic and conservative therapy. Therefore, we attempted treatment with prednisolone. A week later, the symptoms disappeared and the peripheral eosinophilia normalized.
Abdominal Pain ; Aged ; Cholecystectomy ; Cholecystitis ; Cholecystitis, Acute ; Eosinophilia ; Eosinophils ; Female ; Fever ; Gallbladder ; Gallstones ; Humans ; Hypersensitivity ; Leukocytes ; Prednisolone ; Rare Diseases ; Steroids

Human sparganosis is caused by the larval tapeworm of genus Spirometra. This parasite commonly invades subcutaneous tissues and muscles. However, infection in the pleural cavity is rare. A 65-year-old male patient, who had undergone surgical excision of subcutaneous masses due to a parasite infection (presumed to have been sparganosis) approximately 10 years ago, showed pleural effusion and peripheral eosinophilia. The anti-sparganum specific IgG antibody levels in the serum and pleural fluid were significantly higher than the normal control levels. Three consecutive doses of praziquantel (75 mg/kg/day) were administered for control of pleural effusion and peripheral eosinophilia. In this patient, sparganosis was suspected, and the probable cause of the infection was ingestion of raw snakes and frogs. Immunoserologic tests using ELISA can be helpful in diagnosis of pleural sparganosis and praziquantel is suggested as an alternative treatment for surgically unresectable cases.
Cestoda ; Eating ; Enzyme-Linked Immunosorbent Assay ; Eosinophilia ; Eosinophils ; Humans ; Immunoglobulin G ; Male ; Muscles ; Parasites ; Pleural Cavity ; Pleural Effusion ; Pleurisy ; Praziquantel ; Snakes ; Sparganosis ; Sparganum ; Spirometra ; Subcutaneous Tissue

Clostridium difficile is the most common nosocomial pathogen of the gastrointestinal tract. Pseudomembranous colitis occurs as a result of a severe inflammatory response to Clostridium difficile toxins. Pseudomembranous colitis is an increasingly frequent cause of morbidity and mortality among elderly hospitalized patients. Diarrhea is the most common manifestation. According to the literature, stools are almost never grossly bloody, and range from soft and unformed to watery or mucoid in consistency. We now report the cases of three patients with pseudomembranous colitis whose main clinical manifestation was hematochezia.
Aged ; Clostridium difficile ; Diarrhea ; Enterocolitis, Pseudomembranous ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Humans

PURPOSE: To evaluate whether alpha-lipoic acid (ALA) is effective at restoring the levels of nitric oxide synthase (NOS) expression and preventing ultrastructural changes in the bladder of rats with streptozotocin- induced diabetes. MATERIALS AND METHODS: Nine-week-old male Sprague-Dawley rats were used. The experimental groups included a control group (n=6), a diabetes group (n=6), and two groups of diabetic rats treated with intraperitoneal injections of ALA (n=12) at either 50 (ALA50) or 100mg/kg/day (ALA100) for 8 weeks after the induction of diabetes. Diabetic oxidative stress was determined based on evaluation of immunohistochemical staining for 8-hydroxy-2-deoxyguanosine (8-OHdG). The measurements of the levels of eNOS and nNOS expressions, as well as an assessment of the ultrastructural changes in detrusor smooth muscle cells were performed. RESULTS: The highest expression of 8-OHdG was observed in the diabetes group; whereas, the 8-OHdG expression in the ALA-treated groups was similar to that in the control group. Both eNOS and nNOS were constitutively expressed in the control group. The expression levels of both eNOS and nNOS proteins were higher in the diabetes group, which had experienced increased oxidative stress, than in the ALA50 and ALA100 groups. Compared with the control group, the diabetes group exhibited severe degeneration of the detrusor muscle cells. In the rats treated with ALA, the detrusor muscle cells showed mild to moderate degeneration. The mean numbers of mitochondria per smooth muscle cell in the control, diabetes, ALA50 and ALA100 groups were 12.6+/-1.5, 5.1+/-0.7, 18.3+/-0.7 and 19.3+/-1.3, respectively (p<0.01). CONCLISIONS: Our data suggest that diabetes enhanced the levels of eNOS and nNOS expressions in the bladder, and ALA inhibited the expressions of eNOS and nNOS. ALA had a protective effect against the degeneration of intracellular micro-organelles produced by diabetic oxidative damage in detrusor muscle cells. This study suggests that early treatment with ALA can reduce the damage caused by diabetic oxidative stress.
Animals ; Antioxidants ; Diabetes Mellitus ; Humans ; Injections, Intraperitoneal ; Male ; Mitochondria ; Muscle Cells ; Myocytes, Smooth Muscle ; Nitric Oxide Synthase* ; Nitric Oxide* ; Oxidative Stress ; Rats* ; Rats, Sprague-Dawley ; Thioctic Acid* ; Urinary Bladder*

Melanosis ilei is a condition that's characterized by gross greyish-black or brownish-black pigmentation of the mucosa of the terminal ileum. There were several substances that produce gastrointestinal tract pigmentation such as lipofuscin, iron sulphide (FeS), Hemosiderin and exogenous material such as silicates and titanium. We report here on a case of a 58-year-old female who ingested charcoal for a long time, and she was diagnosed with melanosis ilei by colonoscopy. Her condition improved after she stopped ingesting the charcoal.
Charcoal ; Colonoscopy ; Female ; Gastrointestinal Tract ; Hemosiderin ; Humans ; Ileum ; Iron ; Lipofuscin ; Melanosis* ; Middle Aged ; Mucous Membrane ; Pigmentation ; Silicates ; Titanium

Most ingested foreign bodies spontaneously pass through the upper and lower intestinal tract. The impaction of an ingested foreign body in the colon is rare. Foreign bodies swallowed inadvertently often cause serious complications, such as perforation, obstruction, abscess formation, enterocolic fistula, or hemorrhage. Physicians should proceed with routine medical care while considering the possibility of the ingestion of a foreign body In cases where abdominal pain of an unknown origin is observed, particularly in elderly patients who wear dentures, alcoholics, mentally disturbed, or rapid eating, and presenting with altered bowel habits. We report a case of a colonoscopically-removed wooden toothpick that impacted the sigmoid colon and was complicated by the formation of a local abscess with a review of the literature.
Abdominal Pain ; Abscess ; Aged ; Alcoholics ; Colon ; Colon, Sigmoid* ; Colonoscopy ; Dentures ; Eating ; Fistula ; Foreign Bodies ; Hemorrhage ; Humans

Hypereosinophilic syndrome, the disease with continuous over production of eosinophil from bone marrow without any identifiable underlying disorder, causes various symptoms or signs by infiltrating organs. As many as 28,780/mm3 eosinophils in peripheral blood, the eosinophilic hyperplasia in bone marrow and features of hepatic involvement -revealed elevated serum AST, ALT and ultrasonogram of abdomen showed the multiple nodules scattered throughout the liver, we have reached to make a diagnosis of the rare hyper eosinophilic syndrome carrying the eosinophil-rich exudate in pleural effusion. The patient showed improvement of clinical symptoms with oral administration of predinisolone, and we report this case with literature consideration.
Abdomen ; Administration, Oral ; Bone Marrow ; Diagnosis ; Eosinophils ; Exudates and Transudates ; Humans ; Hypereosinophilic Syndrome ; Hyperplasia ; Liver ; Pleural Effusion* ; Ultrasonography