Although ischemic colitis is often considered to be a condition occurred in elderly patients or in patients with vascular diseases, it also can occur in younger healthy persons. Some drugs, such as oral contraceptives, may play an important role in the development of ischemic colitis in young women. However, constipation also can play an important role in this condition. We recently experienced a case of reversible ischemic colitis of a young woman, who had been suffered from obstructive type of chronic constipation, after taking a laxative and enema. We report this case with literature review. Proper managements and educations in patients with chronic constipation should be emphasized.
Aged ; Colitis, Ischemic* ; Constipation* ; Contraceptives, Oral ; Enema ; Female ; Humans ; Vascular Diseases

Solitary rectal ulcer syndrome is an uncommon, chronic benign condition characterized by rectal bleeding, the passage of mucus, tenesmus and excessive straining during defecation. Occasionally, solitary rectal ulcer syndrome has been reported to be associated with defecation disorder such as pelvic floor dyssynergia, rectal intussusception and rectal prolapse. However, it is ambiguous how these associated defecation disorders contribute to make the rectal ulcer. We report a case of solitary rectal ulcer syndrome suggesting the pathophysiology of rectal ulcer by typical findings of evacuation defecography and MR defecography. A 40-year-old man presented with lower abdominal pain, rectal bleeding, passage of mucus and tenesmus intermittently for the past 4 years. Colonoscopy showed a large geographic and circumferential ulcer at the 10 cm distance from the anal verge. A biopsy revealed fibromuscular proliferation of laminar propria, hyperplasia of crypt and focal superficial ulceration. Finally, he was diagnosed as solitary rectal ulcer syndrome. Evacuation defecography showed paradoxical movement of puborectal sling and unusual invagination of rectal walls during defecation. In addition, rectum showed spastic movement and anterior rectal wall directly merged into posterior rectal wall making a kissing appearance. The invagination of the rectum at evacuation defecography proved to be the rectal wall thickening at MR defecography. After 9 sessions of biofeedback therapy, his defecation symptoms improved. However, ulcer was still observed without interval change.
Abdominal Pain ; Adult ; Ataxia ; Biofeedback, Psychology ; Biopsy ; Colonoscopy ; Defecation ; Defecography* ; Hemorrhage ; Humans ; Hyperplasia ; Intussusception ; Mucus ; Muscle Spasticity ; Pelvic Floor ; Rectal Prolapse ; Rectum ; Ulcer*

Diabetic gastroparesis is a pathologic condition of delayed gastric emptying with gastrointestinal symptoms such as nausea, early satiety and vomiting in the absence of mechanical obstruction in patients with diabetes mellitus. We report a case of diabetic gastroparesis who had diabetes mellitus for 13 years and suffered from nausea and vomiting with marked gastric dilatation of acute onset. Blood glucose level of the patient was very high and any mechanical obstruction was not found by gastroduodenal endoscopy, hypotonic duodenography, celiac angiography, electrogastrography and CT scan. Acute gastric dilatation was resolved with conservative treatment of gastric drainage, glucose control and hydration. Gastrointestinal symptoms of nausea and vomiting improved and diet was well tolerated thereafter.
Angiography ; Blood Glucose ; Diabetes Mellitus ; Diet ; Drainage ; Endoscopy ; Gastric Dilatation* ; Gastric Emptying ; Gastroparesis* ; Glucose ; Humans ; Nausea ; Tomography, X-Ray Computed ; Vomiting

Esophageal retrograde peristalsis is known to be absent normally. This rare finding, if it happens, usually suggests a possibility that proximal ends of the manometric catheter are connected to the pressure transducers in a reverse order. We report a case showing repeated retrograde peristalsis during an esophageal manometric examination due to an inadventently hooked catheter in the esophagus during insertion. We suggest that if a retrograde peristalsis is repeatedly observed during a manometric session, an erroneous recording due to a hooked catheter in the esophageal lumen should be considered as one possibility.
Catheters* ; Esophagus* ; Peristalsis* ; Transducers, Pressure

BACKGROUND/AIMS: Trinitrobenzene sulphonic acid (TNBS)-induced colonic inflammation in rat alters colonic motor function. The aims of this study were to investigate the effect of TNBS-induced colitis on the colonic motor function of a guinea pig along the course of colitis and to document persistently altered colonic motor function after resolution of inflammation. METHODS: Colitis was induced in about 300 g male guinea pigs (Hartley) by intrarectal administration of 0.3 mL TNBS in 50% ethanol, while controls received 0.3 mL of 50% ethanol or not. After 24 hours, 48 hours, 72 hours, 1 week, and 2 weeks, the distal colon was taken for the investigation of gross and microscopic findings, muscle tension, and colonic transit. RESULTS: Maximal mucosal injury and inflammation were evident from the 2nd day following the induction of colitis. Seven days after the induction of colitis, some portions of the damaged mucosa began to recover. Development of tension in response to carbachol was not altered significantly along the course of colitis. Colonic transit was delayed significantly at 3, 7, and 14 days after administration of TNBS. CONCLUSIONS: Colonic transit in TNBS-induced colitis of guinea pigs is delayed, but not linearly related to the degree of inflammation. Delayed colonic transit is not related to the muscarinic receptor-mediated contractions of circular muscle from the inflamed colon. Further studies are required to determine the mechanism(s) involved in this motor change.
Animals ; Carbachol ; Colitis* ; Colon* ; Ethanol ; Guinea Pigs* ; Guinea* ; Humans ; Inflammation ; Male ; Mucous Membrane ; Muscle Tonus ; Rats

BACKGROUND/AIMS: This study was performed to evaluate the relationship between bowel symptom changes and dysmenorrhea in irritable bowel syndrome (IBS) according to the menstrual cycle. METHODS: Two hundred thirty-seven female medical students filled up questionnaires including change of bowel symptom, dysmenorrhea and perimenstrual symptom. Seventeen volunteered to keep diaries concerning their bowel habits and menstruation for two menstrual cycles. RESULTS: One hundred and sixty-three (68.8%) reported that their bowel habit was changed according to menstrual cycle. Ninety-three (39.2%) fit the Rome II criteria of IBS. The number of subjects who reported changed bowel habit during the menstruation period was more in the IBS group than in the non-IBS group (84/93 vs. 83/144, p<0.005). The severity of dysmenorrhea was not different between IBS and non-IBS groups. The menstrual distress score during the menstruation period was significantly higher in the IBS group than in the non-IBS group. In 17 volunteers (12 IBS, 5 non-IBS), stool consistency and frequency were not significantly different between the menstruation and non-menstruation periods, regardless of their IBS status. The mean score of abdominal pain was higher in the menstruation than in the non-menstruation period only in the IBS group. CONCLUSIONS: IBS women have more bowel symptoms during their menstruation period than non-IBS women. Its mechanism should be further clarified.
Abdominal Pain ; Dysmenorrhea* ; Female ; Humans ; Irritable Bowel Syndrome* ; Menstrual Cycle ; Menstruation ; Students, Medical ; Volunteers ; Surveys and Questionnaires

BACKGROUND/AIMS: It is difficult to clinically distinguish infants with Hirschsprung disease (HD) from those with other causes of intestinal obstruction. Therefore, reliable and safe diagnostic procedures are particularly necessary in infants with early onset symptoms. The purpose of this study was to assess the accuracy of anorectal manometry in the diagnosis of HD in infancy. METHODS: Forty five infants who were suspected of having HD, at Seoul National University Children's Hospital, from May 1999 to July 2002, were enrolled in this study. The diagnostic accuracy of recto-anal inhibitory reflex (RAIR) and transition zone was evaluated. RESULTS: Final diagnosis of HD was made in 18 cases. The presence of transition zone was proved to be very specific (100%), but sensitivity was very low (39%). The sensitivity and specificity of anorectal manometry were 100% and 93% in total 45 infants. However the sensitivity and specificity of this test were 100% in infants older than 3 months. CONCLUSIONS: It could be stated that the diagnostic accuracy of the RAIR is a highly valid diagnostic value for HD in young infancy. It is particularly helpful when clinical and radiological findings are inconclusive.
Diagnosis* ; Hirschsprung Disease* ; Humans ; Infant ; Intestinal Obstruction ; Manometry ; Reflex* ; Sensitivity and Specificity ; Seoul

BACKGROUND/AIMS: Two most common functional anorectal pains, levator ani syndrome and proctalgia fugax, have a significant overlap in diagnosis and a controversy in pathogenic mechanism. Our aim was to evaluate the differences of anorectal symptoms and physiologic findings between the patients with levator ani syndrome and proctalgia fugax. METHODS: Eight patients and 10 patients, who fulfilled Rome II criteria for levator ani syndrome and proctalgia fugax respectively, were evaluated for the various anorectal symptoms using questionnaire and diary, anorectal manometry, balloon defecation, and defecography. RESULTS: Compared with patients with proctalgia fugax, the patients with levator ani syndrome showed higher percentage of symptoms of straining (87.5+/-30.6% vs. 40.5+/-44.9%, p<0.05), and tended to have higher percentage of the sensation of incomplete evacuation (88.1+/-26.4% vs. 53.0+/-41.9%, p=0.056). In anorectal manometric findings, squeezing pressure of the distal anal sphincter tended to be higher in patients with levator ani syndrome (201.7+/-127.7 mmHg vs. 113.0+/-43.9 mmHg, p=0.056). CONCLUSIONS: Levator ani syndrome may be related to the constipation and hyper-contractile external anal sphincter, suggesting that different mechanisms may play a role in the development of anorectal pains in patients with levator ani syndrome and proctalgia fugax.
Anal Canal ; Constipation ; Defecation ; Defecography ; Diagnosis ; Humans ; Manometry ; Sensation ; Surveys and Questionnaires

BACKGROUND/AIMS: After gastrectomy, patients often experience various gastrointestinal symptoms due to the rapid emptying of ingested food into the small intestine. Symptoms of the postgastrectomy syndrome, however, decrease as time passes. The aim of this study is to evaluate the role of sensory function of the small intestine in postgastrectomy patients. METHODS: Liquid meal loading test and balloon distension stimuli test were carried out in 39 postgastrectomy patients and 32 healthy controls. The polyethylene balloon was advanced to intestine, 10 cm apart from anastomosis in patients and 3rd portion of duodenum in controls. Sensory function was assessed by scoring perception for nausea, fullness, and abdominal discomfort or pain during random-order stimulus of 20, 40, and 60 ml of balloon inflation. RESULTS: The maximum tolerable volume of liquid meal intake for postgastrectomy patients was significantly less than that of the controls (p<0.05). Twelve of the 26 patients, who ingested less than normal range, had symptoms of the postgastrectomy syndrome. Total sensation scores after balloon distension stimuli were significantly lower than those of the controls. The type of gastrectomy and the postsurgical duration did not affect the maximum tolerable volume of liquid meal and total sensation scores after balloon distension stimuli. CONCLUSIONS: In comparison to healthy controls, postgastrectomy patients showed an obviously lower maximum tolerable volume of liquid meal, in addition to being significantly less perceptive of small intestine to distension stimuli. This decrease of small intestinal perception is deduced to be part of the adaptation to rapid emptying of ingested food into the small intestine in such patients.
Compliance ; Duodenum ; Gastrectomy* ; Humans ; Inflation, Economic ; Intestine, Small ; Intestines ; Meals ; Nausea ; Polyethylene ; Postgastrectomy Syndromes ; Reference Values ; Sensation

BACKGROUND/AIMS: Changes in gastric motility in patients with liver cirrhosis is not yet established in South Korea. In this study changes in gastric emptying time with attention to factors that effect this change in patients with liver cirrhosis were investigated. METHODS: Fifteen patients with liver cirrhosis (11 males and 4 females) and 15 healthy controls (11 males and 4 females) were enrolled in this study. Gastric emptying time was measured by gastric scintigraphy using a dual-head gamma camera after ingestion of the mixture of 99mTc-labeled egg and fried rice (754Kcal). Data acquisition was performed for 120 minutes with 15 minutes interval and geometric mean and decay correction were calculated for gastric emptying time. RESULTS: There were no differences in age and sex between the two groups. The half time of soild gastric emptying was 78.0+/-87.0 minutes and 70.2+/-2.8 minutes for liver cirrhosis and healthy control group, respectively (p>0.05). The level of serum cholesterol was statistically correlated with gastric emptying time (B=-0.165, p<0.01). CONCLUSIONS: There was no significant difference in gastric emptying time between liver cirrhosis and healthy control group.
Cholesterol ; Eating ; Gamma Cameras ; Gastric Emptying* ; Humans ; Korea ; Liver Cirrhosis* ; Liver* ; Male ; Ovum ; Radionuclide Imaging