Endoscopic and clinicopathological features of segmental colitis associated with diverticulosis.

Objectives: Segmental colitis associated with diverticulosis (SCAD) has close endoscopic and pathological similarities to ulcerative colitis (UC) and Crohn's disease. Clinical data on SCAD are limited in Japan. We examined the endoscopic and clinicopathological features of patients with SCAD. Methods: This single-center retrospective study included 13 patients with SCAD between 2012 and 2022. Endoscopic findings were categorized as follows: type A (swollen red patches 5-10 mm at the top of mucosal folds), mild and moderate type B (mild-to-moderate UC-like findings), type C (aphthous ulcers resembling Crohn's disease), and type D (severe UC-like findings). Results: Overall, six, five, and two patients were diagnosed with type A, mild type B, and moderate type B disease, respectively. Among the type A cases, two spontaneously progressed to moderate type B and one escalated to type D, necessitating an emergency sigmoidectomy owing to perforation peritonitis, despite repeated antibiotic treatments. Histopathologically, diffuse neutrophil and lymphocyte infiltration with cryptitis were noted in all type A cases, whereas UC-like alterations were observed in type B and D cases. Seven type B cases were treated with oral 5-aminosalicylic acid and/or salazosulfapyridine. Clinical remission was achieved in three mild type B cases and one moderate type B case, while clinical relapse and remission were noted in three moderate type B cases. No anti-inflammatory treatment was required in three type A and two mild type B cases. Conclusions: Aggressive anti-inflammatory treatment should be considered for SCAD with UC-like findings due to the potential risk of severe ulceration, stenosis, and/or perforation.

Palliative surgical treatment for enterostasis caused by recurrent gastric cancer: analysis of survival and QOL based on pathological features.

To improve quality of life (QOL) and prolong survival, enterostasis caused by recurrent gastric cancer must be treated appropriately. We reviewed the current treatment retrospectively. The subjects were 43 patients with enterostasis caused by recurrent gastric cancer and treated by surgical procedures at our hospital from 1988 to 1997. Survival and QOL were analyzed in relation to the mode of recurrence, the pathological diagnosis at the initial operation, and surgical procedures. The patients treated by colostomy, ileostomy, or bypass for local occlusion caused by isolated peritoneal recurrence or lymph node recurrence had significantly better quality of life and longer survival [discharge rate: colostomy and ileostomy, 81.8% (9/11); bypass, 77.8% (14/18); survival time: colostomy and ileostomy, 223.5 +/- 171.9 days; bypass, 129.6 +/- 91.0 days] than those who underwent exploratory laparotomy, gastrostomy, or enterostomy and had diffuse disseminated lesions of peritoneal recurrence [discharge rate: 21.4% (3/14); survival time: 44.6 +/- 31.5 days; P < 0.05]. In the patients in whom the pathological diagnosis at initial surgery was differentiated type or poorly solid type, the risk of exploratory laparotomy alone was low (5.6%; 1/18; P < 0.01). Enterostasis with pathological diagnosis at initial surgery of differentiated type or poorly solid type should be treated with aggressive laparotomy and colostomy, ileostomy, or bypass to improve survival and QOL.

[Gastric cancer producing AFP/HCG which had a rapidly progressive course with metastasis to the brain discovered postoperatively].

A 69-year-old man was admitted to our hospital with nausea and vomiting. Gastric endoscopy revealed advanced gastric cancer in the upper body of the stomach. Serum AFP increased to 254 ng/ml, but abdominal CT showed no liver metastasis. Total gastrectomy was performed and histologic examination revealed poorly differentiated adenocarcinoma, and positive immunohistochemical staining for AFP and HCG. He was discharged without complications at postoperative day 19. However, he was admitted again with severe headache 3 days later. Brain CT showed a high density mass in the cerebellum. Tumorectomy was performed, and brain metastasis from the gastric cancer was confirmed pathologically.