RESUMEN
Acute cholecystitis is an infectious disease of the gallbladder caused mainly by Escherichia coli, Klebsiella, and Enterococcus species. Streptococcus gallolyticus subsp. pasteurianus, previously known as Streptococcus bovis biotype II/2, rarely causes endocarditis, meningitis, and septicemia, mainly in children. Biliary tract infections by Streptococcus gallolyticus subsp. pasteurianus are extremely rare. There have been no reports of cases in Japan. Here, we describe the first case in Japan of acute calculous cholecystitis caused by Streptococcus gallolyticus subsp. pasteurianus infection. A 63-year-old man was admitted to our hospital with epigastric pain and vomiting. He had moderate tenderness and a full sensation in the epigastrium. Abdominal imaging revealed multiple stones in the gallbladder. After admission, he had a high fever that did not improve with antibiotics. Percutaneous transhepatic gallbladder drainage was performed. The patient underwent open cholecystectomy. During surgery, several small stones in the gallbladder and an abscess were observed at the gallbladder base. Streptococcus gallolyticus subsp. pasteurianus was detected by bacterial culture of the bile juice. The gallstones were bilirubin calcium stones. The endoscopic study showed three adenomas in the colon, but the histopathological examination demonstrated no malignant cells. Although infection by this bacterium may not be rare, this is the first reported case in Japan of acute calculous cholecystitis caused by Streptococcus gallolyticus subsp. pasteurianus infection.
Asunto(s)
Neoplasias de la Mama/química , ADN de Neoplasias/química , ARN Neoplásico/química , Manejo de Especímenes , Automatización , Neoplasias de la Mama/genética , Femenino , Formaldehído , Humanos , Técnicas de Amplificación de Ácido Nucleico , Adhesión en Parafina , Reproducibilidad de los Resultados , Fijación del TejidoRESUMEN
A 78-year-old woman presented with fever, severe abdominal pain, and distension. She had been institutionalized for depression and senile dementia. Laboratory examinations disclosed a leucocytosis (WBC: 12,500/microL) and elevated levels of serum C-reactive protein (2.8 mEq/L). Diagnosis of acute cecal volvulus was made from a "coffee bean sign" on an abdominal computed tomography and a "beak sign" on a gastrographin enema. An emergent laparotomy confirmed the diagnosis and an ileo-colectomy with primary anastomosis was carried out. The patient recovered after intensive respiratory care and fluid therapy, and then returned to her former institution. A review of Japanese literature disclosed that: (1) a marked increase of aged patients with mental disability presenting with cecal volvulus, (2) adoption of ileo-colectomy as the standard surgical procedure, and (3) improved survival of the patients, were observed in the last decade.
Asunto(s)
Ciego/patología , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/patología , Anciano , Ciego/diagnóstico por imagen , Ciego/cirugía , Femenino , Humanos , Vólvulo Intestinal/diagnóstico por imagen , Vólvulo Intestinal/cirugía , Japón , RadiografíaRESUMEN
Gastrointestinal stromal tumor (GIST) of the stomach was treated by endoscopic enucleation in five patients. They were three men and two woman, aged 36-56 years. Tumors located in the cardia were completely enucleated endoscopically without any serious complication. The largest diameter of removed tumors ranged from 1.2 to 2.5 cm. Histopathological diagnosis was GIST with low risk of malignancy (mitotic index < 5/50 high power field) in all cases. The patients were disease-free for 10.5-42.2 mo after endoscopic enucleation.