Gastric marginal zone B cell lymphoma of the duodenum.

Small bowel lymphomas of the extranodal type occur in the young and are characteristically associated with malabsorption syndrome. We present the case of an elderly in whom there was no malabsorption and the duodenal tumor was a gastric type marginal zone B cell lymphoma also known as gastric mucosa-associated lymphoid tissue (MALT) lymphoma. A 73-year-old woman presented to the emergency room with 2 weeks of general weakness, recurrent vomiting containing food particles and abdominal distension. She had been diagnosed with diabetic gastroparesis 4 years prior. CT of the abdomen and pelvis was suggestive of gastric outlet obstruction but no evidence of pancreatic or duodenal mass. Endoscopy and biopsy of the tumor obstructing the distal first part of the duodenum confirmed a gastric marginal MALT lymphoma. The patient's symptoms improved with radiotherapy. Gastric MALT lymphoma, an extranodal lymphoma primarily described in the stomach, can also present in the small bowel and is not associated with malabsorption.

The significance and work-up of minor gastrointestinal bleeding in hospitalized nursing home patients.

Twenty-seven consecutive admissions from nursing homes who underwent a gastrointestinal (GI) consult for coffee ground vomitus or occult GI bleeding to evaluate the outcome were reviewed retrospectively to determine whether a GI work-up was or would have been useful. There were 15 deaths, all associated with severe infection or respiratory failure. Endoscopy, barium studies, and a history of nonsteroidal anti-inflammatory drug use or peptic ulcer disease did not affect the management or outcome. No patient developed major GI bleeding. When nursing home patients present with coffee ground vomitus or newly found occult blood in the stool, efforts should be made to identify and vigorously treat any acute underlying infection or respiratory failure. Endoscopy is not helpful in this clinical situation. Both the primary care physician and the GI consultant should be aware of these associations and should focus on the underlying etiology.

Colonic perforation in Crohn's disease.

A case of free perforation of the colon in an 18-year-old male with Crohn's disease treated with metronidazole is presented. The 17 previously reported cases are reviewed.

Endoscopic findings in chronic hemodialysis patients with upper gastrointestinal bleeding.

Over a 7-year period 20 episodes of upper gastrointestinal bleeding in 18 patients on chronic hemodialysis were evaluated endoscopically. The site, type of lesion and outcome were studied. We confirm that 1) mucosal inflammation is more commonly found in these patients than that reported in upper gastrointestinal bleeding in the general population and 2) mortality of gastrointestinal bleeding is not higher in this subset of patients than in the general population. The indications for endoscopy in this population are better defined than in other upper gastrointestinal bleeders.

Nonspecific ulcer of the colon in a chronic hemodialysis patient.

A 41-year-old man on maintenance hemodialysis was admitted for fever and hematochezia. He was found to have circumferential ulceration of the left colon. Hemicolectomy was performed because of continued bleeding. The resected bowel showed nonspecific ulcer. Patients on chronic hemodialysis with lower gastrointestinal bleeding, should not be assumed to have uremic colitis without suitable workup.

Diverticulitis manifesting as transverse colocutaneous fistula: report of a case and review of literature.

A case of spontaneous colocutaneous fistula arising from the transverse colon is reported and the literature is reviewed.

A diagnostic approach to occult blood in the stool.

Occult blood in the stool may be the first sign of otherwise asymptomatic colorectal cancer or other gastrointestinal disease. All patients over 40 should therefore have a rectal examination that includes a Hemoccult slide test. A rational diagnostic plan is essential to identify the source of occult blood in the stool. Most gastrointestinal cancer is operable if diagnosed early, so early detection of these lesions is imperative.