Pneumatosis intestinalis: a rare manifestation of acute appendicitis.

Pneumatosis intestinalis (PI), the presence of gas within the bowel wall, is a rare condition. To our knowledge, only two cases of PI secondary to acute appendicitis have been reported in the literature. We present a new case of a 46-year-old man who complained of abdominal pain and progressive abdominal distension for 4 days and oliguria for 1 day. In the Emergency Department, his abdomen was markedly distended and showed peritoneal signs. Preoperative blood culture grew Bacteroides fragilis. Abdominal computed tomography scan revealed marked bowel distension, bubble-like intramural gas scattered in the proximal small bowel, and localized fluid accumulation in the right lower quadrant of the abdomen. Small bowel ischemia was interpreted preoperatively. Emergency laparotomy revealed that the appendix was gangrenous and perforated, with local abscess formation but no bowel infarction. Hence, only appendectomy was performed, with subsequent uneventful patient recovery. The presence of PI may not always be an ominous sign; rather, it depends on the severity of any underlying diseases.

Preoperative serum C-reactive protein and gastric cancer; clinical-pathological correlation and prognostic significance.

BACKGROUND: C-reactive protein (CRP) is a widely-used systemic biomarker for inflammation. Serum CRP is elevated in many malignancies, and is also a prognostic indicator of malignant potential. However, the prognostic significance for survival from gastric cancer has not yet been clarified. We studied the clinical- pathologic association and prognostic significance of preoperative serum CRP in gastric cancer patients. METHODS: A total of 170 gastric cancer patients were included in this study. The mean age of the patients was 65.1 years (range, 29-89), and 112 were men. All gastric cancer patients had undergone gastric resection. The serum CRP levels of patients before the operation along with those from 405 healthy controls were measured by a high sensitivity CRP test. RESULTS: The 95th percentile value (=3.0 mg/L) of the serum CRP data in 405 healthy controls was set as the upper cut-off value of the normal range. Abnormally high levels of serum CRP were observed in 65 (38.2%) of our 170 patients in contrast to only 20 (4.9%) of the 405 healthy controls (p<0.001). Elevated CRP was associated with older age (p=0.009), grossly infiltrative type (p=0.001), larger tumors (p<0.001), serosal invasion (p=0.001), lymph node metastasis (p<0.001), distant metastasis (p=0.017), and lymphatic invasion (p=0.002). Overall, a higher CRP level was strongly parallel to a pathologically more advanced stage (p=0.001). The 5-yr survival rate of patients with an elevated (>3.0 mg/L) CRP was significantly worse than those without (