ABSTRACT
Congenital stenosis of the esophagus is a rare form of esophageal stenosis in adults. The main causes of congenital esophageal stenosis are the esophageal web, esophageal stricture due to tracheobronchial remnants, and idiopathic esophageal muscular hypertrophy. Recently we have experienced a 32-year-old male with dysphagia, indigestion, postprandial chest discomfort who was diagnosed as congenital esophageal stenosis due to tracheobronchial remnant. The esophagogram showed stricture of the distal esophagus with secondary proximal dilatation and endoscopic finding revealed marked stenosis on the distal esophagus with normal surrounding mucosa. The esophageal manometric finding showed decreased body peristalsis and incomplete relaxation of the lower esophageal sphincter. The patient was treated by surgical resection of the stenotic segment with end to end anastomosis. We report this rare case of adult type tracheobronchial remnant with analysis of various worldwide report and with brief review of literature.
Subject(s)
Adult , Humans , Male , Constriction, Pathologic , Deglutition Disorders , Dilatation , Dyspepsia , Esophageal Sphincter, Lower , Esophageal Stenosis , Esophagus , Hypertrophy , Mucous Membrane , Peristalsis , Relaxation , ThoraxABSTRACT
In spite of the recent advances in diagnostic technology in clinical gastroenterology, identifying the cause of acute lower gastrointestinal bleeding is still a challenging task. Hematochezia from the appendiceal bleeding is rare and associated diseases are appendiceal endometriosis, angiodysplasia, arteriovenous malformation, Crohn's disease, appendicitis, carcinoid, lymphoma, diverticulosis, and intussusception of the appendix. We experienced a 31-year-old male with acute lower gastrointestinal bleeding from the appendix. Colonoscopy could demonstrate an active hemorrhage from the orifice of the appendix. Mesenteric arteriography revealed active bleeding from the appendix, which was managed with gelfoam embolization. Next day, appendectomy was done because of recurrent bleeding. Surgically removed appendix could not dislose any abnormal lesion except a small mucosal break.
Subject(s)
Adult , Female , Humans , Male , Angiodysplasia , Angiography , Appendectomy , Appendicitis , Appendix , Arteriovenous Malformations , Carcinoid Tumor , Colonoscopy , Crohn Disease , Diverticulum , Endometriosis , Gastroenterology , Gastrointestinal Hemorrhage , Gelatin Sponge, Absorbable , Hemorrhage , Intussusception , LymphomaABSTRACT
Neurofibroma in gastrointestinal tract are presented as localized forms or in associated with neurofibromatosis. Previous reported cases were presented as relatively large sized esophageal mass and treated by surgical resection. However, a neurofibroma was found incidentally during endoscopy in this case. It was presented as palisade like solitary nodules with or without connecting mucosal bridges in lower esophagus. It was treated by mucosectomy and followed up without recurrence.
Subject(s)
Endoscopy , Esophagus , Gastrointestinal Tract , Neurofibroma , Neurofibromatoses , RecurrenceABSTRACT
BACKGROUND: It has been reported that there are four zones of distinct venous patterns around the gastroesophageal junction (GEJ); i.e. truncal, perforating, palisade (PZ) and gastric zones. Using the distal end of PZ as a marker for GEJ, this study was done to assess the length and patterns of PZ in Koreans, and to assess the prevalence of endoscopic Barrett's esophagus (E-BE) and hiatal hernia (E-HH). METHODS: 847 consecutive patients undergoing diagnostic endoscopy were included. During endoscopy, PZ, squamocolumnar junction (SCJ) and pinchcock action (PCA) were identified. Patterns were classified according to the relationships of the distal end of PZ with SCJ and PCA; A: all three at the same level, B: SCJ proximal to the other two which are at the same level, C: PCA distal to the other two which are at the same level, D: SCJ proximal to the distal end of PZ which is proximal to PCA. Cases with patterns B and D were thought to have E-BE, and those with patterns C and D to have E-HH. RESULTS: Patterns A, B, C and D were 79.2%, 12.1%, 3.8% and 4.9%, respectively. Length of PZ was 3.0+/-0.1 cm. E-BE and E-HH were found in 17.0% and 8.7%, respectively. Both E-BE and E-HH were more frequently found in males and in cases with reflux esophagitis. CONCLUSION: E-BE and E-HH are not so infrequent in Koreans as previously thought, if we use the distal end of PZ as an endoscopic marker of GEJ.
Subject(s)
Female , Humans , Male , Middle Aged , Barrett Esophagus/epidemiology , Capillaries/anatomy & histology , Esophagogastric Junction/anatomy & histology , Esophagoscopy , Esophagus/anatomy & histology , Hernia, Hiatal/epidemiology , Korea/epidemiology , Prevalence , Regional Blood FlowABSTRACT
Low grade mucosa-associated lymphoid tissue (MALT) lymphoma is a very indolent disease and can achieve complete remission with only localized treatment unlike the low grade B-cell lymphoma originating from peripheral lymph nodes. The endoscopic finding of the low grade gastric MALT lymphoma is usually presented as multiple and superficial erosions or ulceration. We recently experienced one case of low grade gastric MALT lymphoma without any mucosal lesion. The patient was initially considered as a submucosal tumor originating from the proper muscle layer of stomach and underwent the subtotal gastrectomy. But the submucosal tumor was confirmed to the low grade gastric MALT lymphoma without H. pylori infection.
Subject(s)
Humans , Gastrectomy , Lymph Nodes , Lymphoid Tissue , Lymphoma , Lymphoma, B-Cell , Lymphoma, B-Cell, Marginal Zone , Stomach , UlcerABSTRACT
BACKGROUND/AIMS: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy. METHODS: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months. RESULTS: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable. CONCLUSIONS: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.