Two Cases of Crohn's Disease Presented with Hematochezia in Patients with Hemophilia

The etiology of Crohn's disease, which is a chronic inflammatory condition that potentially involves any location of the alimentary tract from the mouth to the anus, is unknown. However, there is strong evidence that vascular damage could play a role in the pathogenesis of Crohn's disease. Crohn's disease is mediated by multifocal gastrointestinal infarctions, which occur at an early stage in the disease process. Persistent activation of coagulation in patients with Crohn's disease has been shown. In contrast, hemophilia is an inherited disorder of coagulation. The deficiencies of clotting factors usually involve occult or overt bleeding. The pathogenic mechanisms of Crohn's disease and hemophilia are incompatible. An association between Crohn's disease and hemophilia has not been reported in Korea. We managed 21- and 33-year-old men with Crohn's disease associated with hemophilia, who presented with hematochezia.

A Case of Primary Duodenal Adenocarcinoma Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Primary nonampullary duodenal adenocarcinoma is an extremely rare disease. In the past, almost all duodenal adenocarcinomas were detected at an advanced stage. Yet recently, an increased number of case reports of early duodenal adenocarcinoma has coincided with the advances in the field of endoscopy, and there has also been an increased number of case reports of duodenal adenocarcinoma treated by endoscopic mucosal resection. We report here on a case of primary nonampullary duodenal adenocarcinoma that was treated by endoscopic mucosal resection, and there has been no recurrence for over 3 years, as assessed by endoscopic examination.

Three Cases of Appendicitis Diagnosed by Colonoscopy in Patients with Atypical Presentations / 대한소화기내시경학회지

The diagnostic considerations are broad for patients who clinically present with obscure abdominal pain. Acute appendicitis can be diagnosed according to the clinical signs and symptoms, yet this can often be extremely challenging. Difficulties particularly arise when the presentation is atypical. Investigations that may help include laboratory tests, non-invasive imaging and laparoscopy. We experienced 3 cases of acute appendicitis that were diagnosed by colonoscopy. The colonoscopy revealed a bulging of the appendix into the cecal lumen. The mucosa was erythematous and edematous with pus draining from the appendiceal orifice. These findings were suggestive of appendicitis, which was confirmed after surgical appendectomy. In our experience, making the colonoscopic diagnosis of appendicitis might be helpful for patients with atypical symptoms, but colonoscopy should not be used for the diagnosis in the beginning if appendicitis is initially suspected.

Metastatic Large Cell Neuroendocrine Carcinoma Combined with Gastric Adenocarcinoma / 대한소화기내시경학회지

A 67 year-old man was admitted due to findings that were suspicious for malignancy on gastroscopy at a primary clinic. We also performed gastroscopy and this showed the presence of a 3 cm sized nodular elevated lesion at the angle of the stomach. A biopsy demonstrated the presence of adenocarcinoma of the stomach. A distal gastrectomy with D2 lymph node dissection was performed and the microscopic features of the resected specimen confirmed the diagnosis of adenocarcinoma of the stomach and also metastatic large cell neuroendocrine carcinoma of lymph nodes of an unknown primary origin. Although double primary gastric adenocarcinoma and gastric neuroendocrine tumor with regional lymph node metastasis has been seldom reported, a double primary carcinoma of gastric adenocarcinoma and metastatic large cell neuroendocrine carcinoma of lymph nodes has seldom been reported. We report on this unusual case along with a review of the relevant medical literature.

A Case of Focal Reexpansion Pulmonary Edema after Conventional Thoracentesis of Pleural Effusion / 결핵

A 60-year old male patient admitted with complaints of dyspnea and pleuritic chest pain. The chest X-ray demonstrated right pleural effusion. We planed to do the conventional thoracentesis to evaluate the characteristics of pleural effusion and to relieve the symptom of the patient. Focal reexpansion pulmonary edema was seen on the follow-up chest X-ray. After the 5-day conservative management, the patient recovered without any complications.