Intussusception in a child caused by capillary hemangioma of the colon.

Intussusception is one of the most common abdominal emergencies in children, but identifying the cause is very difficult. Hemangioma is a common tumor of the head and neck area in children, but it rarely arises in the gastrointestinal tract. This report describes a rare occurrence of intussusception caused by capillary hemangioma of the colon that was identified by ultrasonography (US), computed tomography (CT), and colonoscopy. A male child aged 2 years and 10 months developed painful abdominal cramps and hematochezia. Abdominal US and CT revealed both target and pseudo-kidney signs in the colon, indicating colonic intussusception. An initial diagnostic and therapeutic laparotomy did not reveal any abnormalities. Seven days later, severe abdominal pain recurred. A barium enema revealed the shadow of a 25-mm mass at the hepatic flexure of the colon. Colonoscopic findings revealed a submucosal tumor in the descending colon that was moved to the cecum by compressed air introduced through the colonoscope. We considered that the mass in the cecum had caused the intussusception. The tumor was removed at a second laparotomy, and microscopic pathological examination revealed that it was a capillary hemangioma.

Successful treatment for pouchitis with rebamipide refractory to a combination of metronidazole (MNZ) and ciprofloxacin (CFX).

A 35-year-old male who had undergone proctocolectomy and ileo-anal pouch surgery (IPAA) because of ulcerative colitis presented with worsening diarrhea and hematochezia. Pouchitis was diagnosed, and he was prescribed with metronidazole (MNZ) and a betamethasone enema. However, his condition did not remarkably improve despite these strategies. Endoscopy revealed ulceration and inflammation in the ileal pouch together with contact bleeding and mucous discharge. He underwent granulocytapheresis (G-CAP) and was prescribed anal 5-aminosalicylic acid (5-ASA) and oral prednisolone. Oral azathioprine (AZA) and a combination of MNZ and ciprofloxacin (CFX) did not result in any improvement. He was then treated with rebamipide enemas twice daily for 8 weeks without additional drug therapy. Two weeks thereafter, stool frequency started to decrease, fecal hemoglobin became negative, and his symptoms gradually improved. Endoscopic findings after the rebamipide therapy showed that the ulcers in the ileal pouch had mostly healed without obvious inflammation and bleeding. Rebamipide was thus maintained throughout the therapeutic period and for 13 months of follow-up. Rebamipide effectively treated severe pouchitis that was refractory to intensive conventional medication including antibiotics and corticosteroids.