, Shin Hye Kim, Ji Hyen Lee Non-sexually acquired genital ulceration, also known as Lipschutz ulcer, is a rare condition that typically occurs in prepubertal and pubertal girls. It can be misdiagnosed as a sexually transmitted disease or even a sign of child abuse, causing great anxiety for patients and their families. It is often accompanied by systemic symptoms such as fever, myalgia, or lymphadenopathy. Several viruses such as Epstein-Barr virus, cytomegalovirus, and mumps virus have been associated with this entity. Furthermore,
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, Jae Uk Shin, Su Sin Jin, Hyeon Jeong Kang, Ho Wook Jeon, Joon Yub Lee Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.
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, Hyun Joo Song, Min Jung Kim, Weon Young Chang, Bong Soo Kim, Chang Lim Hyun Solitary rectal ulcer syndrome (SRUS) is a rare benign and chronic rectal disease that has a wide spectrum of clinical presentations and variable endoscopic findings. It is usually diagnosed by histopathological examination through biopsy. A 68-year-old man was referred to our hospital with anal pain and difficulty on bowel movement. Colonoscopy showed a hemorrhagic ulcerated mass in the rectum. All radiologic findings such as abdominopelvic computed tomography (CT), positron emission tomography-CT and magnetic resonance imaging were suspicious of rectal cancer. Although the patient underwent repeat endoscopic biopsy and one surgical biopsy, the results were not indicative of malignancy. Two months after conservative management, clinical symptoms and colonoscopic findings were markedly improved. Thus, we report this rare case of a 68-year-old man who had a central ulcerated mass that mimicked rectal cancer on gross colonoscopic and radiologic findings, representing an SRUS variant.
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, Sung Sook Kim This study was aimed to assess the value of rapid urease test (CLO test) for thedetection of Helicobacter (H.) pylori in patiens with duodenal ulcer and compare its resultwith histological technique using H & E stain.
The CLO test and histological study were done using three pieces of antral biopsyspecimens in 46 patients with duodenal ulcer. The clinical histories such as smoking, bloodtype or the previous use of NSAIDs were obtained from the patients.
1) The CLO test was positive in 35 (76.1%) among 46 patients with duodenal ulcer, while H & E stain was positive in 91.3%.
2) When H & E stain positive case was diagnosed as H. pylori infection, the sensitivity of CLO test was 81.0%, the specificitry 75.0% and the predictability was 97.1%.
3) The grading of gastric inflammation showed that the higher the histologogical grade, the more likely CLO test would be positive.
4) There were no differences of recurring history of duodenal ulcer, smoking rate, NSAIDs history and blood type between 34 cases of both CLO and H & E positive cases and 3 cases ofboth negative cases except a mild increasing tendency of age, male predominance and scarringstage of duodenal ulcer in both negative cases.
The CLO test is a rapid and simple test, but it should require other complementary diagnostic tests to increase the sensitivity and specificity.
, Jung En Park, Hee Jung Sohn, Keum Mi Kim, Jung Ran Byun, Young Yub Koh, Doe Young Kim, Il Hwan Moon Ulcerative colitis is an waxing and waning inflammatory bowel disease characterized by rectal bleeding and diarrhea, affecting principally the mucosa of the rectum and colon. Its incidience is being higher in Europe and America and it also seems to be rising increasingly in our country because diagnostic methods are much developed and Korean life styles are westernized. So, we investigated its clinical characteristics.
We analyzed 36 cases of ulcerative colitis which had been treated in the Hospital of Ewha Womans' University from Jan. 1983 to Feb. 1993, retrospectively.
1) The most prevalent age group was 3rd decade and male to female ratio was 1:1.77.
2) The duration of symptoms was less than 6 months in 63.9%.
3) The most common clinical manifestation was hematochezia(86.1%), abdominal pain(75.0%), diarrhea(72.2%), fever(30.6%), weight loss(27.8%) in the order of frequency.
4) According to the severity, moderate type was shown in 52.8%, severe in 33.3% and mild in 13.9%.
5) According to the anatomical distribution of the lesion, pancolitis was shown in 36.1%, the involvement of the rectum and sigmoid colon in 16.6%, the left-sided colon in 13.8%, rectum only in 13.8%, transverse colon in 8.3% and backwash ileitis in 11.1%, respectively.
6) The hematologic laboratory finding was non-specific including anemia, leukocytosis, increased erythrocyte sedimentation rate, bypoalburninemia, electrolyte imbalance, increased serum transaminase and alkaline phosphatase.
7) Colonoscopy revealed ulceration(77.1%) commonly, including hyperemia(51.4%), bleeding(42.5%), mucosal friability(22.9%), pseudopolyp(22.9%), granularity(20.2%).
8) The Barium enema showed granularity commonly and loss of haustral marking(55.2%), luminal narrowing(34.5%), lead pipe rigidity(13.8%), pseudopolyp(3.4%). Also, normal finding was shown in 10.3%.
9) The most common histopathologic finding was inflammation(83.3%) and ryptitis(55.6%), ulceration(50%), goblet cell depletion(19.4%), pseudopolyp(19.4%), necrosis(13.9%), granolarity(8.3%) were also noted.
10) With the medical treatment, 76.5% of the cases showed initial improvement of the symptom, but the recurrence developed in 17.7%. The surgery was performed in 6 cases of patients(16.7%). Emergency operation was performed in 2 cases due to bowel perforation and elective operation in 4 cases.
, Ki Nam Shim, Kyung Joo Kwon, Sun Kyung Na, Hye Won Yun, Do Kyung Song, Suk Hyung Kang Double pylorus is one of the rare anomalies of gastrointestinal tract, which have an accessory canal connecting the distal stomach to the duodenal bulb. The majority of the cases is thought to be acquired lesions from ulcer disease except some congenital cases. We report a case of a 77 year-old male who was visited the hospital because of the melena and diagnosed double pylorus. The relevant literatures on subject were reviewed.
, Ha Suk Bae, Tae Sik Yoon Post stroke dysphagia is a common disorder presented in 30-65% of stroke patients. It can result in severe complication such as aspiration pneumonia. Thus nutritional support with nasogastric(NG) feeding tube is needed in these patients. But this method is not recommended more than 4 weeks. In the patients with severe dysphagia, the percutaneous endoscopic gastrostomy(PEG) is recommended in respective with the complication and prognosis.
We experienced a case of 46 year-old-male with esophagogastric ulcer because of remnant NG feeding tube on stomach. He had not a special past history until admission. He was bedridden and quadriplegic state due to spontaneous intracranial hemorrhage on both fronto-parietal lobe and subdural hemorrhage. NG feeding tube(polyvinyl chloride, 16 French) was inserted because of severe dysphagia and the clinicians attempted the PEG tube insertion but removed the PEG tube due to the sepsis with wound infection and reinserted NG feeding tube. After transfer into our hospital, a sudden blood clot from NG feeding tube was drained. We performed gastrofibroscopic examination and found NG feeding tube remnant (23cm) on stomach. It was removed and multiple esophagogastric linear ulcer with hemorrhage due to exposed vessel was observed. He obtained nutrition by total parenteral nutrition for 4 weeks after that. On follow up gastrofibroscopic examination, esophagogastric ulcers were being healing. So we tried PEG tube insertion again but failed because of granulation tissue on previous PEG tube insertion site and inserted NG feeding tube. After 3 months, he was inserted PEG tube and being supported sufficient nutrition.
Many complications are associated with the prolonged NG feeding tube insertion. So recent studies showed alternative method in case of prolonged dysphagia. We report a case with esophagogastric ulcer associated with remnant NG feeding tube on stomach.
, Sun Young Yi, Jung Eun Shin, Mi Sun Ju, Jung Hyun Chun, Kyung Eun Lee This study is to compare the clinical and cost effectiveness of various pharmacologic therapies with of without endoscopic procedure in the Forrest II ulcer.
Between May 2001 and June 2002, total of 58 Forrest II bleeding activity patients (37 cases of NBVV, 6 adherent blood clots, 9 flat red spot, and 6 flat black spot) with gastric ulcer(32 cases) and duodenal ulcer(26 cases) were analyzed. UGI endoscopy was performed within 12 hours of the first bleeding episodes, and underwent repetitive endoscopy after 48h. All the patients were randomly assigned to receive somatostatin(group I), PPI(omeparzole : group II), only H2 blocker (famotidine, group III), or endoscopic injection therapy followed by famotidine (group IV). We compared with rebleeding rates, changes of ulcer size, and modified estimated costs for 3 day-hospital in four groups respectively.
1) Twelve patients experienced rebleeding(20.7%). 2) The rates of rebleeding were 16.6% (2/12) in group I, 28.6%(4/14) in group II, 5.9%(1/17) in group III, 26.7% in group IV. There was no significant difference in rebleeding rate among the groups, but there was low rebleeding tendency in group III, compared with group II(
In Forrest II bleeding ulcer, medical therapy, especially famotidine could be suggested prudently as a proper treatment modality for this lesion, considering the cost-effectiveness.
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