Jen-Chieh Huang

Small bowel volvulus among adults

Background:  To elucidate clinical experience associated with rare cases of small bowel volvulus among adults, we conducted a retrospective study.

Clinical characteristics of nonB nonC hepatocellular carcinoma compared to HBV- and HCV-related hepatocellular carcinoma

The incidence of nonB nonC hepatocellular carcinoma (NBNC‐HCC) is increasing. The aim was to clarify the risk factors and the clinical features of NBNC‐HCC and compare the clinical characteristics in patients with NBNC‐HCC, B‐HCC (HBsAg positive) and C‐HCC (HCVAb positive).

Acute phlegmonous gastritis

Acute phlegmonous gastritis is an uncommon and often life‐threatening disease characterized by suppurative bacterial infection of the stomach. Here we report a case of acute plegmonous gastritis in a 51‐year‐old male patient with underlying alcoholic cirrhosis. When admitted to the emergency department, he initially presented with upper abdominal pain, and fever for three days. The patients vital signs were unstable, including blood pressure 90/55 mmHg, heart rate 110 beats per minute, respiratory rate 25 breaths per minute, and body temperature 38°C. Emergent imaging results suggested acute phlegmonous gastritis. The patient was admitted to the intensive care unit for immediate treatment with intravenous antibiotics, and results of endoscopic tissue culture and blood culture on day four identified the underlying pathogen as Klebsiella pneumonia. In this case report, we share the patients clinical course, ultrasonography and computed tomography images, and endoscopic findings, accompanied by brief literature review.

Gangliocytic Paraganglioma: Report of A Case

Paragangliomas, known as extra-adrenal pheochromocytomas, are rare neuroendocrine tumors. The symptoms and signs are nonspecific and related to excess secretion of catecholamine. Paragangliomas occur as single tumors. However, when they occur in multiple sites they are usually found as a part of a heritable syndrome such as multiple endocrine neoplasia types II-A and II-B and succinate dehydrogenase (SDH) related mutations. Recognition and diagnosis depends on careful examination for the three cell types (epithelioid/neuroendocrine cells, spindled cells, and ganglion cells) that characterize the tumor. Its behavior is usually benign, although some have lymph node metastasis and are diagnosed as malignant (15-35% of the cases). Surgery remains the mainstay of treatment for all paragangliomas. Herein, we report a case of gangliocytic paraganglioma located in the duodenum that was completely excised.

Clinical Features and Prognostic Factors of Spontaneous Ruptured Hepatocellular Carcinoma

Background and Aims: Ruptured hepatocellular carcinoma (HCC) is a rare, life-threatening event. We designed a retrospective study to better define the clinical features and prognostic factors of patients with ruptured HCC.Materials and Methods: We reviewed the cases of all patients with ruptured HCC treated in our hospital from January 2000 to December 2011. Total 42 patients with ruptured HCC were enrolled and we divided the cases into two groups according to the timing of HCC diagnosis. In one group (first diagnosis group), HCC and rupture were diagnosed simultaneously (n = 24), and in a second group (follow-up group), HCC rupture had been discovered during HCC follow-up (n = 18). We used the t-test, the Pearson chi-squared test, Fishers exact test, and the Kaplan-Meier test to assess the results.Results: Statistically significant differences were found between the first diagnosis group and the follow-up group, respectively, in BCLC stage (P = 0.029), Child-Pugh classification (P = 0.043), morphology of tumors (P = 0.012), total bilirubin levels (1.34 ± 1.30 mg/dL vs. 3.13 ± 3.43 mg/dL; P = 0.048), and albumin levels (2.99 ± 0.53 g/dL vs. 2.52 ± 0.63 g/dL; P = 0.013). The 30-day survival rate was not significantly different between the groups (P = 0.679). When prognostic factors for 30-day survival were analyzed, serum albumin levels were related to 30-day mortality (OR: 0.125; P = 0.019). Kaplan-Meier survival analysis showed that the cumulative survival rate after rupture of HCC was higher in patients with ruptured HCC in first diagnosis group than in follow-up group (P = 0.0304).Conclusions: Despite the limitations of the retrospective study design, the results revealed differences between patients with ruptured HCC in first diagnosis group and follow-up group. Patients with ruptured HCC in first diagnosis group had better liver function reserve and long term survival after rupture of HCC. A future prospective study is needed to confirm the results.

Metastatic Squamous cell Carcinoma of the Small Intestine with Bowel Perforation: Report of a Case

Small bowel metastasis from lung cancer is rare. We report a 64-year-old woman with lung cancer (squamous cell carcinoma) complicated with multiple site metastasis and treated with chemotherapy. She suffered from low abdominal pain and fever for more than two days. Abdominal computerized tomography revealed a mass lesion at the ileum with nearly total obstruction of the bowel and suspicion of focal abscess formation. Exploratory laparotomy was performed and a small intestine tumor was found at the ileum with tumor necrosis, bowel perforation and abscess formation. Segmental resection of the small intestine with end to end anastomosis and abscess debridement were performed. The pathological report showed poorly differentiated metastatic squamous cell carcinoma. The present report describes this unusual case and reviews the literature regarding the incidence, complications and treatment of small bowel metastasis from lung cancer.

Rectal Endometriosis with Complete Intestinal Obstruction: Report of a Case

Intestinal endometriosis is an uncommon disease, the symptoms of which depend on the size of the endometriotic nodule and the location of the involvement. However, complete bowel obstruction in response to this disease is an extremely rare finding. A 38-year-old woman with rectal endometriosis presented to our department with complete obstruction of the intestine. A pre-operative survey including a colonoscopy and an imaging study was conducted but no definite diagnosis was available. Surgery involving a lower anterior resection was performed, and the diagnosis of endometriosis was made by pathological examination of the resected specimen. The present report describes this unusual case and reviews the literature pertaining to the incidence, symptoms, diagnosis, and treatment of intestinal endometriosis complicated by bowel obstruction.

Duodenal Carcinoid Tumor with Bleeding: Report of a Case

Carcinoid tumors are neuroendocrine tumors that arise from neural crest cells. These indolent tumors are rare and often silent clinically. A 78-year-old man presented with upper gastrointestinal bleeding. UGI endoscopy identified a submucosa tumor with central ulceration and bleeding was identified. Subtotal gastrectomy, complete resection of first portion and partial resection of second portion of duodenum, and gastrojejunostomy were performed and histopathology diagnosed a duodenal carcinoid tumor.

Solid and Papillary Neoplasm of the Pancreas: Report of Two Cases

We report two rare cases of solid and papillary neoplasm of the pancreas with pathological correlation and a review of the literature. Both patients were female, aged 12 and 37 years respectively. The first case presented with right upper abdominal pain with vomiting. Abdominal sonography and computed tomography examinations showed a heterogeneous soft tissue mass in the pancreatic head. The second case presented with a palpable mass in the left upper abdomen. Imaging studies revealed an almost completely cystic mass with rim calcification in the pancreatic tail. Both tumors were successfully resected without recurrence. Gross examination showed that these tumors were well-encapsulated and exhibited solid peripheral parts with varying degrees of central hemorrhagic necrosis resulting in cystic components. Microscopically, distinct solid and papillary patterns were shown. The diagnosis of solid and papillary neoplasm should be considered in young women presenting with a well-encapsulated mass in the pancreas. Although a low-grade malignancy, this tumor is potentially curable by surgical resection.

Hepatic Arterial Aneurysm: Report of a Case

A 45 year-old woman was referred to our hospital due to intermittent right upper abdominal pain for many years. Serial work-up disclosed an aneurysm at the common hepatic artery. Aneurysm resection and arterial reconstruction were performed. Pathological examination revealed an aneurysm associated with atherosclerosis. The postoperative course was smooth. This patient was discharged one week later with regular follow up at OPD until now Hepatic arterial aneurysms are rare and the risk of rupture is very high. It is recommended that all cases should be considered for treatment. The management of a hepatic arterial aneurysm includes surgery or embolization that depends upon the etiology and location.