Joo-Hyun Sohn

Colonic lymphangiomatosis associated with protein-losing enteropathy.

Most lymphangiomas are considered to be lymph vessel anomalies. They can occur anywhere in the body and only rarely affect the intestinal tract. However, as endoscopic examination has become more widespread, gastrointestinal lymphangiomas have been reported more frequently. The overwhelming majority of lymphangiomas are solitary; only several cases of multiple lymphangiomas of the colon have been reported so far (1‐3). Here we report multiple colonic and abdominal lymphangiomas in a young Korean woman who presented with protein-losing enteropathy.

Relative adrenal insufficiency in chronic liver disease: its prevalence and effects on long‐term mortality

The relationship between relative adrenal insufficiency (RAI) and chronic liver disease is unclear.

Education and imaging. Gastrointestinal: Sigmoidocecal fistula diagnosed with colonoscopy.

A 42–year–old woman underwent a colonoscopy for evaluation of abdominal bloating of three months’ duration. Colonoscopic view revealed a large collapsed fistulous opening of the sigmoid colon. The ileocecal valve was identified when the colonoscope was passed through the fistulous opening connecting with the sigmoid colon. When the colonoscope reached the cecum through the conventional intra-luminal technique, white numbers corresponding to the colonoscope insertion length markings could be seen through the fistulous opening (Fig. 1). The appendiceal orifice opening was normal. To confirm the fistulous opening, indigocarmine dye was sprayed into the cecum. The blue dye was found in the sigmoid colon confirming the fistulous connection (Fig. 2). Double contrast barium enema and abdominal computed tomography (CT) scan were also performed. The barium enema also demonstrated the fistulous opening with contrast connecting the mid sigmoid colon and the cecum. Abdominal CT scan also demonstrated an air–filled fistulous tract that extended from the mid sigmoid colon to the cecal pole. However, there were no pericolic inflammation, mesenteric infiltration or bowel wall thickening around the lesion. Colocolonic fistulas are usually a complication of an inflammatory or neoplastic process. However, she had no prior history of any of the predisposing factors related to colocolonic fistulas. A thorough search of English literatures revealed only two cases of sigmoidocecal fistula due to sigmoid diverticulitis or granulomatous colitis. A radiologic study with contrast media is usually used to diagnose intra-abdominal fistulas. In addition, the primary role of colonoscopy may directly visualize the lesion that caused the fistula, and if needed, confirm through histopathologic review. In this case, chromoendoscopy was utilized to prove the presence of the sigmoidocecal fistula during the colonoscopy.

Gastrointestinal: Sigmoidocecal fistula diagnosed with colonoscopy

A 42–year–old woman underwent a colonoscopy for evaluation of abdominal bloating of three months’ duration. Colonoscopic view revealed a large collapsed fistulous opening of the sigmoid colon. The ileocecal valve was identified when the colonoscope was passed through the fistulous opening connecting with the sigmoid colon. When the colonoscope reached the cecum through the conventional intra-luminal technique, white numbers corresponding to the colonoscope insertion length markings could be seen through the fistulous opening (Fig. 1). The appendiceal orifice opening was normal. To confirm the fistulous opening, indigocarmine dye was sprayed into the cecum. The blue dye was found in the sigmoid colon confirming the fistulous connection (Fig. 2). Double contrast barium enema and abdominal computed tomography (CT) scan were also performed. The barium enema also demonstrated the fistulous opening with contrast connecting the mid sigmoid colon and the cecum. Abdominal CT scan also demonstrated an air–filled fistulous tract that extended from the mid sigmoid colon to the cecal pole. However, there were no pericolic inflammation, mesenteric infiltration or bowel wall thickening around the lesion. Colocolonic fistulas are usually a complication of an inflammatory or neoplastic process. However, she had no prior history of any of the predisposing factors related to colocolonic fistulas. A thorough search of English literatures revealed only two cases of sigmoidocecal fistula due to sigmoid diverticulitis or granulomatous colitis. A radiologic study with contrast media is usually used to diagnose intra-abdominal fistulas. In addition, the primary role of colonoscopy may directly visualize the lesion that caused the fistula, and if needed, confirm through histopathologic review. In this case, chromoendoscopy was utilized to prove the presence of the sigmoidocecal fistula during the colonoscopy.

The Value of Peracetic Acid (SCOTELIN®) for Endoscopic Disinfection

Background/Aims: Two percent glutaradehyde has been the reference disinfectant for high-level disinfection, but often requires long period of exposure up to 45 minutes. The aims of this study were to evaluate the effectiveness of a new endoscope disinfectant that uses 0.2% peracetic acid, and to compare the culture-positive rate in each different endoscopes and washers used. Methods: Three endoscopes and two washers that differed in purchase year were used. They were cleansed manually and disinfected with peracetic acid for 10 minutes. A total of 86 gastroduodenal endoscopic sessions were included in the study. Results: Overall culture-positive rate was 37.2%, majority of which came from washings of biopsy channel. There was a significant difference in culture-positive rate according to the machine used. Culture positive rate was 11.4% in recently purchased endoscope and washer used. Of the 28 Helicobactor pylori positive cases, there was one Helicobactor pylori DNA PCR positive case, but no Helicobactor pylori was found. Conclusions: When new endoscope and washer is used, peracetic acid is effective as a disinfectant. Significant difference in culture rate according to the different machine used might come from the aging effect and difference of cleansing power of the washer/

Gastrointestinal: Sigmoidocecal fistula diagnosed with colonoscopy: Images of Interest

A 42–year–old woman underwent a colonoscopy for evaluation of abdominal bloating of three months’ duration. Colonoscopic view revealed a large collapsed fistulous opening of the sigmoid colon. The ileocecal valve was identified when the colonoscope was passed through the fistulous opening connecting with the sigmoid colon. When the colonoscope reached the cecum through the conventional intra-luminal technique, white numbers corresponding to the colonoscope insertion length markings could be seen through the fistulous opening (Fig. 1). The appendiceal orifice opening was normal. To confirm the fistulous opening, indigocarmine dye was sprayed into the cecum. The blue dye was found in the sigmoid colon confirming the fistulous connection (Fig. 2). Double contrast barium enema and abdominal computed tomography (CT) scan were also performed. The barium enema also demonstrated the fistulous opening with contrast connecting the mid sigmoid colon and the cecum. Abdominal CT scan also demonstrated an air–filled fistulous tract that extended from the mid sigmoid colon to the cecal pole. However, there were no pericolic inflammation, mesenteric infiltration or bowel wall thickening around the lesion. Colocolonic fistulas are usually a complication of an inflammatory or neoplastic process. However, she had no prior history of any of the predisposing factors related to colocolonic fistulas. A thorough search of English literatures revealed only two cases of sigmoidocecal fistula due to sigmoid diverticulitis or granulomatous colitis. A radiologic study with contrast media is usually used to diagnose intra-abdominal fistulas. In addition, the primary role of colonoscopy may directly visualize the lesion that caused the fistula, and if needed, confirm through histopathologic review. In this case, chromoendoscopy was utilized to prove the presence of the sigmoidocecal fistula during the colonoscopy.