Yasunobu Tsujinaka

Rectal burn caused by hot-water coffee enema.

A 29-year-old woman underwent a coffee enema with hot water to treat constipation. She quickly evacuated it because of lower abdominal pain; however, she developed chills and proctorrhagia a few hours afterward. The following day, she was referred to our hospital complaining of severe anal pain and hematochezia. Proctoscopy showed black necrotic mucosa and severe erosions of the lower rectum (A). The patient refused to be hospitalized and thus was cared for in the outpatient department. She was instructed to maintain a liquid diet and take a betamethasone suppository daily. Hematochezia continued until the second day of observation, after which bowel movements became normal; pain upon defecation continued. Although there was mild stenosis of the lower rectum induced by the circumferential ulcer and edema (B), the patient had a normal bowel movement and was taking a regular diet by the seventh day of observation. On the fifteenth clinical day, endoscopy showed improvement of the rectal erythema and stenosis (C). Anal pain disappeared on the twenty-ninth clinical day. The patient recovered without

Lymphoepithelioma-Like Carcinoma of the Colon

A 70-year-old female underwent follow-up colonoscopy after colonic polypectomy. The colonoscopy revealed the presence of a 7-mm submucosal tumor in the sigmoid colon. The tumor surface was smooth and covered with normal mucosa. It was diagnosed as a submucosal tumor, and polypectomy was performed. Histopathological examination of the resected specimen revealed moderately to poorly differentiated adenocarcinoma measuring 2 × 5 × 3 mm with marked peritumoral lymphocytic infiltration and lymphoid follicle formation. It was diagnosed as carcinoma with lymphoid stroma (lymphoepithelioma-like carcinoma), SM (1,800 μm), ly2, v0, budding; grade 1. We confirmed the indication for noncurative additional surgical resection and performed laparoscopic sigmoid colectomy. No metastases were observed in the dissected lymph nodes.

Gastric Dieulafoy-like lesion presenting as a complication after endoscopic cold biopsy.

Endoscopic tissue sampling, such as cold biopsy, is generally safe and effective. Cold biopsy specimens are routinely obtained from any suspicious lesion during endoscopic evaluation because complication rates of cold biopsy used in the upper and lower GI tract in patients without coagulopathies are exceedingly rare and negligible. Significant bleeding is a rare complication of diagnostic upper endoscopy, including cold biopsy for tissue sampling; however, we report a case of significant bleeding from a gastric Dieulafoy-like lesion caused by an endoscopic cold biopsy of a nonoperated stomach.