Yu-Jan Chen

Identification of Ectopic Pancreas in the Ileum by Capsule Endoscopy

Ectopic pancreas, an uncommon submucosal tumor in the gastrointestinal (GI) tract, is histologically similar to normal pancreatic tissue. We present a case of ectopic pancreas in the ileum. A 35-year-old man had intermittent dark bloody stool for 2 months accompanied by epigastric pain and postprandial abdominal fullness. Esophagogastroduodenoscopy and colonoscopy did not reveal any abnormalities. Capsule endoscopy revealed a small red polyp in the ileum. Abdominal computed tomography scan and small bowel barium follow-through study were not of any help. GI bleeding and abdominal discomfort were resolved after the lesion was surgically removed. Pathologic examination demonstrated pancreatic acinar cells and a secretory duct in the ileal submucosa, consistent with ectopic pancreas. Ectopic pancreas in the small intestine may be a rare cause of obscure GI bleeding. Capsule endoscopy seems to be a good, noninvasive tool for identification in the small bowel, particularly when other imaging modalities fail to detect any abnormalities.

Simultaneous Klebsiella pneumoniae and Amoebic Liver Abscess in an Immunocompetent Patient

Simultaneous Klebsiella pneumoniae and amoebic liver abscess is rarely reported in immunocompetent patients. A 47-year-old man was hospitalized with abdominal pain, fever, chills, and hypotension. Physical examination revealed right upper quadrant tenderness. Abdominal computed tomography showed an area of low attenuation with some liquefaction in the liver. Echo-guided aspiration revealed 30 mL of pus, which grew Klebsiella pneumoniae, and the same organism was isolated from the blood. Cytology examination of the pus showed scattered amoeba. The patient gradually improved over 1 month on treatment with cefmetazole and metronidazole, along with repeated drainage of the abscess. His amoebic indirect hemagglutination titer was 1:128, but no parasite ova or amoeba were found in the stool. He had no evidence of immunocompromise. Parasitic diseases may be a predisposing factor for bacterial infections, including pyogenic liver abscess. The possible coexistence of amoebae and bacteria in a liver abscess should not be discounted.

Gastric polypoid lesion after gastrectomy

An 87-year-old man presented for endoscopy for investigation of anorexia, abdominal bloating and fullness for the previous 2 months. He had had a subtotal gastrectomy with a Billroth II anastomosis 40 years previously for a gastric ulcer with bleeding. Upper endoscopy revealed a 20 mm diameter, broad-based polypoid lesion with a smooth surface at the greater curvature of the middle body of the stomach (figure 1). Biopsies from the surface mucosa showed mild chronic inflammation and mild foveolar hyperplasia and were negative for Helicobacter pylori infection. Abdominal CT revealed a 2×2 cm protruding smooth nodular lesion in an area in keeping with a submucosal lesion such as a gastrointestinal stromal tumour …

Gastrointestinal tract pseudo-obstruction or obstruction due to Mycobacterium tuberculosis breakthrough

The development of tuberculosis-related bowel obstruction or pseudo-obstruction during anti-tuberculosis therapy is rarely reported in immunocompetent patients. A 44-year-old male, who had neither HIV infection nor diabetes, was hospitalized because of pulmonary tuberculosis in November 2006. Three months after starting anti-tuberculosis therapy, he was admitted for suspected mechanical bowel obstruction. An emergency exploratory laparotomy showed distended bowel loops, and multiple skip lesions from the terminal ileum to the ascending colon. PCR analyses showed Mycobacterium tuberculosis. The therapy regimen was unchanged after the operation; the patient gradually improved over the course of a month and was discharged without further symptoms thereafter.

AN UNUSUAL CASE OF HEPATIC TUMOR IN AN ELDERLY PATIENT

SUMMARY Malignant epithelioid hemangioendothelioma is a rare hepatic tumor of vascular origin. It is most commonly found in young to middle-aged women, and the tumors vary in their reported potential for malignancy. The etiologic factors are not yet clear, and some investigators have suggested an association with oral contracep- tives, whereas others have noted an association with exposure to vinyl chloride, asbestos, thorotrast, major trauma to the liver, viral hepatitis, primary biliary cirrhosis, and alcohol consumption. The clinical manifesta- tions are nonspecific, and most are asymptomatic. Among symptomatic patients, the most common symptom is right upper quadrant pain, followed by jaundice, weight loss, fatigue, ascites, hepatomegaly, and fever. The only definitive diagnosis requires immunohistochemical evidence of endothelial differentiation, which is demonstrated by the presence of factor VIII-related antigen and cytokeratins. As with most mesenchymal tumors, surgical resection is the most effective means of controlling local disease and preventing distant metastasis, although adjuvant therapies have been offered for patients with unresectable tumors or who are not transplant candidates. We present the case of an elderly man with a hepatic malignant epithelioid heman- gioendothelioma, and we reviewed the English-language literature. (International Journal of Gerontology 2009; 3(3): 188-191)

Double Cancer of the Liver and Lung: A Report of Three Cases

Hepatocellular carcinoma is one of the most common malignancies and, because of the high prevalence of chronic hepatitis B and C, it is the leading cause of death in Taiwan. Lung cancer coexisting with hepatocellular carcinoma has rarely been reported in the medical literature. It might have been misdiagnosed as lung metastasis in many cases. We report three cases of double cancer of the liver and lung. All of the diagnoses were confirmed by pathology. One of the three cases was diagnosed early enough to be treated with surgical resection of both liver and lung tumors. Computed tomography may be helpful in differentiating primary from metastatic lung cancer. Thus, in patients with hepatocellular carcinoma and lung lesions, the possibility of double cancer of the liver and lung rather than lung metastasis should be kept in mind.

Intestinal Perforation by a Fish Bone Causing an Abscess: Report of Two Cases

The incidence of abscess complicating a gastrointestinal foreign body is unknown, but the condition appears to be relatively rare. We report two cases of intestinal perforation by a fish bone that resulted in an abscess. Both patients, who presented with intermittent abdominal pain, were at high risk for accidental foreign body ingestion as one abused alcohol and the other was elderly. Neither remembered swallowing a fish bone. Abdominal x-rays were unhelpful in the diagnosis, but abdominal CT scans demonstrated a sharp foreign body in both cases. Both patients underwent laparotomy and were found to have abscesses. This is a rare complication of fish bone ingestion, a possibility worth remembering when a patient presents with unexplained abdominal pain.