- 7 Recurrent abdominal pain after an episode of acute diverticulitis
A 60-year-old man was hospitalized because of acute
diverticulitis complicated with Bacteroides fragilis bacteremia.
The computed tomography (CT) scan showed cecal
diverticulitis with superior mesenteric vein (SMV) thrombosis
(Fig. 1). At that time, he received parenteral antibiotics
for 2 weeks and then oral antibiotics for 1 week after
discharge. Nine days later, he presented to our emergency
department with progressive abdominal pain and fever. CT
scan demonstrated improved diverticulitis but progressive
local peritoneal inflammation around the SMV thrombosis
(Fig. 2).
- 6 A man with abdominal fullness
A 64-year-old man presented with abdominal fullness and
intermittent night fever for 1 month. His medical history
included hemodialysis for 1 year and hypertension. He did
not drink alcohol and had no history of chronic hepatitis B
or hepatitis C virus infection. There was no body weight
loss, cough, or bowel habit change. His physical examination
revealed abdominal distension and shifting dullness on
percussion. Laboratory workup revealed anemia (hemoglobin,
8.4 g/dL) and hypoalbuminemia (albumin, 2.8 g/
dL). The chest radiograph was normal. An abdominal
computed tomography with contrast showed ascites,
smooth uniform thickening of the peritoneum (arrowhead),
omental cakes (arrow; Fig. 1), and soft tissue strands with
crowded vascular bundles in the small bowel mesentery
(Fig. 2). The ascitic fluid was cloudy yellow; the analysis
revealed a white blood cell count of 950 cells/mm3 with
67% lymphocytes and a total protein level of 4.73 g/dL.
Ascitic fluid culture, cytology,
- 5 Young man with chronic anemia
A 28-year-old man without any underlying disease presented
with dizziness and general malaise for 6 months. He
came to the clinic for help initially. Vital signs and physical
examination were normal. Blood tests revealed only the
following abnormality: hemoglobin 8.6 g/dL. His fecal
occult blood test result was positive. Esophagogastroduodenoscopy
and colonoscopy showed nonspecific
findings. Ferrous sulfate was prescribed for suspected irondeficiency
anemia. Owing to refractory anemia, he was
transferred to our hospital for further evaluation. Small
bowel series showed a jejunal polypoid lesion with
increasing folds and lumen dilatation in the jejunum
(Fig. 1). Computed tomography of abdomen and pelvis
showed soft tissue mass (4.8 cm 2.5 cm) within a proximal
jejunal loop and intussusception of jejunal loops (Fig. 2,
yellow arrow). This patient received surgical resection. A
long-stalk mass (about 4 cm in size) at the proximal
jejunum, 25 cm distal to the Treit’z ligament (Fig. 3), was
found during the operation, and this tumor caused intussusception
of the jejunum. After surgery, his anemia
improved gradually and he was well until recently.
- 4 Early endoscopic finding of esophageal thermal injury after having spicy hot pot
We herein present the case of a woman who had esophageal thermal injury after
having a spicy hot pot. The patient came to us with complaints of odynophagia, dysphagia, and
burning sensation at the throat and upper chest while eating or drinking for 1 day. An upper
endoscopy was conducted 1 day after the onset of symptoms, which showed a linear, disrupted
bullae-like lesion with a thin detached membrane. Our report depicts the early endoscopic
finding of esophageal thermal injury following the ingestion of hot food. The finding is different
from what has been often reported as the “candy-cane” appearance of esophageal injury,
which results from the ingestion of hot liquid.
Copyright ª 2015, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society
of Taiwan and Taiwan Association for
- 3 A case of massive lower gastrointestinal bleeding from a rectal Dieulafoy lesion
A Dieulafoy lesion is an uncommon and sometimes life-threatening cause of gastrointestinal
hemorrhage. Typically, it presents as a tiny mucosal defect with an exposed protruding
artery with normal surrounding mucosa. An 84-year-old woman developed sudden massive
hematochezia and had an unstable hemodynamic status. The source of bleeding was found to
be an exposed vessel in the rectum without surrounding ulceration. The patient was treated successfully
with an epinephrine injection given endoscopically, followed by hemostatic clipping.
Copyright ª 2015, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society
of Taiwan and Taiwan Association for the
- 2 Serum hepatitis B surface antigen levelmight predict cirrhosis and hepatocellular carcinoma in older patients with chronic hepatitis B
Distinguishing inactive hepatitis B surface antigen (HBsAg)
carriers from hepatitis B e antigen-negative hepatitis remains difficult but is important
because patients with active hepatitis may develop severe complications. Long-term followup
data with stringent criteria are required for the identification of inactive HBsAg carriers.
A single serum HBsAg level may be used to solve this difficult diagnostic issue; however, very
few studies on its application in older patients have been published. This study was designed to
evaluate the clinical significance of a single serum HBsAg level in older patients with chronic
hepatitis B (CHB).
Materials and methods: From January 2012 to December 2012, the clinical manifestations of
1749 HBsAg-positive patients were analyzed including 412 patients aged 60 years (mean
age at enrollment, 68.6 6.9 years; range, 60e90 years; 262 males and 150 females). We
investigated the possibility of using a single serum HBsAg level to predict cirrhosis and hepatocellular
carcinoma (HCC) in older patients with CHB.
Results: Of the 1749 HBsAg-positive patients, those aged
- 1 Outcomes of endoscopic submucosal dissection for early gastric cancer and precancer lesion Experience from a center in Southern Taiwan
Limited data are available on the interval of disease-free status after
endoscopic submucosal dissection (ESD) for early gastric cancer and precancer lesion in
Taiwan. In this long-term (2e105 months) follow-up study, we analyzed the risk factors that
affect the local recurrence and noncurative resection (non-CR) of these lesions.
Methods: We retrospectively studied 65 consecutive treatment-naı¨ve patients with 69 EGC lesions
who were selected to be treated by ESD. A total of 56 lesions (48 CR lesions and 8 non-CR
lesions) were analyzed for local recurrence after ESD.
Results and Discussion: ESD was curative for gastric epithelial tumors in 51 (73.9%) but not in
18 (26.1%) lesions. Unfortunately, five (8.93%) of these 56 lesions in 53 patients had local recurrence.
None of the patients died from gastric cancer-associated diseases during follow-up. In
our studies, the cumulative local recurrence rates were 5.3% in the CR group and 56.7% in the
non-CR group (p Z 0.0091). The disease-free status was high (94.7%) with CR. The risk factors
that affect the non-CR were tumor location (p Z 0.013), deeper invasion (p < 0.001), undifferentiated
histopathology (p < 0.001), and ulcer presence (p Z 0.045).
- 8 Consensus of gastroesophageal reflux disease in Taiwan with endoscopy-based approach covered by National Health Insurance
Gastroesophageal reflux disease (GERD) is emerging as a clinical
complication in the Orient. The consensus comprises recommendations to GERD control under
the advantage of endoscopy-based approach covered by the Taiwan National Health Insurance.
Methods: The steering committee defined the consensus scope to cover diagnostic, therapeutic,
unresolved, controversial, or long-term proton pump inhibitor-related issues to GERD.
- 9 Well-trained and planned Preparation for endoscopic submucosal dissection for early gastric cancer
Doctor Hsieh et al [1] presented their experiences about
the outcome of endoscopic submucosal dissection (ESD) for
early gastric cancer and precancer lesion. In their report,
ESD was curative for gastric tumors in 73.9% and 8.93% with
local recurrence. Further analyzed, the cumulative local
recurrence rates were 5.3% in the curative resection group
and 56.7% in the noncurative resection group. The risk
factors that affect the noncurative resection include:
tumor location; deeper invasion; undifferentiated histopathology;
and ulcer presence.
