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Endoscopic treatment of a giant sigmoid cavernous hemangioma: case report
2580
Abstracts
with surgical G and J- tube. Histopathology showed evidence of ischemic necrosis in the esophagus without any evidence of infectious etiology. His post-operative course continued to be complicated and he died one month following surgery with multi-organ failure. Conclusions: Acute esophageal necrosis with spontaneous esophageal perforation is a rare complication following heat stroke. The pathogenesis of this complication may be related to stress and ischemia involved during this condition. 579 A rare case report of hemochromatosis in an African-American female Jain Hitender, Albornoz MA, Collazo J, Greenblatt JM, Draganescu JM, Mathews Mathew*. Mercy Catholic Medical Center, Darby, PA-19023, United States. Purpose: Introduction: Hemochromatosis is an autosomal recessive disorder often thought to be restricted to the Caucasian population. It has rarely been reported in the African-American population. We present a case of hemochromatosis in an African-American female who presented with abdominal pain. Results: Case: A 42 year old African-American female with past medical history of hypertension, diabetes and pancreatitis presented with a two weeks history of intermittent severe sharp epigastric pain radiating to her back. Other symptoms included nausea and vomiting, arthralgias of hand and knee joints, anxiety, loss of libido, and secondary ammenorrhoea (for last 6 years). On physical examination she had icterus, mild pallor and hepatomegaly. Initial laboratory data showed hemoglobin 11.8 and platelet count 107,000. BUN / Creatinine, electrolytes, B12, folate, PT/PTT, amylase, lipase were with in normal range. Liver function tests were AST 302, ALT 120, Alkaline phosphatase 383 and total/direct bilirubin to be 5.5/3.4 respectively. HIV serology and hepatitis panel was negative. ANA was ⬍1:40, and sedimentation rate was 20. Her thyroid function studies revealed primary hypothyroidism (TSH 11.3). CT scan abdomen showed fatty infiltration of liver. Iron studies were Serum iron 118, TIBC 136, percentage saturation of 87% and a Serum ferritin of 1308. Liver biopsy demonstrated moderate steatosis, stage II fibrosis, and 3⫹ iron stores. Liver iron studies showed Hepatic iron of 5280 g/gm dry weight of liver (normal range being 300 –1400g/g) and a hepatic iron index of 2.3 (normal⬍1.0). Conclusions: Discussion: Most common symptom at presentation is abdominal pain which is thought to be due to release of vasoactive substances like iron from the liver. Hepatic iron index of ⬎2.0 on liver biopsy is diagnostic of this condition. Hemochromatosis is usually considered to be a disorder restricted to the Caucasian population. It is because of this common belief that it is rarely suspected and diagnosed in the AfricanAmerican patients with few case reports in literature. Even though there is no available data regarding the incidence of this condition in AfricanAmerican population, a recently published screening trial in the US population showed similar incidence of raised serum transferrin saturation both in the African-American and the Caucasian population. This trial and our case report strongly point to the need for a heightened awareness among medical professionals of the possibility of hemochromatosis in the AfricanAmerican population. 580 Colo-colonic intussusception from adenocarcinoma in an elderly patient with previously undiagnosed mobile cecum syndrome Jones David P Shaffer Richard T.* SAUSHEC, San Antonio, Texas, United States. Purpose: Intussusception rarely causes colonic obstruction in adults (⬍1%). Ninty percent have and identifiable lead point and 50%– 60% are neoplastic. The presenting symptoms are often non-specific and the majority of adult intussusceptions go undiagnosed until exploratory laparotomy. The treatment is primarily surgical and there is little role for hydro-
AJG – Vol. 95, No. 9, 2000
static or endoscopic reduction prior to surgery in adults. A congenital mobile cecum occurs early in embryonic development when the colonic mesentery fails to fuse and secure the ascending colon into its usual retroperitoneal location. Methods: We describe an otherwise healthy 84 year-old female that complained of five days of non-radiating, crampy, lower abdominal discomfort along with nausea and vomiting. Physical examination was only remarkable for a large, moderatly tender, intra-abdominal mass. Results: Laboratory evaluation indicated only an iron deficiency anemia. An abdominal CT scan identified a targetiod lesion with intra-luminal vasculature and mesentery in the lower middle abdomen. A 2 cm periappendiceal mass (poorly-differentiated adenocarcinoma) was identified as the lead point intra-operatively and a right hemicolectomy performed. The intussesceptum extended all the way to the splenic flexure secondary to the lack of securing fascia overlying the ascending colon. Conclusions: We present a rare and unusual case of a colo-colonic intussusception caused by a peri-appendiceal adenocarcinoma related to an undiagnosed mobile cecum syndrome. 581 Endoscopic treatment of a giant sigmoid cavernous hemangioma: Case report da Silva Edson Jurado, M.D., FACG, Câmara Marcelo, M.D., de Almeida Eleodoro Carlos, M.D. Proctology Department Hospital dos Servidores de Estado do Rio de Janeiro (HSE-RJ)-Brazil. We report here an unusual form of endoscopic therapy for a giant (12 cm in diameter) sigmoid cavernous hemangioma that caused chronic lower G.I. bleeding in a 58-year-old man with diabetes, cardiovascular disease and osteomyelitis sequelae in the left lower limb, secondary to an automobile accident. Sclerotherapy was performed with an Endo-Flex injector device with a 7mm long needle introduced through the instrumental channel of a Fujinon videocolonoscope. The procedure was performed under light sedation with venous meperidine and midazolan. We injected 17 ml of absolute alcohol into the middle of the tumor, that became dark and drizzled. At the end of the procedure a tube was left inside the colon just above the lesion to prevent abdominal distention, and the patient was admitted to the hospital. He had an uneventful recovery and was discharged from the hospital in 3 days. Follow-up examination 1 and 2 years later disclosed an asymptomatic patient with only small residual tumor at endoscopy. Conclusion: For patients at high risk for surgery, endoscopic sclerotherapy of sigmoid hemangiomas with absolute alcohol could be a good treatment alternative. 582 Primary neutrophil-rich, CD30-positive anaplastic large cell lymphoma of the stomach cured by combined chemotherapy Kahaleh Michel, Hermans Philippe, Buset Michel, Dargent Jean-Louis*. CHU Saint Pierre, Brussels, Belgium. Purpose: To determine the natural history as well as the optimal treatment of primary Ki-1 (CD30)-positive anaplastic large cell lymphoma (ALCL) of the stomach. Methods: We recently experienced a case of neutrophil-rich CD30-positive ALCL primarly involving the stomach. The pathological as well as the clinical features found in this patient were compared to those described in the rare reported cases. Using a computer-based Medline search, all cases described as primary Ki-1 (CD-30)-positive T-cell lymphoma of the stomach were recorded and their pathological as well as their clinical features analyzed. In addition, data regarding the various therapeutic regimens were also recorded. Results: A 45-year-old man from Angola complaining of epigastric pain and weight loss underwent a gastroscopy, which showed an ulcerated mass involving the fundus. Microscopic examination of the biopsies revealed a tumoral process, made of large and clear lymphoid cells admixed with a
Abstracts
with surgical G and J- tube. Histopathology showed evidence of ischemic necrosis in the esophagus without any evidence of infectious etiology. His post-operative course continued to be complicated and he died one month following surgery with multi-organ failure. Conclusions: Acute esophageal necrosis with spontaneous esophageal perforation is a rare complication following heat stroke. The pathogenesis of this complication may be related to stress and ischemia involved during this condition. 579 A rare case report of hemochromatosis in an African-American female Jain Hitender, Albornoz MA, Collazo J, Greenblatt JM, Draganescu JM, Mathews Mathew*. Mercy Catholic Medical Center, Darby, PA-19023, United States. Purpose: Introduction: Hemochromatosis is an autosomal recessive disorder often thought to be restricted to the Caucasian population. It has rarely been reported in the African-American population. We present a case of hemochromatosis in an African-American female who presented with abdominal pain. Results: Case: A 42 year old African-American female with past medical history of hypertension, diabetes and pancreatitis presented with a two weeks history of intermittent severe sharp epigastric pain radiating to her back. Other symptoms included nausea and vomiting, arthralgias of hand and knee joints, anxiety, loss of libido, and secondary ammenorrhoea (for last 6 years). On physical examination she had icterus, mild pallor and hepatomegaly. Initial laboratory data showed hemoglobin 11.8 and platelet count 107,000. BUN / Creatinine, electrolytes, B12, folate, PT/PTT, amylase, lipase were with in normal range. Liver function tests were AST 302, ALT 120, Alkaline phosphatase 383 and total/direct bilirubin to be 5.5/3.4 respectively. HIV serology and hepatitis panel was negative. ANA was ⬍1:40, and sedimentation rate was 20. Her thyroid function studies revealed primary hypothyroidism (TSH 11.3). CT scan abdomen showed fatty infiltration of liver. Iron studies were Serum iron 118, TIBC 136, percentage saturation of 87% and a Serum ferritin of 1308. Liver biopsy demonstrated moderate steatosis, stage II fibrosis, and 3⫹ iron stores. Liver iron studies showed Hepatic iron of 5280 g/gm dry weight of liver (normal range being 300 –1400g/g) and a hepatic iron index of 2.3 (normal⬍1.0). Conclusions: Discussion: Most common symptom at presentation is abdominal pain which is thought to be due to release of vasoactive substances like iron from the liver. Hepatic iron index of ⬎2.0 on liver biopsy is diagnostic of this condition. Hemochromatosis is usually considered to be a disorder restricted to the Caucasian population. It is because of this common belief that it is rarely suspected and diagnosed in the AfricanAmerican patients with few case reports in literature. Even though there is no available data regarding the incidence of this condition in AfricanAmerican population, a recently published screening trial in the US population showed similar incidence of raised serum transferrin saturation both in the African-American and the Caucasian population. This trial and our case report strongly point to the need for a heightened awareness among medical professionals of the possibility of hemochromatosis in the AfricanAmerican population. 580 Colo-colonic intussusception from adenocarcinoma in an elderly patient with previously undiagnosed mobile cecum syndrome Jones David P Shaffer Richard T.* SAUSHEC, San Antonio, Texas, United States. Purpose: Intussusception rarely causes colonic obstruction in adults (⬍1%). Ninty percent have and identifiable lead point and 50%– 60% are neoplastic. The presenting symptoms are often non-specific and the majority of adult intussusceptions go undiagnosed until exploratory laparotomy. The treatment is primarily surgical and there is little role for hydro-
AJG – Vol. 95, No. 9, 2000
static or endoscopic reduction prior to surgery in adults. A congenital mobile cecum occurs early in embryonic development when the colonic mesentery fails to fuse and secure the ascending colon into its usual retroperitoneal location. Methods: We describe an otherwise healthy 84 year-old female that complained of five days of non-radiating, crampy, lower abdominal discomfort along with nausea and vomiting. Physical examination was only remarkable for a large, moderatly tender, intra-abdominal mass. Results: Laboratory evaluation indicated only an iron deficiency anemia. An abdominal CT scan identified a targetiod lesion with intra-luminal vasculature and mesentery in the lower middle abdomen. A 2 cm periappendiceal mass (poorly-differentiated adenocarcinoma) was identified as the lead point intra-operatively and a right hemicolectomy performed. The intussesceptum extended all the way to the splenic flexure secondary to the lack of securing fascia overlying the ascending colon. Conclusions: We present a rare and unusual case of a colo-colonic intussusception caused by a peri-appendiceal adenocarcinoma related to an undiagnosed mobile cecum syndrome. 581 Endoscopic treatment of a giant sigmoid cavernous hemangioma: Case report da Silva Edson Jurado, M.D., FACG, Câmara Marcelo, M.D., de Almeida Eleodoro Carlos, M.D. Proctology Department Hospital dos Servidores de Estado do Rio de Janeiro (HSE-RJ)-Brazil. We report here an unusual form of endoscopic therapy for a giant (12 cm in diameter) sigmoid cavernous hemangioma that caused chronic lower G.I. bleeding in a 58-year-old man with diabetes, cardiovascular disease and osteomyelitis sequelae in the left lower limb, secondary to an automobile accident. Sclerotherapy was performed with an Endo-Flex injector device with a 7mm long needle introduced through the instrumental channel of a Fujinon videocolonoscope. The procedure was performed under light sedation with venous meperidine and midazolan. We injected 17 ml of absolute alcohol into the middle of the tumor, that became dark and drizzled. At the end of the procedure a tube was left inside the colon just above the lesion to prevent abdominal distention, and the patient was admitted to the hospital. He had an uneventful recovery and was discharged from the hospital in 3 days. Follow-up examination 1 and 2 years later disclosed an asymptomatic patient with only small residual tumor at endoscopy. Conclusion: For patients at high risk for surgery, endoscopic sclerotherapy of sigmoid hemangiomas with absolute alcohol could be a good treatment alternative. 582 Primary neutrophil-rich, CD30-positive anaplastic large cell lymphoma of the stomach cured by combined chemotherapy Kahaleh Michel, Hermans Philippe, Buset Michel, Dargent Jean-Louis*. CHU Saint Pierre, Brussels, Belgium. Purpose: To determine the natural history as well as the optimal treatment of primary Ki-1 (CD30)-positive anaplastic large cell lymphoma (ALCL) of the stomach. Methods: We recently experienced a case of neutrophil-rich CD30-positive ALCL primarly involving the stomach. The pathological as well as the clinical features found in this patient were compared to those described in the rare reported cases. Using a computer-based Medline search, all cases described as primary Ki-1 (CD-30)-positive T-cell lymphoma of the stomach were recorded and their pathological as well as their clinical features analyzed. In addition, data regarding the various therapeutic regimens were also recorded. Results: A 45-year-old man from Angola complaining of epigastric pain and weight loss underwent a gastroscopy, which showed an ulcerated mass involving the fundus. Microscopic examination of the biopsies revealed a tumoral process, made of large and clear lymphoid cells admixed with a