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Sigmoidorectal intussusception
At the Focal Point...
ducts with a spindle-shaped filling defect in the left intrahepatic duct (A, arrow) small filling defects in the distal bile duct (A, arrowhead), and multiple filling defects in the gallbladder (A, big arrow). A worm was seen to escape from the bile duct after injection of contrast medium (B). Endoscopic sphincterotomy was performed, and black stones were extracted from the bile duct with a Dormia basket (C). Microscopic examination of a bile specimen revealed ova of Clonorchis sinensis (D, orig. mag. 3600). The patient was treated with a course of praziquantel and underwent laparo-
scopic cholecystectomy 2 days after endoscopic sphincterotomy. Kwok-Hung Lai, MD Chao-Ming Wu, MD Ching-Chu Lo, MD Gin-Ho Lo, MD Department of Internal Medicine Kaohsiung Veterans General Hospital School of Medicine National Yang-Ming University Kaohsiung, Taiwan PII: S0016-5107(03)02293-4
SIGMOIDORECTAL INTUSSUSCEPTION
A 78-year-old man presented with 3 episodes of severe constipation/obstipation over the previous 6 weeks, with associated tenesmus, lower abdominal pain, and the intermittent sensation of rectal pressure, which resolved with ambulation and manual pressure. Examination revealed a patulous anal sphincter and oozing of blood from the rectum. On
VOLUME 59, NO. 1, 2004
digital rectal examination, there was a soft, mobile circumferential mass. Sigmoidoscopy revealed a large, friable, and hemorrhagic mass that occupied the entire rectum (A). The sigmoidoscope could be passed proximally between normal colonic wall (B, black arrow) and boggy, erythematous colonic wall (B, white arrow) to 20 cm from the anal verge. CT
GASTROINTESTINAL ENDOSCOPY
79
At the Focal Point...
demonstrated a tubular structure in the distal sigmoid colon that contained multiple linear densities, as well as low attenuation areas consistent with fat (C, arrow). At surgery, a 15-cm intussusception involving the distal sigmoid colon and the entire rectum was found, and a low anterior resection was performed. The gross specimen included a 5.7-cm mass (D, white arrow) with extensive adjacent mucosal necrosis, hemorrhage, and ischemic changes (D, black arrows). Histopathologically, the mass was
a tubulovillous adenoma with focal high-grade dysplasia. David J. Kaufman, DO Marcella Bradway, MD Pars P. Ravichandran, MD Andrew Bedford, MD Departments of Medicine, Surgery, and Pathology Bridgeport Hospital Bridgeport, Connecticut PII: S0016-5107(03)02354-X
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GASTROINTESTINAL ENDOSCOPY
VOLUME 59, NO. 1, 2004
ducts with a spindle-shaped filling defect in the left intrahepatic duct (A, arrow) small filling defects in the distal bile duct (A, arrowhead), and multiple filling defects in the gallbladder (A, big arrow). A worm was seen to escape from the bile duct after injection of contrast medium (B). Endoscopic sphincterotomy was performed, and black stones were extracted from the bile duct with a Dormia basket (C). Microscopic examination of a bile specimen revealed ova of Clonorchis sinensis (D, orig. mag. 3600). The patient was treated with a course of praziquantel and underwent laparo-
scopic cholecystectomy 2 days after endoscopic sphincterotomy. Kwok-Hung Lai, MD Chao-Ming Wu, MD Ching-Chu Lo, MD Gin-Ho Lo, MD Department of Internal Medicine Kaohsiung Veterans General Hospital School of Medicine National Yang-Ming University Kaohsiung, Taiwan PII: S0016-5107(03)02293-4
SIGMOIDORECTAL INTUSSUSCEPTION
A 78-year-old man presented with 3 episodes of severe constipation/obstipation over the previous 6 weeks, with associated tenesmus, lower abdominal pain, and the intermittent sensation of rectal pressure, which resolved with ambulation and manual pressure. Examination revealed a patulous anal sphincter and oozing of blood from the rectum. On
VOLUME 59, NO. 1, 2004
digital rectal examination, there was a soft, mobile circumferential mass. Sigmoidoscopy revealed a large, friable, and hemorrhagic mass that occupied the entire rectum (A). The sigmoidoscope could be passed proximally between normal colonic wall (B, black arrow) and boggy, erythematous colonic wall (B, white arrow) to 20 cm from the anal verge. CT
GASTROINTESTINAL ENDOSCOPY
79
At the Focal Point...
demonstrated a tubular structure in the distal sigmoid colon that contained multiple linear densities, as well as low attenuation areas consistent with fat (C, arrow). At surgery, a 15-cm intussusception involving the distal sigmoid colon and the entire rectum was found, and a low anterior resection was performed. The gross specimen included a 5.7-cm mass (D, white arrow) with extensive adjacent mucosal necrosis, hemorrhage, and ischemic changes (D, black arrows). Histopathologically, the mass was
a tubulovillous adenoma with focal high-grade dysplasia. David J. Kaufman, DO Marcella Bradway, MD Pars P. Ravichandran, MD Andrew Bedford, MD Departments of Medicine, Surgery, and Pathology Bridgeport Hospital Bridgeport, Connecticut PII: S0016-5107(03)02354-X
Receive table of contents by e-mail To receive tables of contents by e-mail, sign up through our Web site at http://www.mosby.com/gie. Choose E-mail Notification. Simply type your e-mail address in the box and click the Subscribe button. Alternatively, you may send an e-mail message to [email protected]. Leave the subject line blank and type the following as the body of your message: subscribe gie.toc. You will receive an e-mail message confirming that you have been added to the mailing list. Note that tables of contents e-mails will be sent out when a new issue is posted to the Web site.
80
GASTROINTESTINAL ENDOSCOPY
VOLUME 59, NO. 1, 2004