A 70-year-old man with portal hypertension, likely due to extrahepatic portal vein occlusion, was followed up by a family doctor. Esophagogastric varices were diagnosed by endoscopic examination and he was referred to our hospital for treatment of the varices. Although the esophageal varices decreased in volume after repeated courses of endoscopic injection sclerotherapy, massive hematemesis occurred from ruptured gastric varices. Endoscopic hemostasis was resistant for the gastric varices located in the cardia and fornix of the stomach. The dilated left gastric vein was primarily responsible for gastric varices. Percutaneous transhepatic transcatheter variceal embolization via the portal vein was considered to be difficult because of the marked tortuosity and stenosis of the portal trunk with cavernous transformation. The transileocolic obliteration (TIO) method was selected and conducted. After the procedures, a marked hemostatic effect was achieved. TIO is an effective and useful treatment for hemostasis of gastric varices, especially in patients with marked abnormalities of the portal trunk.
A 63-year-old man visited our hospital because of a positive fecal occult blood test during mass screening. Total colonoscopy was performed, and a lateral spreading tumor (LST) about 30 mm in size was found at the cecum. The tumor was treated with en bloc resection by endoscopic submucosal dissection (ESD) using a hook knife. Pathological findings revealed that the tumor was a well-differentiated adenocarcinoma in adenoma, limited to the mucosa. He left our hospital 3 days after ESD without complications, such as perforation or delayed bleeding. If we are familiar with the characteristics of the endo-knives and know the location of the lesion, we can safely and accurately perform ESD.
A 58-year-old man visited our hospital for follow-up of colonic polyps. Three years ago, colonoscopy demonstrated small erosions at the sigmoid colon and polyps at the descending colon. He has received an a-glucosidase inhibitor for diabetes mellitus for 3 years. Control of his diabetes was poor. Colonoscopy showed multiple elevated lesions similar to submucosal tumors in the rectum and sigmoid colon. Barium-enema study demonstrated the same findings. He was diagnosed with pneumatosis cystoides intestinalis. The α -glucosidase inhibitor was withdrawn because it was suspected to be related to the disorder.
A 46-year-old man demonstrated occult blood reaction in a stool sample on medical examination, and was later diagnosed with ulcerative colitis by colonoscopy. Histological examination of a biopsy specimen from the colon showed epithelioid cell granuloma. This case is presently considered to be suspected Crohn's disease or indeterminate colitis. The patient is currently being treated with 5-ASA, and remission has been maintained.
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