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 The α -glucosidase inhibitor was withdrawn because it was suspected to be related to the disorder.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.
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.
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