A 83-year-old woman complaining of right hypochondralgia was transferred to our hospital for further examination from her home doctor. Investigations revealed leucocytosis, elevation of hepatobiliary enzymes, CRP and CA19-9. Abdominal US revealed heterogeneous hyperechoic mass with hypoechoic lesions and stone with acoustic shadow in the neck of the gallbladder. Abdominal CT scans showing hypovascular area in the thickening gallbladder wall and suspect of infiltrating to the duodenum. Endoscopic findings revealed edematous mucosa and stenosis of duodenum, with partially yellowish mucosa. Operation was performed under the diagnosis of gallbladder cancer infiltrating to the duodenum. The gallbladder appeared extensive adhesions was found to such adjacent organs as liver and duodenum. Diagnosis was gallbladder cancer invasion to the liver and duodenum based on operative findings. Cholecystectomy with partial hepatic resection of the gallbladder bed and a partial resection of the duodenum was done. Surgical specimen revealed marked thickened yellowish wall, the stone was impacted in the neck and made fistula to the duodenum. Histopathological findings revealed foamy histiocytes, inflammatory cells in the thickened gallbladder wall. Xanthogranulomatous cholecystitis was diagnosed. When we observed yellowish mucosa of the duodenum in GFS, xanthogranulomatous cholecystitis must be considered as one of diffential diagnosis.
A 76-year-old female was diagnosed as having adenomas of main papilla, minor papilla and third portion of the duodenum. She was received subtotal colectomy for familial adenomatous polyposis at 41-year-old. Endoscopic retrograde cholangiopancreatogrphy showed stenosis of lower common bile duct and pancreas divism. At first, we resected adenoma of major papilla and inserted plastic tube stent in the common bile duct. Next week, we resected adenomas of minor papilla and third portion of the duodenum. We tried to insert a plastic tube stent in Santorini duct for avoid pancreatitis but we could not. Mild pancreatitis was occurred but improved conservative therapy. Microscopic finding of resected specimens showed moderately dysplastic adenoma, respectively. We experienced rare case of endoscopic resection of adenomas of major and minor papilla in a patient with familial polyposis and pancreas divism.
The palisade vessels present at the distal end of the esophagus are considered to be a landmark of the esophagogastric junction and indispensable for diagnosis of columnar-lined esophagus on the basis of the Japanese criteria. Here we clarified the features of normal palisade vessels at the esophagogastric junction using magnifying endoscopy. We prospectively studied palisade vessels in 15 patients undergoing upper gastrointestinal endoscopy using a GIF-H260Z instrument (Olympus Medical Systems Co., Tokyo, Japan). All views of the palisade vessels were obtained at the maximum magnification power in the narrow band imaging mode. We divided the area in which palisade vessels were present into three sections: the area from the squamocolumnar junction (SCJ) to about 1 cm orad within the esophagus (Section 1); the area between sections 1 and 3 (Section 2); and the area from the upper limit of the palisade vessels to about 1 cm distal within the esophagus (Section 3). In each section, we analyzed the vessel density, caliber of the palisade vessels, and their branching pattern. The vessel density in Sections 1, 2, and 3 was 9.1 ± 2.1, 8.0 ± 2.6, and 3.3 ± 1.3 per high-power field (mean ± standard deviation [SD]), respectively, and the differences were significant between Sections 1 and 2 (P= 0.0086) and between Sections 2 and 3 (P < 0.0001). The palisade vessel caliber in Sections 1, 2, and 3 was 127.6 ± 52.4 µm, 149.6 ± 58.6 µm, and 199.5 ± 75.1 µm (mean ± SD), respectively, and the differences between Sections 1 and 2, and between Sections 2 and 3, were significant (P < 0.0001). With regard to branching form, the frequency of branching was highest in Section 1, and the 'normal Y' shape was observed more frequently than in Sections 2 and 3. Toward the oral side, the frequency of branching diminished, and the frequency of the 'upside down Y' shape increased. The differences in branching form were significant among the three sections (P < 0.0001). These results indicate that the density of palisade vessels is highest near the SCJ, and that towards their upper limit they gradually become more confluent and show an increase of thickness. Within a limited area near the SCJ, observations of branching form suggest that palisade vessels merge abruptly on the distal side. We have demonstrated that palisade vessels are a useful marker for endoscopic recognition of the lower esophagus.
Pneumatosis cystoides intestinalis (PCI) is a rare intestinal condition that is characterized by the presence of gaseous cysts within the intestinal wall. We herein report a case of PCI after treatment with mitiglinide/voglibose. A 74-year-old man had diabetes mellitus for 7 years, and was being treated with mitiglinide/voglibose since 5 years and 5 months. Recently, after he complained about constipation, further examination was performed. Colonoscopic examination revealed multiple elevated lesions with smooth surface-like submucosal tumor in the sigmoid colon. Histopathological findings demonstrated fissure-like cavities and granuloma with multinuclear foreign body giant cell. Computed tomography showed multiple cystic lesions in the colonic wall of the sigmoid colon. We diagnosed PCI, and discontinued treatment with mitiglinide/voglibose. Two months later, he was retreated with only mitiglinide. Four months later, colonoscopic examination revealed elimination of elevated lesions.
