Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding.
Background/Aims: Colorectal cancer (CRC) is one of the major causes of death and poses a major public health concern.The National CRC Screening Programme (NCSP) provides annual CRC screening using a fecal occult blood test for individuals ＞50 years of age since 2004.The purpose of the current study was to determine the outcomes and efficacy of a fecal immunochemical test (FIT) based on the NCSP in a quality-controlled university hospital setting.Methods: We retrospectively reviewed the medical records and a standardized questionnaire from the NCSP of 3,852 individuals who underwent a FIT between March and December 2009.All of the subjects submitted a stool specimen for a FIT, while a double-contrast barium enema or colonoscopy was performed as a confirmatory examination for FIT-positive individuals.The CRC screening rate and rate of detection colorectal adenomas, advanced adenomas, and colorectal cancers by FIT were evaluated.Results: The CRC screening rate with FIT was very high (72.3%),but the positive rate of detection by FIT was only 1.3%.The rate of detection for colorectal cancers, adenomas, and advanced adenomas by FIT was 0.08%, 0.39%, and 0.13%, respectively.The quantitative values of FIT in individuals with colorectal adenomas and cancers were significantly higher than other colorectal diseases.Men (P=0.001) and elderly individuals (P=0.039) were significantly more common in the FIT-positive group than the FIT-negative group.Approximately 28% of the subjects with FIT-positive tests did not receive a confirmatory examination.Conclusions: Although the FIT had a low rate of detection, the FIT was a useful screening tool for detection of CRC in the NCSP.It will be important to increase CRC screening rates and confirmatory examination rates.
A 75-year-old man attended our hospital for replacement of a percutaneous endoscopic gastrostomy (PEG) tube. He had originally undergone PEG tube placement at our hospital 2 years ago, and after insertion the position of the hub had been checked by gastroscopy. However, placement of the most recent PEG tube had been done at another hospital 1 year ago, with no gastroscopic evaluation. When the patient attended our hospital 1 year later for replacement of the PEG tube, we could not find its hub in the stomach on gastroscopy. Instead, a scar was detected at the previous gastrostomy site. A nonenhanced abdominal computed tomography (CT) scan taken to check the location of the PEG tube revealed that it had been inserted into the small intestine ([Fig. 1 a, b]).
Recent consensus guidelines suggest that the laparoscopic approach may be a useful, safe and feasible approach in emergency general surgery. Despite this, the UK National Emergency Laparotomy Audit (NELA) suggests the rate of laparoscopy is low (9% fully laparoscopic) and slow to increase over time. A European survey found uptake to be variable. This UK survey was therefore undertaken to establish current UK practice and to determine factors affecting implementation.A questionnaire survey of currently practising UK consultant general surgeons was carried out by the North West Surgical Research Collaborative, using a secure web-based database maintained by the North West Surgical Trials Centre.A total of 151 completed questionnaires were returned from 22 UK centres; 18% of respondents were unaware that laparoscopic cases should be reported to NELA. Appendicectomy (97%) and cholecystectomy (87%) were routinely performed laparoscopically. Laparoscopy was infrequently used in perforation, ischaemia or obstructed hernias. There appears to be equipoise regarding laparoscopic compared with open surgery in small-bowel obstruction among all subspecialty emergency general surgeons, in perforated peptic ulcer among upper gastrointestinal surgeons and in Hinchey III diverticulitis among colorectal surgeons.Uptake of laparoscopy in UK emergency general surgery is influenced by surgeon preference, subspecialty, patient and operative factors. Further research into outcomes may help to identify areas of greatest potential benefit. The rate of laparoscopy reported by NELA may be an underestimate due to the 18% of surgeons unaware that laparoscopic cases should be reported, which may affect the validity of analyses performed from this dataset.
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