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A 54-year-old man presented with melena and was conservatively monitored for duodenitis. He developed epigastric pain, and dynamic computed tomography revealed abnormal blood flow in the pancreatic head. The endoscopic retrograde cholangiography revealed that the common bile and pancreatic ducts were simultaneously enhanced, thereby indicating the perforation of an arteriovenous malformation into both ducts. Despite medical treatment, the epigastric pain rapidly worsened and therefore, pancreatoduodenectomy was performed. The present report suggests that if the patient's general condition permits, surgical resection should be actively considered for the treatment of symptomatic pancreatic arteriovenous malformation.

A 63-year-old woman with abdominal pain was referred to our hospital. Her pancreatic enzymes were elevated, and an abdominal computed tomography (CT) scan showed an enlarged pancreas, consistent with pancreatitis, and gas collection containing an impacted stone adjacent to Vater's papilla. This finding raised the suspicion of a duodenal diverticulum. A subsequent ERCP showed a juxtapapillary duodenal diverticulum (JPDD) filled with calculi and pus. The pancreatitis improved with 2 weeks of conservative treatment. Subsequently, the patient underwent resection of the uterus and bilateral adnexa to remove a large ovarian cyst that was also identified on the admission CT scan. On the third postoperative day, she developed abdominal pain and vomiting. CT revealed small bowel obstruction caused by an enterolith expelled from JPDD. Enterotomy was performed to remove the stone. To our knowledge, only three similar cases have been previously reported in Japan.

We evaluated the clinicopathological features of patients who developed intestinal complications following surgery for gastrointestinal non-Hodgkin's lymphoma (NHL) and determined the risk factors for complications. We retrospectively analyzed 28 patients with gastrointestinal NHL who were treated at our institution between January 2007 and June 2012. Seven patients (25.0%) underwent surgery for bleeding, perforation, or ileus caused by the gastrointestinal NHL, particularly those with involvement of the jejunum or ileum. Half the patients with small intestinal NHL required surgery for complications; patients with this form of NHL were therefore considered to be at a high risk of complications. Those with semicircular ulcerative lesions, a protruding deformity, or systemic NHL involving the small intestine were also considered to be at a particularly high risk of intestinal complications.

A 63-year-old woman who presented with chest and back pain underwent an upper gastrointestinal endoscopy which revealed elevated legion in the antrum mucosa. Histologic examinations of gastric biopsies were showing monoclonal proliferation plasma cells containing Russell bodies. Differential diagnosis from B-cell lymphoma and plasmacytoma is difficult, because of monoclonality. Molecular analyses of immunoglobulin heavy chain (IgH) gene demonstrated that gene rearrangement was negative. Thus, diagnosis of Russell body gastritis was made. The Giemsa stains were also showing infection of Helicobacter pylori (H.pylori). After eradication therapy for H.pylori, follow-up upper gastrointestinal endoscopy was performed. She then recovered.

We report a case of diverticular form type of congenital choledochal dilatation with anomalous arrangement of pancreaticobiliary duct and bile duct stone. The patient was a 63-year-old woman with the chief complaint of epigastralgia. Abdominal CT showed low density area suggesting cystic lesion at the region of pancreatic head. MRCP and ERCP revealed dilatation of the common bile duct in the multiple diverticular form with anomalous arrangement of pancreaticobiliary duct. A 2.0cm sized stone was also recognized in the dilated common bile duct. The patient underwent resection of gall bladder and dilated common bile duct, followed by hepatico-jejunostomy. Histological findings did not revealed malignant changes in the mucosa of both gall bladder and dilated common bile duct.

A 68-years-old Japanese woman was hospitalized emergently because of hemorrhagic gastric ulcer. For the hospitalization period, elevated levels of white blood cell count, eosinophilic leucocyte count, serum IgE and positive MPO-ANCA were recognized. With considering clinical course and these laboratory findings, we diagnosed Churg-Strauss syndrome (CSS). Steroid therapy in combination with cyclophosphamide was effective. CSS is a rare disease, but we should discriminate this disease when we encounter gastrointestinal bleeding of unknown etiology, especially PPI-resistant gastric ulcer.

Acute gastric mucosal lesions in the rats were produced by intermittent electrical stimuli to a main trunk of the left gastric artery (LGA), right gastroepiploic artery (RGEA) or a posterior branch of the left gastric artery (PLGA). The image processing analysis was applied to determine the relation between distribution of the lesions and perfusion area of the supplying artery to which electrical stimuli were given. Electrical stimuli of 50 Hz, 5 msec, 100 microA was supplied to the artery for 30 sc three times with 10 sec interval. A series of these stimuli was repeated three times. The mucosal blood flow measured with the laser doppler method in each perfusion area was reduced to less than 35% of the control value during the electrical stimuli for 30 sec. After the repeated electrical stimuli to LGA, 85.8 and 95.4% of the mucosal lesions were found in the mean and maximum perfusion area of LGA, respectively. Electrical stimuli to PLGA caused 84.5% and 95.3 of the lesions in the mean and maximum area of PLGA, respectively. Stimuli to RGEA caused 53.4% and 74.1% of the lesions in the mean and maximum perfusion area of RGEA. In the antrum, electrical stimuli to LGA, PLGA or RGEA produced 0%, 5.4% or 5.0% of the mucosal lesions. It is concluded that the corpus mucosal lesions induced by regional ischemia are distributed in the ischemic area.