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Solitary fibrous tumor is neoplasm of mesenchymal origin commonly involving visceral pleura however we are presenting an unusual case with involvement of urinary bladder. It is generally indolent in nature therefore proper diagnosis is required for complete characterization to avoid unnecessary extensive surgical resection. Our patient was a 64-year-old female who presented with lower abdominal fullness with change in her bowel movement pattern. On imaging partially necrotic mass with heterogenous enhancement was found which was later biopsied and resected with clean surgical margin. Solitary fibrous tumor is overall a benign tumor with satisfactory outcome. Physicians should keep it in a differential of pelvic masses and with the risk recurrence, 6 monthly follow up imaging are usually required after resection.

Background. While evaluating a child with multicystic liver pathology, both the congenital and acquired etiologies need to be considered. While typicality of findings on abdominal imaging makes the diagnosis of cystic echinococcosis relatively easy, choosing the appropriate line of management is equally crucial. Case Presentation. An 8-year-old previously healthy lad presented to the office with progressive upper abdominal fullness and pain for a year. Blood workup was normal. CT imaging made a diagnosis of multicystic giant hepatic hydatidosis. Treatment consisting of oral albendazole combined with surgical excision resulted in a fruitful outcome. To the best of our knowledge, this probably represents the first case of multiple giant hepatic hydatidosis at such a young age being reported from Nepal. Conclusion. Childhood liver cysts are uncommon. Considering the endemicity, echinococcal etiology needs consideration. Surgical ablation is required for large cysts, and the mode of management is dictated by the size and location.

Functional dyspepsia (FD) is a common disease that can markedly impair quality of life. In the 2016 Rome IV criteria, a diagnosis of FD requires the presence of bothersome FD symptoms. In 2009, a new diagnosis, early chronic pancreatitis (ECP), was proposed as a means to facilitate early treatment of chronic pancreatitis and prevent progression to chronic pancreatitis. Although chronic pancreatitis was reported to be a cause of dyspepsia, data on the relation between ECP and FD patients are limited. We therefore investigated differences between ECP patients and FD patients in the percentages of those with severe epigastric pain, early satiety, and postprandial abdominal fullness. Several studies reported an association between the cause of chronic pancreatitis and endosonographic features. In addition, endosonography was useful for distinguishing ECP patients from FD patients with pancreatic enzyme abnormalities. Thus, we compared endosonographic characteristics in these patient groups. Future studies should attempt to determine why selected FD patients with pancreatic enzyme abnormalities develop ECP.

Thoughts and emotions triggered by stress can have an effect on stomach and bowel movement. Physical signs and symptoms of stress overload include chest pain, rapid heartbeat, loss of sexual drive, diarrhoea/ constipation. In this article we have tried to enlighten the association of stress and constipation. The mainly observed clinical features of Vibandha are Hard Stools, Excessive Straining, Sense of Incomplete Evacuation, Flatulence and Lower Abdominal Fullness. The stress hormone may contribute to constipation.

Gastroparesis is a chronic condition characterized by delayed gastric emptying in the absence of mechanical obstruction, which results in typical symptoms of nausea, vomiting, abdominal fullness, early satiation, bloating, distention and upper abdominal pain. While gastric emptying scintigraphy (GES) is the most commonly ordered test for diagnosis of gastroparesis, wireless motility capsule (WMC) can measure transit and pressure parameters throughout the entire gastrointestinal tract. As gastroparesis frequently presents with co-existing upper and lower gastrointestinal symptoms, this ability to monitor the entire GI tract may provide additional diagnostic information with the potential to identify important subgroups of patients, influence clinical decision making and potentially reduce or eliminate additional diagnostic testing.

Background There are no previous reports of debulking of giant liver hemangioma. This report describes our experience with debulking surgery for a patient with bilateral giant liver hemangiomas with severe symptoms. Case presentation We present a case of symptomatic giant liver hemangioma in a 41-year-old woman. She presented with abdominal pain and fullness at a local hospital and underwent trans-arterial embolization (TAE). TAE was not effective, and she was not able to walk a long distance. Giant liver hemangiomas, 30 cm and 15 cm in diameter, were located in the right liver and in the left lateral section, respectively, and normal liver parenchyma with tiny liver hemangiomas was present in segment 4. The liver function was normal. However, right hemi-hepatectomy with left lateral sectionectomy was considered to be risky according to the 3DCT volumetry. Therefore, we performed right hemi-hepatectomy in order to reduce her symptoms. The postoperative course was uneventful, and she was discharged on the 14th day after surgery. The abdominal fullness and abdominal pain disappeared immediately after surgery. The hemangiomas in the remnant liver, 15 cm in diameter, showed no change, and she is well without symptoms 7 years after surgery. Conclusions Debulking surgery is one of the options for bilateral giant liver hemangiomas with severe symptoms.

Two patients with tuberous sclerosis complex each had multiple bilateral renal angiomyolipomas. After undergoing embolization for a ruptured angiomyolipoma, patient 1 experienced long-lasting abdominal fullness; contrast-enhanced computed tomography (CECT) revealed a large chronic hematoma without contrast extravasation. Patient 2 underwent embolization for the largest right renal angiomyolipoma which contained a chronic hematoma. 2 weeks later, the symptom of abdominal fullness presented, and CECT revealed that the preexisting hematoma had enlarged without contrast extravasation. In both cases, a second embolization of the angiomyolipomas resulted in shrinking of the intratumoral hematomas and alleviation of the associated symptoms. Therefore, chronic postembolization intratumoral bleeding from renal angiomyolipoma may present as a persistently large or growing hematoma with an associated symptom of abdominal fullness but without the typical CECT feature of active extravasation.

Primary retroperitoneal non Hodgkin lymphoma is extremely rare, its diagnosis is often difficult and it may requires a time consuming and a costly diagnostic workup. We report the case of a 46-year-old patient complaining of abdominal fullness and dorsal pain, who was diagnosed with an extra-nodal non-Hodgkin lymphoma presenting as a unique and large retroperitoneal mass. The suggested diagnosis was a malignant retroperitoneal tumor and the patient underwent an excision of the tumor throw a lombotomy followed by an R-CHOP chemotherapy regimen with good outcome. Keywords: Lymphoma, Large B-cell lymphoma, Diffuse lymphoma, Retroperitoneal extra-adrenal mass

Small cell carcinoma of the ovary, hypercalcemic type, is a rare undifferentiated carcinoma which characteristically presents in women over 40 years of age with abdominal fullness, unilateral tumor, and hypercalcemia.[1][1] It is an aggressive cancer with a poor prognosis (

An 82-year-old Japanese man visited our hospital with abdominal fullness accompanied by lower abdominal pain. He presented with small bowel obstruction due to multiple diospyrobezoars. The bezoars were successfully removed without any surgical intervention by the administration of Coca-Cola Zero through a long intestinal tube and subsequent endoscopic manipulation. Such a combination may be the treatment of choice for small bowel obstruction due to bezoars.

A 44-year-old Japanese woman with autosomal dominant polycystic kidney disease was admitted to our hospital for evaluation of abdominal distension. Her eGFR was 53.7 mL/min/1.73 m2. Total kidney volume was 2,614 mL. Tolvaptan (60 mg/day) was started to treat renal involvement. The patient’s abdominal fullness began to improve and liver volume, indicating advanced polycystic liver disease (PLD), decreased from 9,750 mL to 8,345 mL after 17 months of tolvaptan treatment, though there was no significant change in kidney volume. This case indicates that tolvaptan may be a therapeutic option for hepatomegaly in patients with symptomatic PLD.

Ethnopharmacological relevance Aucklandiae Radix (AR) and Vladimiriae Radix (VR), as traditional Chinese medicine, have been included in many editions of Chinese Pharmacopoeia with similar efficacy such as promoting qi and relieving pain, which are used to treat chest, hypochondriac, abdominal fullness and pain, diarrhea and tenesmus. In most conditions, VR is used to be a substitute of AR or a local habit. However, whether VR could substitute for AR to play a same role in the formulation and clinical applications needs further study. Aim of the study In this study, similarities and differences between AR and VR would be assessed, and possible reasons that may influence the efficacy of the AR and VR would be explained from the perspective of chemical composition. Materials and methods HPLC-PDA was used to obtain the data of 10 batches of AR and VR, and to establish chemical fingerprint and chemometric analysis. UPLC-ESI-Q-TOF-MS was used to identify the structure of chemical compounds which contributed to the differences between AR and VR. Results The chemical fingerprint analysis results showed that 20 peaks in common for AR and 26 peaks in common for VR both presented a good similarity (>0.9), and 15 peaks in common for AR and VR also showed a good similarity (>0.9). Nevertheless, chemometric showed AR was distinct from VR and three chemical compounds, which leading to their differences, were identified by UPLC-ESI-Q-TOF-MS. The three chemical compounds were 3β-acetoxy-11β-guaia-4 (15),10 (14)-diene-12,6α-olide, 10α,14-epoxy-11β-guaia-4 (15)-ene-12,6α-olide and costunolide, respectively. Conclusion In general, AR and VR were highly similar, but their differences were deserved to be paid attention to. This research could provide reference for quality control and set a foundation for clinical applications of AR and VR.

IgG4-related diseases (IgG4-RDs) have recently been reported in many organs other than the salivary, pancreatic and hepatobiliary systems. A 64-year-old woman was referred to our department for her abdominal fullness and cardiomegaly on chest X-ray. After draining the pericardial fluid, her symptom promptly diminished, and pericardial friction rubbing became clearly audible. Elevated serum levels of IgG and IgG4 and ureteral wall thickening on computed tomography suggested IgG4-RD. After the initiation of oral corticosteroid therapy, the pericardial effusion was resolved, and she has been in a steady-state condition for the past two years.

Congestive symptoms of dyspnea, abdominal fullness, and edema are some of the most common clinical manifestations of heart failure. Diuretics remain one of the most important therapies in heart failure because they improve congestive symptoms and, in some cases, improve organ function. Despite the benefits of diuretics, studies have shown increased mortality in heart failure patients treated with diuretics, particularly in high doses. Resistance to diuretic therapy is a common problem in patients with heart failure and is associated with increased mortality. In addition, diuretics may be associated with worsening renal function in heart failure patients. Chronic kidney disease commonly coexists with heart failure and contributes to diuretic resistance and increased mortality. The normal counterregulatory responses to diuretics are aggravated by neurohormonal changes of heart failure, further contributing to diuretic resistance. Appropriate diuretic management in heart failure requires an understanding of diuretic resistance, mechanisms of perturbations in renal function during diuretic treatment, and an understanding of the pharmacology of diuretics.

Rupture of the common bile duct because of blunt trauma is extremely rare. Preoperative diagnosis is very difficult because bile causes little peritoneal irritation. We present a case of a 19-year-old young woman with rupture of the common bile duct due to blunt trauma. She arrived at our hospital 1 hour after a car accident. She was diagnosed as pancreatic head injury, and conservative therapy was administered. It was effective, but after starting oral intake 6 days after the injury, she presented with abdominal fullness because of increased ascites. The ascites contained large amounts of bile. Rupture of the common bile duct became apparent, thus, she underwent emergency surgery 13 days after the injury. The common bile duct was ruptured completely at the lower bile duct. We repaired it by choledochojejunostomy. Her postoperative course was uneventful, and she discharged on the 12 days after the surgery. Preoperative drip-infusion-cholangiography-CT was useful for its diagnosis.

Single anastamosis loop duodenal switch (SALDS) is a new surgical technique that was first described by Torres in Spain [1]. As this procedure is gaining in popularity worldwide, it is important to document the rare complications associated with it [2]. An unusual complication that can occur is retrograde filling of the afferent limb, causing symptoms like partial bowel obstruction. However, this has not been described in the literature as occurring after SALDS. This paper presents the first 2 cases of retrograde filling of the afferent limb causing chronic nausea that have been seen after laparoscopic SALDS surgery and subsequent management.

Trichobezoars are concretions of hair, which accumulate in the gastrointestinal tract. Trichotillomania is a psychiatric illness with compulsive desire to pull out ones hair. Trichobezoars are rarely described in the absence of trichotillomania. We report a case of trichobezoar associated with trichophagia in the absence of trichotillomania. An 18 year old thin built girl presented with complaints of pain in abdomen and upper abdominal fullness with loss of appetite and weight loss for the last 2 months. Ultrasound abdomen and upper gastrointestinal endoscopy were suggestive of gastric bezoars. Exploration of history revealed that the patient works as a hairstylist. However, she denied of pulling her own hairs. Physical examination of scalp and other body parts did not show any evidence of alopecia or pulling of hair/short hair. She was managed surgically and was counseled about the consequences of eating hairs and was discouraged from eating hair. The absence of trichotillomania should not be considered as absence of trichophagia and sometime the occupational history of the patient can be helpful in leading to the diagnosis. CONCLUSION: The absence of trichotillomania should not be considered as absence of trichophagia and sometime the occupational history of the patient can be helpful in leading to the diagnosis.

Background Obesity represents one of the common medical disorders that carries a high risk of morbidity and mortality. Insertion of intragastric balloon is one of the recently introduced lines of treatment of obesity. It allows patients to sense abdominal fullness and reduce their food intake. However, gastric ulceration may be a serious adverse effect that may be associated with intragastric balloon insertion. Aim To assess the role of silent helicobacter pylori infection in intragastric balloon-induced ulcers and to explore the possible methods for amelioration of this effect. Methods Thirty patients were divided into 2 equal groups; one of them received triple therapy for helicobacter pylori eradication and the other group received placebo treatment. Then, they underwent intragastric balloon insertion. After removal of the balloon, gastroscopy was performed to evaluate the gastric mucosal lesions, if present. Results There was significant decrease in the incidence of gastric erosions and ulcerations in the group that received triple therapy for helicobacter pylori eradication compared to the group that received placebo treatment. Conclusion Eradication of silent helicobacter pylori infection may represent a promising hope to decrease the incidence and improve symptoms of gastric erosions and ulceration that may be associated with intragastric balloon insertion.

Aim Within the Kampo medical system, there exists a system specific to Japan of abdominal diagnosis called abdominal palpation, or Fukushin, which is used to obtain a holistic picture, called an abdominal pattern, of the physical indications in the abdominal area. In order to educate students in this system, we have devised and continued to develop a Fukushin simulator, incorporating various improvements as appropriate. The present study describes some recent additions to the model with the aim of increasing its applicability across a broad range of abdominal patterns. Methods The simulator is modeled on the abdomen of a healthy adult man, from which we took a mold using flexible silicon resin. To increase the resistance in some areas, we used urethane foam mixed with silicon rubber or attached parts consisting of silicon rubber; to reduce the resistance to pressure in other areas, we used urethane foam in small quantities. Results By such adjustments, we were able to reproduce patterns seen frequently in abdominal palpation, that is, stuffiness and rigidity below the heart, rectus muscle tension, fullness in the chest and hypochondrium, and lower abdominal fullness, each marked by localized increases in resistance to touch; and lower abdominal numbness, marked by a localized reduction in resistance to touch. Conclusion It is expected that the simulator will make an important contribution not only to medical education but also to the standardization of abdominal diagnosis.

Approximately half the patients with autosomal dominant polycystic kidney disease (ADPKD), a condition due to deficiency in polycystin 1 or 2, have end-stage kidney disease by 60 years of age.1,2 Once progression begins, the mean decline in the estimated glomerular filtration rate (GFR) is approximately 4 to 6 ml per minute per 1.73 m2 of body-surface area per year. Therapy to prevent deterioration of GFR in patients with ADPKD has been elusive, despite mechanistic studies targeting pathogenesis. In addition, the burden of therapy in patients who have other symptoms from their ADPKD — hypertension, abdominal fullness and pain from cysts, . . .

A 37-year-old nulligravid woman presents with a chief complaint of a 1-year history of infertility. Prior to this, she used oral contraceptives for 18 years, and she does not currently take any medications. Her menses occur every 28–30 days, are of moderate flow, and last 3–4 days. There have been no recent changes in her menstrual flow volume or duration. She also complains of >6 months of gradually increasing abdominal discomfort that she describes as a feeling of abdominal fullness with weekly episodes of severe cramping pain. Her pain is unrelated to activity or menses. She also complains of urinary frequency, but denies any other urinary symptoms or changes in bowel habits or dyspareunia. Her past medical, surgical, and social histories are unremarkable.

Cystic lesions of the spleen are a rare encounter in surgical practice and are broadly split into two categories: true and false, depending upon the presence of a defined epithelial lining. True cysts can further be broken down into parasitic and non-parasitic origins while false or pseudocysts tend to develop commonly after a traumatic event. We present here a 23-year-old female who came to the clinic with symptoms of abdominal fullness, early satiety and left flank pain which was diagnosed as a large splenic cyst after radiology confirmation. The patient was prepared and underwent laparoscopic splenic cyst fenestration successfully without any complications. Laparoscopic fenestration for benign uncomplicated splenic cysts is a viable alternative to splenectomy with low rates of recurrence and less patient morbidity along with the advantage of preservation of splenic function.

Morgagni hernia is a rare congenital anomaly arising from the fusion defect between the septum transversum and sternum. The diagnosis is usually difficult since the presentation may be asymptomatic or with respiratory symptoms, abdominal and/or retrosternal pain, abdominal fullness, or gastrointestinal obstruction. In this report, we discuss the clinical presentation and management of this rare condition in five consecutive cases. Between 2009 and 2015, five cases underwent surgery for Morgagni hernia (three laparoscopic and two open repair surgeries); one patient developed recurrent hernia 7 months after the laparoscopic surgery. This case is the first reported recurrence in literature following laparoscopic repair in adults. Surgery is the only treatment option for Morgagni hernias, which can be performed through transthoracic, transabdominal, laparoscopic, or thoracoscopic approach. The issues of using mesh and reducing the hernial sac remain controversial.

We report an appendiceal collision tumour in a 23-year-old woman who presented with constipation and abdominal fullness. Imaging revealed a right lower quadrant abdominal mass that was laparoscopically resected. Histology revealed an appendiceal collision tumour composed of a low-grade mucinous neoplasm and well-differentiated neuroendocrine neoplasm. A right hemicolectomy for complete oncological control was performed revealing metastatic spread of the neuroendocrine component to the lymph nodes. No further treatment was recommended and the patient was followed with expectant management. At 2-year follow-up, no evidence of disease was found on surveillance imaging. Appendiceal collision tumours can arise in young adults; treatment should be guided by oncological principles of the component tumours.

Objectives Food retention (FR) is a pathological process which manifests as epigastric or abdominal fullness or pain, dyspepsia, water brash, sickness, languidness, edema, weight gain, or joint pain. The present study was conducted to examine the reliability and validity of a food retention questionnaire (FRQ) and to define its optimum cut-off score. Methods A total of 194 outpatients (62 men, 132 women) were asked to complete the FRQ. Thirteen clinicians determined whether or not the 194 outpatients exhibited FR. We estimated the internal consistency and construct validity for the FRQ. The total scores from the FRQ and clinicians’ diagnoses of the patients were used to perform receiver operating characteristics (ROC) curve analyses and to define an optimum cut-off score for the FRQ. Results The FRQ exhibited a satisfactory internal consistency ( α = 0.852). In the test of construct validity using principal component analysis, a total of four factors (gastrointestinal distress, Dampness, food hypersensitivity, and stool–urine–pain) were extracted (total percentage of variance = 53.2%). ROC curve analyses showed that the FRQ had a moderate discriminative ability for FR (sensitivity = 70.7%, specificity = 76.8%, and AUC = 0.788). The optimum cut-off score was defined as six points. Conclusions Our results suggest that the FRQ is a valid and reliable instrument for evaluating FR.

We present a case of delayed onset seroma formation presenting 5 years after ventral incisional hernia repair (VIHR) with mesh. The patient presented with several months of progressive abdominal fullness and eventual spontaneous drainage from a prior abdominal surgical incision site. Surgical drainage was performed with evolvement of mesh infection. After 5 months of conservative management, the patient remained symptomatic and continued to show evidence of infection. Subsequently, she underwent mesh explantation and definitive repair with complex abdominal wall reconstruction. To the best of our knowledge, this case represents the longest delay in the onset of seroma formation post-VIHR, reported in the literature.

A 33-year-old man presented with abdominal fullness, chest tightness, and weight loss. He had undergone esophageal reconstruction at age 2 for congenital esophageal atresia. Sequelae of substernal interposed ileocolon gradually developed, including narrowing of cologastrostomy, subxiphoid compression of neoesophagus, redundancy of neoesophagus, and intestinal adhesion. In order to solve the aforementioned problems, he underwent revision surgery including enterolysis, release of subxiphoid compression, revision of cologastrostomy, and creation of colojejunostomy. Following the revision surgery, the alimentary tract achieved good patency and the neoesophagus yielded shrinking. He was discharged uneventfully on postoperative day 14.

Rationale:Advanced breast cancer frequently metastasizes to the lungs, liver, and bones. Metastatic involvement of the duodenal bulb is extremely rare and difficult to detect by endoscopy.Patient concerns:A 51-year-old menopausal woman presented with abdominal fullness and obstructive sympto

A 48-year-old woman with a prolonged history of glucocorticoid use presented with abdominal fullness. Computed tomography showed numerous gas-containing cysts within the colonic wall.

A 71-year-old male was admitted for abdominal fullness. The condition rapidly deteriorated in a short period (3 weeks), and the patient died. Autopsy revealed a protruding lesion measuring about 3 cm with erosion measuring 5 mm in diameter immediately below the esophago-gastric conjugation site, suggesting primary cardial undifferentiated adenocarcinoma. In the primary focus, changes on the mucosal surface were almost normal However, below the mucosa, infiltration of cancer cells was observed in an approximately 3 cm area along the gastric wall. Simultaneously, the site of infiltration was markedly increased in deep areas. Extraserous infiltration was observed. The morphology was special, and resembled an octopus pot, a trap used to catch octopuses in Japan, with a narrow top and a broad base. In our patient, metastatic lesions were detected in multiple organs, including the stomach.

[Figure][1] A 41-year-old, HIV-positive Somalian man presented to the HIV clinic with fatigue and abdominal fullness. He denied fever or any other symptoms. The laboratory workup revealed mild pancytopenia and elevated liver function enzymes. Computed tomography identified hepatosplenomegaly

An 80-year-old female with janus kinase 2 positive myeloproliferative disease with stable blood parameters on aspirin and anagrelide admitted to the emergency department after a fall over the kerb complaining of pain limiting mobility. Initial assessment was stable without any external injuries noted. Pelvic X-ray demonstrated a stable pubic rami fracture (figure 1). Later on, her haemoglobin dropped 106 g/dL to 67 g/dL for no apparent cause. She was also noted to have an abdominal fullness and examination revealed a suprapubic mass. CT scan showed a well-defined hypointense collection measuring …

A 45-year-old man presented to us with a history of upper abdominal fullness, early satiety and decreased appetite. He also had a history of symptoms suggestive of left-sided portal hypertension. CT scan (figure 1) demonstrated a large cystic lesion arising from the left lobe of the liver, compressing the stomach, splenic vein and left renal vein, and a left-sided varicocele. Figure 1 Coronal CT scan showing large cystic lesion in the liver (thick arrow) and contrast in the dilated venous channels in the left hemiscrotum suggestive of varicocele (thin arrow). The …

Pesticide Poisoning among Farmers in a Rural Province of Korea: Seok-Joon SOHN, et al. Department of Preventive Medicine, Chonnam National University Medical School and The Research Institute of Medical Science, Chonnam National University—Pesticide poisoning is one of the most important occupational health hazards for farmers, but the exact prevalence or incidence of the poisoning has not been fully investigated in Korea. The present study assessed the pesticide poisoning in a rural province of Korea based on episodes reported by farmers. The total number of interviewees in this survey was 8,831. Of these, only 8,420 farmers who worked longer than one hour every day during the past one year were included in the analysis. Questionnaires collected from 8,420 persons were analyzed by means of a SAS statistical package. The average days spent for pesticide spraying was 6.8; the farmers at work experienced pesticide-related symptoms during the last one-year period at the rate of 7.0%; the average length of a hospital stay was 4.4 d: and the period of clinic visit averaged 1.7 d. Pesticide poisoning was statistically related with age, sex, region of residence and degree of pesticide use. Among the complaints in the farmers’ syndrome, pesticide poisoning was signif icant ly related with shoulder st i f fness, sleeplessness, dizziness and a feeling of abdominal fullness, but not with lumbago, limb paresthesia, nocturnal frequency or dyspnea. The present data offer the baseline for the health resources planning and rural health program. (J Occup Health 2001; 43: 101–105)

A 51-year-old woman presented with anorexia, abdominal fullness and weight loss of 1 year duration. There was a history of bilateral facial paralysis 4 years ago. There was no history of fever, cough polyarthralgia or altered bowel habits. Examination revealed bilateral lower motor neuron type facial palsy and non-tender hepatomegaly. Haematological workup revealed normocytic normochromic anaemia (9 g/dL) with an elevated erythrocyte sedimentation rate (85 mm/hour) and a WCC of 8800/cu.mm. Her blood biochemistry showed increased levels of alkaline phosphatase—685 U/L (40–125), gamma-glutamyltransferase of 1251 U/L (

Ogilvie syndrome is an acute pseudo-obstruction of the colon without mechanical stenosis, the and pathogenesis of which is still unknown. This paper presented two cases of Ogilvie syndrome. Case 1: A 57-year-old man was admitted to the hospital because of symptoms suggesting intestinal obstruction. Through examination revealed no mechanical stenosis of the colon. Since decompression for the dilated colon using colonos-copy was not successful, sigmoidostomy was performed because of the risk of colon perforation. Case 2: A 75-year-old man with no past history of disease, was admitted with abdominal fullness and dilation of the colon. Various examinations revealed an extremely dilated colon without mechanical'stenosis, and the diagnosis of idiopathic Ogilvie syndrome was made. This case was treated by colonos-copic decompression. In the literature, colonoscopic decompression is the first treatment of choice before surgery in some cases of the Ogilvie syndrome. In this paper, two cases of Ogilvie syndrome treated endoscopically or operatively are reported.

Leiomyomas of the mesentery are very rare, and only 11 cases including this case have been seen in the Japanese literature. A 71-year-old man was seen at the hospital because of the abdominal fullness and constipation. An infant head-sized mass which was elastic soft and smooth on its surface was palpated on the right lower abdomen with a remarkable mobility. Preoperative examination revealed a well-defined tumor with slightly heterogenous internal image in the mesentery. He was diagnosed as to have a mesenteric tumor and an operation was performed. The tumor was located in the mesentery of the small intestine, covering from 1.8 m to 3 m oral side from the Bauhin's valve and compressed the small intestine extramurally at two portions. No infiltration into the small intestine nor metastasis of mesenteric lymph nodes was found and a resection of the small intestine including the tumor was performed. The resected material was histologically diagnosed as leiomyoma.

Emphysematous cholecystitis that is caused by gas-producing bacteria is a reratively rare entity in which the gallbladder or gallbladder wall contains gas. This paper presents a case emphysematous cholecystitis associated with pneumobilia and intraabdominal free air, together with a review of the literature. An 81-year-old man was admitted to the hospital because of appetite loss and abdominal fullness. Blood studies showed severe inflammation and jaundice without liver injury. There was no tenderness nor muscle gurding. Abdominal CT scan showed gas in the gallbladder, intrahepatic bile duct and right subphrenic space. With a diagnosis of acute emphysematous cholecystitis, an emergency operation was done because the patient was in a preseptic state and the wall of gallbladder was thin and weak. Histological examination of the gallbladder showed necrosis without cholecystlitiasis. Postoperative course was uneventfull, and the patient was discharged from the hospital 16 days after the operation.

輸液にて腹部膨満感を訴えた太陽病と少陽病の併病を経験した。62歳の女性で主訴は, 輸液後の腹部膨満感, 全身倦怠感, 頭重感と耳鳴りである。悪寒, 発熱, 頭痛の太陽病の症状と眩量や口苦咽乾および心下痞鞭の少陽病の症状を伴うことより太陽病と少陽病の併病と診断した。輸液を中止し柴苓湯を投与した結果, 全身倦怠感の消失, 食欲の回復, 心下痞鞭の改善および体重減少が認められた。嘔気や上腹部圧迫感は柴胡桂枝湯が奏功し, 笑顔と活力がみられ旅行に行くまで回復した。足腰の冷えと痛みは, 当帰四逆加呉茱萸生姜湯が奏功した。栄養補給や脱水の治療として輸液がなされるが, かぜ症候群の輸液療法の適応には注意が必要である。

Dyspepsia is defined as predominantly midline pain or discomfort located in the upper abdomen [1]. Discomfort refers to a subjective, negative feeling that is not “painful”. Dyspepsia can incorporate a variety of symptoms including early satiety or upper abdominal fullness. Although the term implies a relationship with eating and the majority of patients have symptoms worsened by food, this is no longer necessary to diagnose dyspepsia [2]. During the investigation of dyspepsia, three major structural causes are readily identifiable: peptic ulcer disease (10%), gastroesophageal reflux (20%) (with or without esophagitis), and malig‐ nancy (2%) [3]. Thus, most (50%-70%) patients with chronic dyspepsia do not have a significant focal or structural lesion found at endoscopy. When symptoms are chronic or recurrent (table 1) but without an identifiable structural cause using standard diagnostic tests (usually endoscopy), the condition is usually labelled functional or functional dyspepsia [4, 5]. Hence functional dyspepsia is a diagnosis of exclusion, the implication being that symptoms have been investigated without demonstrating an organic or anatomical cause [5].