Renal amyloidosis as a late complication of Crohn's disease:a case report and review of the literature from Japan

INTRODUCTION Secondary amyloidosis is a rare but seriouscomplication of Crohn’s disease(CD).Theincidence of the association of secondaryamyloidosis in patients with CD has been reportedto be 0.5%-8% in Western countries.However,in Japan,the number of patients with CDcomplicated by amyloidosis is limited.Thecharacteristics of their clinical manifestations andthe incidence of association are uncertain.Therefore,we report herein a patient with

Primary hepatic benign schwannoma

Schwannoma is predominantly a benign neoplasm of the Schwann cells in the neural sheath of the peripheral nerves.Occurrence of schwannoma in parenchymatous organs,such as liver,is extremely rare.A 64-year-old man without neurofibromatosis was observed to have a space-occupying lesion of 23mm diameter in the liver during follow-up examination for a previously resected gastrointestinal stromal tumor(GIST)in the small intestine.He underwent lateral segmentectomy of the liver under a provisional diagnosis of hepatic metastatic recurrence of the GIST.Histological examination confirmed the diagnosis of a benign schwannoma,confirmed by characteristic pathological findings and positive immunoreactions with the neurogenic marker S-100 protein,but negative for c-kit,or CD34.The tumor was the smallest among the reported cases.When the primary hepatic schwannoma is small in size,preopera- tive clinical diagnosis is difficult.Therefore,this disease should be listed as differential diagnosis for liver tumor with clinically benign characteristics.

Peritoneovenous shunt for intractable ascites due to hepatic lymphorrhea after hepatectomy

A peritoneovenous shunt has become one of the most effi cient procedures for intractable ascites due to liver cirrhosis.A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented.A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection.After hepatectomy,a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy,including numerous infusions of albumin and plasma protein fraction and administration of diuretics.Since the patient's general condition deteriorated,based on the diagnosis of intractable hepatic lymphorrhea,a subcutaneous peritoneovenous shunt was inserted.The patient's postoperative course was uneventful and the ascites decreased rapidly,with serum total protein and albumin levels and hepatic function improving accordingly.For intractable ascites due to hepatic lymphorrhea after hepatectomy,we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.

Refractory ulcerative colitis accompanied with cytomegalovirus colitis and multiple liver abscesses: A case report

Various hepato-biliary complications are an increased incidence in patients with inflammatory bowel disease,and portal bacteremia is well documented in patients with ulcerative colitis (UC). However, few reports mention UC in association with liver abscesses. Recently, there are several reports describing cytomegalovirus (CMV) infection in association with disease exacerbation and steroid refractoriness in patients with UC. Here we present a case of refractory UC accompanied with multiple liver abscesses and CMV colitis. The patient, a 72-year-old male, with a five-year history of repeated admissions to our hospital for UC, presented with an exacerbation of his UC.Sigmoidoscopy performed on admission suggested that his UC was exacerbated, then he was given prednisolone and mesalazine orally, and betamethasone enemas.However, he had exacerbated symptoms. Repeat sigmoidoscopy revealed multiple longitudinal ulcers and pseudopolyps in the rectosigmoid colon. Although immunohistochemical staining of biopsy specimens and the serum testing for antigenemia were negative on admission and after the repeat sigmoidoscopy, they became histologically positive for CMV. Nonetheless, the patient developed spiking fevers, soon after ganciclovir was administered. Laboratory studies revealed an increased white cell count with left shift, and Enterococcus fecalis grew in blood cultures. An abdominal computed tomography (CT) scan was obtained and the diagnosis of liver abscesses associated with UC was made, based on CT results. The hepatic abscesses were successfully treated with intravenous meropenem for 6 wk, without further percutaneous drainage. To our knowledge, this is the first reported case of multiple liver abscesses that develop during UC exacerbation complicated by CMV colitis.