Eosinophilic peritonitis with colon cancer: a case report

BACKGROUND

Eosinophilic gastrointestinal disorders (EGIDs) are a rare group of inflammatory disorders that can occur anywhere along the gastrointestinal tract, from the esophagus to the rectum. In particular, those with malignant or benign tumors are extremely rare.

CASE PRESENTATION

A 62-year-old man was referred to our hospital with a chief complaint of abdominal fullness. The peripheral white blood cell count was 19,400/µL, and the eosinophil count was 13,300/µL. Abdominal computed tomography showed massive ascites. Cytology of the ascitic fluid showed a large amount of eosinophils and no malignancy. Upper and lower gastrointestinal endoscopies were performed on the suspicion of EGIDs, and colon cancer with no other abnormalities was found. The biopsies of the cancer lesions and non-cancer lesions also showed significant differences in eosinophil counts per high-power field (HPF) between the cancer and non-cancer lesions (median 77.5 [IQR 52-115] vs. 40.5 [35-56]/HPF, P < 0.05). Exploratory laparoscopy showed cloudy massive ascites and thickening of the mesentery. Pathological examination of the mesentery showed a large amount of eosinophils (median 177.5 [IQR 91-227]/HPF) and no malignancy. Based on these findings, it was suspected that the massive ascites due to eosinophilic peritonitis could be associated with colon cancer. Steroid administration resulted in immediate disappearance of the ascites, and laparoscopic left hemicolectomy was safely performed 6 weeks after steroid administration.

CONCLUSION

This report presented a case of eosinophilic peritonitis that could be related to colon cancer. Exploratory laparoscopy was useful to detect the cause of ascites. The possibility that eosinophilic peritonitis was associated with colon cancer is discussed based on the histopathological findings.

Multicentric recurrence of intraductal papillary neoplasms of bile duct in the remnant intrahepatic bile duct after curative resection

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Intraductal papillary neoplasm of the bile duct (IPNB) is a newly-recognized disease concept and its long-term prognosis and pattern of recurrence are poorly understood so far.

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We report a case of IPNB patient with early stage carcinoma who had multicentric recurrence in the remnant hepatic bile duct around 2 years after R0 resection.

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We should bear in mind multicentric remnant intrahepatic bile duct recurrence in IPNB patients with multiple lesions.

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Endoscopic approach using double balloon enteroscopy is useful in diagnosis of recurrence and palliation of symptoms in selected patients.

Introduction

There have been few reports on the prognosis of patients with intraductal papillary neoplasms of the bile duct (IPNB). Here we report a case of IPNB in a patient with early-stage carcinoma who had multicentric recurrence in the remnant hepatic bile duct after curative resection.

Case presentation

A 78-year-old man with hepatic dysfunction and cholestasis was referred to our hospital. Preoperative imaging studies revealed the presence of papillary tumors in the left hepatic duct and common hepatic duct, while no tumor lesions were detected in the right hepatic duct. This patient underwent left hepatectomy, extra-hepatic bile duct resection with biliary reconstruction, and regional lymphnode dissection. On the basis of pathological examination, this patient was diagnosed with multiple IPNB with early-stage adenocarcinoma with negative surgical margin. Postoperative work-up was periodically performed, indicating no evidence of recurrence, while the patient had sustained hepatic dysfunction, cholestasis, and repetitive cholangitis since the early postoperative period. Finally, recurrence in the remnant intrahepatic bile duct of the posterior segment was revealed by double balloon enteroscopy at 29 months after surgery. At 34 months after surgery, internal drainage stents were replaced in both endoscopic and percutaneous manners within the relapsed intrahepatic bile ducts to address repetitive cholangitis. These procedures enabled the patient to remain asymptomatic until death at 41 months after surgery.

Discussion

Multicentric recurrence in the remnant intrahepatic bile duct after surgery may occur in IPNB patients with multiple lesions. An endoscopic approach may be useful in such cases, not only in the diagnosis of remnant intrahepatic bile duct recurrence but also for palliation of symptoms.

The trajectory of the point of application of the resultant force of body mass at different walking speeds. Statistical analysis of human walking

Parameters of walking at ordinary, fast and slow speeds in 30 male and 30 female young adults were investigated. More than 10 trials were made for each speed by each subject. The number of subjects and trials was large enough to permit a statistical analysis. The focus of the study was the movement of the point where the resultant foot-ground force intersects the ground. Its pathway, or trajectory, begins at touch-down from the middle part of the heel, then runs quickly on a straight line to the heads of the first or second metatarsal bones, turns medially and moves slowly towards the base of the first toe, ending at the tip of the first or second toe, or between them. This result confirms that the ankle joint works like a hinge during the stance phase, and that the human foot structure is relatively robust. Remarkably high positive correlations between stride length and stature, as well as iliospinal height were found in male subjects. However in females these clear correlations were not found, except at fast walking speeds, although were not so notable as in males. Correlations calculated from the data from all female subjects indicated significantly quite high values, as in males, but it is almost impossible to estimate exact stature or iliospinal height reliably from stride length because of its relative high variation. The sexual difference in walking speed is not due to stride duration, but to stride length.