Virendra A. Parikh, MD




Pseudomembranous Colitis

September 14, 2005

Following mechanical bowel preparation and prophylactic antibiotic therapy, a 59-year-old man underwent transanal excision of a villous adenoma of the distal rectum. Two weeks after discharge, he returned with a temperature of 38.9°C (102°F), abdominal pain, and diarrhea.

Herpesvirus Infections

September 14, 2005

Ten days before presenting for evaluation, a 69-year-old man began to experience neuralgic pain and noticed the eruption of painful erythematous macules and papules on the right side of his chest. Within 24 to 72 hours, vesicles and pustules arose at the site. One week after onset, several of the lesions dried and crusted.

Sigmoid Colonic Volvulus

September 14, 2005

A 79-year-old male nursing home resident with Parkinson's disease was brought to the emergency department after 3 days of severe constipation and inability to pass flatus. Examination showed generalized abdominal distention with tympany. Results of rectal examination were normal.

Colovesical Fistula

September 14, 2005

For 2 months, a 73-year-old man had experienced dysuria, pneumaturia, and foul-smelling urine. He had an attack of diverticulitis a year earlier. At that time, he underwent a barium enema study, which showed multiple sigmoid colonic diverticula with spasm.

Villous Adenoma

September 14, 2005

Endoscopic evaluation of a 61-year-old man hospitalized with a 4-month history of rectal bleeding, mucous discharge, and change in bowel habits revealed this large, sessile villous adenoma. The lesion occupied half the circumference of the bowel wall in the distal sigmoid colon, 25 cm from the anal verge. Examination of biopsy specimens showed benign villoglandular adenoma with atypia, with no invasive carcinoma. Sigmoid resection was carried out, and the patient recovered well.

Colonic Adenoma

September 14, 2005

When a 59-year-old man's stool tested positive for occult blood, colonoscopic evaluation was carried out. This is the endoscopic appearance of a pedunculated colonic adenoma-the source of the bleeding-being removed by a snare.

Colocolic Intussusception

September 14, 2005

For 3 days, a 69-year-old man had had intermittent colicky pain on the right side of the abdomen, loose bowel movements, and a low-grade fever. Examination disclosed a mildly tender, palpable, diffuse mass in the right upper quadrant and hyperactive bowel sounds. The patient's stool was positive for occult blood, and a complete blood cell count showed a low hemoglobin level and a slightly elevated white blood cell count.

Pilonidal Sinus

September 14, 2005

Pain, swelling, and purulent, blood-stained drainage around the lower back had plagued a 21-year-old woman for 3 weeks. On examination, multiple openings were seen overlying the natal cleft, the sacrococcygeal region, and the upper part of the midline. The last was the area of drainage. Insertion of a metal probe at that point revealed a pilonidal sinus that communicated with centrally located openings.

Melanosis Coli

September 14, 2005

A 65-year-old woman had had diarrhea for 1 year. Stool studies were negative for occult blood, and flexible sigmoidoscopy revealed a cobblestone-patterned colonic mucosa. A detailed history revealed that for the past year, the patient had been taking a daily herbal multivitamin supplement, the ingredients of which included cascara. Her diarrhea resolved completely when she stopped taking the pills.