mg%. Barium enema showed only diverticulosis. Flexible sigmoidoscopyrevealed boggy mucosa which was histopathologically interpreted as col-lagenous colitis. The patient had resolution of diarrhea after institution ofmesalamine. In February of 2000, the patient presented with multipleulcerating lesions on the right lower extremity. There were no abdominalcomplaints. On lesion was drained and the partient was treated withamoxicillin/clavulinate. The lesions did not improve and biopsy was per-formed. Histopathology suggested PG.Results: The lower extremity ulcerations healed with oral prednisonetherapy. In March 2000, a left ulcer developed and required steroid andciprofloxicin treatment. In August vulvar ulcerations developed. Cultureswere negative, and biopsy was again consistent with PG. These lesions alsohealed with oral prednisone. Currently the patient is symptom-free withplans to introduce cyclosporine if refractory PG occurs.Conclusions: To date, there have been no reported cases of PG and CC.Given the relatively strong association between PG and IBD, and thepossible continuity of the microscopic colitides with IBD, it is of interestto describe a case of CC with subsequent development of PG.

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Portal vein gas: a benign finding in 2 post-endoscopy patientsAshish Sharma M.D., Rashmi V. Patwardhan M.D.* and John M. LeveyM.D. 1Gastroenterology, University of Massachusetts Medical Center,Worcester, MA; and 2Gastroenterology, Worcester MedicalCenter/Fallon Clinic, Worcester, MA.

Purpose: To better characterize the clinical significance of portal vein gas(PVG) detection after endoscopic interventions.Methods: Review of abdominal CAT scans of 2 asymptomatic patientsafter ERCP(1) and colonoscopy(1).Results: CAT scans were performed, for other clinical reasons, in twopatients that had undergone endoscopic procedures within the previous 24hours. Gas in the portal vein was detected in both cases. These patients didwell without any interventions or antibiotics, suggesting that the presenceof PVG was an incidental finding.Conclusions: These cases illustrate that with the increasing sensitivity ofimaging modalities (CT scan, MRI, etc.) and widespread use of endoscopicprocedures, benign cases of portal vein gas are being diagnosed with higherfrequency. Previously, PVG has been associated with acute abdominalconditions and disruption of the mucosal barrier (perforation, pneumoperi-tonium, ischemia, etc.) with resultant need for surgery and high mortality.Given its often benign association with endoscopic procedures, PVG byitself has poor sensitivity as a predictor of an acute abdominal process orincreased mortality. The setting in which PVG occurs appears to be a morerelevant predictor of outcome. The significance of PVG should be reviewedin its clinical context, especially if the history of a recent endoscopicprocedure exists.

694

Oral vitamin A therapy for a severely symptomatic post-radiationanal ulcerationJosh Levitsky M.D., John J. Hong, M.D., Eli D. Ehrenpreis M.D.Gastroenterology Division, University of Chicago Hospitals, Chicago,Illinois.

Case Report: A 36-year-old African-American male developed threemonths of increased fatigue, weight loss, and constipation. A 10 cmexophytic anal mass was seen at colonoscopy; biopsy revealed a well-differentiated squamous cell carcinoma. He was found to be HIV positivewith a CD4 count of 200 cells/mm2. He received 5-fluorouracil, mitomycin,and a radiation dose of 63.4 Gray to the anorectal tumor site. Two monthslater, he developed worsening diarrhea, incontinence, and anorectal pain. Asigmoidoscopy revealed a large radiation-induced anal ulcer without evi-dence of tumor. His anorectal pain intensified and was treated with high

doses of immediate release morphine tablets and a transdermal fentanylpatch. When he refused surgical diversion, he was referred to our hospital.The patient appeared ill and uncomfortable. His cardiac, pulmonary, andabdominal exams were within normal limits. An internal rectal exam wasdeferred secondary to pain with minimal manipulation of the anus. Thepatient was prescribed vitamin A capsules 8,000 IU twice daily. Within oneweek, he noted considerable relief of rectal pain. Within six weeks, thepatient had no anorectal pain and had discontinued all pain medication. Asigmoidoscopy revealed mild radiation proctopathy and no ulceration. Thevitamin A dosage was reduced to 8,000 IU daily. After six months offollow-up, he has gained 42 pounds without recurrence of rectal pain ordiarrhea.Discussion: Anal carcinoma is rare and is typically associated with humanpapillomavirus type 16. Chemotherapy plus radiation is the preferredtreatment over surgical resection of anal carcinoma. Radiation-induced analulceration typically requires surgical diversion for relief of pain and in-continence. Vitamin A has well-known wound healing properties. In skin,retinoic acid causes vascularization of the epidermis and increases thepresence of repair cells. Our patient had rapid, symptomatic improvementin anorectal pain with oral vitamin A therapy. The endoscopic appearanceof the ulcer was also significantly improved after six weeks of vitamin A.We hypothesize that the patient’s anal ulcer healed successfully because ofthe well-known wound healing and repair properties of vitamin A. VitaminA is inexpensive, well tolerated, and rarely toxic, and should be consideredin the treatment of radiation-induced anorectal ulceration.

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Adult hypertrophic pyloric stenosis (AHPS) after orthotopic livertransplantation (OLT): an unusual occurrenceJames H Lewis1*, Gustavo Marino1, Lynt Johnson2, Norio Azumi3 andRheena Jha4. 1Gastroenterology, Georgetown University, Washington,DC, United States; 2Surgery, Georgetown University, Washington, DC,United States; 3Pathology, Georgetown University, Washington, DC,United States; and 4Radiology, Georgetown University, Washington,DC, United States.

Purpose: Clinical vignette.Methods: A 55yo female complained of GERD and early satiety withocassional episodes of bilious vomiting beginning about 3 yr after OLT forLaennec cirrhosis. She was treated with PPIs in addition to her immuno-suppressive regimen that included tacrolimus. EGDs had been unrevealinguntil 5yr post-OLT when her symptoms progressively worsened. An initialEGD was normal but a follow-up exam 1 mo later revealed a stenoticpylorus. EUS was performed with a miniprobe and showed a circumfer-ential submucosal mass that appeared to invade the muscularis propria.Biopsies were non-diagnostic although a lymphoproliferative process couldnot be excluded in the setting of post-OLT immunosuppression. An UGIseries showed significant reflux but an otherwise normal esophagus andproximal stomach. The pylorus was severely narrowed, extending 5cm intothe bulb. It had smooth margins c/w AHPS. An abd CT scan did not revealany extrinsic mass lesion or lymphadenopathy in the area. A diagnosticlaparotomy was then performed as her symptoms persisted. At surgery theproximal stomach was normal but there was marked thickening of theantrum and pylorus. Frozen sections did not reveal malignancy and it waselected to proceed with antrectomy and Bilroth II reconstruction. The finalpathology revealed marked muscle hypertrophy of both the muscularispropria and muscularis mucosae w/o evidence of any neoplastic process,c/w AHPS, although the cause was uncertain. We are not aware of anysimilar cases after OLT. It was speculated that possible inadvertent partialdenervation or devascularization of the antrum during OLT might have setthe process in motion. AHPS is not reported with any of her medications.She had an uncomplicated post-op course and presently is well without anyGI complaints.

S218 Abstracts AJG – Vol. 96, No. 9, Suppl., 2001