sels limited to the sub-mucosa without any evidence for collaterals. EUSand Doppler flow examination of the vascular lesions in the recto-sigmoidcolon with a 7.5 MHz curvilinear array echoendoscope demonstrated amesenteric venous flow pattern.

Our case of KTWS is unique, as the patient did not present with thecharacteristic triad. Endoscopic differentiation of the sub-mucosal heman-giomas from varices due to portal hypertension was not feasible. EUS withDoppler flow studies successfully demonstrated the presence of sub-mu-cosal varices and the absence of collaterals due to portal hypertensionconsistent with the diagnosis of aforme frusteKTWS.

683

Chronic mesenteric arterial thromosis associated withanticardiolipin antibodySuman Amitabh M.D., Wald Arnold M.D. FACG. Division ofGastroenterology. Hepatology, & Nutrition; University of PittsburghMedical Center, Pittsburgh, PA.

A previously healthy 50 yr.old white male presented with a 8 week historyof abdominal pain, non-bloody diarrhea and a 50 lb weight loss. Hereported nausea, vomiting, occasional diarrhea, and vague abdominal dis-comfort for 6 months prior to his illness. This was initially ascribed toarsenic intoxication as his blood arsenic level was found to be elevated (283ppm) during a routine professional screening. However arsenic levels haddecreased to 12 ppm when his symptoms became more severe. There wasno history of coronary artery disease, hypertension or diabetes mellitus. Hewas a cigarette smoker who possibly was exposed to arsenic while workingin building demolition.

Physical examination showed normal blood pressure: all peripheralpulses were palpable. There were no Mee’s lines or palmar hyperkaratosis.Cardiac, chest, and neorological examinations were normal. Abdominalexamination was significant for generalized mild abdominal tenderness: noabdominal bruit was audible: stool was negative for occult blood. Labo-ratory investigation included normocytic anemia(Hb 10.5g %) with lowiron saturation (10 %); total bilirubin 1.3 mg%, AST 40IU/L, ALT 31 IU/LGGTP 35 IU/L, and alk phos 179 IU/L. Endoscopy revealed multiple antraland duodenal ulcers. Biopsy from the second part of duodenum wasnormal: antral biopsy was negative for H pylori. Serum gastrin levels werenormal. Endoscopy after one month of omeprazole revealed no change infindings. Colonoscopy, abdominal CT, small bowel series. ERCP andgastric emptying study were normal. Coagulation profile revealed persis-tently elevated PTT with normal INR. This led to further work up whichidentified anticardiolipin antibody(IgG level 35). Angiography subse-quently revealed occlusion of the celiac and superior mesenteric arteries attheir origins. EKG and stress echocardiogram were normal. The patientunderwent celiac and mesenteric artery bypass surgery with resolution ofsymptoms. Three months later, he was asymptomatic with a 37 lb weightgain.

This is a case of chronic mesenteric arterial ischemia. The associationwith anticardiolipin antibody is distinctly rare. High arsenic levels mayhave contributed to a significant delay in the diagnosis.

684

An unusual cause of pancreatitis in a thirteen year old femaleChotiprasidhi Poonputt, Swartz Katrina L, Treem William R, BranchMalcom S*. Duke University Medical Center, Durham, NC, UnitedStates.

Purpose: A 13 year-old white female presented following a brief hospi-talization for acute pacreatitis. Approximately 1-month prior, she devel-oped abdominal pain with nausea and vomiting, but no fever. She wasmildly jaundiced. Labs revealed AST: 189, ALT: 147, AP: 322, TB: 2.9,amylase: 722 and lipase of 2560. Triglycerides were normal (55). Viralhepatitis serologies were negative. CT scan of the abdomen revealed intra-and extra- hepatic ductal dilatation.

Methods: ERCP revealed: a stone in the mid pancreatic duct (extractedafter pancreatic sphincterotomy), some irregular side-branches of the pan-creatic duct, and saccular dilatation of the common bile duct, whichappeared to drain through the uncinate branch of the main pancreatic duct.

The patient was referred to the surgery service for consideration ofsurgical correction.Results:This patient has an anomalous pancreaticobiliary ductal union (Ytype junction), which is a rare congenital malformation, especially inCaucasians. The union of the bile duct and pancreatic duct occurs outsidethe duodenal wall. This condition prediposes to pancreatitis, choledochalcyst, gallstones, gall bladder cancer, bile duct cancer, pancreaticolithiasis,and biliary strictures. Reflux of bile into the pancreatic duct (and vice versa)may contribute to these conditions.Conclusions: While endoscopic sphincterotomy may be helpful in man-aging choledocholithiasis and cholangitis in this condition, cholecystec-tomy and excision of the extrahepatic bile duct (with high biliary diversion)are recommended to reduce the lifetime risk of biliary malignancies. Howsuccessful this approach is remains unknown.

Anomalous pancreaticobiliary duct junction is rare and would be bestmanaged in a tertiary care center using a multidisciplinary approach.

685

A case report of abdominal epilepsy in an adult with recurrentemesisThompson Christopher, MD, Ahmad Mejdi, MD, Ouyang Ann, MD*.Pennsylvania State University, College of Medicine, Hershey, PA,United States.

Purpose:Abdominal epilepsy is well described in children but is rare in theadult population. There are variable clinical presentations due to the varietyof neurological and abdominal symptoms. We present a case of episodicvomiting that was associated with characteristic EEG abnormalities andresolved on Lamictal.Methods: Case Report:A 41-year-old male who was in good health untilseven months prior to presentation when he developed sudden onset ofvomiting. The episodes initially occurred about every three days and couldlast from 12 to 24 hours. At presentation they were occurring about everytwo weeks. They were preceded by mild nausea and a fullness in his chest,and progressed to recurrent emesis until he produced only bile. During theepisodes he could not keep down any liquids or food. There was noconsistent precipitating event, although his wife mentioned that he wouldcomplain that all food smelled particularly foul around the time of theevents. He has had a 15 pound weight loss. He has no significant medicalhistory and denied alcohol or tobacco use. Dysphagia, abdominal pain, andchange in bowel habits were denied. Physical examination revealed a welldeveloped, well nourished male, without obvious abdominal pathology.Results:An extensive work up including small bowel series, upper endos-copy, gastric emptying test, abdominal ultrasound, abdominal CT, and headCT were all normal. An EEG was then performed and revealed sharp waveactivity in the non-dominant temporal lobe. The patient was then started onLamictal and his symptoms resolved. He has been symptom free for oneyear.Conclusions: Abdominal epilepsy is a diagnostic challenge due to thevariety of clinical presentations that occur with the wide spectrum of bothneurological and abdominal symptoms. Abdominal symptoms are abrupt inonset and can last hours to days. Pain is most common, however nausea,emesis, or diarrhea may be the sole presenting symptom. Neurologicalsymptoms may be very subtle and tend to occur only in association with thegastrointestinal manifestations. Bursts of sharp waves or spikes over thenon-dominant temporal lobe are the most common EEG findings. Sleepdeprived EEGs have the highest yield. Diagnostic criteria include parox-ysmal gastrointestinal symptoms, exclusion of visceral pathology, symp-toms suggestive of a CNS abnormality without structural abnormality onCT scan, an abnormal EEG, and sustained relief of symptoms on anticon-vulsant therapy.

2610 Abstracts AJG – Vol. 95, No. 9, 2000