biliary cirrhosis, Brucellosis or HIV and further work up including AntiSmooth Muscle Antibody, ANA, Iron studies were all within normal limits.Conclusion: The unique case presented has liver granuloma with nodetectable cause for granulomatous hepatitis. The role of Hepatitis C information of liver granulomas is of much interest and should be investi-gated further.

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Use of digital imaging in poster presentation: can you survive it?Houssam Al Kharrat, MD, Shams Tabrez, MD, Gerald Foster andIngram Roberts, MD*. 1Department of Gastroenterology, Yale Healthsystem, Bridgeport Hospital, Bridgeport, CT, United States.

Purpose: The use of digital imaging in medical presentation is a commonevent.Methods: We are presenting this computer interactive poster of a patientwith Heterotopic pancreas presenting as an abdominal pain.Results: The case will be presented from a portable computer screen. Youwill be able to (walk your self through the case) with different blood,Endoscopy, and imaging testing until you reach the final diagnosis. Therewill be a video commentary from the authors at the click of mouse atdifferent times. This case is unique and educational. You will be able to seethe capability of Power Point 2000 software. The case was designed andprepared by fellows using resources which are available at all institutions.Conclusions: As we will be seeing an increase in the use of digital imagingin medical presentation in the years to come we hope that future versionsof the software will be more user friendly with less limitation.

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Endoscopic diagnosis of entero-enteric intussusception due tometastatic malignant melanomaJamil Akhras, M.D., Prasad Kulkarni, M.D., Firdous Siddiqui, M.D.Wayne State University School of Medicine. Detroit, MI.

Introduction: Malignant melanoma (MM) is the most common metastatictumor to the gastrointestinal tract, small intestine being the most commonsite (58%). Although small bowel neoplasms are the most common causeof in the Western world, very few cases of MM presenting this way havebeen reported. The standard means of diagnosing intussusception has beenupper gastrointestinal barium study.Case: A 44-year-old Caucasian male with a history of MM presented withmelena, vague abdominal pain, and hemoglobin value of 6.5 g/dl. Hisprimary lesion in the right lower extremity was treated by wide localexcision four years ago, had recurred 2 years later in the right groin and wastreated with neo-adjuvant biochemotherapy followed by surgery. On ad-mission he appeared pale, had abdominal distension and epigastric tender-ness with normal bowel sounds. After fluid resuscitation and blood trans-fusions, he underwent diagnostic testing.Results: Initial abdominal films showed mild paralytic ileus. CT-Scan ofthe abdomen revealed a 10 cm mass effect of varying densities in themid-jejunum. With a high suspicion of metastatic MM as the cause ofgastrointestinal bleeding, enteroscopy was performed revealing multiplenon-bleeding submucosal masses in the proximal jejunum (pathologicallyconfirmed as MM) and a near-complete obstructing mass in mid-jejunum.Intussusception was suspected and confirmed by a barium small bowelfollow-through study. Patient underwent exploratory laparotomy with seg-mental resection of the small bowel and had an uneventful recovery.Conclusion: The clinical manifestations of intussusception in adults are notspecific, and a delay in diagnosis is common. As melena and vagueabdominal pain may be the only symptoms of metastatic MM, diagnosticevaluation by endocopy and/or barium imaging studies should be initiatedpromptly to make the diagnosis, and facilitate the surgical intervention,which is the palliative treatment of choice.

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Pancreatic tuberculosis: the great mimicker!Jamil Akhras, M.D., Christopher Steffes, M.D., Firdous Siddiqui, M.D.Division of Gastroenterology Wayne State University School ofMedicine. Detroit, MI.

Introduction: Pancreatic tuberculosis (TB) is an extremely rare clinicalentity. It is most often associated with miliary TB or occurs in immuno-compromised patients but it is uncommon in non-endemic geographic areasand can present in variant manifestation.Case: A 19-year-old African-American female presented with a 7 weekshistory of worsening intermittent epigastric pain associated with nausea,vomiting, and 6 pounds weight loss. Esophagogastro-duodenoscopy re-vealed a large and deep ulcer at the anterior bulbar wall, Ranitidine� wasprescribed without much improvement. CT-Scan of the abdomen showedmultilocular cystic-appearing masses at the head of the pancreas. Physicalexamination was unremarkable except for mild epigastric tenderness. Ini-tial blood tests showed normal values. Endoscopic retrograde pancreatog-raphy revealed normal pancreatic duct and no communication with thecystic mass. Due to a high suspicion for pancreatic cystic neoplasm, anexploratory laparotomy was performed.Results: Multiple small, firm, whitish nodules scattered throughout thesurface of both lobes of the liver with diffuse enlarged adenopathy in theperiaortic, celiac, portal, and retroperitonum. Whipple procedure was per-formed. Pathological examination of the lesions showed granulomatousinflammation. Stain for Acid-Fast bacilli was negative, however the culturegrew Mycobacterium Tuberculosis Complex. Patient was started on anti-tuberculosis medications. HIV test and Chest X-ray were negative.Conclusion: Of the 43 cases of pancreatic TB reported in the literature sofar, this represents the youngest ever-reported case. Because it can mimica pancreatic neoplasm, a high degree of suspicion and careful microbio-logical exam is needed for successful diagnosis and treatment of pancreaticTB. It should be considered in the differential diagnosis of pancreatic masslesions in the appropriate setting.

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A case of pharyngeal adenocarcinoma and possible association withZenker’s diverticulumMohammad Y Al-karain1, Amir T Awad1, Baskar P Soundarapandian1,Alan A Bloom1 and Vasanth K Siddalingaiah1*. 1Medicine/Gastroenterology, Bronx Lebanon Hospital Center, Bronx, NY, UnitedStates.

Purpose: A Case Report of an unusual association between Zenker’sDiverticulum and adenocarcinomaResults: The patient is a 73-year-old woman who presented with chronicdry cough for six weeks. At time of presentation patient denied dysphagiaor shortness of breath. She also described a right-sided neck swelling thathad been increasing in size over the past several months. Head and neckexamination confirmed the right-sided neck mass that measured 6 cm in thelongest diameter and extended from the right submandibular area to theclavicle. The rest of the physical examination was unremarkable.

Fine needle biopsy of the mass revealed adenacarcinoma. Subsequentlyfurther work up was done in order to identify the primary tumor. This workup included panendoscopy and CT of the chest, abdomen and pelvis. CTchest revealed that the neck mass extended into the chest with diffuselymphadenopathy. Esophagogastroduodenoscopy revealed a clear margindiverticulum compatible with Zenker’s diverticulum on the left side of theneck. Diagnosis of zenker’s diverticulum was confirmed with a bariumswallow. No primary malignancy was found.

Subsequently the patient developed stridor and required tracheostomy tomaintain airway patency. Patient now is receiving further care by theoncology team.Conclusions: In this case we find an unusual association of adenocarci-noma with Zenker’s diverticulum. Zenker’s diverticula are formed byherniation of hypopharyngeal mucosa through an area of weakness in the

S173AJG – September, Suppl., 2001 Abstracts