Semin Respir Crit Care Med 2002; 23(6): 529-542
DOI: 10.1055/s-2002-36517
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Hepatic, Splenic, and Gastrointestinal Involvement with Sarcoidosis

Marc A. Judson
  • Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina
Further Information

Publication History

Publication Date:
07 January 2003 (online)

ABSTRACT

Sarcoidosis is a multisystem granulomatous disease of unknown cause that primarily affects the lung and lymphatic systems of the body.[1] However, any organ may be affected, including the abdominal organs and gastrointestinal tract.[1] As with other forms of sarcoidosis, abdominal sarcoidosis presents diagnostic, prognostic, and therapeutic dilemmas. This article reviews the various forms of abdominal sarcoidosis, with particular attention given to methods of diagnosis and treatment options.

REFERENCES

  • 1 Hunninghake G W, Costabel U, Ando M. ATS/ ERS/WASOG statement on sarcoidosis.  Sarcoidosis Vasc Diff Lung Dis . 1999;  16 149-173
  • 2 Lehmuskallio E, Hannuksela M, Halme H. The liver in sarcoidosis.  Acta Med Scand . 1977;  202 298-299
  • 3 Klastskin G. Hepatic granulomas: problems in interpretation.  Ann NY Acad Sci . 1976;  278 427-432
  • 4 Iwai K, Oka H. Sarcoidosis: report of ten autopsy cases in Japan.  Am Rev Respir Dis . 1964;  90 612-622
  • 5 Irani S K, Dobbins W O. Hepatic granulomas: a review of 73 patients from one hospital and survey of the literature.  J Clin Gastroenterol . 1979;  1 131-143
  • 6 Hercules H C, Bethlem N M. Value of liver biopsy in sarcoidosis.  Arch Pathol Lab Med . 1984;  108 831-834
  • 7 Vatti R, Sharma O P. Course of asymptomatic liver involvement in sarcoidosis: the role of therapy in selected cases.  Sarcoidosis Vasc Diff Lung Dis . 1997;  14 73-76
  • 8 Devaney K, Goodman Z D, Epstein M S, Zimmerman H J, Ishak K G. Hepatic sarcoidosis: clinicopathologic features in 100 patients.  Am J Surg Pathol . 1993;  17 1272-1280
  • 9 Chamuleau R A, Sprangers R L, Alberts C, Schipper M E. Sarcoidosis and chronic intrahepatic cholestasis.  Neth J Med . 1985;  28 470-476
  • 10 Baughman R P, Teirstein A S, Judson M A. Initial clinical characteristics of patients with sarcoidosis in the United States.  Am J Respir Crit Care Med . 2001;  164 1885-1889
  • 11 James D G, Sherlock S. Sarcoidosis of the liver.  Sarcoidosis . 1994;  11 2-6
  • 12 Warshauer D M, Molina P L, Hamman S M. Nodular sarcoidosis of the lever and spleen: analysis of 32 cases.  Radiology . 1995;  195 757-762
  • 13 Israel H L, Margolis M L, Rose L J. Hepatic granulomatosis and sarcoidosis.  Digest Dis Sci . 1984;  29 353-356
  • 14 Maddrey W C, Johns C J, Boitnott J K, Iber F L. Sarcoidosis and chronic hepatic diseae: a clinical and pathologic study of 20 patients.  Medicine . 1970;  49 375-395
  • 15 Ishak K G. Sarcoidosis of the liver and bile ducts.  Mayo Clin Proc . 1998;  73 467-472
  • 16 Moreno-Merlo F, Wanless I R, Shimamatsu K. The role of granulomatous phlebitis and thrombosis in the pathogenesis of cirrhosis and portal hypertension in sarcoidosis.  Hepatology . 1997;  26 554-560
  • 17 Murphy J R, Sjorgen M H, Kikendall J W, Peura D A, Goodman Z. Small duct abnormalities in sarcoidosis.  J Clin Gastroenterol . 1990;  12 555-561
  • 18 James D G. Sarcoidosis.  Postgrad Med J . 1984;  60 234-241
  • 19 Schaffner F. Primary biliary cirrhosis. In: Berk JE, Haubrich WS, Kaiser MH, Roth JLA, Schaffner F, eds. Bockus Gastroenterology 4th ed. Vol 5. Philadelphia: Saunders 1985: 171
  • 20 Periera-Lima J, Schaffner F. Chronic cholestasis in hepatic sarcoidosis with clinical features resembling primary biliary cirrhosis: report of two cases.  Am J Med . 1987;  83 144-148
  • 21 Karlish A J, Thompson R PH, Williams R. A case of sarcoidosis and primary biliary cirrhosis.  Lancet . 1969;  2 599
  • 22 Rudzki C, Ishak K G, Zimmerman H J. Chronic intrahepatic cholestasis of sarcoidosis.  Am J Med . 1975;  59 373-387
  • 23 Thomas E, Micci D. Chronic intrahepatic cholestasis with granulomas and biliary cirrhosis.  JAMA . 1977;  238 337-338
  • 24 Bass N M, Burroughs A K, Scheuer P J, James D G, Sherlock S. Chronic intrahepatic cholestasis due to sarcoidosis.  Gut . 1982;  23 417-421
  • 25 Baughman R P. Sarcoidosis: usual and unusual manifestations.  Chest . 1988;  94 165-170
  • 26 Bloom R, Sybert A, Mascetello V J. Granulomatous biliary tract obstruction due to sarcoidosis.  Am Rev Respir Dis . 1978;  117 783-787
  • 27 Valla D, Pessegueiro-Miranda H, Degott C. Hepatic sarcoidosis with protal hypertension: a report of seven cases with a review of the literature.  Quart J Med . 1987;  242 531-544
  • 28 Tekeste H, Latour F, Levitt R E. Portal hypertension complicating sarcoid liver disease: case report and review of the literature.  Am J Gastroenterol . 1984;  79 389-396
  • 29 Melissant C F, Smith S J, Kazzaz B A, Demedts M. Bleeding varices due to portal hypertension in sarcoidosis.  Chest . 1993;  103 628-629
  • 30 Lu C L, Chen C Y, Hou M C, Chang F Y, Lee S D. The experience of endoscopic tissue glue injection in the treatment of hepatic sarcoidosis-related gastric variceal bleeding: report of a case.  Hepato-gastroenterol . 1999;  46 2293-2295
  • 31 Russi E W, Bansky G, Pfaltz M. Budd-Chiari Syndrome in sarcoidosis.  Am J Gastroenterol . 1986;  81 71-75
  • 32 Nataline M R, Goyette R E, Owensby L C, Rubin R N. The Budd-Chiari syndrome in sarcoidosis.  JAMA . 1978;  239 2657-2658
  • 33 McCluggage W G, Sloan J M. Hepatic granulomas in Northern Ireland: a thirteen-year review.  Histopathol. 25 219-228
  • 34 Britt A R, Francis I R, Glazer G M, Ellis J H. Sarcoidosis: abdominal manifestations at CT.  Radiology . 1991;  178 91-94
  • 35 Warshauer D M, Dumbleton S A, Molina P L. Abdominal CT findings in sarcoidosis: radiologic and clinical correlation.  Radiology . 1994;  192 93-98
  • 36 Folz S J, Johnson D, Swensen S J. Abdominal manifestations of sarcoidosis in CT studies.  J Comput Assist Tomogr . 1995;  19 573-579
  • 37 Farman J, Ramirez G, Brunetti J. Abdominal manifestations of sarcoidosis: CT appearances.  Clin Imaging . 1995;  19 30-33
  • 38 Nakata K, Iwata K, Kojima K, Kanai K. Computed tomography of liver sarcoidosis.  J Comput Assist Tomogr . 1989;  13 707-708
  • 39 Scott G C, Berman J M, Higgins J L. CT patterns of nodular hepatic and splenic sarcoidosis: a review of the literature.  J Assist Comput Tomogr . 1997;  21 369-372
  • 40 Kessler A, Mitchell D G, Israel H L, Goldberg B B. Hepatic and splenic sarcoidosis: ultrasound and MR imaging.  Adbom Imaging . 1993;  18 159-163
  • 41 Panasci D J, Gordon D H, Sadovsky R. Sarcoidosis of the liver: evaluation with multiple imaging modalities.  Comput Med Imaging Graph . 1992;  16 55-58
  • 42 Warshauer D M, Semelka R C, Ascher S M. Nodular sarcoidosis of the liver and spleen: appearance on MR images.  J Mag Resonance Imag . 1994;  4 553-557
  • 43 Flickinger F W, Pfeifer E A. Hepatic sarcoidosis: MR findings [letter].  Am J Radiol . 1991;  156 1324-1325
  • 44 Kataoka M, Nakata Y, Hiramatsu J. Hepatic and splenic sarcoidosis evaluated by multiple imaging modalities.  Intern Med . 1998;  37 449-453
  • 45 Anderson C S, Nicholls J, Rowland R, LaBrooy J T. Hepatic granulomas: a 15-year experience in the Royal Adelaide Hospital.  Med J Austral . 1988;  148 71-74
  • 46 Collins M H, Jiang B, Croffie J M, Chong S KF, Lee C H. Hepatic granulomas in children Am J Surg Pathol .  1996;  20 332-338
  • 47 Sartin J S, Walker R C. Granulomatous hepatitis: a retrospective review of 88 cases at the Mayo Clinic.  Mayo Clin Proc . 1991;  66 914-918
  • 48 Israel H L, Goldstein R A. Hepatic granulomatosis and sarcoidosis.  Ann Intern Med . 1973;  79 669-678
  • 49 Judson M A, Baughman R P, Teirstein A S, Yeager H, ACCESS Research Group. Defining organ involvement in sarcoidosis: the ACCESS proposed instrument.  Sarcoidosis Vasc Diff Lung Dis . 1999;  16 75-86
  • 50 Ludwig J, Colina F, Poterucha J J. Granulomas in primary sclerosing cholangitis.  Liver . 1995;  15 307-312
  • 51 Alam I, Levenson S D, Ferrell L D, Bass M M. Diffuse intrahepatic biliary strictures in sarcoidosis resembling sclerosing cholangitis.  Digest Dis Sci . 1997;  42 1295-1301
  • 52 Brinker H. Granulomatous lesions of unknown significance in biopsies from lymph nodes and other tissues: the GLUS syndrome. 1st WASOG Meeting, Lisbon, October 1989, Abstract 21
  • 53 Brinker H. Granulomatous lesions of unknown significance: the GLUS syndrome. In: James DG, ed. Sarcoidosis and Other Granulomatous Disorders 1994, Vol 73. Philadelphia: WB Saunders 1994: 69-86
  • 54 Brinker H, Pedersen N T. Immunological marker patterns in granulomatous lymph node lesions.  Histopathology . 1989;  15 495-503
  • 55 Gottlieb J E, Israel H L, Steiner R M, Triolo J, Patrick H. Outcome in sarcoidosis: the relationship of relapse to corticosteroid therapy.  Chest . 1997;  111 623-631
  • 56 Baughman R P. Methtrexate for sarcoidosis.  Sarcoidosis Vasc Diff Lung Dis . 1998;  15 147-149
  • 57 Poupon R E, Chretien Y, Poupon R, Paumgartner G. Serum bile acids in primary biliary cirrhosis: effect of ursodeoxycholic acid therapy.  Hepatology . 1993;  17 599-603
  • 58 Becheur H, Dall'osto H, Chatellier G. Effect of ursodeoxycholic acid on chronic intrahepatic cholestasis due to sarcoidosis.  Digest Dis Sci . 1997;  42 789-791
  • 59 Baratta L, Cascino A, Delfino M. Ursodeoxycholic acid treatment in abdominal sarcoidosis.  Digest Dis Sci . 2000;  45 1559-1562
  • 60 Hughes G S, Kataria Y P, O'Brien T F. Sarcoidosis presenting as biliary cirrhosis: treatment with chlorambucil.  South Med J . 1983;  76 1440-1442
  • 61 Sherlock S, Dooley J. Hepatic sarcoidosis. In: Sherlock S, ed. Diseases of the Liver and Biliary System 10th ed. Oxford: Blackwell Science 1997: 163-173
  • 62 Vilinskas J, Joyeuse R, Serlin O. Hepatic sarcoidosis with portal hypertension.  Am J Surg . 1970;  120 393-396
  • 63 James D G. Life-threatening situations in sarcoidosis.  Sarcoidosis Vasc Diff Lung Dis . 1998;  15 134-139
  • 64 Casavilla F A, Gordon R, Wright H I. Clinical course after liver transplantation in patients with sarcoidosis.  Ann Intern Med . 1993;  118 865-866
  • 65 Bain V G, Kneteman N, Brown N E. Sarcoidosis, liver transplantation, and cyclosporine [letter].  Ann Intern Med . 1993;  119 1148
  • 66 Fidler H M, Hadziyannis S J, Dhillon A P, Sherlock S, Burroughs A K. Recurrent hepatic sarcoidosis following liver transplantation.  Transplant Proc . 1997;  29 2509-2510
  • 67 Hunt J, Gordon F D, Jenkins R L, Lewis W D, Khettry U. Sarcoidosis with selective involvement of a second allograft: report of a case and review of the literature.  Mod Pathol . 1999;  12 325-328
  • 68 Barbers R G. Role of transplantation (lung, liver, and heart) in sarcoidosis.  Clin Chest Med . 1997;  18 865-874
  • 69 Kataria Y P, Whitcomb M E. Splenomegaly in sarcoidosis.  Arch Intern Med . 1980;  140 35-37
  • 70 Salazar A, Mana J, Corbella X, Albareda J M, Pujol R. Splenomegaly in sarcoidosis: a report of 16 cases.  Sarcoidosis . 1995;  12 131-134
  • 71 Selroos O. Sarcoidosis of the spleen.  Acta Med Scand . 1976;  200 337-340
  • 72 Selroos O, Koivunen E. Usefulness of fine-needle aspiration biopsy of spleen in diagnosis of sarcoidosis.  Chest . 1983;  83 193-195
  • 73 Webb A K, Mitchell D N, Bradstreet C MP, Salsbury A J. Splenomegaly and splenectomy in sarcoidosis.  J Clin Pathol . 1979;  32 1050-1053
  • 74 Mana J, Salazar A, Manresa F. Clinical factors predicting persistence of activity in sarcoidosis: a multivariate analysis of 193 cases.  Respiration . 1994;  61 219-225
  • 75 Neville E, Walker A N, James D G. Prognostic factors predicting the outcome of sarcoidosis: an analysis of 818 patients.  Quart J Med . 1983;  208 525-533
  • 76 Thadani U, Aber C P, Taylor J J. Massive splenomegaly, pancytopenia and haemolytic anemia in sarcoidosis.  Acta Haematol . 1975;  53 230-240
  • 77 Haran M Z, Feldberg E, Miller G, Berrebi A. Sarcoidosis presenting as massive splenomegaly and bicytopenia [letter].  Am J Hematol . 2000;  63 232-233
  • 78 Sharma O P. Splenic rupture in sarcoidosis: report of an unusual case.  Am Rev Respir Dis . 1967;  96 101-102
  • 79 Taavitsainen M, Koivuniemi A, Helminen J. Aspiration biopsy of the spleen in patients with sarcoidosis.  Acta Radiol . 1987;  28 723-725
  • 80 Stone R W, McDaniel W R, Armstrong E M. Acquired functional asplenia in sarcoidosis.  J Nation Med Assoc . 1985;  77 930-936
  • 81 Coon W W. Splenectomy for splenomegaly and secondary hyperplenism.  World J Surg . 1985;  9 437-443
  • 82 Sigematsu H, Kurita A, Omura Y. Gastric cancer with sarcoid reactions in the regional lymph nodes, the stomach wall, and the splenic panenchyma: report of a case.  Surg Today . 1999;  29 549-552
  • 83 Nadel E M, Ackerman L V. Lesion resembling Boeck's sarcoid in lymph nodes draining an area containing a malignant neoplasm.  Am J Clin Pathol . 1950;  20 952-957
  • 84 Rosenberg J C. Portal hypertension complicating hepatic sarcoidosis.  Surgery . 1971;  69 294-299
  • 85 Uthman I W, Bizri A RN, Shabb N S, Khury M Y, Khalifeh M J. Peritoneal sarcoidosis: case report and review of the literature.  Semin Arthritis Rheum . 1999;  28 351-354
  • 86 Wheeler J E, Rosenthal N S. Bloody ascites in sarcoidosis.  Chest . 1985;  88 917-918
  • 87 Robertson L E, Cunningham J T. Primary peritoneal sarcoidosis.  Digest Dis Sci . 1990;  35 1545-1548
  • 88 Edmond M, Borrelli G S, Wenzel R P. A 38-year-old woman with new-onset ascites.  Am J Med Sci . 1997;  313 170-175
  • 89 Becker W F, Coleman W O. Surgical significance of abdominal sarcoidosis.  Ann Surg . 1961;  153 987-995
  • 90 Wong M, Rosen S W. Ascites in sarcoidosis due to peritoneal involvement.  Ann Intern Med . 1962;  57 277-280
  • 91 Trimble E L, Saigo P E, Freeberg G W, Rubin S C, Hoskins W J. Peritoneal sarcoidosis and elevated CA-125.  Obstet Gynecol . 1991;  78 976-977
  • 92 Provenza J M, Bacon B R. Chylous ascites due to sarcoidosis.  Am J Gastroenterol . 1991;  86 92-95
  • 93 Ngo Y, Messing B, Marteau P. Peritoneal sarcoidosis: an unrecognized cause of sclerosing peritonitis.  Digest Dis Sci . 1992;  37 1776-1780
  • 94 Bacal D, Hoshal V L, Schaldenbrand J D, Lampman R M. Sarcoidosis of the pancreas: case report and review of the literature.  Am Surg . 2000;  66 675-678
  • 95 Siavelis H A, Herrmann M E, Aranha G V. Sarcoidosis and the pancreas.  Surgery . 1999;  125 456-461
  • 96 Brady M S, Garfein C F, Klimstra D, Brenann M F. Sarcoidosis of the pancreas.  J Surg Oncol . 1993;  54 132-137
  • 97 Rodriguez J, Dyek W P. An unusual case of sarcoidosis presenting as a pancreatic mass [letter].  Am J Gastroenterol . 1996;  91 2253-2254
  • 98 Chaun H, King D M, Gofton J P, Sutherland W H, Bogoch A. Sarcoidosis of the pancreas.  Digest Dis . 1972;  17 725-730
  • 99 Garcia C, Kumar V, Sharma O P. Pancreatic sarcoidosis.  Sarcoidosis Vasc Diff Lung Dis . 1996;  13 28-32
  • 100 Snook B, Duggan M, Birkett D. Sarcoidosis of the pancreas: a case report.  Am Surg . 1996;  62 947-948
  • 101 Friedman H Z, Weinstein R A. Sarcoidosis of the pancreas.  Arch Intern Med . 1983;  143 2182-2183
  • 102 McCormick P A, O'Donnell M, McGeeney K. Sarcoidosis and the pancreas.  Irish J Med Sci . 1988;  157 181-183
  • 103 Sturmer J, Becker V. Granulomatous pancreatitis: granulomas in chronic pancreatitis.  Virchows Arch A . 1987;  410 327-338
  • 104 Maher L, Choi H, Dodds W J. Noncaseating granulomas of the pancreas.  Am J Gastroenterol . 1981;  75 222-225
  • 105 Farman J, Ramirez G, Rybak B. Gastric sarcoidosis.  Abdom Imaging . 1997;  22 248-252
  • 106 Palmer E D. A note on silent sarcoidosis of the gastric mucosa.  J Lab Clin Med . 1958;  52 231-234
  • 107 Wadina G S, Melamed A. Gastric granuloma (sarcoidosis?).  Am J Gastroenterol . 1966;  45 11-21
  • 108 Konda J, Ruth M, Sassaris M, Hunter F M. Sarcoidosis of the stomach and rectum.  Am J Gastroenterol . 1980;  73 516-518
  • 109 Bellan L, Semelka R, Warren C PW. Sarcoidosis as a cause of linitis plastica.  J Can Assoc Radiol . 1988;  39 72-74
  • 110 Fireman Z, Sternberg A, Yarchovsky Y. Multiple antral ulcers in gastric sarcoid.  J Clin Gastroenterol . 1997;  24 97-99
  • 111 Espinel J, Jorquera F, Fernandez-Gundin M J. Endoscopic management in symptomatic gastric sarcoidosis.  Endoscopy . 1999;  31(suppl) S35
  • 112 Pope J B, Danford J R. Symptomatic gastric sarcoidosis and Helicobacter pylori infection.  J Am Board Fam Pract . 1996;  9 451-454
  • 113 Low V HS, Heyneman L E. Gastric ulceration due to sarcoidosis.  Am J Roentgenol . 1999;  172 251-252
  • 114 Levine M S, Ekberg O, Rubesin S E, Gatenby R A. Gastrointestinal sarcoidosis: radiographic findings.  Am J Roengenol . 1989;  153 293-295
  • 115 Tiechman R F, Brandt-Rauf P W. Gastric sarcoidosis.  J Royal Soc Med . 1991;  84 50-51
  • 116 Masuda R, Toyoshima H, Bandou T, Isoyama T. Malignant lymphoma of the stomach associated with systemic sarcoidosis.  Cancer . 1992;  70 2592-2596
  • 117 Ectors N L, Dixon M F, Geboles K J. Granulomatous gastritis: a morphological and diagnostic approach.  Histopathology . 1993;  23 55-61
  • 118 Shapiro J L, Goldblum J R, Petras R E. A clinicopathologic study of 42 patients with granulomatous gastritis: is there really an ``idiopathic'' granulomatous gastritis?.  Am J Surg Pathol . 1996;  20 462-470
  • 119 Matsuhashi N, Nakajima A, Fukushima Y. Sarcoid reactions in association with a leiomyosarcoma of the stomach.  Am J Gastroenterol . 1996;  91 2623-2624
  • 120 Newton C, Nochomovitz L, Sackier J M. Gastric adenocarcinoma associated with isolated granulomatous gastritis.  Ann Surg Oncol . 1998;  5 407-410
  • 121 Tham T CK, Larkin C. Sarcoidosis of the duodenum presenting as dyspepsia.  Am J Gastroenterol . 1995;  2057-2058
  • 122 Fleming R H, Nuzek M, McFadden D W. Small intestinal sarcoidosis with massive hemorrhage: report of a case.  Surgery . 1994;  115 127-131
  • 123 Noel J M, Katona I M, Pineiro-Carrero V M. Sarcoidosis resulting in duodenal obstruction in an adolescent.  J Pediatric Gastroenterol Nutrit . 1997;  24 594-598
  • 124 Babaryka I, Thorn L, Langer E. Epithelioid cell granulomata in the mucosa of the small intestine in Whipple's disease.  Virchows Archiv A . 1979;  382 227-235
  • 125 Ernst B B, Lowder C Y, Meisler D M, Gutman F A. Posterior segment manifestations of inflammatory bowel disease.  Ophthalmol . 1991;  98 1272-1280
  • 126 Bewig B, Manske I, Bottcher H. Crohn's disease mimicking sarcoidosis in bronchoalveolar lavage.  Respiration . 1999;  66 467-469
  • 127 Fellerman K, Stahl M, Dahlhoff K. Crohn's disease and sarcoidosis: systemic granulomatosis?.  Eur J Gastroenterol Hepatol . 1997;  9 1121-1124
  • 128 Smiejan J M, Cosnes J, Chollet-Martin S. Sarcoid-like lymphocytosis of the lower respiratory tract in patients with active Crohn's disease.  Ann Intern Med . 1986;  104 17-21
  • 129 Wallaert B, Colombel J F, Tonnel A B. Evidence of lymphocyte alveolitis in Crohn's disease.  Chest . 1985;  87 363-367
  • 130 Wallaert B, Bonniere P, Prin L. Primary biliary cirrhosis: subclinical inflammatory alveolitis in patients with normal chest roentgenograms.  Chest . 1986;  90 842-848
  • 131 Spiteri M A, Johnson M, Epstein O. Immunological features of lung lavage cells from patients with primary biliary cirrhosis may reflect those seen in pulmonary sarcoidosis.  Gut . 1990;  31 208-212
  • 132 Rauf A, Davis P, Levendoglu H. Sarcoidosis of the small intestine.  Am J Gastroenterol . 1988;  83 187-189
  • 133 Oakley J R, Lawerence D AS, Fiddian R V. Sarcoidosis associated with Crohn's disease of the ileum, mouth, and oesophagus.  J Royal Soc Med . 1983;  76 1068-1071
  • 134 Dines D E, DeRemee R A, Green P A. Sarcoidosis: associated with regional enteritis (Crohn's disease).  Minnesota Med . 1971;  54 617-620
  • 135 Kohn N N. Sarcoidosis of the colon.  J Med Soc New Jersey . 1980;  77 517-518
  • 136 Hilzenrat N, Spanier A, Lamoureux E, Bloom C, Sherker A. Colonic obstruction secondary to sarcoidosis: nonsurgical diagnosis and management.  Gastroenterol . 1995;  108 1556-1559
  • 137 Dumot J A, Adal K, Petras R E, Lashner B A. Sarcoidosis presenting as granulomatous colitis.  Am J Gastroenterol . 1998;  93 1949-1951
  • 138 Clarke H, Pollett W, Chittal S. Sarcoidosis with involvement of the appendix.  Arch Intern Med . 1983;  143 1603-1604
  • 139 Munt P W. Sarcoidosis of the appendix presenting as appendiceal perforation and abscess.  Chest . 1974;  66 295-297
  • 140 Gould S R, Handley A J, Barnard D E. Rectal and gastric involvement in a case of sarcoidosis.  Gut . 1973;  14 971-973
  • 141 Tobi M, Korbin I, Ariel I. Rectal involvement in sarcoidosis.  Dis Colon Rectum . 1982;  25 491-493
  • 142 Zech J R, Kroger E, Bonnin A J, Richmond G W. Sarcoidosis: unusual cause of a rectal mass.  South Med J . 1993;  86 1054-1055
  • 143 Gaskins R D, Pasquale D N. Granulomatous diseases of the pharynx and esophagus.  Otolaryngol Clin N A . 1982;  15 533-538
  • 144 Wiesner P J, Kleinman M S, Condemi J J, Resnicoff S A, Schwartz S I. Sarcoidosis of the esophagus.  Digest Dis . 1971;  16 943-951
  • 145 Cook D M, Dines D E, Dycus D S. Sarcoidosis: report of a case presenting as dysphagia.  Chest . 1970;  57 84-86
  • 146 Sprague R, Harper P, McClain S, Trainer T, Beekin W. Disseminated gastrointestinal sarcoidosis: case report and review of the literature.  Gastroenterol . 1984;  87 421-425
  • 147 McMaster K R, Hennigar G R. Drug-induced granulomatous hepatitis.  Laboratory Invest . 1981;  44 61-73
  • 148 Eisenberg R L. Decreased-attenuation masses in the spleen. In: Eisenberg RL, ed. Gastrointestinal Radiology: A Pattern Approach 3rd ed. Philadelphia: Lippincott-Raven 1996: 1134-1141