A Case of Acute pancreatitis Due to Duodenal ulcer

편성익,황종호,이상호,이재남,정재훈,오공진 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Duodenal ulcers and acute pancreatitis are commonly encountered gastrointestinal diseases among the general population. However, duodenal ulcer-induced pancreatitis is very rarely reported worldwide. A 28-year-old man, had been hospitalized for acute pancreatitis. His social history was insignificant except for light alcohol consumption. On abdominal CT scan, mild diffuse enlargement of the pancreas without any stone was observed. A linear ulcer scar on the second part of the duodenum observed by ERCP. However, any specific ampullar shapes were not detected. ERCP was repeated 7 days after the first ERCP. It was inferred thata pin-shaped ampulla was likely situated on the fibrotic band caused by the duodenal ulcer scar. After stricture and distortion of the ampulla caused by the duodenal ulcer were diagnosed, followed by insertion of 7 French plastic stents into the pancreatic duct. The patient has not shown any recurrence of symptoms since the removal of the plastic stent 1 month after insertion. Through a series of initial evaluations, 75% to 90% of the causes of acute pancreatitis can be found. The common causes are gallstones and alcohol intake. The remaining cases are referred to as idiopathic acute pancreatitis and show a high recurrence and mortality rate. In this sense, it can be clinically important to identify the causes. When it is difficult to find a cause of acute pancreatitis, considering the possibility of acute pancreatitis being accompanied by strictures and distortion of the ampulla following ulcer healing.

식도 내 벽외성 압박의 위치에 따른 임상적 의미

편성익,김광하,윤정빈,전혜경,이봉은 대한상부위장관ㆍ헬리코박터학회 2017 Korean Journal of Helicobacter Upper Gastrointesti Vol.17 No.3

Background/Aims: Differentiation of an extraluminal compression from a true subepithelial tumor (SET) in the esophagus by using endoscopy alone is often difficult. EUS is known as the best method for differentiating an extraluminal compression from a true SET. Extraluminal compression in the esophagus is occasionally observed, but its clinical significance has been rarely reported. Therefore, we aimed to evaluate the clinical significance of extraluminal compression in the esophagus according to the location of the lesion. Materials and Methods: Sixty-one patients were diagnosed as having an extraluminal compression in the esophagus by using EUS between January 2006 and March 2014. Some patients underwent chest computed tomography for accurate diagnosis. Results: The extraluminal compression was located at the mid-esophagus in 26 cases, lower esophagus in 22 cases, and upper esophagus in 13 cases. Of the 61 cases, 55 were caused by normal structures and 6 were caused by pathological lesions. The causes of the normal structures were the aorta, vertebra, trachea, left main bronchus, azygos vein, and diaphragm. The causes of the pathological lesions were engorged vessels and calcified lymph nodes. The posterior wall was the most frequent location of the extraluminal compression. However, the lesions in the anterior and right walls showed a higher frequency of pathological lesions than those in other sites. Conclusions: If the extraluminal compression is found in the anterior and right walls of the esophagus, more careful evaluation should be performed considering the high frequency of pathological lesions in the site.

우연히 발견된 직장의 원발성 소포림프종

편성익 ( Sung Ik Pyeon ),송근암 ( Geun Am Song ),백동훈 ( Dong Hoon Baek ),김광하 ( Gwang Ha Kim ),이봉은 ( Bong Eun Lee ),이성준 ( Seong Jun Lee ),윤정빈 ( Jung Bin Yoon ),한성용 ( Sung Yong Han ),박도윤 ( Do Youn Park ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.2

The gastrointestinal tract is the most common site of extra-nodal non-Hodgkin lymphoma. However, the incidence of primary rectal lymphoma is extremely rare. Among the primary gastrointestinal lymphomas, follicular lymphoma has been described as a rare disease. It is difficult to diagnose rectal lymphoma due to its variable growth patterns and inadequate biopsies. Majority of patients with rectal lymphoma have non-specific symptoms or negative biopsies, often delaying the diagnosis. Our patient is a 62-year-old female. Two sessile and smooth subepithelial lesions with a yellowish normal mucosa were found on a screening colonoscopy. The initial mucosal biopsy finding was chronic inflammation, but we were highly suspicion of malignancy; we performed an endoscopic mucosal resection. Herein, we present a rare case of rectal follicular lymphoma diagnosed by endoscopic mucosal resection with a literature review. (Korean J Gastroenterol 2017;69:139-142)

고령의 복통 환자에서 발견된 소장의 위장관 간질 종양 천공 1례

오공진,황종호,편성익,신재규,박호준,채철병 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Acute abdominal pain is a common presenting complaint in elderly patients. Presentation may differ from that of the younger patient and is often complicated by coexistent disease, delays in presentation, and physical and social barriers. In elderly patients, the diagnostic accuracy is lower and the mortality far higher than the younger patients. In the geriatric population, biliary tract disease is the most common cause of abdominal pain, followed by malignancy, bowel obstruction, complicated peptic ulcer disease, incarcerated hernia, non-specific pain. Early and correct diagnosis for the elderly patients with acute abdomen is critical and significantly influences the outcome. In this report, we describe a case of a 84-year-old man with a ruptured small bowel gastrointestinal stromal tumor (GIST) who presented emergency department with presentation of acute abdomen. Laparotomy was performed, since perforation of a tumor in the jejunum found by computed tomography. Diagnosis is confirmed on histopathology and immunohistochemistry. We recommend to consider small bowel disease when exploring the cause of acute abdominal pain in elderly patients.

고령의 복통 환자에서 발견된 소장의 위장관 간질 종양 천공 1예

오공진,황종호,이호영,편성익,신재규,박호준,채철병 대한노인병학회 2014 Annals of geriatric medicine and research Vol.18 No.4

Acute abdominal pain as a common complaint in elderly patients may differ from that in younger patients. In elderly patients, the diagnostic accuracy of acute abdominal pain is lower compared to that in younger patients. On the other hand, the mortality in elderly patients with acute abdominal pain is far higher than that in the younger patients. Therefore, early and correct diagnosis of acute abdominal pain for the elderly patients could significantly influence the outcome. In this report, we describe a case of a 84-year-old man with a ruptured small bowel gastrointestinal stromal tumor who presented at the Emergency Department with acute abdominal pain. Laparotomy was performed because perforation of a tumor in the jejunum was found by computed tomography. Diagnosis was confirmed by histopathology and immunohistochemistry. Therefore, small bowel disease should be considered when exploring the cause of acute abdominal pain in elderly patients.

간세포양 샘암종의 임상병리학적 특성

윤정빈,김광하,박도윤,김영금,편성익,이봉은,송근암 대한상부위장관ㆍ헬리코박터학회 2017 Korean Journal of Helicobacter Upper Gastrointesti Vol.17 No.2

Background/Aims: Gastric hepatoid adenocarcinoma (GHA), a rare type of primary gastric cancer, is characterized by a histologyresembling hepatocellular carcinoma. Previous case studies reported that patients with GHA have a poor prognosis due to earlylymph node or liver metastasis, but information concerning GHA is still limited. Therefore, we aimed to evaluate the clinicopathologicalfeatures of GHA. Materials and Methods: We reviewed the medical records of 9 patients who were diagnosed as having GHA between January 2011and December 2016. The clinicopathological characteristics of these patients were retrospectively analyzed. Results: The median age of the patients at diagnosis was 68.9 years. Seven of the 9 patients were male. Serum AFP levels were elevatedin 3 of 4 patients. All the tumors were >4 cm (range, 4∼12 cm), and 7 tumors were located at the lower third of the stomach. Five tumors were classified as Borrmann’s type 3, with a purple, berry-like surface. Of the 6 patients without distant metastasis, 5received curative-intent surgery and 3 received adjuvant chemotherapy. Three patients with distant metastasis received either palliativeoperation and/or chemotherapy. Their median survival time was 11.8 months (range, 1∼36 months). Two patients with elevatedserum CEA levels had poor outcomes. Conclusions: GHA is a rare subtype of gastric cancer that is prone to liver metastasis. All GHAs are advanced gastric cancer witha purple, berry-like surface at diagnosis. Although the prognosis of advanced-stage GHA is poor, active multimodality treatmentmight provide some benefit.

Endoscopic Clip Closure of Duodenal Perforation Causedby Percutaneous Drainage Procedure

한동훈,황종호,이상호,이태무,편성익,이동욱,신재규,오공진 대한상부위장관ㆍ헬리코박터학회 2014 Korean Journal of Helicobacter Upper Gastrointesti Vol.14 No.4

Acute cholecystitis is a disease commonly treated in health care institutions. Cholecystectomy is the standard treatment for acute cholecystitis, and emergent laparoscopic cholecystectomy is acceptable as an effective and safe treatment modality. One of the complications after laparoscopic cholecystectomy is intra-abdominal abscess. The standard treatment for postoperative intra-abdominal abscess is percutaneus transhepatic drainage and use of antibiotics. However, duodenal perforation can occur during insertion of the pigtail catheter for drainage. Operation is the treatment of choice for iatrogenic duodenal perforations. Recent reports describe nonsurgical treatments for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation due to pigtail catheter insertion for percutaneous transhepatic drainge that was succesfully treated by using endoclips.

투시영상 없이 시행한 췌장 가성낭종의 내시경초음파 유도하 배액술

한성용 ( Sung Yong Han ),김광하 ( Gwang Ha Kim ),편성익 ( Sung Ik Pyeon ),이문원 ( Moon Won Lee ),송병구 ( Byeong Gu Song ),백동훈 ( Dong Hoon Baek ),김동욱 ( Dong Uk Kim ),송근암 ( Geun Am Song ) 대한췌담도학회 2018 대한췌담도학회지 Vol.23 No.1

배경/목적: 췌장 가성 낭종은 급성과 만성 췌장염의 흔한 합병증이다. 내시경 초음파를 통한 배액술은 여러단계와 여러장비들이 필요하다. 모든 병원에서 선형초음파내시경 기계 및 투시영상 검사실을 같이 갖추진 못하고 있다. 우리는 투시영상없이 초음파내시경을 통한 췌장가성낭종의 배액술의 안전성과 효율성을 확인하고자 한다. 방법: 2009년 1월부터 2016년 12월까지 초음파내시경을 통해서 가성낭종의 배액술을 시행한 10명의 환자를 분석하였다. 경위적 접근법을 통하여 시행하였으며, 1개 혹은 2개의 7Fr 이중돼지꼬리 플라스틱 배액관을 사용하여 배액술을 시행하였다. 결과: 기술적 성공률은 100% 이며, 임상적 성공률은 80% 였다. 2명의 환자에서는 내시경적 배액술로성공하지 못하여, 경피부배액술을 시행하였고, 수술적치료 없이 호전되었다. 3명의 환자에서는 합병증이 발생하였다(출혈, 감염, 스텐트 이탈). 평균 36.5개월을 추적관찰하였을때 가성낭종이 재발한 환자는 없었다. 결론: 투시영상없이 초음파내시경을 통한 췌장 가성낭종의 배액술은 췌장가성낭종의 치료에서 안전하고, 기술적으로 가능하며, 효과적인 방법이다. Background/Aims: Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. Endoscopy ultrasound (EUS)-guided drainage includes multiple steps and requires many resources such as a linear echoendoscope and a fluoroscopy room, which may not be available at all medical centers. We aimed to evaluate the efficacy and safety of EUS-guided pancreatic pseudocyst drainage without fluoroscopy. Methods: This retrospective study analyzed 10 patients who had undergone EUSguided transmural drainage of pancreatic pseudocyst without use of fluoroscopy at the Pusan National University Hospital between January 2009 and December 2016. Drainage was performed via a transgastric approach and one or two 7 Fr double-pigtail stents were inserted. Results: The technical success rate was 100% and the clinical success rate was 80%. In two patients, clinical success was not achieved and additional percutaneous catheter drainage was done. Therefore, pseudocysts in all the patients were treated successfully without surgical drainage. However, there were three adverse events in three patients: bleeding, infection, and stent migration in each respective patient. During the median follow-up period of 36.5 months, there was no recurrence of pseudocysts in any of the patients. Conclusions: EUS-guided transmural drainage of pseudocyst drainage without use of fluoroscopy is a technically feasible, safe, and effective procedure for the treatment of pancreatic pseudocyst. Korean J Pancreas Biliary Tract 2018;23(1):24-31