A Case of Chylothorax in an Adult Patient with Down Syndrome Developed after Mechanical Ventilation / 대한내과학회지

Chylothorax is the accumulation of chyle-containing lymphatic fluid within the pleural space. It is mainly caused by injury or obstruction of the thoracic duct due to neoplasm or trauma. There have been several reports of chylothorax associated with chromosomal anomaly such as Down syndrome. Most cases are congenital, and development of chylothorax in an adult with Down syndrome is rare. Here, we report a case of chylothorax in an adult with Down syndrome who had been treated with mechanical ventilation. A 31-year-old woman with Down syndrome was admitted with urosepsis. She was treated with mechanical ventilation due to severe respiratory acidosis. Four days after mechanical ventilation, she developed unilateral pleural effusion, and analysis indicated chylothorax. After conservative treatment, including fasting and total parenteral nutritional support, the chylous formation completely disappeared.

A Case of Spontaneous Hemoperitoneum without Spleen Injury after a Diagnostic Colonoscopy / 대한내과학회지

Colonoscopy is a widely used diagnostic and therapeutic intervention with an excellent safety profile. Although an intraperitoneal hemorrhage is a rare complication after colonoscopy, and usually associated with splenic injury or solid organ pathology, it is potentially serious and can be life-threatening. We report a rare case of spontaneous intraperitoneal hemorrhage after diagnostic colonoscopy without splenic injury or intra-abdominal abnormality, known as idiopathic spontaneous intraperitoneal hemorrhage. This case emphasizes that physicians should be aware of the emergence of acute abdomen after colonoscopy.

Gastric Outlet Obstruction by Impacted Phytobezoar at the Normal Duodenal Bulb

Phytobezoars are the most common bezoars composed of non-digestible food materials, such as fiber, seeds, skin of fruits. The predisposing factors of bezoars are altered gastrointestinal motility and anatomy. It is uncommon for bezoars occurring in patient with normal gastric anatomy to cause impaction on the duodenal bulb. We experienced a phytobezoar at the duodenal bulb causing gastric outlet obstruction in a patient who had no predisposing factors. The patient was treated by endoscopic removal.