A Case of Successful Laparoscopic Management on Appendiceal Bleeding Diagnosed by Colonoscopy / 대한소화기내시경학회지

Appendiceal causes of lower gastrointestinal bleeding are rare, and identification of the bleeding site is critical. Identification of the bleeding site can be difficult. The differential diagnosis of bleeding in the appendix includes diverticulum, appendicitis, angiodysplasia, Crohn's disease, and appendiceal intussusception, which leads to mucosal erosion and vascular exposure by underlying inflammation. Laparoscopic surgery is commonly performed as a therapeutic procedure for the appendix, also can be a valuable tool in the diagnosis and treatment of hemorrhaging from the appendix. Appendiceal bleeding is rare, and laparoscopic management cases are not widely reported. Herein, we report a case of successful laparoscopic management of appendiceal bleeding diagnosed by colonoscopy with a review of the literature.

Therapeutic Plan for Benign Polypoid Lesion of Gallbladder

PURPOSE: Since the laparoscopic cholecystectomy became an usual procedure, operative indications of the gallbladder polyps have had the tendency to enlarge. There are no precise management plan about the gallbladder polyps which is not included in the accepted operative indications. Therefore a management plan may be required for the patients who has gallbladder polyps which is not accepted operative indications. METHODS: We retrospectively analysed 106 patients with gallbladder polyps who were diagnosed preoperatively by ultrasound and CT from January 1991 to January 2005. Our operation indications are polyp above 10 mm, symptomatic polyp, sessile polyp, coincidence of stone, focal thickening of gallbladder wall, diffuse wall thickening and detection during other operations. The gallbladder polyps which were suspected to the gallbladder cancer strongly on radiologic studies and polyps above 20 mm size were excluded in this studies. RESULTS: Among the 106 patients, 87 patients underwent operation, and polypoid lesions disappeared during the follow-up period in 3 patients, and 16 patients are on regular follow up. Fifty-six cases received operation with accepted operative indications, and the thirty-one cases underwent operation by the patient's demand. Two groups showed significant difference in true polyp on pathological diagnosis (P < 0.001). There was 16.07% true polyp in opertive indication based 56 patients and no true polyp in patient's demanded 31 cases. The pathologic diagnoses were cholesterol polyp in 27 patients (87.15%), no polyp in 2 patients, adenomatous hyperplasia in 2 patients. The correlation of the polyp size and pathologic diagnosis was an inverse relation to the polyp size and incidence of pseudopolyp (P=0.014). CONCLUSION: We propose that the 6-month-interval follow-up observation is fully safe for polyps sized below 10 mm and not included in accepted operative indications.

Small Bowel Perforation Caused by Taenia Solium Infection

Taenia solium is a cestode parasite that infects various human organ systems and it causes several manifestations after ingestion of raw or undercooked pork that's infected with cysticerci. This infection is being now increasingly diagnosed in the more developed countries owing to immigration of tapeworm carriers from endemic zones, but intestinal perforation by parasite infection is a rare complication worldwide. Taenia solium has a complex two-host life cycle. Human beings are the only definitive host and they harbor the adult tapeworm, whereas both people and pigs can act as intermediate hosts and harbor the larvae or cysticerci. Although the majority of parasite-infected individuals are characterized by mild symptoms or none at all and this disease does no reveal overt morbidity, in certain circumstances this disease can lead to severe manifestations. Herein, we reported on two unusual cases of small bowel perforation caused by Taenia solium infection, and these patients were diagnosed at surgery. Efforts through antiparasitic treatment of endemic populations, development of pig vaccines and other measures that are underway will help control and eliminate this disease.

Risk Factor of Recurrent Venous Thrombosis after Endovascular Management of Iliofemoral Deep Vein Thrombosis

PURPOSE: We wanted to evaluate the recurrence rate and risk factors of recurrent venous thrombosis after the endovascular management of acute iliofemoral deep vein thrombosis (DVT). METHOD: Between January 2002 and March 2005, catheter-directed thrombolysis with Urokinase (n=40) and/or stent placement (n=33) and/or aspiration (n=29) was performed in 40 patients with acute iliofemoral DVT. The patients were divided into two groups according to DVT recurrence during the follow-up period: Group A (n=9) with recurrence and Group B (n=31) without recurrence. The risk factors of each group were analyzed for the duration of symptom before the thrombolytic therapy, the risk factors, the dose of Urokinase, and the duration and results of thrombolytic therapy. RESULT: 15 patients were men (mean age; 56.8 yr) and 25 were women (mean age; 61.4yr). The mean duration of symptoms prior to the initiation of thrombolysis for each group was 16.3+/-11.3 days vs. 7.0+/-7.0 days (P=0.040), the average total Urokinase dose was 4.83 million IU vs 2.07 million IU, respectively (P=0.080), and the average duration of therapy was 86.1 hours vs. 59.1 hours, respectively. Complete thrombus resolution was obtained in 33/40 cases. The incidence of decreased anticoagulants such as protein C/S, Antithrombin did not show any difference between two groups. DVT recurred in 5/33 (15.1%) patients for whom the DVT were completely resolved, and in 4/7 (57.1%) patients among the incompletely resolved cases (P=0.034). The causes of recurrence (5/33) in the completely resolved cases were as follows; poor compliance, and other anatomical and systemic diseases (lumbar body anomaly, Behcet's disease and cancer peritonii, after obstetrical dilatation & curettage). CONCLUSION: We can conclude that the residual venous thrombosis and duration of symptom before the thrombolytic therapy are important risk factors for recurrent thrombosis. Its assessment may help to modify the duration of anticoagulation therapy for DVT patient. Whether the evaluation of DVT risk factors may help for the secondary preventive treatment should be assessed by specifically designed intervention studies.