A Case of Idiopathic Segmental Ileal Dilatation with Acute Intestinal Bleeding / 대한내과학회지

Idiopathic segmental ileal dilatation is a rare congenital condition in which the caliber of the bowel lumen increases locally without distal luminal obstruction or thickening of the muscle coats in involved lumen. Congenital abnormalities such as exomphalos, malrotation of the midgut, and Meckel's diverticulum are found frequently in the patients with segmental dilatation of the small bowel. Intermittent abdominal pain or anemia may be the symptoms of segmental dilatation of the small bowel in infants, children and occasionally adults. The radiologic finding in barium studies of the small bowel is characteristic axial segmental dilatation. The pathologic finding is nonspecific ulcer and mild congestion, but it has normal nervous system and smooth muscle bundle. There are no evidence of ischemic changes, inflammatory changes or neoplastic changes. The condition can be cured with surgical excision of the dilated segment. A case of idiopathic segmental ileal dilatation associated with melena and recurrent abdominal pain diagnosed by enteroclysis in a 47 years old man was presented with brief review of the literature.

A Case of Acute Pancreatitis due to Impaction of Ascaris lumbricoides into the Pancreatic Duct / 대한소화기내시경학회지

Acute pancreatitis due to impaction of Ascaris lumbricoides into the pancreatic duct is very rare. Authors hnve experienced one case of pancreatic ascariasis. Patient was a 62-year-old female with epigastric pain. Abdominal USG and endoscopic retrograde cholangiopancreatography showed characteristic finding of pancreatic ascariasis. Ascaris was removed with palypectomy snare and acute pancreatitis was resolved completely.

A Case of Diverticulitis Associated with Intussuseption Diagnosed by Colonofiberscopy / 대한소화기내시경학회지

Intussusception is defined as the telescoping of one segment of the gastrointestinal tract into an adjacent one. The incidence of the adult intussusception is low. It constitutes approximately 5% of all intussusception and accounts for 5% of all cases of intestinal obstruction in adult. The clinical feature in adults is not typical. General symptoms and signs of intestinal obstruction dominate the clinical feature of intussusception in adult. The classic appearance of intussusception on barium studies is the coil spring appearance as contrast is trapped between the intussusceptum and intussuscipiens. Ultrasound and CT scan shows a target-like lesion. Colonofiberscopy shows a round invaginated mass with congested mucosa and by air inflation, round mass is decreased in size and is changed in shape. Differential diagnosis can be made by colonofiberscopy because the most common cause of colonic intussusception in adult is a primary colon cancer. A case of diverticulitis associated with intussusception diagnosed by colonofiberscopy in a 72 years old man was presented with brief review of the literature.

Superficial Spreading Stomach Cancer: Report of One Case / 대한소화기내시경학회지

Superficial spreading stomach cancer, as first described by Stout in 1942, is superficially spreading cancer confined to mucosa and submucosa, and measuring up to 10 cm in diameter. Clinical manifestation is peptic ulcer like symptom with a long duration, and a gross appearance is characterized by reddening, irregular and slight nodular thickening of the involved mucosa. We should be careful to differentiate chronic atrophie gastritis or multiple superficial gastric erosions from superficial spreading stomach cancer. It is classified to a subtype of early gastric cancer type Ilc(IIc'') and the prognosis is as good as early gastric cancer. A 60-yearold woman was admitted to our hospital because of epigastric pain for 2 years. She was confirmed to have superficial spreading stomach cancer by gastroduodenoscopy, endoseopic ultrasonography, and operation. We report a case of superficial spreading stomach cancer with a review of relevant literatures.

Hemostatic Effect of Endoscopic Hemoclip Method, Hypertonic Saline Epinephrine Injection Method and Their Combined Method for Bleeding Peptic Ulcer / 대한소화기내시경학회지

BACKGROUND: Bleeding peptic ulcer is the most common cause of upper gastrointestinal bleeding. Various different endoscopic hemostatic methods were introduced to treat bleeding peptic ulcer. Many studies reported the efficacy and comparision of various methods. Endoscopic injection therapy is the most comman method among them because it is inexpensive and easy in use. Complications of injection therapy such as aggravation of bleeding, tissue neerosis and perforation were repoted rarely. Recently endoscopic hemoclipping method is considered to be safe and effective hemostatic method for upper gastrointestinal bleeding. METHODS: During the period between January 1993 and August 1996, we have conducted clinical trial and retrospective analysis among 100 patients in whom active bleeding or visible vessel was identified. RESULTS: 1) Three groups was divided, Hemoclip group 26 cases, Hypertonic Saline Epinephrine(HSE) group 59 cases, Combination group 15 cases. 2) The sources of bleeding in Hemoclip group were gastric ulcer in 23 Cases and duodenal ulcer in 3 cases, and in HSE group, gastric ulcer in 44 case, duodenal ulcer 14 cases and stomal ulcer in one case, and in combination group, gastric ulcer in 10 cases, duodenal ulcer in 3 cases and stomal ulcer in two cases. HSE and combination method were performed more than Hemoclip method in duodenal ulcer(23.7% and 20.0% versus 11.5%). 3) As the stigmata of bleeding in Hemoclip and HSE and Combination group, spurting were seen in 5 cases and 3 cases and 4 cases, and oozing in 10 cases and 17 cases and 3 cases, and nonbleeding visible vessel in 11 cases and 39 cases and 8 cases, respectively. Hemoclip method was performed more than HSE method in active bleeding state(57.6% versus 33.9%). 4) Initial hemostasis was achieved in 24 cases(92.3%) in Hemoclip group and 52 cases(88.1%) in HSE group, 13 cases(86.7%) in Combination group. 5) The rebleeding developed in 1 case(4.2%) in Hemoclip group and 8 cases(15.4%) in HSE group and 1 case(7.6%) in Combination group, the emergent operation was undewent 2 cases(7.7%) in Hemoclip group and 10 cases(17.0%) in HSE group and 1 case(6.7%) in Combination group, respectively. 6) The death was noticed in 1 cases(3.9%) in Hemoclip group and 2 cases(3.4%) in HSE group and 2 case(13.3%) in Combination group, repectively. 7) Permanent hemostasis by only endoscopic treatment was achieved in 24 cases(92.3%) in Hemoclip group and 48 cases(81.4%) in HSE group, 12 cases(80.0%) in Combination group. 8) Complication was noticed only in HSE group, aggravation of bleeding in one case and hematoma in two cases. CONCLUSION: Hemoclip method was effective hemostatic method same as HSE injection method, and safe method weth low complication in bleeding peptic ulcer. We suggest more detail selection of endoscopic hemostatic method in variously individualized endoscopic features.