Liver cirrhosis and pregnancy: A case report and a review of the reported cases in Korea / 대한내과학회지

Pregnancy is rarely encountered in women with liver cirrhosis, but can occur in all forms of liver cirrhosis. The amount of data regarding pregnancy in cirrhotic patients is not great and thus no clear-cut guidelines for management can be outlined. Another interesting point of pregnancy in liver cirrhosis would be how pregnancy affects liver function in cirrhotic patients. In Korea, only 6 pregnancies in 5 patients have been reported. Recently, we experienced a case of pregnancy in a patient with liver cirrhosis. A 36 year-old, primigravida woman presented at 23 weeks of gestation. B-viral liver cirrhosis was diagnosed 2 months earlier when she had developed generalized edema and ascites. We observed a recovery of hyperbilirubinemia and hypoalbuminemia after a therapeutic termination of pregnancy. This case may illustrate that pregnancy can deteriorate liver function in some patients with liver cirrhosis. We report this case with an analysis of the reported cases in Korea.

Defecographic Findings of Rectal Intussusception / 대한소화관운동학회지

OBJECTIVES: To analyze the findings of rectal intussusception and to find the other accompanied functional anorectal diseases. MATERIALS AND METHODS: We analyzed defecograms in 25 patients with rectal intussusception among 77 patients taken with obstructed defecatory symptom. Females were 16 (64%), males were 9 (36%), and the mean age was 55 years old. The changes of anorectal angle (ARA) and movement of anorectal junction were measured, and the morphologic changes of rectal wall during defecation were analyzed. RESULTS: ARAs measured by central axis method (CAM), the mean angles were 114.6, 102.2, and 119.8 degree, respectively in resting, squeezing, and straining period. By posterior wall methods (PWM), those were 86.7, 72.0, 93.3 degree. The differences of ARA between resting and straining period were 5.2, 6.6 degree, respectively by CAM and PWM. The mean descent of anorectal junction during defecation was 0.83 cm. The most frequent finding associated with rectal intussusception was rectocele (12 cases;48%). The other accompanied findings were 9 spastic pelvic floor syndrome (36%) and 4 fecal incontinence (16%). Total 18 patients out of 25 patients were accompanied with other functional anorectal diseases (72%). CONCLUSIONS: Recognition of rectal intussusception with accompanied diseases would be important for the proper treatment planning.

Defecographic Findings of Rectal Intussusception / 대한소화관운동학회지

OBJECTIVES: To analyze the findings of rectal intussusception and to find the other accompanied functional anorectal diseases. MATERIALS AND METHODS: We analyzed defecograms in 25 patients with rectal intussusception among 77 patients taken with obstructed defecatory symptom. Females were 16 (64%), males were 9 (36%), and the mean age was 55 years old. The changes of anorectal angle (ARA) and movement of anorectal junction were measured, and the morphologic changes of rectal wall during defecation were analyzed. RESULTS: ARAs measured by central axis method (CAM), the mean angles were 114.6, 102.2, and 119.8 degree, respectively in resting, squeezing, and straining period. By posterior wall methods (PWM), those were 86.7, 72.0, 93.3 degree. The differences of ARA between resting and straining period were 5.2, 6.6 degree, respectively by CAM and PWM. The mean descent of anorectal junction during defecation was 0.83 cm. The most frequent finding associated with rectal intussusception was rectocele (12 cases;48%). The other accompanied findings were 9 spastic pelvic floor syndrome (36%) and 4 fecal incontinence (16%). Total 18 patients out of 25 patients were accompanied with other functional anorectal diseases (72%). CONCLUSIONS: Recognition of rectal intussusception with accompanied diseases would be important for the proper treatment planning.

A Case of the Main Pancreatic Duct Injury Due to Blunt Abdominal Trauma Cured by Conservative Management Including Octreotide Administration / 대한소화기내시경학회지

Pancreatic trauma is uncommon, but carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. The principal cause of pancreas specific complication and pancreas specific mortality is the presence of an injury to the pancreatic ductal system. It has been suggested that the main pancreatic duct injury is an indication of surgery or endoscopic therapy depending on the extent of leakage. Recently, we experienced a 53-year-old man who had an injury to the main pancreatic duct due to blunt abdominal trauma by a handlebar. Endoscopic retrograde pancreatography correctly diagnosed a leak at the main pancreatic duct, but his stable clinical condition and narrow main pancreatic duct precluded surgery or endoscopic therapy. Interestingly, this case was successfully treated by conservative management including octreotide administration.

Lower gastrointestinal bleeding due to cytomegalovirus ileal ulcers in an immunocompetent man

Cytomegalovirus (CMV) infections are commonly reported in severely immunocompromised hosts and ulcers of the alimentary tract are frequently observed in systemic CMV infections. However, invasive and ulcerative disease of the gastrointestinal (GI) tract caused by CMV has also been reported in healthy adults. Many reports show that a CMV infection can produce localized ulcerations in the esophagus, stomach, small intestine, and colon in nonimmunocompromised individuals. The most common site of involvement by CMV infection in the GI tract is the colon followed by the upper GI tract and the least common site is the small intestine. Although GI bleeding is one of the major presenting symptoms of patients with CMV infections of the GI tract, lower GI bleeding due to CMV ileal ulcers in immunocompetent patients, to our knowledge, has not been reported in the English literature. Recently, we experienced a case of lower GI bleeding due to CMV ileal ulcers in a 57-year-old man who had no evidence of immunocompromise. This case suggests that small intestinal ulcers due to CMV infection should be included in the differential diagnosis of lower GI bleeding even in immunocompetent hosts.