Acute Pancreatitis after Extracorporeal Shock Wave Lithotripsy for a Urolithiasis / 대한췌담도학회지

48-year-old woman was admitted to emergency room due to left flank pain. It was diagnosed with left ureteral stone and underwent extracorporeal shock wave lithotripsy (ESWL). However, 12 hours later, the patient complained acute upper abdominal pain with pulmonary edema and low blood pressure. A diagnosis of moderate acute pancreatitis with local complication was considered and we decided conservative therapy including fluid resuscitation, inotropics and antibiotics. It was suggested that ESWL was responsible for the acute pancreatitis. The patient gradually recovered and was discharged on 13th day of admission. ESWL is considered the standard treatment for urolithiasis. Although, it has proved to be safe and effective, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and cardiac arrhythmia. Although the possibility of post-ESWL acute pancreatitis is extremely low, physicians should take care of this complication.

Pseudomyxoma Peritonei in a Patient with History of Breast Cancer / 대한소화기학회지

Pseudomyxoma peritonei is a very rare condition, and even rarer in patients with history of cancer. A 70-year old woman with a history of breast cancer was admitted with abdominal pain and distention. Abdominal computed tomography revealed ascites collection, diffuse engorgement and infiltration of the mesenteric vessel, suggesting peritonitis or peritoneal carcinomatosis. Diagnostic paracentesis was attempted several times, but a sufficient specimen could not be collected due to the thick and gelatinous nature of the ascites. Therefore, the patient underwent diagnostic laparoscopy for tissue biopsy of the peritoneum, which indicated pseudomyxoma peritonei. However, the origin of the pseudomyxoma peritonei could not be identified intraoperatively due to adhesions and large amount of mucoceles. Systemic chemotherapy was performed using Fluorouracil, producing some symptomatic relief. After discharge, abdominal pain and distention gradually worsened, so at 18 months after initial diagnosis the patient received palliative surgery based on massive mucinous ascites and palpable mass at the omentum. The patient expired after surgery due to massive bleeding.

A Case of Eosinophilic Gastroenteritis with Rapid Deterioration Mimicking Borrmann Type 4 Advanced Gastric Cancer

Eosinophilic gastroenteritis is an uncommon disease of unknown etiology that is characterized by massive tissue infiltration of eosinophils in the tissue layers of various areas of the gastrointestinal tract. An accurate diagnosis is difficult as clinical presentations, symptoms, endoscopic and radiologic findings are nonspecific. A 51-year-old man visited our hospital presenting with abdominal pain. Esophagogastroduodenoscopy revealed diffuse hyperemic mucosal lesions at the stomach, duodenum. Symptoms and endoscopic findings deteriorated rapidly after three days. Small amounts of eosinophilic infiltration without malignant cells was confirmed from biopsy. However, we could not exclude malignancy and performed a subtotal gastrectomy. Stomach specimen showed eosinophilic infiltrations, and the patient was finally diagnosed as eosinophilic gastroenteritis. We report a case of atypical eosinophilic gastritis with rapid deterioration mimicking Borrmann type 4 advanced gastric cancer.

A Case of Anomalous Left Coronary Artery Originating from the Right Sinus of the Valsalva Presenting with Syncope / 대한내과학회지

Congenital anomalies of the coronary artery are associated with various symptoms including syncope, myocardial ischemia, and sudden cardiac death. The abnormality depends on the adjacent structure and pathway of the coronary artery. Most patients with an anomalous left coronary artery that arises from a right coronary sinus of the valsalva have no symptoms and are usually diagnosed at autopsy. Therefore, their first symptom might present as sudden death, particularly when the left coronary arterial course is between the aorta and the pulmonary trunk. Symptomatic patients could be diagnosed early with an anomalous coronary artery, and the risk of fatal events could be decreased by surgical correction. Here, we report the case of 62-year-old male who experienced a first episode of syncope with an anomalous left coronary artery arising from the right sinus of the valsalva with a separate orifice from the right coronary artery. He is alive and in good health receiving medical treatment, and has had no medical events for over 2 years.