Early duodenal carcinoma successfully resected by endosopic mucosal resection / 대한내과학회지

Primary duodenal adenocarcinoma is rare disease with a poorly defined natural history. It represents less than 0.35% of all gastrointestinal tract malignant neoplasms and accounts for up to 33 to 45% of small bowel cancers. Diagnosis is always late because of the non-specific symptoms, consequently leading to poor prognosis. Surgical resection is the only potentially curative treatment, but not all patients whose tumor is removed necessarily survive long term. Recent widespread use of endoscopy has increased early detection of duodenal adenocarcinoma. Thanks to early detection, duodenal adenocarcinoma can now be treated endoscopically, which allows the patient's quality of life to be maintained. We have experienced one case of the primary early duodenal adenocarcinoma of the first portion, which was diagnosed by biopsy with endoscopic examination as part of a routine medical evaluation and was resected by endoscopic mucosal resection technique. We report the first primary early duodenal adenocarcinoma successfully treated by EMR method in Korea.

Ileal Perforation due to Cytomegalovirus Enteritis in a Patient with Acquired Immune Deficiency Syndrome / 대한소화기내시경학회지

Cytomegalovirus (CMV) infection is one of important opportunistic infections and cause significant morbidity and mortality in immunocompromised patients. The colon, stomach, and esophagus are the organs frequently involved with CMV infection. CMV enteritis makes up less than 10% of the CMV gastroenteritis cases, usually presents with diarrhea, bleeding and perforation. Several reports have described patients with acquired immune deficiency syndrome (AIDS) in whom CMV enterocolitis were complicated by ileal perforation, but have been rarely reported in Korea. We report a case of multiple ileal perforation associated with CMV enteritis in 67 years old man who was diagnosed as AIDS later. He complained of hematochezia and abdominal pain. During emergency operation, multiple perforated lesions were seen at the distal ileum above ileocecal valve. Colonoscopic examination revealed multiple shallow aphthoid ulcers at descending colon. CMV enteritis and colitis were diagnosed by microscopic findings of both surgical and endoscopic specimens. He was recovered by antiviral therapy with ganciclovir.

The Correlation of Bile Acid and Gastroduodenal Lesions in Hepatobiliary, Pancreas Diseases / 대한소화기내시경학회지

BACKGROUND/AIMS: Various gastric and duodenal lesions were observed in patients with obstructive biliary disease. Previously we knew that serum bile acid level may be correlated with gastric and duodenal lesion in obstructive biliary disease. Now we will confirm the correlation of the serum bile acid concentration and gastro-duodenal lesions. METHODS: A clinical analysis of the endoscopic finding and serum bile acid concentration was carried out in 120 patients with hepatobiliary and pancreas disease, from January 1999 to December 1999, in the department of Internal medicine, Chungnam National University Hospital. RESULTS: 1) In the 120 patients, sex distribution showed predominance in the males (84/36). 2) Disease profiles were included, liver cirrhosis (66.7%), hepatocellular carcinoma (38.3%), pancreatic cancer (15.8%). 3) The gastroduodenal lesions were erosive gastritis (33.3%), gastric ulcer (20.0%), duodenal ulcer (16.7%) in orders. 3) According to serum bile acid concentration, gastroduodenal lesions were more than in elevated bile acid concentration group. CONCLUSIONS: Gastroduodenal lesions in hepatobiliary and pancreas disease patients were related with serum bile acid concentration.