A Successful Endoscopic Injection Sclerotherapy of a Bleeding Duodenal Varix / 대한소화기내시경학회지

Bleeding frorn the duodenal varix is an unusual event. Upper gastrointestinal endoscopy is the diagnostic procedure of choice in diagnosing duodenal varices. If performed during active bleeding, it can differentiate between esophageal and duodenal varices as the source, which has important therapeutic implications. A thorough examination of the duodenum for varices is important in an upper gastrointestinal hemorrhage. Treatment modalites for bleeding duodenal varices are sclerotherapy, varix suture ligation, portocaval shunt, and duodenal resection. Although endoscopic sclerotherapy has lirnited success in controlling active duodenal varix as initial treatment, endoscopic injection sclerotherapy is a useful first-line therapeutic measure in the treatment of bleeding duodenal varices. In this study we present a case of a ruptured duodenal varix, which was defected by an endoscopy, in a 61-year-old male. An endoscopic examination showed small and nonbleeding esophageal varices and a prominant ulcerated varix was identified in the 2nd portion of the duodenum. Endoscopic sclerotherapy was performed by injecting ethanolamine oleate into the varix. Our report demonstrate that endoscopic sclerotherapy can be efficient even in the presence of acute bleeding and that it can provide a definitive method of curing of a bleeding duodenal varix.

A Case of Occult Foreign Body Lodged in Bronchus for a Long Period and Removal by Flexible Bronchoscopy / 결핵

Aspiration of foreign bodies into tracheobronchial tree is more common in children than in adults. Foreign bodies in airway commonly occur by accident, and in most cases they get removed without delay. Small foreign bodies that lodge in the peripheral airway are often asymptomatic initially and can result in respiratory symptoms several years later. Although foreign body aspiration is frequently suspected in children with acute or recurrent pulmonary symptoms, it is rarely considered in adults, unless a clear history of an aspiration event can be obtained. We have experienced and studied a case of occult aspiration of a shrimp which had been lodged for a long period.

Two Cases of Non-Surgical Removal of Intravascular Foreign Bodies

One of the complication during or after subclavian vein cannulation is intravascular catheter or wire embolization. Although some studies have reported safety of retaining foreign body embolization, and even death. The intravascular foreign body can be removed surgically or non-surgically. With improvement in instrument technology and technique, percutaneous retrieval of intravascular foreign bodies has become a relatively common procedure. Commonly used methods to remove intravascular foreign bodies are loop snare and basket technique. Sometimes biopy forcep can be used. We have experienced 2 cases of non-surgical removal of intravascular foreign bodies. One of the foreign bodies was 7cm wire fragment in right atrium(RA), the other was a 50cm guide wire. We used the standard loop snare technique for removal of 7cm wire fragment in RA and stone removal basket and 3.0mm ACS PTCA balloon to remove the 50cm short guide wire.