A Case of Endoscopically Treated Laryngopharyngitis Resulting from Clinostomum complanatum Infection / 대한소화기학회지

A 46-year-old woman visited our hospital presenting throat pain and globus sensation. The symptoms occurred seven days after eating raw perch and mullet. An endoscopy under sedation showed a fluke―with an approximate length of 4.8 mm and width of 1.5 mm―on the left aryepiglottic fold, with active motility on the mucosa. It was extracted from the larynx using biopsy forceps and was identified as Clinostomum complanatum. To the best of our knowledge, this is the second reported case of human infection with Clinostomum complanatum diagnosed and treated by an endoscopy in Korea. Endoscopy is a useful tool in the diagnosis and treatment of patients at risk for parasitic infections complaining of throat pain.

Spontaneous Common Bile Duct Perforation Treated with Placement of Metal Stent / 대한췌담도학회지

Perforation of the biliary tree mostly results from injury to the bile duct during surgery or procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and spontaneous bile duct perforation is rare in adults. As the clinical picture varies, early diagnosis and treatment of spontaneous biliary peritonitis is difficult. A 52-year-old male patient presented with abdominal pain and intractable ascites. He already experienced severe abdominal pain 2 months ago and underwent percutaneous pigtail drainage for the ascites at nearby hospital. ERCP showed large filling defect with leakage of contrast media from the mid common bile duct (CBD) into the peritoneal cavity. We performed endoscopic sphincterotomy and extracted CBD stones with basket and balloon catheter. Then fully covered self expandable metal stent was placed in CBD. After the procedure, the symptom was improved and the amount of pigtail drainage from abdominal cavity was dramatically decreased. 6 weeks later, removing the metal stent, there was no more leakage of contrast media into peritoneal cavity. We report a very rare case of spontaneous bile leakage which was successfully managed with placement of metal stent.

Spontaneous Common Bile Duct Perforation Treated with Placement of Metal Stent / 대한췌담도학회지

Perforation of the biliary tree mostly results from injury to the bile duct during surgery or procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and spontaneous bile duct perforation is rare in adults. As the clinical picture varies, early diagnosis and treatment of spontaneous biliary peritonitis is difficult. A 52-year-old male patient presented with abdominal pain and intractable ascites. He already experienced severe abdominal pain 2 months ago and underwent percutaneous pigtail drainage for the ascites at nearby hospital. ERCP showed large filling defect with leakage of contrast media from the mid common bile duct (CBD) into the peritoneal cavity. We performed endoscopic sphincterotomy and extracted CBD stones with basket and balloon catheter. Then fully covered self expandable metal stent was placed in CBD. After the procedure, the symptom was improved and the amount of pigtail drainage from abdominal cavity was dramatically decreased. 6 weeks later, removing the metal stent, there was no more leakage of contrast media into peritoneal cavity. We report a very rare case of spontaneous bile leakage which was successfully managed with placement of metal stent.

A Case of Suspected Intrahepatic Bile Duct Perforation after Direct Peroral Cholangioscopy / 대한췌담도학회지

Direct peroral cholangioscopy (POC) which permits direct visualization of the biliary tree has recently gained widespread clinical use for diagnosis and treatment of various pancreatobiliary diseases. But, there is currently little reliable data on evaluating the complications of POC. POC is associated with complications such as pancreatitis, cholangitis, hemorrhage, rarely air embolism, and ductal perforation. The incidence of complication during POC is 2.9-12%. However, pneumoperitoneum due to intrahepatic bile duct perforation after POC has not yet been reported in Korea. We report a case of pneumoperitoneum after POC which has been successfully managed with endoscopic nasobiliary drainage and antibiotics.

A Case of Endoscopic Removal of a Giant Appendicolith Combined with Stump Appendicitis

Stump appendicitis is an acute inflammation of the residual appendix and is a rare complication after appendectomy. The physician should be aware of the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy so that delayed diagnosis and treatment can be prevented. Stump appendicitis is usually treated by surgical resection, and endoscopic treatment has not been reported previously. A 48-year-old man who had undergone appendectomy 35 years earlier presented to the hospital because of right lower quadrant discomfort. A computed tomography scan showed a large stone in the residual appendix. Colonoscopic findings revealed a large, smooth, protruding lesion at the cecum with a stone inside the appendiceal orifice. Endoscopic removal after incision of the appendiceal orifice was performed successfully.

A Case of Enteritis Cystica Profunda in the Ampulla of Vater Mimicking Choledochocele

Enteritis cystica profunda is a very rare disease in which a mucin-filled cystic space is surrounded partially with nonneoplastic columnar epithelium in the submucosa of the small intestine. Most of the cases are accompanied by intestinal diseases, and the disease usually occurs in the jejunum and the ileum and there has been no report of a case that occurred in the ampulla of Vater. A 58-year-old healthy female patient without any particular symptom visited the hospital to get additional examination for a mass found on the ampulla of Vater by accident. In esophagogastroduodenoscopy, a cystic mass showing a positive pillow sign was found on the ampulla of Vater. Endoscopic retrogradecholangiopancreatography was conducted as choledochocele was suspected, but no abnormality was found in the biliary system. In endoscopic ultrasonography, multiseptated cystic structures were detected in the submucosal layer of the duodenum. The lesion was resected completely through endoscopic snare polypectomy and the case was histologically diagnosed as enteritis cystica profunda.

A Case of Refractory Esophageal Stricture Induced by Lye Ingestion and Treated by Temporary Placement of Newly Designed Self-Expanding Metal Stent and Wetting with Mitomycin C / 대한소화기내시경학회지

Ingestion of strong acids or strong alkalies may produces severe inflammation on the mucosa of the esophagus and this may also causes esophageal stricture. Several forms of non-operative dilatations have been utilized for the treatment of esophageal stricture and they have shown good results. Yet some patients do not achieve acceptable symptom relief despite of intensive dilatation. Temporary placement of esophageal stent has recently been used in some of these patients. Furthermore, mitomycin C has been used as a conservative treatment for refractive esophageal stricture in children, yet its efficacy has not been well established. We experienced a case of a 64-year old man with severe, recurrent esophageal stricture, and this was successfully managed by temporary placement of an esophageal stent, together with a spray of mitomycin C. We report on this case along with the review of the literature.

A Case of Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, and Subcutaneous Emphysema after Endoscopic Submucosal Resection / 대한소화기내시경학회지

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.

A Case of Pneumoperitoneum, Pneumoretroperitoneum, Pneumomediastinum, and Subcutaneous Emphysema after Endoscopic Submucosal Resection / 대한소화기내시경학회지

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.

Protein Kinase C-mediated Neuroprotective Action of (-)-epigallocatechin-3-gallate against Abeta1-42-induced Apoptotic Cell Death in SH-SY5Y Neuroblastoma Cells

The neurotoxicity of amyloid beta (Abeta) is associated with an increased production of reactive oxygen species and apoptosis, and it has been implicated in the development of Alzheimer's disease. While (-)-epigallocatechin-3-gallate (EGCG) suppresses Abeta-induced apoptosis, the mechanisms underlying this process have yet to be completely clarified. This study was designed to investigate whether EGCG plays a neuroprotective role by activating cell survival system such as protein kinase C (PKC), extracellular-signal-related kinase (ERK), c-Jun N-terminal kinase (JNK), and anti-apoptotic and pro-apoptotic genes in SH-SY5Y human neuroblastoma cells. One microM Abeta1-42 decreased cell viability, which was correlated with increased DNA fragmentation evidenced by DAPI staining. Pre-treatment of SH-SY5Y neuroblastoma cells with EGCG (1microM) significantly attenuated Abeta1-42-induced cytotoxicity. Potential cell signaling candidates involved in this neuroprotective effects were further examined. EGCG restored the reduced PKC, ERK, and JNK activities caused by Abeta1-42 toxicity. In addition, gene expression analysis revealed that EGCG prevented both the Abeta1-42-induced expression of a pro-apoptotic gene mRNA, Bad and Bax, and the decrease of an anti-apoptotic gene mRNA, Bcl-2 and Bcl-xl. These results suggest that the neuroprotective mechanism of EGCG against Abeta1-42-induced apoptotic cell death includes stimulation of PKC, ERK, and JNK, and modulation of cell survival and death genes.