A Case of Esophageal Benign Schwannoma Removed by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Esophageal schwannoma is a very rare neoplasm. The differentiation of schwannoma from the other submucosal tumors such as GISTs or leiomyoma is very difficult to do on the preoperative examination with performing esophagoscopy and computed tomography. The diagnosis is generally not confirmed until the histologic and immunohistochemical tests of the tumor are performed. A 38- year-old man presented to us with neck discomfort. The endoscopy showed a middle esophageal submucosal tumor that measured 12 mm in size and there were no mucosal changes. The endoscopic ultrasonography showed a tumor in the muscluaris mucosa layer without lymphadenopathy. After band ligation of the lower part of the tumor, it was removed by performing endoscopic mucosal resection and using a snare. A definitive diagnosis of esophageal benign schwannoma was made from the pathologic findings, which included positive immunohistochemical staining for S-100 protein and negative staining for C-kit, CD34 and actin. We report here on an esophageal benign schwannoma that was removed by endoscopic mucosal resection.

Clinical Effectiveness of Transcatheter Arterial Embolization for Acute Upper and Lower Non-variceal Gastrointestinal Bleeding / 대한소화기학회지

BACKGROUND/AIMS: Although the initial rate of hemostasis achieved by endoscopic treatment for acute non-variceal gastrointestinal bleeding (NVGIB) is high, recurrent or persistent bleeding occurs in 10% to 25% of the patients. The aim of this study was to assess the efficacy and safety of transcatheter arterial embolization (TAE) in patients with acute upper and lower NVGIB who could not be managed by endoscopic treatment. METHODS: A retrospective analysis of the clinical data was done in 43 patients (M/F: 26/17, mean age: 60 years) whom underwent angiography or TAE for acute upper and lower NVGIB between January 1998 and December 2003. Among 43 patients, 18 had upper NVGIB, 19 had lower NVGIB, and 6 had obscure gastrointestinal bleeding. Demographic characteristics and outcome parameters including the rates of hemostasis, in-hospital death, and complications were analyzed. RESULTS: Thirty-four patients underwent TAE while 9 patients underwent angiography. TAE was used as the first line treatment in 17 patients and as the second line treatment in others. Hemostasis was achieved in 29 of 34 patients (85.3%) by TAE. According to the site of bleeding, hemostasis was achieved in 14 of 17 patients (82.4%) with upper NVGIB and in 15 of 17 patients (88.2%) with lower NVGIB. There was no significant angiography or TAE-related complications such as bowel ischemia or infarction except a hematoma on the angiography site in one patient. CONCLUSIONS: TAE is effective and safe in patients with acute upper or lower NVGIB who cannot be managed by endoscopic treatment.

A Case of Duodenal Gastrointestinal Stromal Tumor Presenting with Gastrointestinal Bleeding / 대한소화기내시경학회지

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial tumor of the gastrointestinal tract. GISTs are most common in the stomach, followed by small intestine, colon and rectum, and esophagus. We report a case of duodenal GIST presenting with gastrointestinal bleeding in a 53-year-old male. Upper gastrointestinal endoscopy revealed a protruded mass with central ulceration on the second portion of the duodenum. Spontaneous spurting blood was encountered from the central ulcer of the mass. Abdominal computed tomography scan and celiac angiography revealed hypervascular tumor, located in the second portion of the duodenum. Laparotomy with wedge resection was performed. Histological and immunohistochemical studies on resected specimen revealed a duodenal GIST of a combined smooth muscle and neural type.

A Case of Maternal Tetanus in Korea

Tetanus is uncommon in Korea due to the introduction of vaccination programs and advances in public health. A case of maternal tetanus occurred on the 9 day postpartum in a 29-yr-old woman, who had not received a 10-yr-booster of tetanusdiphtheria toxoid after receiving the primary series of tetanus-toxoid-containing vaccine. There has hitherto been no reports on maternal tetanus in Korea. This case illustrates that tetanus remains a medical problem, principally among nonand underimmunized adults. The only way to fully prevent this disease is to ensure adequate immunization in all adults.

A Clinical Study on the Upper Gastrointestinal Tract Injury Caused by Corrosive Agent / 대한소화기내시경학회지

BACKGROUND/AIMS: The incidence of corrosive injury has been decreased, compared with past years. However, the ingestion of corrosive agent for suicidal attempt is on an increasing trend. Though corrosive injury on gastrointestinal tract is very common, there are few clinical studies on this field. METHODS: Retrospective study was performed on 48 patients who ingested corrosive agent from 1992 to 1998. The kinds of corrosive agent, cause of ingestion, symptoms, gastroscopic findings, treatment and complications were analyzed. RESULTS: The most common agent of ingestion was acetic acid (47.9%), followed by hydrocholoric acid (18.8%), cresol (10.4%), lye (10.4%), sulfuric acid (4.2%). Ingestion for suicidal attempt (60.4%) was more frequent than accidental ingestion (39.6%). The frequent symptoms were sore throat (31.3%), dysphagia (27.1%), epigastric pain (22.9%), vomiting (18.8%), chest pain (18.8%), GI bleeding (12.5%), dyspnea (12.5%) and hematuria (8.3%). The esophagus was the most common site of corrosive injury and Grade IIa injury was the most frequent finding on gastroscopy. In most cases, prophylactic antibiotics with or without steroid was administered for conservative treatment. For long-term sequelae, there were 7 cases (14.6%) of esophageal stricture, and 2 cases (4.2%) of gastric outlet obstruction. CONCLUSIONS: Corrosive injury on gastrointestinal tract is frequently observed on early gastroscopy and can cause significant late sequelae, such as stricture. Therefore, it is necessary to evaluate regular follow up gastroscopy for the management of late sequelae.