Electrohydraulic Lithotripsy of an Impacted Enterolith Causing Acute Afferent Loop Syndrome

Afferent loop syndrome caused by an impacted enterolith is very rare, and endoscopic removal of the enterolith may be difficult if a stricture is present or the normal anatomy has been altered. Electrohydraulic lithotripsy is commonly used for endoscopic fragmentation of biliary and pancreatic duct stones. A 64-year-old man who had undergone subtotal gastrectomy and gastrojejunostomy presented with acute, severe abdominal pain for a duration of 2 hours. Initially, he was diagnosed with acute pancreatitis because of an elevated amylase level and pain, but was finally diagnosed with acute afferent loop syndrome when an impacted enterolith was identified by computed tomography. We successfully removed the enterolith using direct electrohydraulic lithotripsy conducted using a transparent cap-fitted endoscope without complications. We found that this procedure was therapeutically beneficial.

Transformation of Castleman's Disease into Follicular Dendritic Cell Sarcoma, Presenting as an Asymptomatic Intra-abdominal Mass / 대한소화기학회지

Follicular dendritic cell (FDC) sarcoma is an extremely rare malignant neoplasm arising from FDCs. The exact origin of FDCs remains unclear; both a hematopoietic lineage origin and a stromal cell derivation have been proposed. Proliferation of FDCs can lead to benign reactive lesions or generate neoplastic conditions. The lesions are most commonly found in lymph nodes and usually involve the head and neck area. Castleman's disease is a rare non-neoplasitic lymphoproliferative disorder. Rare cases of hyaline-vascular Castleman's disease have been associated with FDC sarcoma, but a clonal relationship has not been convincingly demonstrated. A pathway toward tumor evolution, beginning with hyperplasia and dysplasia of FDCs, has been proposed. Despite this known association between Castleman's disease and FDC sarcoma, there have only been few reported cases of sarcoma arising as a complication of pre-existing Castleman's disease, especially in abdominal lesions. We describe here a 51-year-old female with an FDC sarcoma arising from unicentric, hyaline-vascular type Castleman's disease in an intra-abdominal mass. Pathologically, the lesion showed a series of changes during the process of transformation from Castleman's disease to FDC sarcoma.

A Single Institution's Experience of Ten Pediatric Patients with Endoscopic Retrograde Cholangiopancreatography / 대한소화기내시경학회지

BACKGROUND/AIMS: ERCP is being used increasingly as a diagnostic and therapeutic tool for children with pancreaticobiliary disorders. Differences between thirteen pediatric ERCPs and adult ERCPs were reviewed with respect to their indications, method of anesthesia, choice of endoscope and complications. METHODS: The medical records of 13 ERCPs for 10 children (age: 23 months to 14 years) done between 2005 and 2008 were reviewed retrospectively. RESULTS: ERCP was indicated for gallstone pancreatitis (6), choledocholithiasis (3), and unexplained pain (1). The method of anesthesia was intravenous sedation with a single agent or a combination of midazolam, propofol or ketamine. The quality of sedation was satisfactory in 10 cases and unsatisfactory in three cases. These 3 cases were less than 8 years old and sedated with a combination of midazolam and propofol. Selective biliary cannulation was successful in 92.3% (12/13) of attempts. Therapeutic ERCP included sphincterotomy (4), endoscopic papillary balloon dilatation (3), and both (5). Complications occurred in 7.7% of attempts (1/13; 1 duodenal perforation) which was successfully managed by surgery. CONCLUSIONS: Pediatric ERCP is a feasible and useful technique. Special caution is needed, however, because of differences with adult ERCP in terms of the effectiveness of intravenous sedation, complications, and size of the gastrointestinal tract.

A Case of Acute Renal Infarction with Protein S Deficiency / 대한신장학회지

Acute renal infarction is an uncommon disease that is often misdiagnosed initially because of its nonspecific presentation. Cardiovascular disease is the major cause of thromboembolic event, but renal infarction can also occur in patient with special conditions such as hypercoagulable states. Protein S deficiency is a rare cause of the hypercoagulable states and induces both venous and arterial thrombosis. Protein S are a vitamin K dependent plasma protein that serves as a cofactor for the anticoagulant effects of activated protein C. Patients deficient in protein S is prone to recurrent thromboembolic disease. We reported a case of acute renal infarction that was associated with type II protein S deficiency in a 38-year old patient without underlying cardiovascular disease.

A Case of Bile Peritonitis with Acute Cholecystitis in a Continuous Ambulatory Peritoneal Dialysis Patient / 대한신장학회지

Peritonitis is the most common complication of CAPD (continuous ambulatory peritoneal dialysis). Major cause of peritonitis is bacterial infection by septic manipulation and catheter exit infection. In patients with CAPD, bile peritonitis by acute cholecystitis is rare. A 80-year-old female patient who had been treated with CAPD for 18 months visited our hospital for abdominal pain and change of dialysate color. These symptoms suggested peritonitis. Although we administered intraperitoneal antibiotics, abdominal pain did not subside. Therefore, we checked abdomen computerized tomography. CT findings showed gall bladder stone with distension, wall thickening and pericholecystic fluid collection. Acute cholecystitis with microperforation was suspected. She underwent percutaneous transhepatic gall bladder drainage and systemic antibiotics therapy. After conservative treatment, abdominal pain was subsided and peritoneal fluid came out clear. The patient was discharged and maintained on CAPD When CAPD patients visit hospital due to abdominal pain and dialysate color change (dark brown color or greenish color), physicians should consider bile peritonitis and early treatment.