Vestibular Rehabilitation after Traumatic Head Injury with Dizziness / 대한평형의학회지

The vestibular symptoms such as dizziness and imbalance that occurred after traumatic head/brain injury were caused by a combination of central factors such as abnormalities of white matter, diffuse axonal injury and microhemorrhage, and peripheral factors like decreased vestibulo-ocular reflex caused by the energy transmitted to the semicircular canal and otolith organs. These symptoms can affect on the patient's overall physical, cognitive, emotional, and quality of life. There have been reports that vestibular rehabilitation for the treatment of dizziness and imbalance after head trauma can promote vestibular compensation, stabilize of the gaze movements, and also affect the treatment outcomes of the associated injuries. The frequency, duration, and number of people participating in vestibular rehabilitation varied with each study, and physical therapy, occupational therapy, cognitive counseling, medication treatment, duration of treatment for associated injuries were also variable. Most studies have shown that many patients who get the vestibular rehabilitation have a significantly reduced time to return to work and sports activities, and may be able to speed up the recovery of vestibular symptoms. However, further research is needed on its long-term effects. In addition, patients with traumatic head/brain injuries are more susceptible to injuries of other organs as well as vestibular disorders, therefore consideration of treatment planning for associated injuries including precise evaluation mental support, and cognitive therapy is expected to be more effective with vestibular rehabilitation therapy.

Outcome of Canalith Repositioning Procedure in Patients with Persistent and Transient Geotropic Direction-Changing Positional Nystagmus: Short-term Follow-up Evaluation / 대한평형의학회지

OBJECTIVES: Patients, who showed persistent geotropic-direction changing positional nystagmus (p-DCPN) tend to have different clinical manifestations from those who showed transient geotropic DCPN (t-DCPN). We investigated the clinical characteristics between p-DCPN and t-DCPN patients, and its recovery rate after canalith repositioning procedure (CRP). METHODS: Based on the duration of nystagmus, 117 geotropic DCPN patients were classified to 2 groups, p-DCPN and t-DCPN. Barbeque maneuver had been introduced towards the opposite direction of null plane for the p-DCPN patients, and to the opposite direction of stronger nystagmus for the t-DCPN patients. RESULTS: Seventy-four patients showed t-DCPN and 43 patients were classified to the p-DCPN cases. No p-DCPN patient showed prompt improvement after the 1st canalolith reposition therapy. Among the t-DCPN patients, 18 canal switch cases were found , but, there was no canal switch cases found among the p-DCPN The CRP has showed less effective for the p-DCPN patients than the t-DCPN patients (after the 1st CRP, 37 in 74 improved, p < 0.001). CONCLUSIONS: Due to its distinguishing clinical manifestation, p-DCPN may have different pathogenesis and clinical mechanisms from t-DCPN. And for the p-DCPN patients, the CRP seems not an efficient treatment compared to the t-DCPN patients. Further study with larger number of enrolled subjects is necessary.

Analysis of Fall Accidents of Dizzy Patients in a Tertiary Hospital in South Korea (2011-2015) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A fall refers to a sudden fall accident resulting in injury and hurt of the human body. In the hospital, fall accidents occur mainly in dizzy patients or elderly people, but can also occur even in young people who fail to adapt to the unfamiliar hospital environment. This study analyzed the incidence of fall accidents and its pattern in dizzy patients in a tertiary hospital in South Korea. SUBJECTS AND METHOD: This study was conducted using 477 fall accidents that occurred in a tertiary hospital in Korea from 2011 to 2015. Extensively investigated were related fall risk factors such as patient's sex, age, medical department, diagnosis, first witness, mental status, physical activity, patient risk factors, walking aids, medication use and treatment. RESULTS: Dizziness induced falls consisted of 20.5% of the total fall accidents. Sedative medications were frequently used in patients of dizziness induced falls (42.9%). Fall acidents were mainly detected by nurses 33%. The frequente sites of fall were the bed rooms (55%), the corridor (15%) or the bath rooms (8%). Types of physical damage were no damage (47%), abrasion or bruising (20%), laceration (10%), bath rooms (8%), fracture (3%), and head trauma (1%). In 532 treatments, observation was recommended for 68%, sterilization 15.2%, suture 4.7%, cast 1%, and surgery 1%. CONCLUSION: The study finds that the fall risk screening test and Multifactorial Fall Prevention Program should be performed for all high-risk patients of fall. About 20% of falls were associated with otologic dizziness, and otolaryngology doctors should pay attention to the fall problem and the medication related to dizziness, which may potentially increase the risk of falls.

Dizzy and Psychological Scales in Benign Paroxysmal Positional Vertigo: Suspicious Patients without Characteristic Nystagmus / 대한평형의학회지

OBJECTIVES: Patients, who have had a history of benign paroxysmal positional vertigo (BPPV)-like symptoms, but no characteristic nystagmus, were often present. They are diagnosed as having a resolved state from BPPV or normal, and tend to be overlooked. We investigated the dizzy and psychological scales in BPPV-suspicious patients. METHODS: Thirty-nine patients, which they had vertigo of a short duration at the specific head position, and clinically suspicious BPPV, but no nystagmus in positional tests, were enrolled. We compared dizzy and psychological scales of suspicious BPPV patients with 138 BPPV patients, using dizziness handicap inventory (DHI), the beck depression inventory (BDI), and the Spielberger state-trait anxiety inventory. Additionally, among the BPPV-suspicious group, patients with a BPPV history were compared with those with no previous BPPV. RESULTS: No differences in the all scales were found between the two groups. However, DHI scores of patients with a previous BPPV attack were significantly higher than those of patients with no BPPV-like symptoms; in particular, there was a significant difference in emotional scores. CONCLUSION: Although the patients had no characteristic nystagmus, if they have a BPPV-like history and symptoms, emotional support and periodic follow up are needed. In particular, careful observation should be performed in patients with previous BPPV attack.

Risk of Falls in Dizzy Patients / 대한평형의학회지

Dizziness is the most common symptom in elderly patients and has been identified as a risk factor for falls. They can affect objectively the ability to achieve a stable gaze, posture, and gait. Research on the relationship between vestibular hypofunction and falls in elderly people has been rarely performed and the evidence is controversial. Because falls result from various combinations of many factors, validated tools should be used for assessment of falling. Many of the tests and numerous parameters associated with the risk of falling have already been introduced, however guidance on which test is most appropriate for use in a specific setting still lack in the medical community. Therefore, developement of comprehensive fall risk management guideline and assessment tool including physical, psychosocial, environmental factors are necessary to prevent falls in the elderly. Establishment of validity and reliability for relationship among several vestibular function test are more important to evaluate efficiently risk of falls in the dizzy patients. Also we can expect that decreasing risk of fall when conduct the developement of additional customized intervention method using verified assessment tools.

Clinical Analysis of Dizzy Patients with High Levels of Depression and Anxiety

BACKGROUND AND OBJECTIVES: Some patients experiencing dizziness also report psychological distress. However, the association between vestibular deficits and psychological symptoms remains controversial. Thus, the aim of this paper is to report the proportion of patients who complained of dizziness who also had high depression and anxiety indices. Also we investigated the severity of their dizziness and the distribution of the diseases underlying this symptom. SUBJECTS AND METHODS: We assessed the dizziness and psychological distress of 544 patients experiencing dizziness using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We also reviewed the audio-vestibular symtoms of patients with high levels of depression and anxiety. RESULTS: The incidences of high depression and anxiety scores were 11% (60/544) and 18% (98/544), respectively. Patients with vestibular migraine were most likely to have high depression and anxiety indices. Patients in the high-BDI or high-STAI groups (117/544) obtained significantly higher DHI scores than those in neither the high-BDI nor the high-STAI group (427/544). We noticed that about 20% of the patients experiencing dizziness had high levels of psychological distress in this study; this group also suffered from various vestibular diseases and more symptoms of dizziness. CONCLUSIONS: The results of the study suggest that psychological evaluation should be considered when assessing patients with vertigo.

Analysis of Electrocochleography: According to the Position of Summating Potential Peak / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze the summating potential (SP)/action potential (AP) ratio of electrocochleography (ECoG) recorded from the position of SP peak. We compared the SP/AP ratios of negative polarity and positive polarity graphs from the same ECoG of each patient by assuming different the position of SP peak. In addition, we attempted to evaluate the utility of two different manners of recording the ECoG graph in the diagnosis of Meniere's disease. SUBJECTS AND METHOD: Retrospectively, we analyzed the results of ECoG in 67 patients with unilateral definite Meniere's disease. ECoG was analyzed in two different manners. From the AP peak, the SP peak was determined close when positioned in the negative polarity; on the other hand, SP peak was considered distant when positioned in the positive polarity. The SP/AP ratio was interpreted with reference to the base line value. The ratio of two different ECoG values from each patient of Meniere's disease was calculated. RESULTS: In the abnormal side, the negative polarity ECoG showed significantly greater value of SP/AP ratio (mean: 0.334±0.10) than the positive polarity ECoG (mean: 0.283±0.09) (p<0.001). In the normal side, the negative polarity ECoG, showed significantly greater value of SP/AP ratio (mean: 0.250±0.09) than the positive polarity ECoG (mean: 0.204±0.06), as well as in the abnormal cases (p<0.001). CONCLUSION: The standard SP/AP ratio for the diagnosis of Meniere's disease can be variable according to the manner of determining the SP peak.

Analysis for Effects of Hearing Aids Performance by Applicability of Hydrophobic Nano-Coating Technique: A Pilot Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although popular as a method for aural rehabilitation with hearing impairment, hearing aids are susceptible to inflow of foreign materials such as water, sweat, and dust, causing corrosion of the circuit board and eventual device failure. Performance of hearing aids is evaluated by assessing the applicability of hydrophobic nano-coating technique using waterproof hearing aids electronic devices. SUBJECTS AND METHOD: Performance was evaluated using a Fonix 7000 for the maximum output sound pressure level (Max OSPL 90), high frequency average full on gain (HFA FOG), total harmonic distortion and input noise level for 13 hearing aids. Nine of the 13 hearing aids were tested after nano-coating was applied to 2.5 µm of thickness. Fro the immersion test, hearing aids were subjected to 1 m of depth of water and performance was immediately measured; they were also measured after a day and also after a month. RESULTS: In the coated group, Max OSPL 90, HFA FOG were significantly reduced but the corrosion of the circuit board was not observed. The four hearing aids without nano-coating failed to work immediately after the immersion test. However, there were no changes in performance after a month of immersion in any of the aids. For the non-coated group, corrosion of the circuit board was observed after 1 month. CONCLUSION: Nano-coating is a competitive technology and an advangtage to have to ensure waterproof effect and corrosion prevention. Thus it should be recognized as essential technology to enhance performance of hearing aids.

Analysis of Voice and Swallowing Symptoms after Thyroidectomy in Patients without Recurrent Laryngeal Nerve Injury in Early Postoperative Period

BACKGROUND AND OBJECTIVES: After thyroidectomy, many patients experience problems report such things as reduced voice range and vocal fatigue, swallowing problems without superior and recurrent laryngeal nerve injury. The purpose of this study was to evaluate voice and swallowing problems before and after thyroid surgery without laryngeal nerve injury. MATERIALS AND METHODS: Ninety-three patients who underwent thyroidectomy without laryngeal nerve injury and completed the follow-up evaluations were studied between June 2013 and December 2015. Each evaluation was performed preoperatively, as well as 1 week, 1 month postoperatively. Analysis was performed including voice handicap index (VHI), dysphagia handicap index (DHI), and acoustic voice analysis. RESULTS: Patients show significant variation of parameters in the fundamental frequency (F), maximal phonation time (MPT), shimmer, jitter and soft phonation index (SPI) early after operation, and most of them showed recovery of parameters after 1month of operation. Perceptive complaint of voice and swallowing also showed significant decreased after operation (p<0.005). After 1 month of operation, MPT, highest frequency and frequency ranges still showed significant decreased parameters. Comparing acoustic and perceptive parameters of total thyroidectomy and lobectomy, there was no significant changes between them except highest frequency (p=0.042). CONCLUSION: The results from both subjective and objective evaluations show voice and swallowing disturbance after thyroidectomy even in the absence of laryngeal nerve and provide patients information about the recovery process after surgery. Highest frequency parameter showed most significant changes after operation.

Effect of Tianeptine on Depressed Tinnitus Patients

BACKGROUND AND OBJECTIVES: Tianeptine is a tricyclic antidepressant that has a novel pharmacological property: it increases the reuptake of 5-hydroxytryptamine. Recent studies have reported that the prevalence of depression is greater in patients with tinnitus than in control subjects who do not have tinnitus. The purpose of this study was to assess the efficacy of tianeptine for the relief of tinnitus, especially in patients with depressive mood. SUBJECTS AND METHODS: Among a total of 52 tinnitus patients, 15 had depressive mood. The depressed tinnitus patients were prescribed Stablon® 12.5 mg once daily for 1 month without any other drug. We assessed the severity of tinnitus, level of depression, and the quality of sleep in these patients by using the Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI). Hearing impairment and severity of tinnitus were measured with pure tone audiometry, speech audiometry, and tinnitograms. These evaluations were conducted before and after medication treatment. RESULTS: For the 15 depressed tinnitus patients, THI scores significantly correlated with BDI and PSQI scores prior to medication treatment. These results showed that the discomfort of tinnitus was closely related to depression and sleep disorder. After medication treatment, THI and BDI scores significantly decreased, indicating that tinnitus and depression improved. However, no significant alteration in PSQI score was observed, indicating that there was no improvement in sleep quality. CONCLUSIONS: In the treatment of depressed tinnitus patients, tianeptine might be an efficient drug to treat both tinnitus and depression. However, tianeptine is unlikely to improve the quality of sleep in these patients.

The Therapeutic Effect of Neurologic Music Therapy and Speech Language Therapy in Post-Stroke Aphasic Patients

OBJECTIVE: To investigate the therapeutic effect of neurologic music therapy (NMT) and speech language therapy (SLT) through improvement of the aphasia quotient (AQ) in post-stroke aphasic patients. METHODS: Twenty-one post-stroke, nonfluent aphasia patients who had ischemic/hemorrhagic stroke on radiologic evaluation were divided into the NMT and SLT groups. They received NMT and SLT for 1 month. Language function was assessed by Korean version-Western Aphasia Battery before and after therapy. NMT consisted of therapeutic singing and melodic intonation therapy, and SLT consisted of language-oriented therapy. RESULTS: Significant improvements were revealed in AQ, repetition, and naming after therapy in the NMT group and improvements in repetition in the SLT group of chronic stroke patients (p<0.05). There were significant improvements in language ability in the NMT group of subacute stroke patients. However, there was no significant improvement in the SLT group of subacute stroke patients. CONCLUSION: We concluded that the two therapies are effective treatments in the chronic stage of stroke and NMT is effective in subacute post-stroke aphasic patients.

A Case of Sinonasal Tearatocarcinosarcoma of Nasal Cavity / 대한이비인후과학회지

Sinonasal teratocarcinosarcoma is extremely invasive malignant tumor that has a histological characteristic of having both more than one epithelial and mesothelial tissue components. It is a rare cancer of having less than 50 cases reported until now and domestically. This case presents a 51 year-old male who had nasal stuffiness for 2 months. A mass was noticed in his right nasal cavity, and histopathologic findings revealed the mass as a teratocarcinosarcoma. Computed tomography and magnetic resonance imaging showed that the mass originated from right nasal septum and did not invade the sinuses and that it was touching the inferior turbinate. No cervical lymph node metastasis was observed (T2N0M0, Stage II). Wide excision of the mass was performed, and no invasion in the resection margin was confirmed. Radiotherapy was performed postoperatively. Currently, the patient has been followed up on a regular basis for 28 months. Thus, the authors present a report of very rare sinonasal teratocarcinosarcoma.

Expression of Aquaporin-1, Vascular Endothelial Growth Factor and Vascular Endothelial Growth Factor Receptor-1 in the Peritoneal Tissues of Peritoneal Dialysis Patients / 대한신장학회지

PURPOSE: AQP-1 (Aquaporin-1) and VEGF (vascular endothelial growth factor) are known to play an important role in ultrafiltration in peritoneal dialysis. The aim of this study was to evaluate the expression of AQP-1 and VEGF and VEGFR-1 (VEGF type 1 receptor) in peritoneums obtained from uremic non-dialyzed patients and peritoneal dialysis patients and to see if expression of these molecules are correlated with each other and with pathological findings in peritoneum. METHODS: Peritoneal expressions of AQP-1, VEGF and VEGFR-1 were examined by immunohistochemistry using specific antibody to each molecule. The degree of vascular proliferation and inflammation in peritoneal tissues were assessed semi-quantitatively by a single pathologist. RESULTS: AQP-1, VEGF and VEGFR-1 were mainly expressed in the vascular endothelial cells in the peritoneum. No significant difference in peritoneal expression of these molecules was found according to the clinical situations in which peritoneal tissues were obtained. The degree of expression of AQP-1 and VEGF were related to each other but not related to expression of VEGFR-1. The expressions of AQP-1 and VEGF were related to the vascular proliferation. The expression of AQP-1 was also related to inflammation. CONCLUSION: In end-stage renal disease patients before and after initiation of peritoneal dialysis, the peritoneal expressions of AQP-1 and VEGF were related to vascular proliferation. Inflammation might have some influence in expression of AQP-1.

A Case of Multiple Osteomas in the External Auditory Canal / 대한이비인후과학회지

Osteoma is a benign neoplasm that can occur and extend beyond the nearest region in the external auditory canal (EAC); however, a multiple growth of the tumor in the ipsilateral ear has never been reported. A 41-year-old male patient having a past history of uncertain chronic otitis media complained of recent otalgia and progressive hearing loss in the same ear. Physical examination showed that two hard masses arising from both anterior and posterior aspect of the right EAC were contacting each other and obstructing most of the lumen. High resolution computed tomography scan revealed not only two growing exophytic bone lesions causing EAC stenosis but also inflammation of the middle ear and sclerotic mastoid cavity. We performed excision and middle ear surgery at the same time. Both specimens were pathologically confirmed as osteomas, so we report this unusual case with a review of literature.

Seroprevalence of IgG Anti-HAV in Hospital Employees below 40 Years Old / 대한소화기학회지

BACKGROUND/AIMS: Hepatitis A is an acute infectious disease transmitted by fecal-oral route. As the incidence of hepatitis A has been increased in Gwangju and Chonnam province of Korea recently, the number of hepatitis A patients in hospital employees has also increased. Thus, we investigated the seroprevalence of IgG anti-HAV in hospital employees below 40 years old. METHODS: We analysed the seroprevalence of anti-HAV IgG from 1,002 Chonnam national university hospital empolyees (men: 190, women: 812) who were below 40 years old. The age group was divided by 5 years; 21-25 years old 199 (19.9%), 26-30 years old 426 (42.5%), 31-35 years old 215 (21.5%), 36-40 years old 162 (16.1%). RESULTS: Overall seropositive rate of IgG anti-HAV was 32.8% (329/1,002). The seropositive rate of men was 40.5% (77/190) and that of women was 31.0% (252/812). The seropositive rates of each age group were 1.5% (3/199) in 21-25 years old, 21.6% (92/426) in 26-30 years old, 48.4% (104/215) in 31-35 years old, and 80.2% (130/162) in 36-40 years old. The seropositivity rate of the high risk group (doctors, nurses, technicians) was 28.9% (234/809). CONCLUSIONS: The seropositive rate of IgG anti-HAV was the lowest in early twenties of hospital employees and below 50% in early thirties. Therefore, hepatitis A vaccination may be warranted in the hospital empolyees below the early thirties.

A Case of Incidentally Found Primary Esophageal Bezoar in a Patient with Situs Inversus Totalis / 대한소화기내시경학회지

Situs inversus totalis (SIT) is very rare autosomal recessive condition, and patients with SIT have complete mirror image reversal of the thoracic and abdominal viscera. There have been no case reports of esophageal bezoar in a patient with situs inversus totalis. Bezoars are retained concretions of indigestible foreign material, including food material, vegetable material and hair, and they are usually founded in the stomach, small intestine and rectum. Esophageal bezoars are very rare, but they are known to occur in patients with anatomical defects or esophageal motility disorders. The treatment of esophageal bezoar is usually based on endoscopic fragmentation and extraction, dissolution with papain, cellulose, pancreatic enzyme and/or Coca cola. We report here on a case of an endoscopically treated primary esophageal bezoar in a patient with situs inversus totalis, and the patient experienced no complications from the treatment.

Gastric Wall Abscess Caused by a Fish Bone and Treated with Endoscopic Management / 대한소화기내시경학회지

Intramural gastric abscess is a rare condition representing a localized form of suppurative gastritis. According to the extent of the disorder, suppurative gastritis is classified into diffuse and localized types. The diffuse or phlegmonous type is more common and involves the entire stomach with inflammation spreading to all layers from the submucosa. The localized form referred to as "intramural gastric abscess" accounts for 5% to 15% of cases. The pathogenic mechanism includes direct invasion by microorganisms and hematogenous spread from a distant source. Cases are usually diagnosed with a combination of imaging modalities such as ultrasound, computed tomography, endoscopic ultrasound, and esophagogastroduodenoscopy. Herein we report a case of intramural gastric abscess that developed following ingestion of a fish bone. It was successfully treated with endoscopic incision and drainage of pus.

Strains of abutment and bones on implant overdentures / 대한치과보철학회지

STATEMENTS OF THE PROBLEM: Over the past decades, conventional complete dentures were used for various patients although they have incomplete function. Overdentures using dental implants could help the improvement of denture function. PURPOSE: The purpose of this study was to compare the strains of abutment and bone on implant overdenture between splinted and unsplinted type of prosthesis. Additionally, the strain values of parallel placed implant model and unparallel placed implant model were compared. MATERIAL AND METHODS: Two acrylic resin model were prepared and two implants were placed at the canine positions in each model. In the first model, two implant were placed parallel. In the second model, two implants were placed with 10 degree labiolingual divergence. Two types of abutment were connected to the fixtures alternatively. One was splint type of Hader bar, the other was unsplint type of ball abutment. Overdentures were fabricated with corresponding attachment systems and seated on abutments. Strains of abutments and labial bone simulants were measured with electric resistance strain gauges when static load from 100 N to 200 N were applied to overdentures. RESULTS: 1. Splinted type of overdentures using bar and clip showed higher absolute strain values. But the strain was compressive and the load was shared by two implants (P < .05). 2. Unsplinted type overdentures using ball and O-ring showed low absolute strain values (P < .05). 3. Labially inclined implant showed higher tensile strain values in unsplinted type of prosthesis than in splinted type of prosthesis. Lingually inclined implant showed rather low strain values under load (P < .05). 4. Non parallel implant model showed higher absolute strain values than parallel placed implant model comprehensively (P < .05).

Musculus Uvulae Shortening for the Treatment of Snoring

BACKGROUND AND OBJECTIVES: We investigated the effectiveness of shortening the uvula muscle for the treatment of snoring. This new and simple procedure was developed to promote the elevation of the uvula position using a minimally invasive technique. SUBJECTS AND METHODS: Fifteen habitual snorers were included in this study. In order to find the exact anatomical position of the uvula muscle, we first dissected the soft palate of a cadaver to better understand the exact anatomical location and structure of the uvula muscle. With this result, we developed a new surgical technique for treating snoring. The results of our surgery were evaluated by both the patient and bed partner before surgery, at 30 days, and 90 days after surgery respectively using the visual analogue scale (VAS). RESULTS: Post-operative physical examinations showed superiorly displaced uvula position. The lower half of the soft palate and uvula were also anteriorly flexed. Those findings remained unaltered beyond the 90th post-operative day. The patient and bed partner snoring symptoms assessed by VAS were significantly improved compared to the pre-treatment values (p<0.05). CONCLUSION: The uvula muscle shortening is an effective and simple method for the treatment of snoring.

A Case of Primary Pancreatic Lymphoma That Manifested with Acute Pancreatitis and Obstructive Jaundice / 대한소화기내시경학회지

Primary pancreatic lymphoma (PPL) is a rare form of extranodal lymphoma, and this accounts for less than 0.5% of all pancreatic tumors. Differentiating PPL from pancreatic adenocarcinoma is important because the prognosis and survival of PPL is much better than those of pancreatic adenocarcinoma. Although the treatment usually consists of a combination of chemotherapy and radiation therapy, PPL patient with biliary tract or gastrointestinal obstruction should undergo biliary or gastric bypass to relieve the symptoms. Herein, we describe a case of PPL with acute pancreatitis and obstructive jaundice, and the patient was successfully managed with endoscopic retrograde pancreatic and biliary drainage.