Recurrent Cholangitis due to Hem-o-lok Clip Migration after Laparoscopic Common Bile Duct Exploration Treated with Endoscopic Retrograde Cholangiopancreatography / 대한췌담도학회지

Clip migration into the common bile duct (CBD) is a rare complication of laparoscopic biliary surgery. We report a case of Hem-o-lok clip migration-induced CBD stone in a 66-year-old man who underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) 4 years ago. The patient visited the emergency room for upper abdominal pain. CT scan revealed increased CBD diameter and multiple CBD stones. We performed endoscopic retrograde cholangiopancreatography for CBD stone extraction. Cholangiography revealed multiple suspected filling defects in the CBD; stones and unknown foreign body were removed using Basket. The foreign body found in the duodenum was a Hem-o-lok clip. When epigastric pain develops in a patient who has undergone LC and LCBDE, it is possible that biliary stone occurs due to clip migration.

Recurrent Cholangitis due to Hem-o-lok Clip Migration after Laparoscopic Common Bile Duct Exploration Treated with Endoscopic Retrograde Cholangiopancreatography / 대한췌담도학회지

Clip migration into the common bile duct (CBD) is a rare complication of laparoscopic biliary surgery. We report a case of Hem-o-lok clip migration-induced CBD stone in a 66-year-old man who underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) 4 years ago. The patient visited the emergency room for upper abdominal pain. CT scan revealed increased CBD diameter and multiple CBD stones. We performed endoscopic retrograde cholangiopancreatography for CBD stone extraction. Cholangiography revealed multiple suspected filling defects in the CBD; stones and unknown foreign body were removed using Basket. The foreign body found in the duodenum was a Hem-o-lok clip. When epigastric pain develops in a patient who has undergone LC and LCBDE, it is possible that biliary stone occurs due to clip migration.

Cholangitis Caused by Hereditary Spherocytosis in Adulthood Treated by Endoscopic Retrograde Cholangiopancreatography / 대한췌담도학회지

Hereditary spherocytosis is a disease caused by deficiency of erythrocyte lipid membrane protein. Hereditary spherocytosis shows hemolysis of erythrocyte, and it leads to anemia, jaundice by elevation of indirect bilirubin. Almost of patients are diagnosed in their infancy, and can be cured by splenectomy about their age 6–7. Herein, we report a rare case of 33-year-old male was suffered from gallbladder stone and cholangitis those are thought to be the late complications of hereditary spherocytosis. We performed endoscopic retrograde cholangiopancreaticography to remove common bile duct stones. After he got cholecystectomy and splenectomy, there was no recurrence of choledocholithiasis. This is the first case in Korea who didn’t undergo splenectomy until grown up, shows cholangitis as a late disease manifestation of hereditary spherocytosis.

Discrepancy between the Actual Clinical Status of Patients with Hepatocellular Carcinoma and Expectations from Hepatocellular Carcinoma Surveillance: a Single-Center Study

BACKGROUND/AIMS: The National Liver Cancer Screening Program (NLCSP) has been implemented for the past 15 years in Korea. However, the actual clinical experience in Korea is inconsistent with the expectations of the hepatocellular carcinoma (HCC) surveillance program. To evaluate the actual clinical situation of HCC diagnoses, we investigated disease severity in patients with HCC and the diagnostic environment. METHODS: From January 2011 to December 2015, all patients who were diagnosed with HCC in a single secondary hospital in Daejeon city were retrospectively enrolled in this study. Severity of HCC was evaluated according to the Barcelona Clinic Liver Cancer (BCLC) staging system. RESULTS: Over the course of 5 years, 298 participants were enrolled. The mean age of participants was 64.0 years. Positive hepatitis B surface antigen was confirmed in 134 patients (45.0%), 35 patients (11.7%) tested positive for anti-hepatitis C virus antibody, and 93 patients (32.2%) had more than 40 g/day of alcohol consumption. The proportions of patients according to BCLC stages were as follows: BCLC-0, 28 patients (9.4%); BCLC-A, 42 patients (14.1%); BCLC-B, 26 patients (8.7%); BCLC-C, 134 patients (45.0%); and BCLC-D, 68 patients (22.8%). The diagnostic environments were as follows: 19 patients were in the NLCSP group (6.4%), 114 in the group with presenting signs (38.3%), 110 in the regular outpatient care group (36.9%), and 55 patients in the incidental diagnosis group (18.5%). CONCLUSIONS: Most patients (67.8%) had advanced stage HCC at diagnosis, and curative treatment was not indicated due to the severity disease. Thus, the actual situation is far worse than the theoretical expectation of HCC surveillance, suggesting that many high-risk patients for HCC are missed in surveillance.

Hepatic Failure Due to Hepatitis E Virus Infection in a Patient with Necrotic Hepatocellular Carcinoma

In patients with hepatocellular carcinoma (HCC) or liver cirrhosis (LC) accompanied by hepatitis E virus (HEV) infection, hepatic failure often leads to debility. Here, we report about a 63-year-old man with alcoholic LC who was referred to our hospital with jaundice and abdominal distension 10 days earlier. Abdominal computed tomography showed necrotic HCC accompanied by left lobe shrinkage without tumor progression. Laboratory and imaging findings revealed no acute infection focus. The patient reported no herbal medicine or alcohol consumption, and there was no evidence of acute viral hepatitis. One month later, HEV immunoglobulin M positivity was confirmed, and deterioration of liver function due to HEV infection was suspected. The patient often ate raw oysters and sashimi, as well as boar meat, which is a well-known risk food for HEV infection. His umbilical hernia deteriorated due to tense ascites and infection by skin abrasion. The patient progressed to hepatorenal syndrome and eventually died. Liver function preservation is important when treating HCC patients. Therefore, clinicians should pay more attention to the prevention of HEV and others causes of direct liver injury.

Acute Pancreatitis in a Pregnant Patient with Type IV Hyperlipoproteinemia / 대한췌담도학회지

Most cases of hypertriglyceridemia (HTG)-induced gestational pancreatitis occur when a person with hyperlipidemia is overweight due to pregnancy or has secondary triggers associated with triglycerides (TGs). In Korea, 6 cases of HTG-induced gestational pancreatitis have been reported, but none of the affected patients had TG levels below 1,000 mg/dL. A 36-year-old female at 30 weeks of gestation was admitted due to pain in her upper abdomen. Initial biochemical analysis revealed a TG level of 260 mg/dL, an amylase level of 2,951 U/L and a lipase level of 3,500 U/L. Abdominal ultrasonography showed pancreatic swelling with a hypoechogenic rim. After several days, the patient was discharged and had a normal delivery at 38 weeks of gestation. This case report is the first to describe acute pancreatitis occurring in the presence of type IV hyperlipoproteinemia even though the TG level was less than 500 mg/dL, contrary to findings in previously reported cases.

Selective Biliary Cannulation for a Papilla in the 9 o'clock Position Using Pull and Rotatable Sphincterotome / 대한췌담도학회지

No abstract available.

Long-Term Clinical Outcome of Clostridium difficile Infection in Hospitalized Patients: A Single Center Study

BACKGROUND/AIMS: Antibiotic usage and increasingly aging populations have led to increased incidence of Clostridium difficile infection (CDI) in worldwide. Recent studies in Korea have also reported increasing CDI incidence; however, there have been no reports on the long-term outcomes of CDI. We therefore investigated the long-term clinical outcomes of patients with CDI, including delayed recurrence, associated risk factors and mortality. METHODS: Hospitalized patients diagnosed with CDI at Seoul Paik Hospital between January 2007 and December 2008 were included. Their medical records were retrospectively investigated. 'Delayed recurrence' was defined as a relapse 8 weeks after a successful initial treatment. Multivariate logistic regression analysis was performed to identify risk factors for the delayed recurrence. Kaplan-Meier curves were used to analyze mortality rates. RESULTS: A total of 120 patients were enrolled; among them, 87 were followed-up for at least 1 year, with a mean follow-up period of 34.1+/-25.1 months. Delayed recurrence was observed in 17 patients (19.5%), and significant risk factors were age (over 70 years, P=0.049), nasogastric tube insertion (P=0.008), and proton pump inhibitor or H2-blocker treatments (P=0.028). The 12- and 24-month mortality rates were 24.6% and 32.5%, respectively. No deaths were directly attributed to CDI. CONCLUSIONS: Delayed recurrence of CDI was not rare, occurring in 19.5% of the study population. Although CDI-related mortality was not reported, 2-year (32.5%) mortality rate of CDI patients implies that a CDI diagnosis may predict severe morbidity and poor prognosis of the underlying disease.