A Case of Small Bowel Lymphangiectasia that Presented with Gastrointestinal Bleeding and was Treated by Small Bowel Resection / 대한내과학회지

Intestinal lymphangiectasia (IL) is a rare disorder, characterized by dilatation of intestinal lymphatics and leakage from ruptured lacteals to the intestinal lumen. Primary IL may be due to a congenital malformation of the lymphatic system, whereas secondary IL is caused by decreased lymph flow from thoracic ductsdue to elevated left subclavian vein pressure as a result of a preceding inflammatory or neoplastic disease. IL can present as protein-losing enteropathy with clinical manifestations of hypoproteinemia, hypoalbuminemia, edema, ascites, or pleural effusions. In very rare cases, it can present as severe intestinal bleeding. We experienced a 48-year-old woman presenting with recurring hematochezia and melena. She was diagnosed bydouble balloon enteroscopy, and surgical resection was needed to stop bleeding. In conclusion, IL can present clinically as painless chronic blood loss. If IL is locally distributed, surgical resection may be needed to control bleeding and to exclude other underlying causes in some patients.

Implantation of ICD in a Ventricular Fibrillation Patient with a High Defibrillation Threshold

ICD (implantable cardioverter-defibrillator) has been recently accepted as the most effective treatment for patients with medically refractory or life threatening ventricular tachycardia or ventricular fibrillation. Determination of the DFT (defibrillation threshold) is important in the implantation of ICD. DFT is the lowest shock energy that successfully terminates ventricular fibrillation. Preoperative amiodarone use, increased body size, and left ventricular dilatation are associated with high DFT. Recently, we experienced a 66 year-old male patient presenting with syncope due to idiopathic ventricular fibrillation in whom DFT was high and unstable, probably due to preoperative use of amiodarone.

Papillary Carcinoma of Thyroid in Association with Familial Adenomatous Polyposis

Familial adenomatous polyposis (FAP) includes early development of up to thousands of colorectal adenoma and of colonic adenocarcinoma in all untreated cases. Moreover, a variety of extracolonic manifestation are seen. Several reports have demontrated a high incidence of papillry carcinoma of thyroid. We experienced a case of familial adenomatous polyposis, presenting with thyoid papillry carcinoma, and reported with a brief review of literatures.