A Case of Iatrogenic Bronchobiliary Fistula / 대한소화기내시경학회지

Bronchobiliary fistula is a rare condition. It is defined by the presence of a passage between the biliary tract and the bronchial tree. Many conditions can give rise to the developement of such a communication. The patient was a 71-year-old man who had obstructive jaundice due to liver mass. At first, we inserted an uncovered metallic stent for biliary drainage. However, the bile duct was perforated due to the trapping of a catheter in the distal end of the deployed stent. The operation was performed immediately, but only the sump draingage was placed in the retroperitoneum because the perforation site could not be found. After 20 days from the procedure, the patient complained of bilioptysis because of a bronchobiliary fistula. We inserted a covered stent into the previous uncovered metallic stent. Bilioptysis rapidly resolved after the successful procedure. We report a case of iatrogenic bronchobiliary fistula which was managed by endoscopic biliary stenting.

A Case of Jejunal Infarction and Perforation due to Acute Pancreatitis / 대한소화기학회지

Jejunal infarction as a complication of acute pancreatitis is not common and can not be well recognized. This jejunal infarction usually arises from the venous thrombosis rather than arterial thrombosis. Jejunal infarction results in bowel perforation or stenosis according to its extension of injury and progression rate. Pathologic findings of the involved jejunum show a segmental transmural infarction and mesenteric venous thrombotic occlusions. Early diagnosis should be made for better prognosis. We report a patient with jejunal infarction resulting perforation due to acute pancreatitis, in which the initial presenting symptoms were hematemesis and abdominal distention.

The Prevalence of Metabolic Syndrome in Patients with Nonalcoholic Fatty Liver Disease / 대한간학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is associated with dyslipidemia, obesity, and insulin resistance, which are the main features of metabolic syndrome. First, we examined the prevalence of metabolic syndrome among patients with NAFLD. We then compared the prevalence of metabolic syndrome in simple steatosis with that in nonalcoholic steatohepatitis (NASH). Finally, we sought to identify clinical factors associated with the stage of liver fibrosis. METHODS: From November 2002 to March 2004, we enrolled consecutive 25 patients with NAFLD from patients visiting outpatient clinic. The 17 controls were healthy persons who visited our health promotion center. We compared the clinical and biochemical data of the NAFLD group with those of the control group. Using histologic findings, we divided NAFLD into simple steatosis and NASH. We then compared the clinical and biochemical data of the simple steatosis group with those of the NASH group. RESULTS: Fourteen patients (14/25, 56%) had metabolic syndrome in the NAFLD group. There was no difference in the prevalence of metabolic syndrome between the simple steatosis (5/10, 50%) and the NASH group (9/15, 60%). We found significant differences in cardiovascular risk factors between the two groups, but homeostasis model assessment insulin resistance was the only significantly different factor between the simple steatosis group and the NASH group. In addition, no difference in histological features was found between NASH with metabolic syndrome and without metabolic syndrome. CONCLUSIONS: A considerable number of patients with NAFLD had metabolic syndrome. There was a close correlation between NAFLD and metabolic syndrome. We could not find any cardiovascular risk factors that could predict a severe fibrosis.

A Case of Small Cell Carcinoma in the Stomach / 대한소화기내시경학회지

Small cell carcinoma (SmCC) of stomach is a very rare and aggressive malignancy with extremely poor prognosis. Most patients with gastric SmCC die within 1 year of diagnosis. A standard treatment for gastric SmCC has not been established, but surgical excision and/or combination chemotherapy should be considered to promote long term survival. We report a case of small cell carcinoma of stomach in a 66-year-old woman with dysphagia. A gastroscopic examination revealed a polypoid mass with ulceration on the lesser curvature of the gastric body extending to the gastro-esophageal junction. An endoscopic biopsy showed a solid proliferation of small, monotonous tumor cells with hyperchromatic nuclei and scanty cytoplasm. Immunohistochemically, the neoplastic cells were positive for chromogranin, synaptophysin and NSE, and negative for CD45. No tumor was detected on examination of the chest. Therefore, primary SmCC was diagnosed preoperatively.

A Case of Spontaneous Renal Artery Dissection Causing Renal Infarction in a Previously Healthy Man / 대한신장학회잡지

Spontaneous renal artery dissection is an uncommon cause of renal infarction. Previous reports of spontaneous renal artery dissection has been associated with hypertension or fibromuscular dysplasia. We report herein the case of a previously healthy, normotensive patient with renal infarction due to spontaneous renal artery dissection who remained normotensive throughout his course without therapy. A previously healthy 31-year-old man with well- documented normotension had a sudden onset of right flank pain and delayed onset of elevation of lactic dehydrogenase, hematuria, and proteinuria. Thin section spiral computerized tomogram shows linear intraluminal filling defect suggesting intimal flap. Angiography shows dissection of main right renal artery. Six months later, he has remained well and normotensive without therapy. To our knowledge, this is the first case of spontaneous renal artery dissection in normotensive patients in Korea.

A Case of Acute Myocardial Infarction Associated with Myocardial Bridge Treated by Primary Coronary Stenting

The clinical significance of myocardial bridges (MBs) is variable, and most patients are asymptomatic. However, angina, myocardial infarction and sudden death, associated with MBs, have been reported. Intracoronary stents offer a novel, and potentially definitive, treatment for myocardial ischemia associated with clinically significant MBs. We describe the use of intracoronary stenting for primary angioplasty in a patient with an anterior myocardial infarction associated with MBs.

A Case of Watermelon Stomach Treated by Hemigastrectomy / 대한소화기내시경학회지

Gastric antral vascular ectasia (watermelon stomach) is a rare cause of chronic gastrointestinal bleeding, characterized endoscopically by a distinctive appearance of prominent red vascular folds traversing the gastric antrum and radiating to the pyloric sphincter; this appearance has been likened to the dark stripes on the surface of a watermelon. The etiology is unknown, and the usual presentations are iron-deficiency anemia and melena due to chronic gastric blood loss. Diagnosis is made by the characteristic endoscopic appearance and histologic findings. The treatment of choice is not known yet; surgical resection is curative method, but results from endoscopic treatment with heat probes or lasers are promising. We experienced a case of gastric antral vascular ectasia presenting with epigastric pain and melena in a 34-year-old female. The patient was treated with hemigastrectomy and Billroth II anastomosis.