Type 2 Autoimmune Pancreatitis with Ulcerative Colitis Manifesting as Acute Pancreatitis / 대한내과학회지

Autoimmune pancreatitis (AIP) occurs in two forms. Type 1 AIP is an IgG4-related systemic fibro-inflammatory disease. Type 2 AIP is not associated with altered levels of IgG4, and involves only the pancreas. Here, we report a case of type 2 AIP manifesting as acute pancreatitis in a 20-year-old male with ulcerative colitis. The patient was definitely diagnosed with type 2 AIP based on typical pancreatic imaging, supportive histology, history of ulcerative colitis, and steroid responsiveness.

Clinical Outcomes of Angiography and Transcatheter Arterial Embolization for Acute Gastrointestinal Bleeding: Analyses according to Bleeding Sites and Embolization Types / 대한소화기학회지

BACKGROUND/AIMS: The clinical outcomes of angiography and transcatheter arterial embolization (TAE) for acute gastrointestinal bleeding (GIB) have not been completely assessed, especially according to bleeding sites. This study aimed to assess the efficacy of angiography and safety of TAE in acute GIB. METHODS: This was a retrospective study evaluating the records of 321 patients with acute GIB who underwent angiography with or without TAE. Targeted TAE was conducted in 134 patients, in whom angiography showed bleeding sources. Prophylactic TAE was performed in 29 patients when the bleeding source was not detected but a specific vessel was strongly suspected by other examinations. The rate of technical success, clinical success, and complications were analyzed. RESULTS: The detection rate of bleeding source via angiography was 50.8% (163/321), which was not different according to the bleeding sites. The detection rate was higher if the probable bleeding source had already been found by another investigation (59.7% vs. 35.8%, p<0.001). TAE sites were upper GIB in 67, mid GIB in 74, and lower GIB in 22. The technical success rate was 99.3% (133/134), and the clinical success rate was 63.0% (104/163). The prophylactic embolization group showed lower clinical success rate than the targeted embolization group (44.8% vs. 67.9%, p=0.06). The TAE-related complication rate was 12.9% (21/163). Ischemia and/or infarction was more common after TAE for mid and lower GIB than for upper GIB (15.6% vs. 3.0%, p=0.007). CONCLUSIONS: Angiography with or without TAE was an effective method for acute GIB. Targeted embolization should be performed if possible given that it has a higher clinical success rate.

Biliary-Colonic Fistula after Hepatectomy Treated by Colonoscopic Clipping / 대한췌담도학회지

Biliary-colonic fistula is a rare complication after hepatic resection. We present at a case of asymptomatic biliary-colonic fistula that developed 6 months after hepatectomy in a 73-year old female patient. She had been undergoing endoscopic treatment for a postoperative bile leakage, and the fistula was found by follow-up endoscopic retrograde cholangiopancreatography (ERCP). The fistula was formed between the right posterior segmental duct and the colon, and it was closed by colonoscopic clipping under fluoroscopic guidance. There was no recurrence at the 6-week follow-up ERCP.

A Sporadic Case of Epstein Syndrome: A Rare Cause of Refractory Thrombocytopenia / 대한내과학회지

A 37-year-old female presented to our hospital with a history of bleeding episodes (excessive bleeding after tooth extraction, gum bleeding, easy bruising, and excessive menstruation) and severe thrombocytopenia (2,000/µL). She had no family history of bleeding tendency or thrombocytopenia. No peripheral lymphadenopathy or splenomegaly was noted. The patient's white blood cell count was normal; hemoglobin was 9.7 g/dL. A peripheral blood smear showed markedly decreased platelets, with occasional giant or large platelets. Bone marrow examination found increased megakaryocytes. The patient also complained of hearing difficulty; a hearing test indicated sensory-neural hearing impairment. Her thrombocytopenia was refractory to treatment with glucocorticosteroids, intravenous gamma-globulin, and danazol. In the 13 years following her initial presentation, the patient required anti-hypertensive treatment, a hearing-aid for progressive hearing loss, and started maintenance kidney dialysis. Her clinical history of refractory thrombocytopenia, progressive hearing impairment, and renal failure suggested myosin heavy chain 9 gene-related congenital syndrome (Epstein syndrome), which was confirmed by the presence of a heterozygous deletion mutation, c.221_223del, (p.Lys74del) in peripheral leukocyte deoxyribonucleic acid.