A Case of Duodeno-cecal Fistula Developed due to Foreign Body / 대한소화기내시경학회지

Gastrointestinal foreign bodies are a common problem. It can be managed by observation, endoscopic removal, and/or surgical intervention. Bowel perforation, obstruction, bleeding, fistularization and abscess formation are common significant complications associated with foreign bodies.A 38-year-old woman with a toothbrush in the duodenum was referred to our hospital due to abdominal pain. Three years ago, she ingested a tooth brush. Esophagogastroduodenoscopy showed a tooth brush placed in the second portion of the duodenum. We removed a tooth brush by a snare and found a fistula at the junction of the second and third portion of the duodenum. Upper gastrointestinal series revealed a fistula between the duodenum and cecum. We report a case of duodeno-cecal fistula developed due to a toothbrush ingested 3 years before.

Segmental Groove Pancreatitis: Report of One Case

Groove pancreatitis is a special form of chronic pancreatitis in which scarring is found mainly in the groove between the pancreatic head, duodenum, and common bile duct. Preoperative differentiation between groove pancreatitis and pancreatic cancer is difficult. Here we report one case of segmental groove pancreatitis diagnosed by clinical and radiological features. The patient was a 46-year old man with severe abdominal pain, weight loss, and a long history of alcohol abuse. Computed tomography revealed swelling of the pancreatic head and a heterogeneously enhanced low-density lesion in the groove. MR images revealed a mass in the groove that had a low signal on T1-weighted images and a low signal relative to the pancreatic head on T2-weighted images. T1-weighted images on dynamic study showed the medial wall thickening of descending duodenum, several small cysts in the groove and thickened duodenal wall. The patient has been under conservative treatment for 2 months and his severe abdominal pain has improved.

A Case of CMV Infection Associated with Simultaneous Esophageal and Colonic Ulcers / 대한소화기내시경학회지

Gastrointestinal cytomegalovirus (CMV) disease causes substantial morbidity and mortality in immunocompromised patients, especially in transplant recipients and those who infected with HIV. Although acute infection is generally asymptomatic or produces only non-specific symptoms in the immunocompetent host, acute CMV infection accompanies gastrointestinal ulceration in a small number of patients. The colon is the most common site of the infection, although it may occur in other gastrointestinal tract. CMV infection associated with simultaneous esophageal and colonic ulcers has not been reported in Korea. We report a patient with subarchnoid hemorrhage who had suffered from simultaneous esophageal and colonic ulcers associated with CMV infection which showed characteristic histologic findings of CMV infection.

Histological Comparison of Endoscopic Forceps Biopsy with Endoscopic Resection in Gastric Mucosal Elevated Lesion / 대한소화기내시경학회지

BACKGROUND/AIMS: The correct histological diagnosis of gastric adenoma is important, because it has been reported to be precancerous lesion and associated with focal gastric carcinoma. However, there is some discrepancy between the histology of the forceps biopsy and that of the endoscopic resection. In this study, we compared the histologic findings of gastric mucosal elevated lesion between the specimens of forceps biopsy and endoscopic resection. METHODS: We reviewed retrospectively 137 cases of gastric mucosal elevated lesion which had been removed by the resection such as polypectomy or endoscopic mucosal resection. All patients had undergone forceps biopsy before endoscopic resection. We compared the histologic findings of the specimens by forceps biopsy with those by resection. RESULTS: The histologic fidings were accordant at 101 of the 137 cases (73.7%), and different at 30 cases (21.9%). Among the 86 cases with adenoma in the biopsied specimens, 10 cases (11.6%) were finally diagnosed as gastric cancer in the resected specimens. CONCLUSIONS: Because biopsy specimens may not be presentative of the entire lesion, endoscopic resection of gastric mucosal elevated lesion is needed for accurate histologic diagnosis and treatment if adenoma is suspected.

Tuberculous Peritonitis Diagnosed by Laparoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: Tuberculous peritonitis is still a very important cause of exudative ascites in Korea. We analized the clinical features and laparoscopic findings in patients with tuberculous peritonitis diagnosed by laparoscopy. METHODS: We studied 51 patients who had tuberculous peritonitis confirmed by laparoscopic biopsy from 1980 to 2000, in retrospective method. RESULTS: The ratio of male to female was 1:2. The peak incidence was between 21 and 40 years of age. The mean duration of symptoms is 60 days. The most frequent chief complaints and physical findings was abdominal fullness (88.2%) and shifting dullness (94.1 %). Involvement of other organs included pulmonary tuberculosis (27.4%), cervical tuberculous lymphadenitis (3.9%). The mean ascitic fluid protein concentration was 4.9 gm/dL, mean WBC count 1,240/mm3 and lymphocyte dominant exudate 88.2%. AFB smear was positive only one patient (2.0%). Tuberculous nodules on laparoscopy were noted in all of the patients. Histolologic findings were caseating granuloma (72.6%), non-caseating granuloma (19.6%) and nonspecific inflammation (7.8%). Tissue AFB stain was positive 10 patients (19.6%). CONCLUSIONS: Tuberculous peritonitis shows nonspecific clinical features. Therefore, laparoscopic examination with biopsy is the most useful method to make differential diagnosis of patients who are suspected tuberculous peritonitis.

A Case of Intraluminal Gallbladder Hematoma after Percutaneous Liver Biopsy / 대한간학회지

Percutaneous liver biopsy is valued in the diagnosis of diffuse or localized liver disease. Serious complications after ultrasonography-guided liver biopsy are rare. We report a case of a 69-year-old man who underwent a percutaneous liver biopsy for the evaluation of his underlying liver disease with subsequent late complication of intraluminal gallbladder hematoma.

A Case of Gastric Metastasis from Breast Carcinoma Manifested by Upper Gastrointestinal Bleeding / 대한소화기내시경학회지

Breast carcinoma is common malignancy in women and frequently metastasize to multiple organ such as lung, bone, lymph node and liver. But metastasis to gastrointestinal tract is rare and only two cases have been reported in Korea. We experienced a case of upper gastrointestinal bleeding caused by gastric metastasis from ductal carcinoma of breast and report this case with review of several literatures.

Two Cases of Primary Esophageal Small Cell Carcinoma / 대한소화기내시경학회지

Primary extrapulmonary small cell carcinoma have been described in the esophagus, stomach, pancreas, salivary gland, paranasal sinus, small bowel, uterus, urinary bladder and skin. Primary small cell carcinoma of the esophagus has rarely been reported since McKeown had reported the first 2 cases of small cell carcinoma of the esophagus in 1952. Primary small cell cancer of esophagus is extremely aggressive tumor with grave prognosis. Because of the highly malignant potency, multimodality treatment including chemotherapy for the primary therapy is accepted generally. We experienced 2 cases of small cell carcinoma of the esophagus. One patient was a 57 year-old male without metastasis and we treated him with a multi-drug regimen (cisplatin and VP-16) being used in small cell carcinoma of the lung at our hospotal. But the other patient was a 67 year-old male with bone metastasis, and he refused all management.

Prevalence Alteration of Reflux Esophagitis in Recent Years / 대한소화기내시경학회지

BACKGROUND/AIMS: Reflux esophagitis is pertained to gastroesophageal reflux disease. On recent studies, western GERD patients shows reflux esophagitis over than 50% on gastroscopy. We expect lower incidence of reflux esophagitis in Korea, but few epidemiological data are available for korean patients. We intended to investigate the alteration of incidence of reflux esophagitis by gastroscopy result for patients who visited general health screening center and department of gastroenterology with chief complaint of gastrointestinal symptoms. METHODS: The 13,439 people of general health screening center visitors, 28,037 patients who visited department of gastroenterology due to gastrointestinal symptoms from March, 1996 to August, 1999 were underwent gastroscopy. And 24,952 patients who showed gastrointestinal symptoms and general health screening center visitors from March, 1993 to Feburary, 1996 were also underwent gastroscopy. The grading of esophagitis was based on the Savary-Miller classification and prevalence alteration of reflux esophagitis was investigated by retrospective manner. RESULTS: 1) Overall prevalence of general health screening people group and patients with gastrointestinal symptoms from March, 1993 to Feburary, 1996 was 2.08%. 2) Overall prevalence of general health sceening group from March, 1996 to August, 1999 was 2.37%. During the same period, Overall prevalence of patients with gastrointestinal symptoms was 3.69%. Overall prevalence was 2.96% and it was higher than that of 3 years ago (2.02%). CONCLUSIONS: On recent gastrofiberscopy studies, prevalence of reflux esophagitis is increasing. So further investigation is needed on the prevalence of reflux esophagitis over the whole country by prospective manner.

A Case of Liver Abscess Associated with Fascioliasis Diagnosed by MRI / 대한간학회지

Fascioliasis is a zoonotic helminthiasis caused by Fasciola hepatica, the sheep liver fluke. Humans are accidental hosts in the life cycle of the parasite. They are infected by the ingestion of water or raw aquatic vegetables contaminated with the metacercaria. The diagnosis of fascioliasis is based on clinical symptoms, absolute eosinophilia, serologic test (ELISA), radiologic finding, and presence of eggs in the feces or duodenal fluid. Recently, some radiologists have been reporting specific findings of fascioliasis by MRI. We report a case of liver abscess associated with fascioliasis diagnosed by MRI.

A case of bypass arthritis-dermatitis syndrome after bypass gastrojejunostomy / 대한내과학회지

Bypass surgery, as therapy for morbid obesity, was introduced in 1952. Multiple complications such as arthritis and dermatitis as well as liver dysfunction, renal injury, diarrhea, malnutrition and electrolyte imbalance were reported after bypass surgery. Recently, we have experienced a case of bypass arthritis-dermatitis syndrome in a patient after pyloric exclusion and bypass gastrojejunostomy due to traumatic duodenal perforation. He complained arthralgia of left knee, both wrist and both ankle and developed erythematous maculopapular rash over lower extremities. He was successfully treated with NSAIDs and clindamycin.

Abdominal Actinomycosis Initially Diagnosed As a Colorectal Cancer or Periappendiceal Abscess / 대한소화기내시경학회지

BACKGROUND/AIMS: Colonic actinomycosis is a rare disease with clinical and radiographic findings that overlap those of other inflammatory and neoplastic conditions. We performed this study to analyze clinical manifestation, characteristic radiologic findings of 5 cases of abdominal actinomycosis, which was initially diagnosed as a colorectal cancer or periappendiceal abscess. METHODS: We analyzed chief complaint, predisposing factor, presence of leukocytosis and sulfur granule, involved site, presence of LN involvement and abdominal CT findings, retrospectively. RESULTS: The most common clinical manifestation was abdominal pain. In 3 cases, predisposing factors were identifiable, which were intrauterine contraceptive device (IUD), previous appendectomy, and diabetes mellitus (DM) respectively. Leukocytosis was noted in 4 cases (80%) and sulfur granule in all 5 cases. Sigmoid colon was the most common involved site (4 cases) followed by appendix and rectum. On computed tomography, inhomogeneous mass or severe inflammation along the bowel wall or serosa was noted. Explorations were performed in 4 cases. Preoperative diagnosis was a colorectal cancer in 3 cases and periappendiceal abscess in 1 case. CONCLUSIONS: Actinomycosis should be born in mind in the differential diagnosis of patients with IUD, previous appendectomy and DM, presenting leukocytosis and CT finding of inhomogeneous mass and relatively uncommon LN involvement to eliminate unnecessary explorations.

A Case of Carcinoid Tumor of the Rectum / 대한소화기내시경학회지

Carcinoid tumor primarily affects the intestinal tract, which arise from the Kulchitsky cells found at the base of the crypts of Lieberk hn. Rectal carcinoids are relatively uncommon lesions, representing only 1.3 percent of all rectal tumors. Rectal carcinoids have benign course and are usually asymptomatic. While their prognosis is generally favorable, it is known that about 15% of these tumors metastasize. Rectal carcinoid tumors should be treated appropriately and aggressively when indicated. Present-day treatment programs call for radical cancer resection only for lesions larger than 2 cm in diameter and local resection for all others. We have experienced a case of carcinoid tumor of the rectum treated by endoscopic polypectomy.

A case of bilateral primary adrenal lymphoma / 대한내과학회지

Primary adrenal lymphoma is extremely rare with only 65 cases reported in the worldwide literature until 1998. The presenting symptom may be related to the lymphoma itself or to adrenal insufficiency. Most of the lymphomas were of B cell diffuse large cell type with only two seemed to be T-cell in origin. The therapeutic modalities include surgery, combination chemotherapy, surgery followed by chemotherapy and/or radiation therapy, in addition to corticosteroid replacement. A 65 year old man with chronic hepatitis C and hemangioma of liver presented with general weakness. Abdominal ultrasonography showed bilateral adrenal masses. The adrenal masses were diagnosed as a primary adrenal non-Hodgkin's lymphoma by open biopsy. The histologic findings were consistent with B cell diffuse large cell lymphoma. After three cycles of CHOP chemotherapy, the adrenal mass disappeared on follow up abdominal CT scan, but the patient died 4 months after diagnosis due to sepsis.

A Case of Lower Esophageal Ring with Dysphagia / 대한소화기내시경학회지

Lower esophageal ring are uncommon. We experienced a case of lower esophageal ring in a 51-year-old man who had intermittent swallowing difficulty for 2 years. Endoscopy revealed a circumferential narrowing at 34 cm from the incisors and congested and eroded mucosa was noted proximal to the ring. Esophagography revealed an elevation of G-E junction above the diaphragm and a reflux of dye from the stomach into the esophagus with thickened and irregular esophageal wall.

Epigastric appendiceal abscess with spontaneous drainage into the stomach

The appendiceal abscess is a common complication of acute appendicitis and usually is located in the right lower quadrant of the abdomen. An epigastric appendiceal abscess has never been reported at an unusual location. We experienced an unusual case of a 49-year-old man with an epigastric appendiceal abscess. Initially, this abscess was suspected to be a pancreatic abscess. Abdominal CT scan and barium enema demonstrated a hyperrotated cecum with an appendiceal abscess in the left upper quadrant of the abdomen. An gastroscopy revealed a small fistula-like lesion with purulent coating at the bulging posterior gastric wall. The abscess resolved spontaneously. We believe that the abscess drained into the stomach through a small fistula between the stomach and abscess cavity. There was no recurrence for over 6 months.

A Case of Esophageal Carcinoma in a Patient with Primary Achalasia / 대한소화기내시경학회지

Achalasia is believed to be a predisposing factor for the development of esophageal cancer. The prevalence rate of esophageal cancer is 1~7% among all patient with achalasia. The presumed mechanism responsible for the development of cancer are food stasis and gastroesophageal reflux. We experienced a case of esophageal carcinoma in a 47-year-old man,who had diagnosed as achalasia ten years ago. Esophagogram, esophagoscopy with biopsy and chest CT scanning can reveal esophageal carcinoma arising in patients with achalasia.

A Case of Budd-Chiari Syndrome with IVC Web Treated by Balloon Dilatation / 대한간학회지

Budd-Chiari syndrome is acute or subacute occlusion of the hepatic vein and IVC, The occlusion of hepatic veins often reveals dramatic illness characterized by abdominal pain, ascites, hepatomegaly and a poor prognosis. Several recent reports have suggested that balloon dilatation may be effective in Budd-Chiari syndrome. We experienced a case of Budd-Chiari syndrome with IVC web which was successfully treated with balloon dilatation. We report the case here with a brief review of literature,

Study of Gastric Emptying and Orocecal Transit in Patients with Dysmotility like Functional Dyspepsia(DLFD) / 대한내과학회지

OBJECTIVES: Although DLFD is the most common subtype of functional dyspepsia in the Orient including Korea, previous studies on gastric emptying in DLFD patients are inconclusive and reports on small bowel transit in these patients are uncommon. This study is to evaluate the occurrence of delayed gastric emptying(GET) and orocecal transit time(OCTT) in DLFD patients.' METHODS: 98 DLFD patients without organic disease including diabetes (M:F=23:75, Mean Age=43.1(23-69)) and 67 normal subjects (20 for GET and 47 for OCTT, Mean Age=39.9(25-69)) without gastrointestinal problems were recruited. Solid phase gastric emptying was assessed by radionuclide scintigraphy using ADAC dual head gamma camera after ingestion of 99mTc labeled 425 calorie solid meal. OCTT was determined by the measuring exhaled hydrogen every 10 minutes for 3 hours after ingestion of 60.5 calorie potato soap with 20gm lactulose. OCTT was defined by the time interval between test meal to sustained increase in exhaled breath hydrogen by 10ppm above baseline. A delayed GET was defined as T1/2 above the mean value plus 1 SD of controls (74.6 +/- 17.6 min, M +/- SD) and a delayed OCTT as time exceeding the mean value plus 2 SD(81.9 +/- 13.3 min, MSD). RESULTS: Among the 98 DLFD patients, only 7(7.1%) patients had a delayed GET(66.04 +/- 16.1 min vs 74.6 +/- 17.6 min, p=0.14) while a delayed OCTT was found in 36(36.7%) patients(100 +/- 32.9 min vs 81.9 +/- 13.3 min, p<0.01) and 3(3.1%) had both delayed GET and OCTT. CONCLUSION: Delayed OCTT was more frequently observed than delayed GET which was not significant comparing to wide ranged controls. Small bowel transit rather than gastric emptying plays some role in pathophysiology of the patients with DLFD.

Esophageal Motility and Acid Clearance in Patients with Esophageal Varices / 대한소화기내시경학회지

The presense of the esophageal varices might have a partial machanical obstruction and cushion effect on esophageal lumen due to blood within the varices. It may affect on the motility and acid clearance in the esophagus. The aim of this study was to evaluate the acid clearance and the esophageal motility according to the degree of the varices in patients with esophageal varices. We have performed esophageal manometry and acid clearance test in 41 patients with esophageal varices. Esophageal motility disorder was abserved in 29.4% of patients with esophageal varices. The number of swallowing for acid clearance was significantly increased in patients with esophageal varices than control group(23.5 +/- 14.1 Vs 6.1 +/- 1.6, p=0.004). However, there was no significant corelation with form, location, and redcolor sign of the varices. In conclusion, patients with esophageal varices accompanied esophageal motility disorders and delayed acid clearance. This results might be a useful referance data for changes in esophageal motility before and after treatment of esophageal varices.