A Case of Barium Appendicitis after a Small Bowel Series / 대한소화기내시경학회지

Barium appendicitis is a rare complication that occurs due to barium retention in the appendix after a barium study. It is believed that retained barium in the appendix forms a barium-coated fecalith and causes barium appendicitis. A 19-year-old man visited the hospital due to melena. He underwent an endoscopy and a colonoscopy but no bleeding focus was discovered. Next, a small bowel series was performed to confirm the absence of small bowel bleeding. Two weeks later, he felt right lower quadrant pain in his abdomen and developed a fever. A blood test revealed an elevated white blood cell count. A plain abdominal radiograph indicated retained barium in the appendix. A computed tomography scan revealed a dilated barium filled appendix. Thus, the pain was thought to caused by barium retention in the appendix that precipitated acute appendicitis. He underwent an appendectomy and healed well without complications.

Ascaridiasis biliar en un paciente pediátrico. Reporte de caso

La ascaridiasis, es la parasitosis intestinal más frecuentes en humanos, con una alta prevalencia en países subdesarrollados. La migración a vesícula es poco frecuente en niños y cuando esto ocurre el tratamiento por lo general es endoscópico o quirúrgico. Caso clínico: paciente femenino de 13 años de edad, quien presentó dolor abdominal recurrente en cuadrante superior derecho. Los hallazgos de laboratorio revelaron elevación de enzimas hepáticas y leucocitosis. El ultrasonido abdominal (USA) evidenció imagen longitudinal y móvil en el interior de la vesícula, así como dilatación del colédoco. Se hospitaliza con el propósito de realizar colagiopancreatografía retrógrada endoscópica (CPRE) al siguiente día; la paciente expulsa espontáneamente áscaris por boca el mismo día, por lo que se difiriere la CPRE. Se practicó un segundo USA sin evidencia de áscaris. Se complementa tratamiento médico con albendazol vía oral. El ultrasonido abdominal es un método efectivo y poco costoso en la confirmación diagnóstica y monitorización de la ascaridiasis biliar. La ascaridiasis biliar no complicada debe tratarse de manera conservadora ya que la eliminación espontánea de Ascaris lumbricoides puede suceder hasta en 80 % de los casos.

ascariasis is the most frequent intestinal parasitosis in humans, with a greater prevalence in undeveloped countries. Hepatobiliary migration of ascaris in children is uncommon, when it occurs; treatment is generally endoscopic or surgical. Clinical case: we present the case of a 13 year old female patient admitted to the emergency room with right upper quadrant persisting pain, of 1-month duration. Laboratory tests revealed elevation hepatic enzymes and WBC. Abdominal ultrasonography (AUS) showed a long, linear, moving echogenic structure in the distended lumen of the gallbladder, with an abnormal dilation of the choledochus. An Endoscopic Retrograde Cholangiopancreatography (ERCP) was programmed for the following day. However, the patient spontaneously expelled a long ascaris orally the same day. Another AUS was performed with no evidence of ascaris in the gallbladder or the choledochus; thus the ERCP was differed. Medical treatment was complemented albendazole given orally. AUS is an effective and low cost method in the diagnostical confirmation and monitorization of biliary ascariasis, given the symptoms of pain, cholangitis and acute cholecystitis. Non complicated biliary ascariasis must be treated in a conservative manner given that spontaneous elimination can occur in up to 80% of the cases.

Comparison of Double Balloon Enteroscopy and Small Bowel Series for the Evaluation of Small Bowel Lesions / 대한소화기학회지

BACKGROUND/AIMS: The role of double balloon enteroscopy (DBE) is still evolving. The aim of this study was to compare the diagnostic yield of DBE with that of small bowel series (SBS). METHODS: We enrolled patients with suspected small bowel disease consecutively, and performed both DBE and SBS in all patients. RESULTS: Eighteen patients (M:F=12:6, 14-82 years) were included. Indications for small bowel evaluation were obscure gastrointestinal bleeding (10), abdominal pain (5), diarrhea (2) and abnormal CT finding (1). Of 10 obscure gastrointestinal bleeding patients, 6 showed the same findings in both studies. However, 4 showed negative findings in SBS while DBE detected erosions or ulcerations. Of 5 abdominal pain patients, 3 showed the same results in both studies. However, 2 demonstrated different results. One was suspected of early Crohn's disease in SBS, but proved to be normal in DBE, and the other was suspected of malignancy in SBS but was suspected of benign ulcers in DBE. Of 2 chronic diarrhea patients, one was diagnosed as Crohn's disease in both studies. The other was suspected of tuberculosis in SBS but diagnosed as lymphangiectasia by DBE with biopsy. One patient with jejunal wall thickening in CT proved to be normal in both DBE and SBS. There were no serious complications associated with DBE and SBS. CONCLUSIONS: DBE is better than SBS in terms of diagnostic accuracy. DBE may become an important method for the evaluation of small bowel diseases.