Endoscopic Drainage Through a Duodenal Fistula in a Patient with a Retroperitoneal Abscess that Developed after Acute Pancreatitis / 대한소화기내시경학회지

The incidence of retroperitoneal abscess with fistula formation after acute pancreatitis is rare, but the mortality rate for patients with this condition is very high. The standard treatment for this condition has been surgical removal and drainage. However, recent studies have shown that percutaneous catheter drainage or noninvasive endoscopic abscess drainage with using endoscopic ultrasonography is effective and safe for the treatment of pancreatic and peripancreatic abscess. A retroperitoneal abscess with duodenal fistula that developed after acute pancreas and its endoscopic treatment has never been reported on in Korea. We experienced a 45-year-old man who had been treated for acute pancreatitis at other hospital, and he was then referred to our hospital and diagnosed as having a retroperitoneal abscess with fistula, which communicated with the third portion of duodenum, as assessed by abdominal CT and duodenoscopy. So we treated him with endoscopic double-pigtailed stent insertion through the fistulous tract and we drained the abscess. Endoscopic drainage may be a suitable alternative for the management of the retroperitoneal abscess with fistula that develops after acute pancreatitis.

A Case of Pulmonary Thromboembolism in Active Ulcerative Colitis / 대한소화기학회지

Inflammatory bowel disease often involves extra-intestinal organs. Cerebral thrombosis, portal vein thrombosis and pulmonary thrombosis have been reported. Deep vein thrombosis and pulmonary thromboembolism are significant causes of mortality in patients with inflammatory bowel disease. A 48-year-old woman was diagnosed as inflammatory bowel disease on colonoscopy and histology. We used hydrocortisone and mesalazine for the treatment of disease. Nineteen days later, she complained of abrupt dyspnea. Pulmonary CT angiography revealed a thromboembolism in right pulmonary arteries. After the treatment of heparin therapy, follow-up pulmonary CT angiography showed significant improvement of previously thrombosed pulmonary arteries.

Deep Cutaneous Ulcer Caused by Serratia marcescens after Fresh Water Exposure / 감염과화학요법

Serratia marcescens causes various diseases. Skin ulcer is one of S. marcescens related diseases, but it is rare clinical syndrome. We experienced a case of skin ulcer caused by S. marcescens in a woman with alcohol induced cirrhosis. After exposure to fresh water while trimming the codfish, she developed deep ulcer on her right hand and bacteremia by S. marcescens. S. marcescens should be considered as a specific etiology of skin infection presenting after fresh water exposure.

Deep Cutaneous Ulcer Caused by Serratia marcescens after Fresh Water Exposure / 감염과화학요법

Serratia marcescens causes various diseases. Skin ulcer is one of S. marcescens related diseases, but it is rare clinical syndrome. We experienced a case of skin ulcer caused by S. marcescens in a woman with alcohol induced cirrhosis. After exposure to fresh water while trimming the codfish, she developed deep ulcer on her right hand and bacteremia by S. marcescens. S. marcescens should be considered as a specific etiology of skin infection presenting after fresh water exposure.

A Case of Duodenal Intramural Hematoma Complicated with Chronic Pancreatitis / 대한소화기내시경학회지

The majority of cases of duodenal intramural hematoma occur in children due to blunt abdominal trauma. In adult patients, the etiology of hematoma is quite varied. A hematoma may occur due to the usage of anticoagulants, hemophilia, Henoch-Schonlein purpura, vasculitis, pancreatic disease, endoscopic coagulation of duodenal ulcer bleeding and following an endoscopic retrograde cholangiopancreatogram. A 53-year-old male patient was admitted for hematemesis. The patient was a heavy alcoholic and had a history of chronic pancreatitis, but there was no definite trauma history or other medical illness. In the duodenal second portion, a huge submucosal mass obstructed the lumen with submucosal hemorrhage. As depicted on an abdominal CT and an endoscopic ultrasonogram, chronic pancreatitis and a duodenal submucosal tumor was suspected. On the eighth hospital day, abdominal pain suddenly became worse and peritoneal-irritation signs were observed. Therefore, a surgical procedure was urgently performed. Considering the rarity of its etiology in Korea, we report a case of duodenal intramural hematoma complicated with chronic pancreatitis.

A Case of Bronchial Artery Aneurysm with Bronchiectasis and Successful Coil Embolization / 결핵및호흡기질환

Bronchial artery aneurysm (BAA) is a rare entity that requires early diagnosis and immediate treatment due to the possibility of a life-threatening massive hemorrhage through rupture. The standard treatment is a surgical resection of the aneurismal artery. However, various embolization techniques, including coil embolization, are currently used as the optimal treatment because they are less invasive. A 65-year-old woman was referred for the treatment of intermittent hemoptysis. A chest CT scan showed an approximately 2 cm sized vascular mass with strong contrast enhancement originating from the right bronchial artery on the bronchiectatic parenchyma. On the angiogram, the inferior portion of the bronchial artery with a hypertrophic aspect and a huge bronchial artery aneurysm was detected on the left side branch. The bronchial artery aneurysm was embolized successfully with coils at the proximal and distal portion of the aneurysm. After coil embolization, the selective bronchial angiogram confirmed complete occlusion. We report this case of a bronchial artery aneurysm that was treated successfully with coil embolization.