Anisakiasis Induced Segmental Jejunum Obstruction / 대한소화기학회지

Human anisakiasis is a disease caused by an infestation of the third stage larvae of family anisakidae. The ingested larvae invade the gastrointestinal wall, causing clinical symptoms that include abdomen pain, nausea, and vomiting. Although enteric anisakiasis is extremely rare, it can induce intestinal obstruction. We report a case in which emergency surgery was needed due to intestinal obstruction that coincided with symptoms related to anisakiasis, along with a brief literature review.

Mediastinal pancreatic pseudocyst naturally drained by esophageal fistula / 영남의대학술지

Mediastinal pancreatic pseudocyst is a rare complication of acute or chronic pancreatitis. Pleural effusion and pneumonia are two of the most common thoracic complications from pancreatic disease, while pancreaticopleural fistula with massive pleural effusion and extension of pseudocyst into the mediastinum is a rare complication of the thorax from pancreatic disease. To the best of our knowledge, there have been no case reports of mediastinal pancreatic pseudocyst-induced esophageal fistula in Korea to date. Here in, we report a case about 43-year-old man of mediastinal pancreatic pseudocyst-induced esophageal fistula presenting with chest pain radiating toward the back and progressive dysphagia. The diagnosis was confirmed by an esophagogastroduodenoscopy and abdomen computed tomography (CT). The patient was treated immediately using a conservative method; subsequently, within 3 days from treatment initiation, symptoms-chest pain and dysphagia-disappeared. In a follow-up gastroscopy 7 days later and abdomen CT 12 days later, mediastinal pancreatic pseudocyst showed signs of improvement, and esophageal fistula disappeared without any complications.

Mediastinal pancreatic pseudocyst naturally drained by esophageal fistula / 영남의대학술지

Mediastinal pancreatic pseudocyst is a rare complication of acute or chronic pancreatitis. Pleural effusion and pneumonia are two of the most common thoracic complications from pancreatic disease, while pancreaticopleural fistula with massive pleural effusion and extension of pseudocyst into the mediastinum is a rare complication of the thorax from pancreatic disease. To the best of our knowledge, there have been no case reports of mediastinal pancreatic pseudocyst-induced esophageal fistula in Korea to date. Here in, we report a case about 43-year-old man of mediastinal pancreatic pseudocyst-induced esophageal fistula presenting with chest pain radiating toward the back and progressive dysphagia. The diagnosis was confirmed by an esophagogastroduodenoscopy and abdomen computed tomography (CT). The patient was treated immediately using a conservative method; subsequently, within 3 days from treatment initiation, symptoms-chest pain and dysphagia-disappeared. In a follow-up gastroscopy 7 days later and abdomen CT 12 days later, mediastinal pancreatic pseudocyst showed signs of improvement, and esophageal fistula disappeared without any complications.

A Case of Early Gastric Cancer of Adenosquamous Carcinoma

Gastric cancer is the most common malignancy in Korea. The most common cancers of the stomach are adenocarcinomas. Adenosquamous carcinoma of the stomach is very rare, constituting less than 0.1% of all the gastric cancers. Adenosquamous carcinoma is characterized by the presence of two different cell components, one adenomatous and the other squamous. It occurs more frequently in the upper stomach, and it sometimes invades the muscular layer. Adenosquamous carcinoma limited to the mucosa or submucosa is extremely rare and usually invades deeply into the muscular layer. Thus, it is found in an advanced stage at diagnosis and has a worse prognosis than adenocarcinoma. We report a case of early gastric cancer of adenosquamous carcinoma type on the basis of standard endoscopy in a 76-year-old woman. The patient received endoscopic submucosal dissection followed by subtotal gastrectomy to achieve complete resection.

A Case of Appendiceal Schwannoma

Schwannomas are mainly benign tumors arising from the sheath of the peripheral nerves. Gastrointestinal schwannomas account for 2-6% of all gastrointestinal tumors; they originate most commonly in the stomach, and are extremely rare in the appendix. Their clinical features are non-specific, thus, they are usually found accidentally through radiologic examinations and confirmed by immunohistochemical stainings. A 39-year-old male was admitted with complaints of right lower quadrant pain. There was a well-enhancing tumor in the appendix on a computed tomography scan. It was laparoscopically resected and diagnosed as appendiceal schwannoma with histopathologic and immunohistochemical findings. There has been no evidence of specific complication or recurrence until now for the past 22 months.

A Case of Isolated Hepatic Lymphangioma / 대한소화기학회지

Hepatic lymphangioma is a rare benign neoplasm. It usually occurs as a part of systemic lymphangiomatosis. Isolated hepatic lymphangioma is extremely rare. A 58-year-old woman with weight loss was referred for the evaluation of chronic renal insufficiency and hepatic mass. Abdominal computed tomography showed 3 cm sized multilobulated cystic lesion with calcification and thick septal enhancing focus in the segment V of the liver. On abdominal magnetic resonance imaging, the masses exhibited low signal intensity on the T1-weighted images and high signal intensity on the T2-weighted images. Malignant tumor could not be ruled out, and therefore, the patient underwent right anterior segmentectomy of the liver. Gross pathology reveraled a 3.0x2.2x1.5 cm mass with multichamber cyst, which was filled with mucoid material. Histologically the mass was composed of irregularly shaped vascular channels filled acellular homogeneous lymph fluids. The final diagnosis was hepatic isolated cavernous lymphangioma. Herein, we report a case of isolated hepatic lymphangioma and also review the existing literature.

A Case of Cholesterol Granuloma in Pancreas / 대한소화기학회지

Cholesterol granuloma is a histological term used for the description of a tissue response to a foreign body such as cholesterol crystals. Cholesterol granuloma is histologically characterized as fibrous granulation tissue containing cholesterol crystals within surrounding giant cells. Cases of cholesterol granuloma of the pancreas are very rare. We report a case of a 47-year old male who had a cholesterol granuloma of the pancreas. Abdominal CT showed 24 mm-sized cyst in the pancreas and peri-pancreatic regional mass infiltrating to the stomach. PET-CT revealed increased 18F-FDG uptake at the cyst and peri-pancreatic mass. Thus, Whipple's operation was done. The disease was confirmed by surgical pathologic examination of the tissue. Pathologic examination of resected specimen showed numerous cholesterol crystals surrounded by multinucleated foreign body giant cells. We report on this case and give a brief review of the literature.

A Case of Retrograde Jejunogastric Intussusception Following Subtotal Gastrectomy / 대한소화기내시경학회지

Retrograde jejunogastric intussusception is a rare complication following Billroth ll gastric surgery. It is a segmental invagination of a jejunal loop into the stomach through stoma. Clinical manifestations are epigastric pain, vomiting with bile or blood, and a palpable mass in the epigastrium. Gastroscopy and a upper GI (UGI) series are very helpful in the diagnosis of this disease. Although the management of this disease is usually surgical, when endoscopic reduction has failed, surgery should be immediately done because of the high mortality. We present here a case of jejunogastric intussusception that was diagnosed by gastroscopy in a patient with a history of Billroth ll surgery that had been done 6 years prior due to gastric cancer.

A Case of Peripheral T-cell Lymphoma of the Duodenum and Jejunum / 대한소화기내시경학회지

Primary T-cell lymphoma of the duodenum is uncommon, and peripheral T-cell lymphoma of the duodenum is extremely rare. Approximately 90% of primary gastrointestinal lymphomas originate from B-cells and fewer than 10% originate from T-cells. A peripheral T-cell lymphoma involved in the small intestine is usually detected by complications such as gastrointestinal bleeding, perforation, or obstruction. A 57-year-old man complained of postprandial discomfort and weight loss of 5 kg for 1 month. An esophagogastroduodenoscopy showed a deep ulcer with blood clots and whitish exudates. We conducted a Whipple's operation because of the high risk of ulcer perforation and difficulty in distinguishing the ulcer from malignancy. The resected tissue was confirmed as a peripheral T-cell lymphoma. We reported a case of peripheral T-cell lymphoma of the duodenum and jejunum that extended to the pancreatic head where a diffuse lesion was found without any complications or specific symptoms.

A case of improved Menetrier's disease after the eradication of Helicobacter pylori and treatment with a proton pump inhibitor / 대한내과학회지

Menetrier's disease is a protein-losing hypertrophic gastropathy characterized by diffuse tremendous thickening of the gastric wall caused by excessive proliferation of the mucosa. Although the cause of Menetrier's disease is unknown, an association with Helicobacter pylori has been reported. A 42-year-old man was hospitalized for the evaluation of progressive body weight loss and indigestion for 6 months, with recently aggravated epigastric discomfort. Gastroscopy revealed prominent mucosal folds in the body and fundus. The histological findings revealed gastritis with erosions and foveolar hyperplasia. After eradicating the Helicobacter pylori and treatment with a proton pump inhibitor, clinical and endoscopic resolution ensued.

A Case of a Gastric Gastrointestinal Stromal Tumor with a Fistula and Gastrointestinal Bleeding / 대한소화기내시경학회지

There has been much debate on the origin, differentiation and prognosis of gastrointestinal stromal tumors (GIST). Based on recent studies, we consider Cajal interstitial cell as the origin of a GIST. The common symptoms of a GIST are abdominal pain, hemorrhage, and the presence of a mass. However, there are few reported cases of a GIST with abscess pockets that communicate with the lumen of the stomach via a fistula. We report a case of a GIST of the stomach presenting with an abscess and a fistula communicating with the lumen of the stomach. An 84-year-old man presented with continuous fever and general weakness. We were able to diagnose the disease by an endoscopic examination, CT scan, biopsy and by cellular immunohistochemical staining.

A Case of Sigmoid Volvulus Treated by Emergency Endoscopic Reduction and Surgical Colonic Resection / 대한소화기내시경학회지

An intestinal obstruction is a common cause of acute abdominal diseases which need emergency measures. Sigmoid volvulus is one of rare causes of colonic obstruction and occupies 2~3% of its causes in Korea. Volvulus requires a prompt diagnosis and decompression in order to prevent its progression to strangulation and gangrene. Although 90% of sigmoid volvulus can be diagnosed just by plain abdominal x-ray, computed tomography or barium enema can be done for more accurate diagnoses. For the successful treatment, accurate early examination, endoscopic reduction and surgical colonic resection are required. Endoscopic reduction has low mortality but is liable to recur, whereas emergency colonic resection has little recurrence rate but a high mortality. We experienced a case of a sigmoid volvulus in a 55-year-old male who companied of sudden abdominal pain. After diagnosed as sigmoid volvulus through plain abdominal x-ray and abdominal computed tomography, endoscopic reduction was done in the early period of development, and the sigmoid resection was performed after 7 days. We report our experience with a review of the literature regarding the diagnosis and treatment of sigmoid volvulus.

A Case of Boerhaave's Syndrome after Bowel Preparation with Polyethylene Glycol / 대한소화기내시경학회지

Polyethylene glycol (Colyte(R)) electrolyte lavage solution is widely used for bowel preparataion before colonoscopy and surgery. The minor complications associated with PEG solution, i.e., nausea and bloating have been reported on. However, major complications such as PEG electrolyte lavage solution-induced Mallory-Weiss tear, esophageal rupture, asystole and aspiration have rarely been reported on. Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a very rare disease and it is often diagnosed late or it is misdiagnosed because of the atypical clinical symptoms. Its mortality increases proportionally to the time between esophageal rupture and treatment. It can cause a fatal outcome unless it is treated early. We authors report here on a case of spontaneous esophageal rupture after bowel preparation with polyethylene glycol.

A Case of Esophageal Tuberculous Abscess / 대한소화기내시경학회지

Primary esophageal involvement by tuberculosis is rare. Clinical symptoms are variable and nonspecific in which dysphagia is the most common presenting symptom. Endoscopic findings are also diverse and nonspecific and ulcerative form is a common manifestation. For a definite diagnosis, Endoscopic biopsies are useful but typical granuloma is seen in approximately 50% of cases and acid-fast bacilli are demonstrated in less than 25% of patients. Fine needle aspiration cytology and polymerase chain reaction are helpful for diagnosis. A 54-year-old man was presented with throat discomport. Endoscopy demonstrated hematoma like lesion with pus discharge from ulceration in the proximal esophagus. Esophageal tuberculosis was confirmed based on the biopsy and culture results, and he was treated with antituberculous medications. At the follow-up endoscopy, 6 months later, previous lesion was completely healed to scar.

A Case of Hepatic Angiosarcoma Presenting as Submucosal Tumor Resulting from Gastric Invasion / 대한소화기내시경학회지

Angiosarcoma accounts for 1% of all soft tissue sarcoma. Common sites of occurrence include the skin, breast, soft tissue, and liver. It metastasizes to the lungs, bone, and spleen. The cause of hepatic angiosarcoma in the 60% of cases is unknown, although specific risk factors such as vinyl chloride, arsenic, thorotrast and external-beam irradiation have been identified. Since 1986, about eight cases of hepatic angiosarcoma have been reported in Korea, but it had not been reported in which the hepatic angiosarcoma invaded to the stomach, yet. So we report a case of histopathologically confirmed primary hepatic angiosarcoma with gastric involvement. In this case, a sixtythree-year-old female was presented with indigestion and epigastric soreness for 1 year. Endoscopic examination of the stomach revealed a submucosal tumor-like protruding mass from the antrum to angle. The mucosal surface showed severe hyperemia and shallow ulcerative change was seen. Endoscopic biopsy and percutaneous liver biopsy confirmed the diagnosis of hepatic angiosarcoma invading the gastric wall.

A Case Of Low Grade B Cell Mucosa Associated Lymphoid Tissue Lymphoma Of Jejunum Presenting Recurrent Lower Gastrointestinal Bleeding And Perforation / 대한내과학회지

The accurate diagnosis and localization of gastrointestinal bleeding may use many tests and procedures including serial hematocrits, angiography, scintigraphy, endoscopy, nasogastric aspiration, barium studies and surgery before success is achieved. However, lower gastrointestinal (GI) bleeding is difficult to localize despite above diagnostic procedures. We had experienced a case of mucosa associated lymphoid tissue (MALT) lymphoma of jejunum. In this case, a 61-year-old male was admitted to our hospital with recurrent lower GI bleeding. The cause of recurrent lower GI bleeding was not defined by extensive evaluation including gastrofiberoscopy, colonoscopy, mesenteric angiography, small bowel series. We diagnosed this case as low grade B cell MALT lymphoma after exploratory laparatomy due to bowel perforation.

A Case of Huge Anal Fibroepithelial Polyp with HemorrhoidsMisdiagnosed as Anal Cancer / 대한소화기내시경학회지

The anal fibroepithelial polyps are well-known polypoid conditions histologically consisting of connective tissue response resulting from local irritation, which is closely associated with hemorrhoids. As previously reported, the size of the polyps ranged from 3 to 19 mm, average 9 mm. A 60-year-old women was admitted complaining of anal bleeding and constipation. Colonoscopy revealed a 3.0 2.5 cm sized, subpedunculated polyp on the dendate line. We removed the polyp by per anal local excision due to its hard stalk after failure of colonoscopic removal. The histologic examination was showed mature stratified squamous epithelium with hyalinized vascular changes. We report a case of huge and hard anal fibroepithelial polyp with hemorroids misdignosed as cancer.

Four Cases of Trichuris Trichiura Infection in the Colon / 대한소화기내시경학회지

Trichuris trichiura (whipworm) is a ubiquitous parasite that resides in the human intestinal tract, and it is known as whipworm because of its whip-like appearance. Trichuriasis is rare in developed countries, but it is more prevalent in tropical countries and areas with suboptimal sanitation. In most patient, whipworm infection is asymtomatic but patient with heavy infection present with anemia, diarrhea, trichuris dysentery syndrome, abdominal pain, weight loss, appendicitis and rectal prolapse. It is characterized by the invasion of the colonic mucosa by the adult Trichuris and produces minor inflammatory changes at the sites of localization. Its diagnosis is usually made by identification of football-shaped eggs in the stool or by confirming adult whipworm during colonoscopy. We report four cases of whipworm infection that were incidentally diagnosed on colonoscopy.

A Case of Duodenal Involvement in Waldenstrom's Macroglobulinemia / 대한소화기내시경학회지

Waldenstrom's macroglobulinemia is a disorder of malignant proliferation of plasmacytoid lymphocytes and monoclonal immunoglobulin M. However, the patients occasionally present with malabsorption and diarrhea due to deposition of extracellular periodic acid-Schiff positive homogenous eosinophilic, amorphorous, and proteinaceous materials in the villi and/or lamina propria of the duodenum. We report a 62-year-old man who, despite involvement of the duodenal mucosa, presented only with fatigue, dypnea on exertion, and anemia. Characteristic duodenoscopic and pathologic findings of this patient are described.

A Case of Mixed Type Hemangioma of the Stomach with Upper Gastrointestinal Hemorrhage / 대한소화기내시경학회지

Hemangioma in the gastrointestinal tract rarely occurs especially in the stomach compared with the small and large intestine. A 45-year-old man was admitted with pneumonia. After hematemesis, the authors performed gastroscopy, which revealed active bleeding on the huge ulcer on the antrum of the stomach and multiple erosive lesions on the whole stomach. After multiple submucosal hypertonic saline injection and hemoclipping at the huge ulcerative lesion, ulcer bleeding stopped. Three days later, recurrent massive upper gastrointestinal bleeding occured at the same site of the stomach. To prevent futher recurrent bleeding, total gastrectomy with esophagojejunostomy and splenectomy was done. The histologic diagnosis of the ulcerative lesion was hemangioma of mixed type. We report this rare case with the brief literature review.