Four Cases of Guidewire Induced Periampullary Perforation During Endoscopic Retrograde Cholangiopancreatography / 대한소화기내시경학회지

Duodenal perforation associated with endoscopic retrograde cholangiopancreatography is very uncommon. However, it usually requires early diagnosis and surgical management. Perforations are commonly caused by endoscopic sphincterotomy, biliary or duodenal stent placement, guidewire-related causes, and endoscopy itself. Perforatioins can follow various clinical courses, and management depends on the cause of the perforation. Among the above causes, guidewire-induced perforation is very rare and related reports and analyses are limited. Herein we describe four cases of guidewire-induced periampullary perforation during endoscopic retrograde cholangiopancreatography, and analyze clinical characteristics and management.

A Primary Repair with Hemoclips and Fibrin Glue Injection in Biliary Stent Induced Duodenal Perforation / 대한소화기내시경학회지

Duodenal perforations caused by biliary prostheses are uncommon, but they are potentially life threatening and require immediate treatment. Here we describe an unusual case of duodenal perforation induced by a plastic biliary stent. It masqueraded as a case of cholecystitis and combined systemic upset with a localized peritonitis and fever. Primary endoscopic closure by hemoclips was difficult due to the position of the lateral wall and the complexity of aligning the perforation with the endoscope. To approximate the perforated hole and adherent hemoclips, glue injection and sprayings were successfully performed under cap-fitted endoscopy. The patient recovered without additional complications.

Successful Bile Duct Cannulation Guided by Indigocarmine Injection via PTGBD / 대한소화기내시경학회지

Even though percutaneous transhepatic gallbladder drainage (PTGBD) is performed prior to ERCP or following ERCP because of the patients' medical condition or failed bile duct cannulation, there are no definite endoscopic landmarks that are useful for successful bile duct cannulation in some cases. We report here on 4 patients in whom selective bile duct cannulation, as guided by the endoscopic landmarks, was successful following indigocarmine injection via PTGBD.

Cap-assisted ERCP in Surgically Altered Anatomy / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is a difficult procedure to perform on patients who have undergone a Billroth II gastrectomy, Whipple's operation or Roux-en-Y gastrobypass surgery. Our study was designed to evaluate the clinical usefulness of cap-assisted ERCP for beginner endoscopists in cases of surgically altered anatomy. METHODS: From April 2008 to March 2010, 16 patients with biliary diseases and who had previously undergone abdominal surgery such as Billroth II gastrectomy or Roux-en-Y operation were analyzed. A single endoscopist performed all the procedures using a cap-assisted gastroscope, after ERCP training. RESULTS: Cap-assisted ERCP was attempted in 24 sessions of 16 patients. Afferent loop intubation and selective bile duct cannulation was successfully achieved in 19 sessions (79.1%). Among the patients who had undergone a Billroth II gastrectomy, 19 out of 20 sessions were successfully conducted. Only 4 patients who had undergone a previous Roux-en-Y operation failed afferent loop intubation. Duodenal free wall perforation developed in one case. There were no cases of mortality. CONCLUSIONS: Therapeutic cap-assisted ERCP was useful in patients who had previously undergone a Billroth II gastrectomy and this may be helpful for inexperienced endoscopists.

Rectal Endometriosis That Is Difficult to Differentiate from Endoscopically Resectable Subepitherial Lesion / 대한소화기내시경학회지

Endometriosis occurs most frequently in the intestine. In the pelvic organs intestinal endometriosis presents with various symptoms and endoscopic findings. If an asymptomatic submucosal lesion is found in the sigmoid colon or rectum of reproductive women, a differential diagnosis should be done. Owing to advancements in endoscopic therapy, endoscopic excision has been attempted for various subepithelial lesions. To successfully do an endoscopic excision, accurate diagnosis should be obtained through diagnostic tests such as endoscopic ultrasonography prior to excision. Here the authors report a case of rectal endometriosis in an asymptomatic woman of reproductive age. They attempted endoscopic resection based on the endoscopic finding that the subepithelial lesion was limited to the submucosal layer in endoscopic ultrasonography. This conclusion turned out to be a mistaken one. Because of tumor adhesion to the proper muscular layer, we failed to successfully conduct an endoscopic excision. Ultimately, we did surgery and diagnosed rectal endometriosis.

A Case of Iliopsoas Abscess Complicating Active Crohn's Disease during Infliximab Induction Treatment

Psoas abscesses are rare clinical entities complicating Crohn's disease (CD). However, psoas abscesses can cause poor outcomes because the diagnosis is frequently delayed due to the non-specific clinical features. Recently, we managed a case of a huge iliopsoas abscess in a 21-year-old man with a 4-year history of CD who presented with a limping gait and flexion contractures of the sacroiliac joint. Notably, the iliopsoas abscess developed during induction treatment with infliximab. The patient was successfully treated with antibiotics, surgical drainage, and a right hemicolectomy. Herein we present the case with a brief review of the literature.

A Case of Iliopsoas Abscess Complicating Active Crohn's Disease during Infliximab Induction Treatment

Psoas abscesses are rare clinical entities complicating Crohn's disease (CD). However, psoas abscesses can cause poor outcomes because the diagnosis is frequently delayed due to the non-specific clinical features. Recently, we managed a case of a huge iliopsoas abscess in a 21-year-old man with a 4-year history of CD who presented with a limping gait and flexion contractures of the sacroiliac joint. Notably, the iliopsoas abscess developed during induction treatment with infliximab. The patient was successfully treated with antibiotics, surgical drainage, and a right hemicolectomy. Herein we present the case with a brief review of the literature.

Clinical Features of Ischemic Colitis in Patients with Chronic Kidney Disease / 대한신장학회지

PURPOSE: Hemodialysis patients are at an increased risk of ischemic colitis because of accelerated arterial vascular disease rate and hypotension during dialysis. But few data exist on the clinical features of ischemic colitis in patients with chronic kidney disease including dialysis patients in Korea. The aim of this study is to identify the clinical features of ischemic colitis in patients with chronic kidney disease (CKD). METHODS: We retrospectively reviewed total 68 patients (63.9+/-16.2 years) with ischemic colitis. We analyzed medical history, colonoscopic findings, clinical characteristics, and compared them according to kidney function. RESULTS: Twenty-two (33.9%) patients had CKD stage > or =3 at diagnosis of ischemic colitis. Prevalence of hypertension and diabetes was higher in patients with CKD than those with normal kidney function. High leukocyte count and low hemoglobin level were demonstrated at diagnosis in CKD patients. In addition, duration of hospitalization in patients with CKD was longer than patients with normal kidney function. However, there was no significant difference in right colonic involvement, cardiovascular diseases, surgical intervention, and mortality. Hospitalization days was positively correlated with increased leukocyte count (p=0.015) and decreased albumin level (p=0.002), while that was negatively correlated with age-adjusted estimated glomerular filtration rate (p=0.002). CONCLUSION: Ischemic colitis in patients with CKD had longer hospitalization than in those with normal kidney function. However, there was no significant difference in surgical intervention and mortality.

A Case of Liposarcoma Arising in the Mesentery / 대한소화기학회지

A liposarcoma is the most common soft tissue sarcoma in adults with an incidence of about 20% of all soft tissue sarcomas. Although incidence differs from a region of origination, a case arisen from mesentery has rarely been reported. We experienced a case of liposarcoma arising from the mesentery of a 51-year-old male patient. He was treated by wide excision. Histologically, the tumor was composed of a mixed well-differentiated liposarcoma with myxoid and spindle cell type.

A Case of Lymphangiomatosis Arising in the Colon / 대한소화기내시경학회지

Lymphangioma is a benign vascular lesion that shows the characteristics of subepithelial tumor, which can proliferate in the lymphatic system. Only a few cases of multiple lymphangimas of the colon, the so called "colonic lymphanigomatosis", have been currently reported on the medical literature. Because lymphangioma is absolutely a benign tumor, it does not require any specific treatment, except for rare disease-related symptoms or complications such as anemia, intussusception and protein-losing enteropathy. Endoscopic resection for this tumor has sometimes been performed for both diagnostic and therapeutic purposes. We recently experienced a case of multiple colonic lymphangomas that arose in the ascending colon of a 46-year-old male patient and these lesions were found during performance of colonoscopy. The final diagnosis was confirmed by a pathologic examination of the specimen that was obtained via endoscopic resection. Follow-up colonoscopy at 1 year after the initial examination showed complete resolution of the previously noted lesions without any specific treatment. We report here on a very rare case of colonic lymphangiomatosis along with a brief review of the relevant literature.