A Case of Esophageal Granular Cell Tumor Which Treated by 'O'-Type Band Ligation and Polypectomy / 대한소화기내시경학회지

Granular cell tumors involving the esophagus are rare tumors. Since Abrikossoff first reported five cases of granular tumor of the tongue in 1926, fewer than 200 cases of esophageal granular cell tumors have been reported in the world. The granular cell tumors usually were seen in tongue, skin & breast. it has rarely been noted in the esophagus. The treatment of this tumor was not established well. Therefore, we report a case of granular cell tumor of the low esophagus, which was resected by polypectomy following 'O'-band ligation. This 56-year-old male patient was transferred to our hospital because of abnormal endoscopic finding on the esophagus at local clinic. There was esophageal polypoid lesion on the low esophagus. After polypectomy, the lesion was revealed as granular cell tumor in histopathologic examination.

Small Colonic Polyps: Histopathology and Spatial Distribution / 대한소화기내시경학회지

BACKGROUND AND AIMS: Our aims in this study were to determine histopathology and distri-bution of small colonic polyps (up to 6 mm). Small polyps were found frequently in the colon and rectum at colonoscopy. The size of polyps which should be removed endo-scopically has been controversial. METHODS: Medical reports of all patients undergoing total colonoscopic examination during 8-year period were reviewed. RESULTS: Eight hun-dred thirty-three small (up to 6 mm) colorectal polyps, removed during colonoscopy, have been analyzed. Of the small polyps, 58.8% were neoplastic, 17.7% were hyperplastic, 22.7% were inflammatory; 0.1% contained atypia, 0.1% were carcinoid, 0.6% were xan-thoma, 0.1% were adenocarcinoma. In the colon except rectum, neoplastic polyps were more common than non-neoplastic polyps. The difference in distribution of the major types of polyps in the right colon and transverse colon was significant (p <0.0001). CONCLUSIONS: Most small polyps proximal to the rectum are neoplastic. All polyps should be removed when encountered during colonoscopy due to the high prevalence of adenoma among small polyps.

A Successful Endoscopic Injection Sclerotherapy of a Bleeding Duodenal Varix / 대한소화기내시경학회지

Bleeding frorn the duodenal varix is an unusual event. Upper gastrointestinal endoscopy is the diagnostic procedure of choice in diagnosing duodenal varices. If performed during active bleeding, it can differentiate between esophageal and duodenal varices as the source, which has important therapeutic implications. A thorough examination of the duodenum for varices is important in an upper gastrointestinal hemorrhage. Treatment modalites for bleeding duodenal varices are sclerotherapy, varix suture ligation, portocaval shunt, and duodenal resection. Although endoscopic sclerotherapy has lirnited success in controlling active duodenal varix as initial treatment, endoscopic injection sclerotherapy is a useful first-line therapeutic measure in the treatment of bleeding duodenal varices. In this study we present a case of a ruptured duodenal varix, which was defected by an endoscopy, in a 61-year-old male. An endoscopic examination showed small and nonbleeding esophageal varices and a prominant ulcerated varix was identified in the 2nd portion of the duodenum. Endoscopic sclerotherapy was performed by injecting ethanolamine oleate into the varix. Our report demonstrate that endoscopic sclerotherapy can be efficient even in the presence of acute bleeding and that it can provide a definitive method of curing of a bleeding duodenal varix.

A Case of Congenital Absence of the Inferior Vena Cava / 대한내과학회지

Obstruction of the inferior vena cava may presented with unusual and varied pathologic condition and be due to thrombus, extension of tumor, extrinsic compression, or intrinsic caval disease. Thrombus is major cause of obstruction of the inferior vena cava and congenital absence of the inferior vena cava with azygos continuation is extremely rare. In congenital absence of the inferior vena cava (Infrahepatic interruption of inferior vena cava with azygos continuation), infrahepatic inferior vena cava is obliterated but infrarenal portion of the inferior vena cava is patent. In this anormaly, blood from the lower extremities and kidney drained into azygous vein and hemiazygous vein via ascending lumbar vein which eventually into the superior vena cava. These anormaly is seen in 0.6% of patients with congenital heart disease, particularly in cases of polysplenia. We experienced one case of congenital absence of the infrahepatic inferior vena cava, which involved infrarenal portion and the common iliac vein with azygos continuation in 63-year-old male. He was complained of lower abdominal pain, constipation. We report this case with reviewing literatures.

Spontaneous Retroperitoneal Hematoma due to Liver Cirrhosis: A Case Report / 대한간학회지

Spontaneous retroperitoneal hemorrhage due to liver cirhosis associated with impaired coagulopathy is very rare disease. Spontaneous retroperitoneal hemorrhage has been recorded as having originated from many retroperitoneal organs and blood vessels, and it may be due to local disease and/or systemic factors. In the majority of patients the bleeding arose from the kidney or adrenal gland. Among the systemic causes of spontaneous retroperitoneal hemorrhage are anticoagulation therapy and chronic hemodialysis during the course of which hemorrhagic complications may occur at many site, including the retroperitoneal space. Blood dyscrasias have been a rare cause of spontaneous retroperitoneal hemorrhage. Conditions reported have been included hemophilia, leukemia, polycythemia and sickle cell trait. Virtually every hemostatic function may be impaired in patients with severe hepatic disease as the result of failure of both the biosynthetic and clearence function of the liver, thrombocytopenia, platelet dysfunction, intravascular coagulation and fibrinogenolysis, and the effects of products of fibrinogen catabolism on the coagulation mechanism. We are reporting a case of spontaneous retroperitoneal hematoma in a patient with alcoholic liver cirrhosis with brief review of literature.

A Case of Occult Foreign Body Lodged in Bronchus for a Long Period and Removal by Flexible Bronchoscopy / 결핵

Aspiration of foreign bodies into tracheobronchial tree is more common in children than in adults. Foreign bodies in airway commonly occur by accident, and in most cases they get removed without delay. Small foreign bodies that lodge in the peripheral airway are often asymptomatic initially and can result in respiratory symptoms several years later. Although foreign body aspiration is frequently suspected in children with acute or recurrent pulmonary symptoms, it is rarely considered in adults, unless a clear history of an aspiration event can be obtained. We have experienced and studied a case of occult aspiration of a shrimp which had been lodged for a long period.

128 Cases of Endoscopic Sphincterotomy (EST) / 대한소화기내시경학회지

Endoscopic sphincterotomy(EST) is now an established therapeutic procedure for various disorder of the pailla of Vater, the biliary tract, and the pancreas. From November 1992 to September l993, 123 cases of E.S.T were performed in our hospital. The success rate of EST was 97.8%, and choledocholithiasis was the indication for EST in 63. 4% of cases. Among 78 cases of choledocholithiasis, 47 cases were presence of gall bladder with stone (16 cases) or without stone (31 cases), especially 46 cases were assisted with needle type papillotome and 23 cases were assisted with guidewire. EST hae relatively low complications and is the therapy of choice for choledocholithiasis and various diisease of biliary tract. Guidewire assisted stanard papillotome probable reduce the use of needle type papillotome in the difficult cases that EST with pull type papillotome was impossible.

A Case of Gastric Metastasis of Malignant Melanoma Diagnosed by Gastroscopy / 대한소화기내시경학회지

Gastric metastasis occurs in about 0.7% to 1.7%, of patients dying of solid tumors of extragastrointestinal origin. Metastatic disease involving the stomach is an unusual and difficult clinical problem and presenting symptoms include nonspecific epigastric pain and melena. In most cases of gastric metastasis, the histologic finding of the gastroscopic biopsy suggests the correct diagnosis. There are only a few reports of gastric metastasis from malignant melanoma. We report a case of malignat melanoma of gastric metastasis, which was diagnosed by gastroscopy.

A Case of Gastric Metastasis of Malignant Melanoma Diagnosed by Gastroscopy / 대한소화기내시경학회지

Gastric metastasis occurs in about 0.7% to 1.7%, of patients dying of solid tumors of extragastrointestinal origin. Metastatic disease involving the stomach is an unusual and difficult clinical problem and presenting symptoms include nonspecific epigastric pain and melena. In most cases of gastric metastasis, the histologic finding of the gastroscopic biopsy suggests the correct diagnosis. There are only a few reports of gastric metastasis from malignant melanoma. We report a case of malignat melanoma of gastric metastasis, which was diagnosed by gastroscopy.

A Case of Chronic Gastric Anisakiasis with Massive Bleeding / 대한소화기내시경학회지

Aniskiasis is caused by the accidental infestation of human by larvae of marine mammals found in saltwater fish and squid. The clinical picture may be severe enough to stimulate an acute surgical abdomen. More commonly, colicky pain, diffuse abdominal tenderness, nausea, vomiting, fever, and leukocytosis are seen. Gastroscopically, 2-to 4-cm larvae can be seen penetrating the mucosa. More characteristically, the larvae burrow into the mucosa of the stomach. Here they produce eosinophilic granulomatous tumors with edema, thickening, and induration which may be mistaken for gastric canceer. The pathalogic changes are thought to be the result of a hypersensitivity reaction. We report a case of chronic gastric anisakiasis, which was diagnosed as submucosal tumor with massive bleeding.