Biliary-duodenal Fistula Following Radiofrequency Ablation Therapy for Hepatocellular Carcinoma / 대한소화기학회지

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occuring worldwide. Surgical resection currently provides the best chance of long-term tumor free survival, but the most HCCs are not candidates for surgical excision due to poor liver function or poor medical background. Numerous noninvasive alternatives to surgical resection have been introduced to treat liver cancers. Radiofrequency thermal ablation has begun to receive much attention as an effective and minimally invasive technique for the local control of HCC. The biliary system related complications after radiofrequency ablation has rarely been reported. We report a case of biliary-duodenal fistula with liver abscess after radiofrequency ablation for HCC. The case was treated by abscess drainage and antibiotics.

The Analysis of Appendiceal Mucocele with Emphasis on the Colonoscopic Findings / 대한소화기내시경학회지

BACKGROUND/AIMS: Appendiceal mucocele is relatively rare disease, however early diagnosis and adequate treatment is important because the rupture of mucocele during operation may results in pseudomyxoma peritonei which is fatal. Colonoscopy is very important tool to diagnose the mucocele of appendix earlier period. METHODS: We retrospectively analysed the medical records of ten cases of appendiceal mucoceles which were suspected by colonoscopy and surgically confirmed from January 1997 to March 2004. RESULTS: There was no gender difference and mean age was 55 years old. The colonoscopic findings of appendiceal mucocele were a type of submucosal tumor and the orifice of appendix was not seen in all the cases. The size was variable from 2.5 cm to 5.0 cm and the shape was spherical in majority, but one case of appendiceal mucocele lately diagnosed as mucinous cystadenocarcinoma had elongated, oval shape. The histologic diagnosis after resection were as follows: mucosal hyperplasia 4 cases (40%), mucinous cystadenoma 5 cases (50%) and mucinous cystadenocarcinoma 1 case (10%). CONCLUSIONS: Colonoscopy is an important diagnostic tool for suspecting appendiceal mucocele. It is important to confirm by surgical resection of appendiceal mucocele which is found even incidentally by colonoscopy.

A Clinical Analysis of Choledochal Cyst: Review of twenty three cases / 대한소화기내시경학회지

BACKGROUND/AIMS: Choledochal cyst is an unusual but serious condition which most commonly affects Oriental people. And it is an unusual entity that has increasingly been encountered by ultrasonography and computed tomography scan, even if the symptoms are variable. METHODS: We reviewed 23 patients with choledochal cyst who were treated at the Department of Internal Medicine, Pusan Paik Hospital from April, 1986 to April 1995. RESULTS: 1) Age ranged from 14 years to 73 years, and sex ratio was 1:1.4 in male vs female. 2) The durations of symptoms varied from 4 days to several years. 3) The major clinical symptoms were right upper quardrant pain in 19 cases, jaundice in 4 cases, abdominal mass in 2 cases. One case had all of above three symptoms. 4) The diagnostic tools were ultrasonography(USG) in l7 cases, ERCP in 11 cases, abdominal CT in 11 cases, PTC in 6 cases and oral GB in 1 case. The eight cases(61.5%) were confirmed as anomalous junction of the pancreaticobiliary ductal system(AJPBS) among the 13 cases who had performed ERCP. 5) The choledochal cysts were classified into type I to V according to the classification of Todani; Fifteen cases were type I, six cases type IVa, one case was type II and one case was type V, respectively. 6) Excision of choledochal cyst and Roux-en-Y hepaticojejunostomy was performed in 10 cases, and choledocho-jejunostomy in 4 cases, and Whipple's operation in 2 cases. 7) The associated diseases were CBD stone in 8 cases, cholecystitis in 6 cases, intrahepatic stone in 2 cases, GB cancer in 1 case, and colon cancer in 1 case. CONCLUSIONS: ERCP should be used when choledochal cyst is suspected by USG, aiming at demonstrating both AJPBS and enabling the morphologic classification. In addition, Surgical procedures including the excision of choledochal cyst and Roux-en-Y hepaticojejunostomy may be effective to reduce mortality and morbidity related to complication of choleclochal cyst.