A Selective Cannulation into the Common Bile Duct by a Guidewire Insertion through the Pancreatic Duct / 대한소화기내시경학회지

When the common bile duct (CBD) cannulation is attempted for the visualization and therapeutic intervention of biliary tree, difficulties can arise in the selective bile duct cannulation due to the deviation of the duodenal ampulla, a mobile ampulla or an acute angle between the CBD and the papillary orifice. During an attempt at a deep biliary cannulation for the endoscopic therapy, pancreatic sliding often occurs, which means a catheter or a sphincterotome inadvertently enter the pancreatic duct instead of the CBD. From our experience, we have learned that an acute angle between the CBD axis and ampullary orifice could cause pancreatic sliding. We could succeed in the deep cannulation of sphincterotome into the CBD after fixing the ampulla and blunting the acute angle of the CBD with a guidewire inserted into the pancreatic duct. No complications had occurred. This method may be a simple and useful tool in cases of recurrent pancreatic sliding and can avoid the post-ERCP pancreatitis subsequent to repeated cannulation of the pancreatic duct.

Santorinicele Associated with Pancreas Divisum / 대한소화기내시경학회지

Santorinicele denotes a focal cystic dilatation of the terminal dorsal pancreatic duct at the minor papilla. Santorinicele results from a combination of obstruction and weakness of the distal dorsal ductal wall. This anomaly has been found in patients with pancreas divisum and recurrent acute pancreatitis. We recently experienced a typical case of santorinicele associated with pancreas divisum incidentally found in a 71-year-old woman presented with acute cholecystitis. At duodenoscopy, the minor papilla was plumped out and bulged into the duodenal lumen after contrast injection. Dorsal pancreatography showed a cystic dilatation at the terminal portion of the dorsal duct and upstream dilatation. In this patient, previous pancreatic-type pain and pancreatitis are thought to be related to this anomaly.

A Case of Metastatic Non-small Cell Lung Cancer Presenting with Numb Chin Syndrome / 결핵

Numb chin syndrome is a rare clinical manifestation, characterized by focal sensory loss and paresthesia of the chin. It is more often associated with cancer than with benign disorders, and can be the first manifestation of a cancer. A 60-year-old man presented with focal numbness of right chin and gingiva for 10 days. Chest computed tomography showed a 3 cm sized mass on the distal left main-stem bronchus. Squamous cell carcinoma was diagnosed on bronchoscopic biopsy. However, bony metastasis of mandible was not evident on reontgenogram, CT scan, bone scintigram and positron emission tomography. Despite the chemotherapy with three cycles of paclitaxel and cisplatinum, the cancer was progressed and pain on the right chin was developed 4 months .later. Bone scintigram showed multiple bony metastasis including mandible. Here we report this case with a brief review of the appropriate literature.

A Case Report of Atypical Rectal Carcinoid / 대한소화기내시경학회지

Carcinoid tumors arise from enterochromaffin cells of neural crest origin. Rectal carcinoid tumors make up 1 to 2% of all rectal tumors. Approximately 50% of rectal carcinoid tumors are found incidentally on routine endoscopy, and they are asymtomatic. Rectal carcinoid is easily diagnosed by the characteristic submucosal tumor with yellowish color. There have been, however, some rare cases where the rectal carcinoid tumor was not easily diagnosed because of its atypical feature. We report a case of atypical rectal carcinoid tumor misdiagnosed as rectal cancer on endoscopic finding: this atypical gross morphology on endoscopy may be due to atypical histopathologic findings.

An Intraductal Papillary Mucinous Tumors (IPMT) of the Pancreas: Clinical, Radiologie, and Pathologie Findings Acccrding to Its Subtypes / 대한소화기내시경학회지

BACKGRONDS/AIMS: Patients with a branch duct type intraductal papillary mucinous tumor (IPMT) of the pancreas with hyperplasia are suggested to be followed up without resection. The aims of this study were to compare the clinical, radiologic, and pathologic findings among the subtypes of IPMT and to find the factors that could predict a hyperplastic lesion preoperatively. METHODS: Twenty two patients with IPMT of the pancreas who underwent surgical resection were investigated. The subtypes of IPMT were classified into the main duct type (7 patients), branch duct type (6 patients), and combined type (9 patients) based on the pathologic findings of the surgical specimens. The clinical, radirologic, and pathoiogic findings of each subtype were analyzed. RESULTS: Asymptomatic patients were more common in the branch duct type of IPMT (p=0.01). The diameter of the main pancreatic duct was <7 mm in most of the branch duet types of IPMT (5/6). Hyperplastic lesions were more likely to be the branch ciuct type (5/6, p=0.01). CONCLUSIONS: A hyperplastic lesion can be predicted if a lesion is the branch duct type of IPMT with the diameter of the main pancreatic duct < 7 mm and without symptoms. Therefore, IPMT of the pancreas with these findings can be followed up without an operation.