Treatment of a Periesophageal Abscess with Endoscopic Ultrasonography-Guided Drainage and Antibiotics: A Case Report / 대한내과학회지

In periesophageal abscesses, the inflammatory reaction occurs on the surrounding esophagus and pus cavity formation accompanies complications of endoscopic procedures or esophageal perforation induced by sharp foreign bodies. Here, we report the treatment of a periesophageal abscess with endoscopic ultrasonography-guided incision and drainage, and broad-spectrum antibiotics. Follow-up endoscopy revealed no lesion other than the incision scar. We report a case of periesophageal abscess that was treated non-surgically and review the relevant literature.

A Case of Brunner's Gland Hyperplasia with Dysplasia / 대한내과학회지

Brunner's gland hyperplasia, also known as Brunner's gland adenoma, polypoid hamartoma, or Brunneroma, is a rare proliferative lesion arising from the Brunner's glands of the duodenum. These lesions have been described previously as benign, with no malignant potential. We report a case of Brunner's gland hyperplasia in the duodenum that was discovered incidentally during the endoscopic evaluation of anal bleeding. Histopathological examination of this Brunner's gland hyperplasia revealed well-marked, low-grade dysplasia. This case suggests a dysplastic stage with malignant potential in the natural history of Brunner's gland hyperplasia.

A Case of Behcet Disease with Intestinal Involvement in an Elderly Patient

Behcet disease is a multisystemic disorder characterized by a chronic relapsing triple symptom complex of recurrent oral ulceration, genital ulceration, and ocular inflammation. The onset of Behcet disease is rare in old age as is whole colon involvement. We recently saw a 78-year-old female patient examined to have intestinal Behcet disease with diffuse colon ulcers. She was admitted due to multiple oral ulcers, genital ulcers, low abdominal pain, and hematochezia. Colonoscopy showed multiple well-demarcated, large, deep, bleeding ulcers from the cecum into the descending colon. The patient was diagnosed with Behcet disease and treated with steroid, colchicine, and mesalazine. This paper describes a case of Behcet disease with unusual intestinal distribution.

A Case of Hyperkalemic Periodic Paralysis Induced by Diabetic Nephropathy / 대한내과학회지

Hyperkalemic periodic paralysis is characterized by episodic flaccid paralysis of the skeletal muscles due to an increase in serum potassium concentrations. Primary hyperkalemic periodic paralysis is caused by point mutations in SCN4A, encoding a voltage-gated skeletal muscle sodium channel. However, hyperkalemia-related diseases, such as renal failure, adrenal insufficiency, hypoaldosteronism, and chronic diuretic use, can induce secondary hyperkalemic periodic paralysis. Diagnosis of this disease is based on clinical features, nerve conduction studies, and a DNA sequence analysis. In cases of diagnostic uncertainty, a provocation test can be used to ensure the correct diagnosis. Here, we report a case of secondary hyperkalemic periodic paralysis with hyperkalemia that was induced by diabetic nephropathy, and review the relevant literature.

Penetration of the Descending Colon by a Migrating Intrauterine Contraceptive Device

Foreign bodies in the gastrointestinal tract often cause serious complications, such as perforation, obstruction, abscess formation, or hemorrhage. This is a case in which a patient visited our hospital and complained of a vague lower abdominal pain that had been present for three months. She had an intrauterine device (IUD) inserted five years earlier. The abdominal X-ray, computed tomography and colonoscopy revealed that the IUD had penetrated into the descending colon. We tried to remove the IUD by colonoscopy but failed due to pain, so we removed the IUD surgically. Thus, we report a case in which a previously inserted IUD had penetrated into the descending colon and was surgically removed. We also present a brief review of the literature.

The Value of Diagnostic Laparoscopy for Assessment of Resectability in Hepatobiliary and Pancreatic Malignancy under the Local Anesthesia / 한국간담췌외과학회지

BACKGROUNDS: Despite the advance of radiologic imaging techniques, not a fewer number of patients with hepatobiliary and pancreatic malignancies are found to be unresectable just at the time of laparotomy. The aim of this study was to evaluate the accuracy of diagnostic laparoscopy for assessing resectability of hepatobiliary and pancreatic malignancies. METHODS: From May 1999 to March 2000, diagnostic laparoscopy was performed in 16 patients with suspected hepatobiliary and pancreatic malignancies after clinical examination, laboratory tests, and radiologic imaging techniques(ultrasonography, computed tomography, ERCP, and PTC). Local anesthesia with intravenous sedation was used. A 10-mm infraumbilical port was used for the telescope and another 5-mm port was used for the working instrument depending upon intra-abdominal findings. During the procedure, we tried to find any evidence of distant metastasis or advanced local invasion such as, peritoneal seeding, metastatic nodule at the liver, major vascular involvement or invasion of adjacent other intraabdominal organ. RESULTS: 4 of 16 patients were found to have unresectable malignancies because of peritoneal seeding, hepatic metastases or ascites by diagnostic laparoscopy. 3 patients had invasion to superior mesenteric vein and adjacent structures overlooked at diagnostic laparoscopy. Sensitivity, specificity, and overall accuracy for assessing resectability were 66.7%, 28.6% and 50.0% for radiologic imaging techniques and 100%, 57.1% and 81.3% for diagnostic laparoscopy. CONCLUSION: Diagnostic laparoscopy under local anesthesia proved to be an effective diagnostic tool for assessing resectability of hepatobiliary and pancreatic malignancies by means of assisting the radiologic imaging technique.