Optimal Methods for the Management of Iatrogenic Colonoscopic Perforation

BACKGROUND/AIMS: Colonoscopic perforations have been managed with exploratory laparotomy, and have resulted in some morbidity and mortality. Recently, laparoscopic surgery is commonly performed for this purpose. The aim of this study was to compare the outcomes of several management strategies for iatrogenic colonoscopic perforations. METHODS: We retrospectively reviewed the medical records of patients who had been treated for colonoscopic perforation between January 2004 and April 2013 at CHA Bundang Medical Center in Korea. RESULTS: A total of 41 patients with colonoscopic perforation were enrolled. Twenty patients underwent conservative management with a success rate of 90%. Surgical management was performed in 23 patients including two patients who were converted to surgical management after the failure of the initial conservative management. Among 14 patients who underwent surgery at 8 hours after the perforation, there was no considerable difference in adverse outcomes between the laparotomy group and the laparoscopic surgery group. The medical costs and claim rate were 1.45 and 1.87 times greater in the exploratory laparotomy group, respectively. CONCLUSIONS: Conservative management of colonoscopic perforation could be an option for patients without overt symptoms of peritonitis or with a small defect size. If surgical management is required, laparoscopic surgery may be considered as the initial procedure even with a delayed diagnosis.

A Case of Hemosuccus Pancreaticus Associated with Pseudoaneurysm of Splenic Artery / 대한췌담도학회지

Splenic artery pseudoaneurysm (SAP) is a rare condition, occurring from many causes like pancreatitis, peptic ulcer, surgery, abdominal trauma and iatrogenic origins. SAP poses a great challenge to clinicians because it can lead to a variety of symptoms from abdominal pain, nausea, vomiting to massive bleeding into gastrointestinal tracts as well as abdominal cavity. A 43-year-old female who had previously been managed for alcoholic chronic pancreatitis and thrombotic thrombocytopenic purpura was admitted with hematochezia and dizziness. Patient went into shock from bleeding, however, there was no bleeding focus on initial CT scan and gastroduodenoscopy. Shock occurred repeatedly due to the severe blood loss from gastrointestinal tracts. On the 4th day in hospital, duodenal bleeding was suspected on gastrointestinal bleeding scan and bleeding from ampulla of Vater was found on follow-up gastroduodenoscopy. SAP which causes hemosuccus pancreaticus was diagnosed on angiography and it was treated successfully by embolization.

A Case of Nodular Regenerative Hyperplasia of the Liver Combined with Toxic Hepatitis / 대한소화기학회지

Nodular regenerative hyperplasia (NRH) is an uncommon liver condition characterized by diffuse transformation of the hepatic parenchyma into regenerative nodules without fibrosis. Portal vasculopathy caused by abnormal hepatic venous flow may induce hepatocyte hyperplasia, which forms regenerative nodules. Underlying diseases or certain drugs may also be the cause of NRH. This condition is often underdiagnosed as the patients remain asymptomatic until development of portal hypertension, and histopathologic confirmation by liver biopsy is the only way of making a definite diagnosis. The management mainly involves prevention and treatment of the complications of portal hypertension. The frequency of diagnosis of NRH has increased rapidly in recent years, however, only a few cases have been reported in Korea. Here, we report on a case of NRH of the liver combined with toxic hepatitis.

Acute Kidney Injury Associated with Disseminated Intravascular Coagulation that Developed after a Hysterectomy in a Patient with Probable Catastrophic Antiphospholipid Syndrome / 대한내과학회지

Acute kidney injury associated with disseminated intravascular coagulation (DIC) and a coagulation factor defect may develop with infection, malignancy, severe trauma, or obstetric complications. However, a gynecological etiology, such as hysterectomy, in a patient with adenomyosis has rarely been reported. We describe a case of a 42-year-old women who presented with DIC and acute kidney injury after a total hysterectomy. We thought that the cause for the acute kidney injury might be small vascular thrombosis and acute tubulointerstital nephritis due to probable catastrophic antiphospholipid syndrome with DIC. The patient was successfully treated with steroid therapy.

Acute Kidney Injury Associated with Disseminated Intravascular Coagulation that Developed after a Hysterectomy in a Patient with Probable Catastrophic Antiphospholipid Syndrome / 대한내과학회지

Acute kidney injury associated with disseminated intravascular coagulation (DIC) and a coagulation factor defect may develop with infection, malignancy, severe trauma, or obstetric complications. However, a gynecological etiology, such as hysterectomy, in a patient with adenomyosis has rarely been reported. We describe a case of a 42-year-old women who presented with DIC and acute kidney injury after a total hysterectomy. We thought that the cause for the acute kidney injury might be small vascular thrombosis and acute tubulointerstital nephritis due to probable catastrophic antiphospholipid syndrome with DIC. The patient was successfully treated with steroid therapy.

Asymptomatic pneumatosis intestinalis following chemotherapy for B lymphoblastic leukemia with recurrent genetic abnormalities in an adolescent patient

Pneumatosis intestinalis (PI) is a rare condition characterized by multiple pneumocysts in the submucosa or subserosa of the bowel. Here, we report a rare case of asymptomatic PI after chemotherapy induction in an 18-yr-old man with B lymphoblastic leukemia with recurrent genetic abnormalities. The patient was treated conservatively and recovered without complications. The possibility of PI should be considered as a complication during or after chemotherapy for hematologic malignancies. Conservative treatment should be considered unless there are complications, including peritonitis, bowel perforation, and severe sepsis.

Intravesical Cidofovir in the Treatment of Hemorrhagic Cystitis after Unrelated Cord Blood Transplantation / 대한내과학회지

Hemorrhagic cystitis is a common complication in hematopoietic stem cell transplant recipients. We report a case of hemorrhagic cystitis after unrelated cord blood transplantation associated with adenovirus infection. Despite hydration, hematuria and large clots persisted. We instilled cidofovir into the bladder, which resulted in clearance of the adenovirus and significant clinical improvement. Our case emphasizes the effectiveness of intravesical cidofovir treatment for viral hemorrhagic cystitis.

Limbic Encephalitis Caused by Human Herpesvirus-6 Infection in Allogenic Hematopoietic Stem Cell Transplantation Patient

No abstract available.