A Case of Gastric Injury by Acute Iron Intoxication / 대한소화기내시경학회지

Iron is a kind of corrosive agent. Iron overdose causes gastrointestinal complication such as mucosal ulceration, bleeding, intestinal perforation and may occur metabolic acidosis, hepatic dysfunction, hepatic failure, renal failure and cardiomyopathy. Delayed sequalae including gastric outlet obstruction develops 4 to 6 weeks after ingestion. The determination of serum iron and TIBC is an important factor in ascertaining the toxic potential in acute iron ingestion and more is the amount of ingested elemental iron, greater is a patient's toxicity. Supportive care is most important and patients who have severe symptom and abnormal vital sign should be treated with deferoxamine. We report the case that a 20-year-old pregnant female (33 weeks gestation) who had visited complaining of gastrointestinal symptom with iron overdose state was administrated with deferoxamine, therefore we removed iron loads within stomach with endoscopic suction and observed multiple gastric erosion with much old iron in endoscopic findings.

A Case of Duodenal Intramural Hematoma Associated with Henoch - Schonlein Purpura / 대한소화기내시경학회지

Henoch-Schonlein purpura is a condition of unknown origin probably related to an autoimmune phenomenon involving an IgA immune complex disorder. Henoch-Schonlein purpura is a rare cause of intramural hematoma of the duodenum. We herein report a case of intramural hematoma of the duodenum and duodenal obstruction associated with Henoch-Schonlein purpura in a 14-yearold boy. On admission, the patient presented with hematemesis due to duodenal ulcer bleeding. Three days later, he developed both forearm and calf purpurae, fever and severe bile juice vomiting. An endoscopy revealed a luminal obstructing erythematous mass with bulging nature at the third portion of the duodenum. Abdominal CT scan and hypotonic duodenography showed intramural hematoma in the third portion of the duodenum and luminal obstruction. Hematoma removal was performed for the correction of intestinal obstruction. Increased awareness of the gastrointestinal manifestations of Henoch-Schonlein purpura should aid in the recognition of this disorder.

Urticaria Reaction by Oral Polyethylene Glycol Ingestion / 대한소화기내시경학회지

Administration of oral PEG electrolyte lavage solution for colonoscopy preparation has been well tolerated by patients and physicians. Overall incidence of adverse reactions of PEG is low. Nausea, vomiting, and abdominal pain are relatively common side effects and serious adverse reactions are rare. PEG is absorbed by intestinal mucosa in very small amount but this minimal absorption could be sufficient to provoke the appearance of systemic reaction in susceptible patients. Allergic reaction manifested as the contact dermatitis in patient treated with the local preparation containing PEG is rarely reported and the case of hypersensitivity response followed oral PEG lavage is more rare. We report a patient who had experienced the urticaria reaction mainly at the trunk after oral PEG intake for colonoscopy preparation.

Primary Gastric Small Cell Carcinoma-Pure Type 1 Case / 대한소화기내시경학회지

Primary gastric small cell carcinoma is very rare, so that its incidence is about 0.1% of all gastric cancer and it was first reported in 1976. The morphologic and biologic features of primary gastric small cell carcinoma are similar to those of small cell carcinoma of the lung. Gastric small cell carcinomas are pathologically classified as a pure type and a composite type combined with adenocarcinoma and/or squamous cell carcinoma. Because the behavior of this cancer is very aggressive and exclusive, it invade lymphatic and/or vascular lumen, and dose distant metastasis easily. We report the case of a 55-yr-old man who developed pure type primary gastric small cell carcinoma. The patient underwent Billroth-II subtotal gastrectomy and recieved a multiagent chemotherapy. He remains free from tumor recurrence 12 months after surgery.

A Case of Splenic Infarction after Histoacryl(R) Injection in Gastric Varix Bleeding / 대한소화기내시경학회지

Histoacryl(R) (n-butyl-2-cyanoacrylate) has been used successfully for the treatment of gastric variceal bleeding. The reported complications of Histoacryl(R) injection therapy include bleeding, perforation, stenosis and embolism. Here we describe a case of splenic infarction as an unusual complication of Histoacryl(R) injection. A 51-year-old male patient with liver cirrhosis was admitted due to acute gastric varix bleeding. Sclerotherapy was successfully carried out using Histoacryl(R) mixed with lipiodol (2.6 mL). 4 days later, he complained left upper quadrant pain and developed a fever of 38.2degrees C. Abdominal CT showed wedge-shaped hypodense area in the spleen compatible with infarction. He was treated conservatively. The fever and abdominal pain gradually subsided and he was discharged without significant problems.

Two Cases of Mallory-Weiss Syndrome During Bowel Preparation for Colonoscopy / 대한소화기내시경학회지

Polyethylene glycol solutions have been usually available for clinical use since 1980 and been considered a standard method of bowel preparations for colonoscopy. There have been many reports about minor complications such as nausea and bloating associated with their use, which are frequently occurred. After ingestion of polyethylene glycol, vomiting occurrs less frequently but it can make major complication such as Mallory-Weiss syndrome and aspiration pneumonia. We have reported here two cases of Mallory-Weiss syndrome, which were occurred after ingestion of polyethylene glycol solution for colonoscopy.

A Case of Pneumatosis Cystoides Intestinalis Presented with Nonspecific Symptom / 대한소화기내시경학회지

Pneumatosis cystoides intestinalis is a relatively rare condition, characterized by multiple gas-filled cysts of varying size in the wall of gastrointestinal tract. Although the etiology of pneumatosis intestinalis remains uncertain, the possibility that both the gas-forming bacteria and mechanical theories develop pneumocysts has recently been advocated. We experienced a case of pneumotosis cystoides intestinalis found by colonoscopy in a 31-year old woman with intermittent abdominal pain.

Efficacy of N-Butyl 2-Cyanoacrylate Injection Therapy for Gastric Variceal Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of the study was to evaluate the efficacy of n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding and to find out the factors related to clinical outcome. METHODS: Sixty-seven patients treated with n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding were retrospectively reviewed. RESULTS: Initial hemostasis was achieved in all 12 patients. Success of therapy was achieved in 88% of the patients. A stepwise logistic regression analysis including age, sex, cause of cirrhosis, Child-Pugh class, variceal form, bleeding site, initial hemoglobin, and presence of hepatocellular carcinoma as variables indicated that only the Child-Pugh class was an independent predictive factor of treatment failure. Rebleeding occurred in 19% of the patients during the 4 weeks after therapy. The cumulative probability of 4-week remaining free of rebleeding was significantly higher in Child-Pugh A and B than in Child-Pugh C. Mortality at 4 weeks was 15%. The Child-Pugh class and the presence of hepatocellular carcinoma were the independent predictive factors of mortality at 4 weeks. CONCLUSIONS: N-butyl 2-cyanoacrylate injection therapy is highly effective in the management of bleeding from gastric varices. Child-Pugh class is an important predictive factor of treatment failure, rebleeding, and survival after the therapy.

A Case of Cutaneous and Gastric Cavernous Hemangiomas / 대한소화기내시경학회지

A hemangioma is a common soft tissue tumor, usually affecting the cutaneous regions of the head and neck in infancy and childhood. A hemangioma in the gastrointestinal tract is rare occurrence which is usually found in the submucosa of the small and large intestine, but rarely in the stomach. Infrequently, multiple cavernous hemangiomas have been reported on skin and in the intestines. A 23-year-old man was admitted with hematemesis. An upper endoscopy revealed a purple colored sessile lesion at the posterior wall side of the fundus which had surface erosion and erythema. This lesion was easy to bleed when the patient retched. Another sessile lesion was detected at the greater curvature side of the upper body. The patient had two intradermal soft masses at the back and left forearm. An X-ray revealed a phebolith that suggested a cavernous hemangioma. An abdomen CT and angiography revealed that these lesions were highly suggestive of hemangioma. Gastric wedge resection was performed and the histological diagnosis was gastric cavernous hemangiomas.

Three Cases of Double Pylorus Due to Gastroduodenal Fistula Complicating Peptic Ulceration: Disappearance of gastroduodenal fistula in 1 case after eradication of a Helicobacter pylori infection / 대한소화기내시경학회지

Double pylorus is either a congenital abnormality or an acquired complication of peptic ulcer disease. An accessory channel normally connects the lesser or greater curvatore of the prepyloric antrum with the duodenal bulb. Three cases of double pylorus, an unusual complication of peptic ulcer disease is herein reported. A peptic ulcer lay in the accessory channel in all cases. In one of the cases, the fistula closed spontaneously after Helicobacter pylori eradication. The remaining 2 patients became asympto-matic despite the persistence of the accessory channel.

Endoscopic Aspiration Mucosectomy of Gastric Adenoma and Early Gastric Cancer: Two Year Experience with Assessment of Results / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic aspiration mucosectomy (EAM) can always lift up the lesion by suction regardless of its location and does not injure the mucosal surface. The clinical usefulness of this method was evaluated as follows. METHODS: Thirty two patients with gastric adenoma (35 lesions) and 6 patients with early gastric carcinoma were treated by EAM from March 1997 to February 1999. Their characteristics (diameter, macroscopic appearance, and histologic diagnosis) were verified at endoscopy with a biopsy specimen. The complete resection was defined as the presence of normal mucosa at the resected margin. RESULTS: The average size of the resected specimens was 17.8 mm in antrum and 16.5 mm in body. The ratio of complete resection by location was 67% in anterior wall, 88% in posterior wall, 86% in lesser curvature and 92% in greater curvature. The complete resection rate for smaller lesions (15 mm). No serious complication was encountered. CONCLUSIONS: EAM is suitable for the treatment of gastric tumors. Lesions 15 mm or less in diameter can be resected easily by single procedure regardless of its location.

A Case of Traumatic Nonfuctional Adrenal Pseudocyst / 대한내분비학회지

The adrenal glands are rarely injured by blunt trauma, because they are well protected by the ribs, paraspinal muscles, and the overlying abdominal contents. Although most of adrenal cysts are clinically silent, the number of incidentally detected adrenal cysts have increased due to advanced and widespread application of various sensitive imaging methods. Recently, we have encountered a case of a 62-year-old man who have developed a left adrenal pseudoeyst one and a half months after the blunt trauma from a pedestrian traffic accident. The pseudocyst was non-functional and measured about 5 * 4 cm in size with the same fluid density of a gall bladder in abdominal computerized tomography(CT). Turbid cystic fluid was aspirated by CT-guided method, and the aspirate was composed of degenerated old blood cells without any malignant cells. Since the cyst was developed following trauma and its microscopic content showed blood cells, impending rupture was anticipated. Hence, a laparoscopic adrenalectomy was performed.

A Case of SIADH Related to Drug-indeced Generalized Maculopapular Rash / 대한내분비학회지

Syndrome of inappropriate antidiutetic hormone(SIADH) secretion is the most common cause of hyponatremia in clinical medicine. Before diagnosis of the SIADH is made, other causes for a decreased diluting capacity and nonosmotic stimuli for AVP release need to be rule out. Disorders associated with SIADH can be divided into 4 major etiologic groups: malignancies, pulmonary diseases, central nervous disorders, and drugs. A 45-year-old woman was admitted due to maculopapular skin eruption and fever after taking medications for fever and myalgia. Generalized tonic clonic seizure was developed nine days later, and laboratory results showed marked hyponatremia. During the evaluation, treatment, and subsequent follow-up, the diagnosis of SIADH was confirmed, but the definitive cause was obscure. With fluid restriction, sodium replacement and demeclocycline therapy, she recovered completely 6 months later. We suggest that the SIADH might be related to drug-induced generalized maculopapular rash via menmgitis-like reaction in CSF as one of systemic adverse side effects to drugs rather than direct effect of related drugs.

A Case of Gastric Leiomyosarcoma with Bleeding / 대한소화기내시경학회지

Leiomyosarcoma accounts for 1-3% of all the gastric malignancies. The most common clinical presentation of gastric leiomyosarcoma is gastrointestinal hemorrhage due to tumor ulceration. Surgical resection is the treatment of choice for gastrointestinal sarcomas and the appropriate surgical management requires deliberate efforts for complete excision of the tumor with an adequate margin of normal tissue. A 70-year-old woman was admitted to our hospital due to a melena persisting for 7 days. A gastrofiberscopy was performed and a large normal mucosa covered lobulated mass with deep multiple round ulcers were found in the fundus. A slightly protruding vessel was visible on the base of the posterior wall of the fundus. An abdominal CT revealed a heterogenous mass with irregular multifocal necrotic portions in the fundus. During on operation, a tumorous mass was found in the fundus. The liver was free of metastasis and lymphadenopathy was not discovered. A total gastrectomy, omentectomy, and an end to end esophagojejunostomy were performed. The pathologic diagnosis determined a high grade leiomyosarcoma.