Gastric duplication cyst associated with dorsal pancreatic agenesis and a cystic pulmonary lesion / 대한내과학회지

Gastric duplication cysts and dorsal pancreatic agenesis are rare congenital anomalies, and little is known of the association between these two anomalies. A 17-year-old woman was admitted with a cystic lung mass detected as part of a health screening program. Chest computed tomography (CT) showed a cystic lung lesion in the right lower lobe and an incidental cystic abdominal mass. She had no specific symptoms or signs. Abdominal CT and endoscopic ultrasonography (EUS) revealed a 9x7x5.5-cm cystic mass and agenesis of the body and tail of the pancreas. The cyst was removed successfully using laparoscopic gastric wedge resection. Microscopically, the muscle coat of the cyst wall was fused with the muscle layer of the stomach. Therefore, the cystic mass was diagnosed as a gastric duplication cyst. We present a patient with a pulmonary cystic lesion associated with two congenital anomalies: a gastric duplication cyst and dorsal pancreatic agenesis.

Relationship between Psychological Factors and Quality of Life in Subtypes of Gastroesophageal Reflux Disease

BACKGROUND/AIMS: Quality of life (QoL) is consistently decreased in gastroesophageal reflux disease (GERD), but the relationship between QoL and psychological factors in GERD has not yet been clearly defined. The present study investigated the relationship between the psychological factors of two subtypes of GERD and QoL. METHODS: A cohort of 769 participants underwent upper endoscopic evaluation in the health-promotion center of St. Paul's Hospital. The severity of GERD symptoms, psychological factors, and QoL were analyzed using the Visual Analogue Scale, the Hospital Anxiety and Depression Scale, and the abbreviated version of the World Health Organization Quality of Life instrument, respectively. RESULTS: Among the total of 769 participants, 153 participants were included in the exclusion criteria. Erosive reflux disease (ERD) and nonerosive reflux disease (NERD) were present in 106 (14%) and 61 (8%) of the participants, respectively, and 449 (58%) acted as controls. In each GERD group, the QoL had no correlatioion with the symptom severity. The scores for anxiety and depression were highest in the NERD group, and QoL scores were lower in both the ERD and NERD groups than in the control group. Anxiety and depression resulted in QoL scores being lower in both the ERD and NERD groups than in the nonanxiety and nondepressed groups, respectively. CONCLUSIONS: This study provides evidence that the QoL associated with the ERD and NERD subtypes may be more related to psychological factors than to symptom severity.

A Case of Retrograde Jejunogastric Intussusception Diagnosed by Gastroscopy / 대한소화기내시경학회지

Retrograde intussusception of the jejunum into the stomach through the stroma of a gastroenterostomy is a very rare, but potentially fatal complication after gastrectomy. Once symptoms develop, the mortality rate is high if this is not treated within 48 hours, so making an early diagnosis with a high index of suspicion and administering prompt treatment are mandatory. Gastroscopy could be a useful diagnostic tool for patients with a history of gastrectomy and who present with abdominal pain and hematemesis, and with considering the possibility of intussusception. A 65-year-old man with a history of Billroth II gastrectomy that was done 35 years ago due to gastric ulcer perforation was admitted with abdominal pain and hematemesis. A necrotic mucosa that was suspicious of an intussuscepted small bowel tissue was detected on gastroscopy. Subsequent open reduction and small bowel resection was performed with successful results. We report here on a case of postoperative retrograde jejunogastric intussusception that occurred 35 years after Billroth II gastrectomy, and it was first diagnosed by performing gastroscopy.

A Case of Eosionophilic Gastroenteritis Involving EntireGastrointestinal Tract with Eosinophilic Ascites / 대한소화기내시경학회지

Eosinophilic gastroenteritis is a rare condition of unknown cause characterized by pheripheral eosinophilia and eosinophilic infiltration of the gastrointestinal tract. Eosonophilic gastroenteritis is generally classified according to the layer of the gastrointestinal tract that is involved. Serosal eosinophilic infiltration is the rarest form of presentation and can result in the development of eosinophilic ascites. We experienced a case of eosinophlilic gastroenteritis involving the entire gastrointestinal tract in a 34-year-old female patient with abdominal pain that was confirmed by multiple biopsies of the gastrointestinal tract with eosinophilic ascites. The patient was successfully treated with corticosteroids. We report this case with a brief review of the literature.

Retrieval of a Retained Capsule due to Isolated Crohn's Enteritis by Means of Double Balloon Enteroscopy / 대한소화기내시경학회지

Capsule endoscopy is being increasingly used for investigating GI bleeding of an obscure origin and also the bleeding that's due to Crohn's disease. Capsule endoscopy is a safe procedure with few complications. Complications of capsule endoscopy are capsule retention, incomplete small bowel examination, swallowing disorders and technical complications. However, capsule retention still remains a major concern. Crohn's disease may rarely show its first manifestation as GI bleeding. We present here a case of obscure GI bleeding in which the diagnosis of isolated Crohn's enteritis was made by using wireless CE. The retained capsule at the jejunal stricture of Crohn's disease was successfully retrieved by performing double balloon enteroscopy.

A Case of Epithelioid Type Gastric Gastrointestinal Stromal Tumor with Gastrointestinal Bleeding / 대한소화기내시경학회지

The stomach is the most frequently noted site (50~60%) of gastrointestinal stromal tumor. This tumor is categorized into three subtypes (the spindle cell type, the epithelioid type or mixed type) according to the shape of the cells that make up the tumor. We herein report on a case of gastrointestinal stromal tumor with an epithelioid subtype in a 60-year-old male. On admission, the patient presented with epigastric pain and melena. Endoscopy revealed a submucosal tumor with a central ulcer at the gastric body. Gastric wedge resection was performed. The tumor cells showed a rounded shape and positive staining for CD117. Because the epithelioid type gastrointestinal stromal tumor is unusual in Korea, we report here on this case along with a review of the relevant literature.

A Case of Epithelioid Type Gastric Gastrointestinal Stromal Tumor with Gastrointestinal Bleeding / 대한소화기내시경학회지

The stomach is the most frequently noted site (50~60%) of gastrointestinal stromal tumor. This tumor is categorized into three subtypes (the spindle cell type, the epithelioid type or mixed type) according to the shape of the cells that make up the tumor. We herein report on a case of gastrointestinal stromal tumor with an epithelioid subtype in a 60-year-old male. On admission, the patient presented with epigastric pain and melena. Endoscopy revealed a submucosal tumor with a central ulcer at the gastric body. Gastric wedge resection was performed. The tumor cells showed a rounded shape and positive staining for CD117. Because the epithelioid type gastrointestinal stromal tumor is unusual in Korea, we report here on this case along with a review of the relevant literature.

Portal and Superior Mesenteric Venous Thrombosis Treated with Urokinase Infusion via Superior Mesenteric Artery / 대한소화기학회지

Portal and mesenteric venous thrombosis is an uncommon disease, but clinically important, because it accounts for 5% to 15% of acute mesenteric ischemia. The diagnosis is often delayed because the conditions are nonspecific abdominal symptoms. In addition, when this occurs in young individual without any known predisposing factor, the diagnosis may become even more difficult. The treatment of mesenteric venous thrombosis involves anticoagulation therapy alone or in combination with surgery. The addition of thrombolytic therapy to the treatment of portal and mesenteric venous thrombosis may enhance the clearance of thrombus and hasten the clinical improvements. We present a case of mesenteric venous thrombosis treated with catheter-directed infusion of urokinase via the superior mesenteric artery and systemic anticoagulation.

A Case of Rectal Anisakiasis / 대한소화기내시경학회지

Anisakiasis refers to the infestation of humans by a species of marine nematode larvae belonging to the subfamily Anisakidae, and this condition is seen in people who eat inadequately prepared or raw salt-water fish and squid. Because Koreans like to eat raw fish, anisakiasis of the stomach has been reported occasionally, but involvement of the small bowel or colon is relatively rare. In the case of the colon, anisakiasis of the ascending colon or the transverse colon has been only infrequently reported, and the incidence of rectal anisakiasis is very rare. The present case is a 58-year-old man with no definite abdominal symptoms who visited our hospital for a medical checkup. A 2 cm sized whitish linear live larva was revealed in the rectum and it was removed by colonoscopy.

A Case of Acromegaly Associated with Lung and Gastric Cancer / 결핵및호흡기질환

Patients with acromegaly have high incidence of benign or malignant neoplasia than general population. Around fifteen percent of the deaths reported in acromegaly are attributable to malignancy of cancer. On the whole, mortality in acromegaly has been shown to be correlated with the degree of growth hormone (GH) control. Especially, the levels of insulin like growth factor-1 (IGF-1) may be higher in neoplasm, but there is no clear evidence to prove that tumor development is triggered by IGF-1 in acromegaly. Henceforth, we report a case of acromegaly associated with lung and gastric cancer in a 58-year-old man, suggesting the possible carcinogenic role of IGF-1.

A Case of Systemic Sclerosis Developed after Autologous Hematopoietic Stem Cell Transplantation in the Patient with Multiple Sclerosis

Herein, the case of a 43-year-old woman, with a relapsing-remitting variant of multiple sclerosis (MS), which began when she was 34 years of age, and gave rise to severe neurological complications, including progressive paralysis in both legs and visual deterioration, is reported. Despite heavy immunomodulatory treatment, her condition relapsed and became aggravated. At this point, the decision was made to perform autologous hematopoietic stem cell transplantation (HSCT). The enrichment of CD34+ cells was followed by depletion of the peripheral T cells. The post-transplantation course was uneventful, and autoimmune thrombocytopenia developed within 7 months of the HSCT. The patient was treated with cyclosporine (CsA) and oral prednisolone, but subsequently developed systemic sclerosis (SSc). The administration of CsA following the syngeneic/autologous HSCT caused a T lymphocyte-dependent autoimmune disease, which resembled graft-versus-host disease (GVHD). It is quite probable the auto-reactive lymphocytes, which were paradoxically elicited by the CsA during the reconstitution of the immune system, partly contributed to the occurrence of the other autoimmune disease, SSc. To our knowledge, this is the first description of a MS patient, having undergone CD34+-selected autologous HSCT followed by the administration of CsA, who subsequently developed SSc.