A Case of Anomalous Drainage of the Common Bile Duct into the Duodenal Bulb Presenting with Obstructive Jaundice / 대한소화기내시경학회지

The common bile duct classically enters the posteromedial aspect of the second part of the duodenum through an oblique, 1 to 2 cm long intramural tunnel. Some case reports of the common bile duct emptying into other sites including the fourth part of the duodenum, the pyloric canal, stomach and duodenal bulb have appeared in the literature. We report a case of a 40-year-old man who showed anomalous drainage of the common bile duct into the duodenal bulb presenting with obstructive jaundice and duodenal ulcer. This patient required choledochoenteric anastomosis to relieve obstructive jaundice and abdominal pain. We report the case with a review of other cases in Korean literature.

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.

Predictors of Outcome in Patients with Primary Achalasia Treated by Pneumatic Dilation / 대한소화기내시경학회지

BACKGROUND/AIMS: Pneumatic dilation is the most effective non-surgical treatment option for the patients with achalasia. The aim of this study was to determine the predictors of outcome after pnematic dilation in patients with primary achalasia. METHODS: Thrity-five patients with primary achalasia between May 1996 and April 2001 were included. They were divided into two groups; responder and nonresponder. Esophageal manometry, scintigraphy and barium esophagogram was performed before dilation and 4 weeks after dilation. RESULTS: Seven patients having symptomatic relapse were treated with repeated pneumatic dilation. Remaining 28 patients (83%) had no recurrence during follow-up period (mean duration 16 month, range 6~43 month). Among the factors evaluated in the initial examination, only young age affected outcome (p=0.039). The post treatment retention fraction at 5, 20 minutes were the most valuable factors for predicting the clinical response (p<0.05). CONCLUSIONS: Older patients are more likely to have sustained response. Radionuclide esophageal emptying test remains a useful objective study evaluating esophageal transit before and after pneumatic dilation in the patients with achalasia and may have an important role in the follow-up evaluation of treatment for achalasia.

A Case of Asymptomatic, Anicteric Early-stage Intrahepatic Ductal Cholangiocarcinoma / 대한소화기내시경학회지

Asymptomatic intrahepatic early-stage bile duct carcinoma without jaundice is difficult to diagnose because it does not have any characteristic clinical signs and symptoms. The clinical implication of early-stage intrahepatic ductal cholangiocarcinoma is great, because it allows curative resection and excellent long-term survival. Recently we experienced early-stage intrahepatic cholangiocarcinoma which was incidentally detected by a clue of elevated serum alkaline phosphatase and gamma-GT without jaundice and any symptoms. Abdominal US showed focal intrahepatic bile duct dilatation. ERCP could not demonstrate the lesion, while MRCP revealed the obstructed duct (S6) with proximal dilatation. For evaluation of a focal intrahepatic stricture, PTCS examination and biopsy were done. With the help of MRCP and PTCS, the lesion was diagnosed as papillary adenocarcinoma preoperatively. The patient was underwent right liver lobectomy and confirmed early-stage intrahepatic ductal adenocarcinoma and she is well-being without cancer recurrence for a follow-up period of 1 year.

A Case of Chylous Ascites Associated with Non-Hodgkin's Lymphoma and Liver Cirrhosis / 대한혈액학회지

Chylous effusion is an unusual complication of malignant neoplasm, usually lymphoma. In cases with cancer, the tumor was usually extensive, and the prognosis was invariably poor with a one year mortality rate of 80%. It was also reported that chylous effusion could also result from liver cirrhosis. The incidence of this complication was reported to be 0.5% in patients with liver cirrhosis and ascites. Here we report a case of 62 year old male with chronic alcoholism history who presented with abdom-inal distension and right cervical mass. He was subsequently diagnosed as non-Hodgkin's lymphoma and chylous ascites with liver cirrhosis and treated with chemotherapy. In spite of treatment, lymphoma progressed and the patient expired.