A case of ciliated hepatic foregut cyst treated by laparoscopic excision / 대한내과학회지

Ciliated hepatic foregut cysts are uncommon lesions of the liver. They arise from remnants of the embryonic foregut, and are usually asymptomatic and benign. They are lined with a layer of ciliated columnar cells and contain mucoid material and debris. Ciliated hepatic foregut cysts are not malignant neoplasms and must be differentiated from cystic neoplasms and hypovascular solid tumors. We experienced a case of ciliated hepatic foregut cyst, which was successfully removed by laparoscopic excision, so we report the case with review of the literature.

A Case of Mucosa-Associated Lymphoid Tissue Lymphoma of Colon as Multiple Large Polypoid Lesions / 대한소화기내시경학회지

Mucosa-associated lymphoid tissue (MALT) lymphoma of colon usually presents with a solitary lesion of polypoid appearance but may rarely present with multiple polypoid lesions. MALT lymphoma of colon presented as multiple polypoid lesions are not easy to differentiate from multiple lymphomatous polyposis. We experienced a case of MALT lymphoma of colon with a large mass in proximal ascending colon involving ileocecal valve and multiple polypoid lesions in entire colon.

Bronchobiliary Fistula as a Late Complication of Hepatic Resection / 대한소화기내시경학회지

A bronchobiliary fistula (BBF), which is defined by an abnormal communication between the biliary system and the bronchial tree, is an uncommon complication after hemihepatectomy, trauma, hydatid disease, choledocholithiasis, and other causes of biliary obstruction. BBF are rare complication of hepatic resection that can present from days to years after operation. Management of fistula is often very difficult and can be associated with high morbidity and mortality rates. Early recognition and proper management are essential to avoid a fatal outcome. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC) are the diagnostic studies of choice and offer the possibility of therapeutic intervention. Although large series in the literature emphasize the surgical management of BBF, the reoperative procedures tend to be complicated, with a significant morbidity and mortality. Nonsurgical intervention via ERCP or PTC are more recently notably successful when resolution of a distal biliary obstruction is accomplished. Only after aggressive attempts at nonoperative, interventional techniques have failed should operative approaches be entertained. We are reporting a case of BBF secondary to hepatic resection of hepatocellular carcinoma which was managed by surgical operation.

The Efficacy of Intraluminal Radiotherapy after Metallie Stent Insertion in Malignant Biliary Tract Obstruction / 대한소화기내시경학회지

BACKGROUND/AIMS: Inoperable malignant biliary tract obstructions (MBTO) are best palliated by drainage procedures followed by radiation therapy. In order to administer high doses in a short time to the central part of the tumor, internal radiotherapy has been proposed for a palliative goa1. The aim of this study is to investigate the effect of intraluminal radiotherapy (ILRT) to the stent patency and patients survival time after expandable metallic stent insertion in MBTO. METHODS: Between August 1996 and July 1998, 28 patients (17 females, 11 males, average age 61.4 years) with inoperable MBTO were provided with percutaneous transhepatic biliary drainage (12 patients; bile duct cancer, 8 patients; pancreatic head cancer, 4 patients; gallbladder cancer; 4 patients; lymph node metastasis from stomach cancer). The 14 patients were treated by only metallic stent. The other 14 patients were treated by metallic stent insertion and followed by ILRT. The ILRT was done by iridium-192 (mean dosage 23.3 Gray, 5 fractions). RESULTS: There were no significant differences in the two groups regarding age, sex, type of disease, and location of the obstruction. The patients tolerated ILRT well. CONCLUSIONS: The ILRT after expandable metallic stent was safe and effective in stent patency and the patient's surviva1 time in inopcrable MBTO.

A Case of Esophagopleural Fistula Treated by Endoscopic Injection of Histoacryl in Boerhaave's Syndrome / 대한소화기내시경학회지

Boerhaave's syndrome is a spontaneous tear through all the layers of the left lateral wall of the esophagus just above the diaphragm, produced by a sudden increase in esophageal pressure. Boerhaave's syndrome is a rare but grave syndrome, with a mortality rate around 40%. Most affected patients are middle-aged men who experience violent vomiting after heavy eating or alcohol intake or both. Vomiting followed by the abrupt onset of pain, dyspnea, and/or shock are the major symptoms. The most important diagnostic tool may be an upright chest X-ray. However, esophagograms and/or a chest CT may be required to locate the lesion. The management of esophagopleural fistula must be individualized, and both the patient's condition and the specific characteristics of the fistula must be considered. Successful management of patients must include adequate nutritional support and effective therapy of the associated empyema. A case of esophagopleural fistula complicated by Boerhaave's syndrome, which was successfully treated by endoscopic injection of Histoacryl , in herein reported.

A case of sclerosing hepatocellular carcinoma with hypercalcemia treated with transcatheter arterial chemoembolization / 대한내과학회지

The sclerosing hepatocellular carcinoma is a histopathologically unusual subtype of primary hepatocellular carcinoma characterized by intense fibrous stroma in which the tubular neoplastic structures are embedded. It has been reported that hypercalcemia is much more frequently associated up to 69% in this subtype than in other subtypes of primary hepatocellular carcinoma. As we know, uncontrolled hypercalcemia may result in fatal outcome, and it was reported that hypercalcemia associated with hepatocellular carcinoma could be controlled with the resection of the tumor when it was possible. We report a case of sclerosing hepatocellular carcinoma with hypercalcemia in which the hypercalcemia was controlled with transcatheter arterial chemoembolization (TACE).

Two Cases of Henoch-Sch nlein Purpura Complicated by Gastrointestinal Bleeding / 대한소화기내시경학회지

In the course of Henoch-Sch nlein purpura, diverse gastrointestinal manifestations are common. Two cases of Henoch-Sch nlein purpura complicated by upper and lower gastrointestinal bleeding is herein reported. For both patients, peculiar endoscopic pictures revealed, severe ulcerations and frank bleeding. A biopsy showed typical leukocytoclastic vasculitis which were the same as with the skin biopsy. The endoscopic finding was determined not to be pathognomonic, but instead characteristic of Henoch-Sch nlein purpura. Therefore, an endoscopy can be useful in the diagnosis of Henoch-Sch nlein purpura, especially for those patients without a typical skin rash.

Gastric malignant stromal tumor with long stalk impacted into duodenum

Most GIST have traditionally been classified as submucosal origin by upper gastrointestinal series (UGIS) or endoscopy. However, we experienced a gastrointestinal mesenchymal origin tumor expressed by polypoid mass with a long stalk. The gastric outlet was obstructed by the polypoid mass on the duodenum. The microscopic findings of the resected mass showed a stromal cell component by immunohistochemical stain. We experienced gastric stromal tumor found as a polypoid mass with long stalk which was easily detected by endoscopy. It would not have been suspected as a stromal tumor as a result of endoscopic findings only.

2 Cases of Transcatheter Embolization Therapy of Massive Lower Gastrointestinal Bleeding due to Typhoid Fever / 대한내과학회지

Typhoid fever is still endemic in developing countries and the cause of much morbidity and mortality. Complications such as intestinal hemorrhage, intestinal perforation, hepatitis, pyelonephritis, cholecystitis, osteomyelitis are known to occur. The classical approach to management of intestinal hemorrhage due to typhoid ulceration has been conservative. In, however, the event of massive, persistent and life-threatening hemorrhage not responding to conservative measures, early surgical intervention is life-saving. But surgical intervention is difficult due to multiple bleeding sites and friable distal ileum and colon. These two cases are reported in order to draw attention to the usefulness of mesenteric arteriography and the effectiveness of transcatheter embolization therapy in massive intestinal hemorrhage due to typhoid fever.

Subcutaneous Implantation Metastasis of a Cholangiocarcinoma of the Bile Duct after Percutaneous Transhepatic Biliary Drainage (PTBD) / 대한소화기내시경학회지

Percutaneous transhepatic biliary catheterization (PTC) has not only been increasingly used in the localization of benign and malignant lesions, but it is also considered rapid, safe and effective method to establish internal and external drainage for decompression of biliary obstructions. Infections and granulomas at the catheter entry site can occasionally develop, but are easily managed. However, such technique, when used both for obtaining malignant cells for diagnosis and for percutaneous decompression of the biliary tract can exposure the patient at risk for dissemination of the tumor along the catheter tract. This rare complication has been observed in a patient who underwent percutaneous transhepatic biliary drainage (PTBD) for malignant biliary tract obstruction. Although tumor cell seeding along the catheter tract is a very rare complication, we think that PTBD should be avoided when curative resection is planned.

Duodenal Variceal Bleeding Treated with a Transjugular Intrahepatic Portosystemic Shunt / 대한소화기내시경학회지

Most cases of upper gastrointestinal bleeding in patients with portal hypertension are caused by esophagogastric varices. Less often, bleeding originates in varices located elsewhere. If ectopic varices are found, the same hemostatic technique tend to be used. However, there is no evidence that such techniques are useful in these cases. Duodenal varices are quite common, although they rarely bleed due to their location deep in the duodenal wall. Consequently, if emergency endoscopy is not conducted, hemorrhage may be wrongfully attributed to coexisting esophagogastric varices in a patient with portal hypertension without active bleeding. Hemorrhage from duodenal varices may be severe and life threatening. We report a patient with portal hypertension and bleeding duodenal varices caused by cirrhosis of the liver. Hemorrhage was subsequently controlled by placement of a transjugular intrahepatic portosystemic shunt. We recommend that in patients with life-threatening hemorrhage from duodenal varices caused by cirrhosis of the liver, transjugular intrahepatic portosystemic shunt (TIPS) be considered in the man-agement.

Pancreatic Pseudocyst Causing Gastrointestinal Hemorrhage (Hemosuccus pancreaticus) / 대한소화기내시경학회지

Hemorrhage into a pancreatic pseudocyst is a rare, but increasingly recognized as a cause of massive gastrointestial bleeding. Bleeding pseudocysts may rupture into the stomach, duodenum, common bile duct, and splenic vein, or can be decompressed via the duct of Wirsung. Also it will result in upper gastrointestinal bleeding. This represents a life-threatening and frequently unrecognized complication of pancreatic disease. Proper diagnostic workup and prompt surgical management afford the patient the best chance for survival. We report a patient with pseudocyst bleeding into the gastrointestinal tract via the duct of Wirsung and discuss the current diagnostic and therapeutic approach.

Computed Tomography of Catamenial Hemoptysis / 결핵

A 41-year-old female was admitted to our hospital for self-audible wheezing sound and dyspnea. On past history, she has been suffered from chest discomfort, and treated recurrently by other hospitals. But, there was no symptomatic improvement. A stridor and mixed wheezing sound was auscultated on whole lung field. PFT revealed fixed type or variable intra- & extra-thoracic air way obstructive pattern. By bronchoscopy & bronchogram, we found web-like structure on the distal trachea. A bronchoplasty was performed and the post-operative PFT showed slight improvement & she had no more complaints.