Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion

Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

A Case of Rectal Ulcer Bleeding Caused by Garlic Inserted into the Rectum

Lower gastrointestinal bleeding can be caused by various etiologies including hemorrhoids, diverticulitis, neoplasms, and ulcerative colitis. However, a rectal ulcer is rarely caused by lower gastrointestinal bleeding, and an anorectal foreign body is a very rare cause of a rectal ulcer. We report the case of a 48-year-old male patient who presented to the emergency department with massive hematochezia and hypovolemic shock that occurred 5 days after inserting garlic into the rectum for treatment of benign prostate hyperplasia.

Hepatocolic Fistula after Radiofrequency Ablation for Hepatocellular Carcinoma / 대한내과학회지

Radiofrequency ablation (RFA) is a relatively safe therapy for patients with hepatocellular carcinoma (HCC); however, complications are not unknown. A hepatocolic fistula is a rare complication after RFA. We report a case of a hepatocolic fistula following a liver abscess after RFA for HCC in a 58-year-old male. The patient was diagnosed with HCC and liver cirrhosis from hepatitis B infection 3 years prior to admission. The HCC was in segment 6 of the liver and was treated with transarterial chemoembolization and RFA. One month after the second RFA, he was diagnosed with a liver abscess, for which he was treated with antibiotics for 2 months, but continued to have intermittent fever and chills. We made a diagnosis of hepatocolic fistula using colonoscopy, fluoroscopy, and liver dynamic computed tomography. The patient underwent a surgical procedure after antibiotic therapy. Although a hepatocolic fistula is a rare complication following RFA, clinicians should be aware of its existence.

A Case of Thyroid Storm with Delayed Diagnosis in Old Aged Person with Parkinson's Disease

A thyroid storm is a potentially fatal complication of hyperthyroidism. Early diagnosis and treatment is essential for reducing morbidity and mortality. Older patients with hyperthyroidism tend to have fewer hypermetabolic signs and increased signs of weight loss, depression, lethargy, cardiac arrhythmia, and apathetic mood. Additionally, comorbid diseases and drug history can affect thyroid function and symptoms. Here, we report an older patient with a thyroid storm and accompanied features of Parkinson's disease. She presented with generalized weakness, delirium, and anxiety. Laboratory findings were consistent with hyperthyroidism. She became drowsy with no precipitating factors. High fever, meningism, and atrial fibrilation occurred with no obvious sources. Suspecting a diagnosis of a thyroid storm, she was treated with an antithyroid drug, Lugol's solution, hydrocortisone, and supportive management. After these treatments, her clinical condition recovered and the neurological signs resolved.

A Case of Pulmonary Artery Endarteritis due to Staphylococcus lugdunensis in Patient with Clinically Silent Patent Ductus Arteriosus / 이화의대지

Staphylococcus lugdunensis (S. lugdunensis) is an unusually virulent coagulase-negative staphylococci (CNS) and uncommon cause of infective endocarditis (IE) involving mainly native left sided valves. S. lugdunensis IE, which was described previously as "surreptitious" and "wolf in sheep's clothing", runs an aggressive course with a high rate of severe in-hospital complications. Therefore, early surgical treatment has been considered for the treatment of S. lugdunensis IE. However, we experienced a case of S. lugdunensis pulmonary endarteritis which was cured with antibiotic therapy alone.

A case of probable endotipsitis after transjugular intrahepatic portasystemic shunt / 대한내과학회지

Transjugular intrahepatic portasystemic shunt (TIPS) is a procedure that inserts an expandable metallic stent into the liver parenchyme by transjugular catheterization. During the past decade, TIPS has been accepted as an alternative to the surgical shunt procedure for controlling the complications of portal hypertension and has become more widely performed. Complications of TIPS include encephalopathy, bleeding, deterioration of liver function and infection. Although periprocedual sepsis has been known since the early days of TIPS stenting, infection by the TIPS device itself has only recently been recognized because of its rare occurrence. The definition of endotipsitis makes it possible to classify it into two groups: definite and probable infection. We report a case of probable endotipsitis with relapsing bacteremia after TIPS for uncontrolled varix bleeding. If relapsing bacteremia without any other clearly attributable source occurs in a patient with TIPS, the possibility of endotipsitis is considered.

A Case of Broncho-esophageal Fistula Treated by Histoacryl(R) Injection Therapy / 대한소화기내시경학회지

Broncho-esophageal fistula is a disease of varying etiologies. Spontaneous fistula occurs as a result of malignancy, radiotherapy or inflammatory disease. The majority of fistulas are caused by iatrogenic causes. Treatment of fistula usually consists of surgery and conservative management. Recently, it has been reported that broncho-esophageal fistula can be treated endoscopically using tissue adhesive agent such as Histoacryl(R) and fibrin glue. We report a case of broncho-esophageal fistula as a complication of tuberculosis that was successfully treated by radiological Histoacryl(R) injection therapy with a review of literatures.

A Case of Henoch-Schonlein Purpura Complicated by Hemorrhagic Ascites / 대한류마티스학회지

Henoch-Schonlein purpura (HSP) is a systemic vasculitis with IgA dominant immune complex deposits affecting small vessels in the skin, joint, gastrointestinal tract, and kidneys. Gastrointestinal symptoms are common and may precede the appearance of characteristic skin rash. These manifestations include abdominal pain, bleeding, bowel infarction, intussusception, or even, perforation. However, hemorrhagic ascites has been rarely described in patients with HSP. The pathophysiologic mechanism is presumably a vasculitis of the small vessels within the serosa. We report a 37-year-old man with HSP complicated by hemorrhagic ascites. Contrast CT of the abdomen showed extensive bowel wall thickening and ascites. A paracentesis yielded hemorrhagic fluid. These abdominal manifestations were improved after methylprednisolone pulse therapy.

Effects of Leukotriene D4 on Ultrastructure of Nasal Mucous Membrane in Guinea Pigs / 대한이비인후과학회지

The aim of this study was to evaluate effects of leukotriene D4(LTD4) on the nasal airway. Fifteen guinea pigs were divided into two groups;10 for experimental group and 5 for control group. Two l of 10(-5)mol LTD4 was administered to both nasal cavities in experimental group and same volume of normal saline in control group. Transmission electron microscopy was performed to investigate ultrastructural change of the nasal mucosal membrane in LTD4 administered guinea pigs. Infiltration of neutrophils and eosinophils from the capillaries were seen in the perivascular space. In the capillaries, some endothelial cells degenerated and intercellular spaces of the cells were widened, especially 6 hours later. Degranulated mast cells and neutrophils were found in the lumen of the capillaries. Several red blood cells with low electron density were seen in the shrunken vessels. The giant mitochondriae with inclusion bodies were observed. The results of this study suggest that leukotriene may be a potent mediator to induce biphasic response in the nasal passage of guinea pigs.

Comparison of skin test and RAST in patients with allergic rhinitis / 대한이비인후과학회지

No abstract available.