Endovascular Treatment of an Abdominal Aortic Pseudoaneurysm in a Patient with Behcet's Disease / 대한내과학회지

Behcet's disease shows systemic involvement, including mucocutaneus, ophthalmical, neurological, pulmonary, gastrointestinal, urogenital, mucoskeletal, and cardiovascular disorders. Aneurysmal changes develop in 65% of patients with arterial involvement and are associated with a poor prognosis. Although many attempts have been made to surgically manage these serious arterial lesions, several reports have shown a high recurrence rate and operation-related complications. Stent-graft placement has been indicated for the treatment of pseudoaneurysms and aneurysms in patients with a high surgical risk, including those with Behcet's disease. We herein describe an abdominal aortic pseudoaneurysm in a patient with Behcet's disease that was successfully treated with stent-graft insertion without an endoleak after 36 months of follow-up.

Complicated Acute Aortic Dissection with Malperfusion of the Left Common Iliac Artery Treated with Thoracic Endovascular Aortic Repair / 대한내과학회지

Acute aortic dissection with malperfusion syndrome is associated with poor clinical outcomes, and surgical treatment for complicated descending aortic dissections is associated with a high risk of operative mortality. Endovascular repair is emerging as a good alternative to surgery. Endovascular repair for a descending aortic dissection with malperfusion syndrome offers good clinical outcomes because of technical and anatomical benefits. Here, we report a case of descending aortic dissection and malperfusion syndrome in the left common iliac artery that was successfully treated with an aortic stent graft and peripheral stent.

Acute Ectopic Pancreatitis Occurring after Endoscopic Biopsy in a Gastric Ectopic Pancreas

Ectopic pancreas is a congenital anomaly and the most common type of ectopic tissue in the gastrointestinal tract. Most patients with an ectopic pancreas are asymptomatic and rarely have complications. Ectopic pancreatitis after an endoscopic biopsy has not been reported. We report a patient who developed acute ectopic pancreatitis in the stomach after an endoscopic biopsy. A 71-year-old male patient presented with a subepithelial tumor (SET) in the stomach and had no symptoms. Endoscopic ultrasonography demonstrated a 30-mm hypoechoic mural mass, lobulated margins, and anechoic duct-like lesions. To obtain proper tissue specimen, endoscopic biopsy was performed through the opening on the surface of the mass. The pathologic results confirmed an ectopic pancreas. One day after the endoscopic biopsy, he developed persistent epigastric pain. His serum amylase and lipase elevated. Computed tomography of the abdomen showed swelling of the SET and diffuse edema of the gastric wall. His condition was diagnosed as acute ectopic pancreatitis occurring after endoscopic biopsy.

Hybrid Treatment of an Aortic Arch Aneurysm with an Aberrant Right Subclavian Artery / 대한내과학회지

Aberrant right subclavian artery (ARSA) is a rare congenital anomaly but is the most common of the congenital vascular anomalies of the aortic arch. We report the case of a 68-year-old female undergoing chemotherapy for multiple myeloma who had a large thoracic aortic aneurysm (7.4 cm) with ARSA. She was treated with a hybrid procedure that combined a left common carotid-to-subclavian artery bypass with a "thoracic endovascular aortic repair (TEVAR)" because of the risk associated with a thoracotomy. A stent graft was deployed in the proximal part of the descending aorta to cover the thoracic aortic aneurysm after a left common carotid-to-subclavian bypass was made to restore blood flow in the left arm. There was no endoleak on digital subtraction angiography. Hybrid therapy can be performed successfully for the treatment of thoracic aortic aneurysm with ARSA.

A Case of Squamous Metaplasia of the Stomach

Intestinal metaplasia of the stomach is a common metaplastic lesion associated with chronic gastritis and mucosal atrophy. However, squamous metaplasia is a comparatively rare condition. On endoscopy, squamous metaplasia is usually observed as a whitish mucosal lesion in the lesser curvature of the cardiac region of the stomach. When Lugol's iodine solution is applied, the lesion stains brown in the same way as normal esophageal mucosa. We report a case of 79-year-old man with a whitish flat lesion in the lesser curvature of the cardiac region on surveillance endoscopy after endoscopic treatment of gastric adenoma. The endoscopic biopsy showed stratified squamous epithelial mucosa.