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.

Gas Gangrene Caused by Streptococcus anginosus / 대한내과학회지

Gas gangrene, a subset of necrotizing myositis, is a bacterial infection that produces gas in tissues in gangrene. It is usually caused by Clostridium species, most commonly Clostridium perfringens. Streptococcus anginosus is a rare cause of gas gangrene, with very few cases reported. We report a rare case of traumatic gas gangrene caused by S. anginosus in a 57-year-old female with diabetes after being stabbed with scissors.

A Delayed Fatal Septic Cerebral Infarction after Endoscopic Retrograde Cholangiopancreatography

Endoscopic retrograde cholangiopancreatography (ERCP)-related complications should be promptly and properly managed in accordance with the type and severity of the complication and the comorbidity of the patient. Neurologic complications occur very rarely, but despite of the prompt management, the patient status can severely deteriorate and sometimes result in fatality. A female patient visited SAM Medical Center for abdominal pain and yellow skin. She has taken a current medication for essential hypertension since 10 years ago. Initial laboratory findings showed obstructive jaundice and abdominal computed tomography (CT) showed two common bile duct stones with moderate dilation of bile duct. Her vital sign with oxygen saturation was stable until the first attack of seizure 12 hours later after removal of stones through the ERCP. Emergent brain CT and magnetic resonance imaging revealed multiple cerebral infarctions of both hemispheres with right predominance of middle cerebral artery territory and no evidence of air emboli. She died four days later despite of intensive care including high oxygen therapy and intravenous broad spectrum antibiotics with antiplatelet drug. We report a rare, delayed occurrence of a fatal multiple cerebral infarctions 12 hours after ERCP.

A Case Of Huge Brunner's Gland Adenoma With Acute Bleeding Treated By Endoscopic Resection / 고신대학교의과대학학술지

Brunner's gland adenoma is a rare benign small bowel neoplasm and it represents 10% of small bowel benign tumor. Most of adenoma manifest as polypoidal, multiple and size does not exceed 1 cm and mostly asymptomatic, but the lesion larger than 1cm is solitary and can cause bleeding, obstruction, intussusception and there are some reports of showing malignant transformation. Until the present, there are two cases of over cm huge Brunner's gland adenoma in Korea and each of their chief complaint was abdominal discomfort and melena, but there is no case report of over 8cm Brunner's gland adenoma accompanied with acute bleeding as seen in this case. We diagnosed an 8cm sized, huge duodenal Brunner's gland adenoma which accompanied with acute bleeding and treated it by endoscopic resection using an IT-knife, successfully.

A Case of Lupus Pneumonitis Therapy in a Patient with Acute Systemic Lupus Erythematosus / 대한내과학회지

Systemic lupus erythematosus is a connective tissue disease with multiple organ involvement due to atypical creation of an antibody to an intracellular component. Although it can directly invade respiratory organs, such as the pleura, pulmonary parenchyma, trachea, pulmonary vessels, and pulmonary muscle, pulmonary involvement is mostly secondary to infection after immunosuppressant use, and pulmonary parenchyma invasion due to an immune response is relatively rare. This is a case report of acute lupus pneumonitis in a patient with systemic lupus erythematosus who was successfully treated with steroid therapy.

A Case of Lupus Pneumonitis Therapy in a Patient with Acute Systemic Lupus Erythematosus / 대한내과학회지

Systemic lupus erythematosus is a connective tissue disease with multiple organ involvement due to atypical creation of an antibody to an intracellular component. Although it can directly invade respiratory organs, such as the pleura, pulmonary parenchyma, trachea, pulmonary vessels, and pulmonary muscle, pulmonary involvement is mostly secondary to infection after immunosuppressant use, and pulmonary parenchyma invasion due to an immune response is relatively rare. This is a case report of acute lupus pneumonitis in a patient with systemic lupus erythematosus who was successfully treated with steroid therapy.

A Case of Malignant Granular Cell Tumor in the Sigmoid Colon

Granular cell tumor (GCT) is an uncommon, usually benign neoplasm; however, a malignant potential has been described. Malignant GCT is an extremely rare neoplasm showing rapid growth and invasion into adjacent muscles, lymph nodes, or vessels, or even distant metastasis. We recently experienced a case of a histologically benign or atypical but clinically malignant GCT, with invasion of the lymph nodes and vessels in the sigmoid colon, diagnosed by segmental colon resection with lymph node dissection. We also performed a review of relevant medical literature.