The outcome of endoscopic management of bile leakage after hepatobiliary surgery

BACKGROUND/AIMS: Despite improvements in surgical techniques and postoperative patient care, bile leakage can occur after hepatobiliary surgery and may lead to serious complications. The aim of this retrospective study was to evaluate the efficacy of endoscopic treatment of bile leakage after hepatobiliary surgery. METHODS: The medical records of 20 patients who underwent endoscopic retrograde cholangiopancreatography because of bile leakage after hepatobiliary surgery from August 2009 to September 2014 were reviewed retrospectively. Endoscopic treatment included insertion of an endoscopic retrograde biliary drainage stent after endoscopic sphincterotomy. RESULTS: Most cases of bile leakage presented as percutaneous bile drainage through a Jackson-Pratt bag (75%), followed by abdominal pain (20%). The sites of bile leaks were the cystic duct stump in 10 patients, intrahepatic ducts in five, liver beds in three, common hepatic duct in one, and common bile duct in one. Of the three cases of bile leakage combined with bile duct stricture, one patient had severe bile duct obstruction, and the others had mild strictures. Five cases of bile leakage also exhibited common bile duct stones. Concerning endoscopic modalities, endoscopic therapy for bile leakage was successful in 19 patients (95%). One patient experienced endoscopic failure because of an operation-induced bile duct deformity. One patient developed guidewire-induced microperforation during cannulation, which recovered with conservative treatment. One patient developed recurrent bile leakage, which required additional biliary stenting with sphincterotomy. CONCLUSIONS: The endoscopic approach should be considered a first-line modality for the diagnosis and treatment of bile leakage after hepatobiliary surgery.

Two Cases of Rhinocerebral Mucormycosis

Mucormycosis is a rare opportunistic fungal infection. The most common infection site is the paranasal sinuses, although it can also occur in the lungs and skin. The fungus adheres to tissue membranes and forms thrombi, causing ischemia and hemorrhagic necrosis. Rhinocerebralmucormycosiscan occurin the nose, but mightrapidly spread to the orbit and intracranium. Therefore, prompt and aggressive treatment is required. However, because of its low incidence, few reported cases have focused on accompanying disease, proper treatment period, and disease progression. Herein, we report two cases of rhinocerebralmucormycosiswith a brief literature review.

Hodgkin's Lymphoma after Autologous Hematopoietic Stem Cell Transplantation for Angioimmunoblastic T-cell Lymphoma / 대한내과학회지

Post-transplantation lymphoproliferative disorder (PTLD) is a serious complication that can develop after either solid organ or hematopoietic stem cell transplantation (HSCT). The incidence of Hodgkin's lymphoma (HL) ranges from 0.5-1.0% of PTLD after HSCT without T-cell depletion. Here, we report a case of HL-PTLD that occurred after autologous peripheral blood stem cell transplantation for an angioimmunoblastic T-cell lymphoma (AITL). A 36-year-old patient developed fever and chills with multiple lymphadenopathies at day 673 after auto-HSCT for AITL. Three months after the transplant, the patient developed fever with elevated plasma Epstein-Barr virus (EBV)-PCR values. The excisional biopsy revealed HL at Ann Arbor stage IIIB. A total of 8 cycles of chemotherapy with ABVD please define were performed, and the patient has remained disease-free. To our knowledge, this is first case report of HL-PTLD after auto-PBSCT in Korea.

Pulmonary Cryptococcosis in a Patient with Ankylosing Spondylitis treated with Etanercept

Ankylosing spondylitis (AS) is a chronic inflammatory disorder, commonly characterized by inflammation of axial skeleton and development of enthesopathies. Tumor necrosis factor inhibitors (TNFi) shows good therapeutic responses in AS patients without good response to non-steroidal anti-inflammatory drugs. Although TNFi are relatively safe for AS patients, serious opportunistic infections, including tuberculosis and fungal infection, could develop. Here, according to our knowledge, we report a first Korean case of pulmonary cryptococcosis in a patient with AS treated with etanercept. A 64 year-old man with AS visited due to a newly appeared pulmonary nodule on a routine chest radiography. He had been administered etanercept for 5 months. Histologic findings of the lung nodule showed characteristic features of cryptococcosis. Etanercept was discontinued and oral fluconazole was administrated, as there was no evidence of central nervous system involvement. After 7 months of treatment, chest CT showed an improvement of the pulmonary lesion.

Muscle Weakness in a Patient with History of Poliomyelitis: A Differential Diagnosis for Post-polio Syndrome (PPS) and Dermatomyositis

Dermatomyositis (DM) is an idiopathic inflammatory myopathy, characterized by inflammation of the proximal skeletal muscles and typical skin manifestations, which results in symmetric muscle weakness. A 43-year-old man was presented with skin rash and left leg weakness, and he had a history of poliomyelitis. Initially, he was diagnosed as having post-polio syndrome (PPS) due to unilateral muscle weakness and a result of an the electromyography (EMG), which had shown patterns of PPS. After 4 months with conservative therapy for PPS, weakness of bilateral upper arms had developed and skin rashes on his entire body had aggravated and progressed. He was diagnosed as having dermatomyositis, based on elevated muscle enzyme levels, typical skin rashes, and typical EMG findings, which indicated muscle disease. When a patient with previous poliomyelitis has a newly developed muscle weakness or pain, we should consider various possible causes other than PPS.