A case of obstructive jaundice due to limy bile in the cystic and common bile ducts / 대한내과학회지

Limy bile is a rare condition characterized by excessive precipitation of calcium carbonate in the gallbladder; limy bile in the common bile duct is also very rare. Limy bile was first described by Churchman in 1911. The etiology of limy bile is unclear, but complete cystic duct obstruction by gallstones is believed to be a prerequisite for the development of limy bile. Recently, we experienced a case with obstructive jaundice in which the initial simple radiograph showed limy bile in the cystic and common bile ducts, but not the gallbladder. Here, we report the case and review the literature.

A Bezoar That Caused Afferent Loop Syndrome and Pancreatitis / 대한소화기내시경학회지

Bezoars are conglomerates of nondigestible matter in the gastrointestinal tract that may or may not be accompanied by gastrointestinal manifestations. Bezoars develop in patients with previous gastric surgery or in those patients with delayed gastric emptying that is due to gastroparesis caused by hypothyroidism or diabetes mellitus. Small bowel obstruction due to a gastric bezoar is rare, but it can lead to severe complications such as intestinal perforation, compression necrosis etc. A female patient came to our department complaining of upper abdominal pain and she was diagnosed as having a bezoar that was causing afferent loop syndrome and pancreatitis. We attempted to manage the patient by inserting a nasogastric tube, performing gastrofibroscopy and implementing percutaneous transhepatic biliary drainage, but the patient's condition worsened and deteriorated into a septic condition. An operation was planned, but the patient showed improvement owing to the migration of the bezoar. Herein, we report on a case of afferent loop syndrome due to bezoar and this was complicated by acute pancreatitis.

A Case of a Submucosal Ganglioneuroma of the Ampulla of Vater That Was Treated by Endoscopic Resection / 대한소화기내시경학회지

Submucosal tumors in the gastrointestinal tract are covered with a mucous membrane such as the surrounding tissue. Therefore, the use of endoscopic biopsy to diagnose submucosal tumors is not as effective as that for epithelial tumors. Although imaging tools such as ultrasonography or computed tomography have made great advances, it is still difficult to diagnose submucosal tumors before resection. The surgical resection of tumors is the most accurate diagnostic method, yet less invasive endoscopic resection has been preferred in recent years. We report herein on a rare case of ganglionueroma arising from the Ampulla of Vater and this lesion was incidentally found during performance of routine esohagogastroduodenoscopy. The lesion was diagnosed as a ganglioneuroma, and it was successfully removed through endoscopic resection.

A Case of Duodenobiliary Fistula Caused by a Metal Stent in a Patient with Hepatocellular Carcinoma / 대한소화기내시경학회지

Biliary drainage can improve the quality of life in a patient with obstructive jaundice caused by malignancy. Biliary metal stent insertion is a very useful method because it drains the bile physiologically and patients have little discomfort with the procedure. It has a few complications such as restenosis, liver perforation, bowel perforation, fistula formation and stent dislocation. Perforation and fistula formation are caused by pressure due to the self expanding characteristics of the metal stent. We report here on a case of duodenobiliary fistula that was caused by a biliary metal stent in a patient suffering with hepatocellula carcinoma, and we also include a review of the relevant literature.