Removal of a Trigger Cord Stuck between Bands during Endoscopic Multiple-Band Ligation for Treating Esophageal Variceal Hemorrhage

Endoscopic variceal ligation is the preferred endoscopic treatment method for esophageal variceal bleeding. The incidence of complications such as chest pain, bleeding, stricture formation, and aspiration pneumonia is low. We report a case wherein a malfunctioning multiple-band ligator could have potentially caused damage to the esophageal varices and massive bleeding. The equipment was safely removed using scissors and forceps. To the best of our knowledge, this is the first published report detailing the management of a case of esophageal variceal bleeding.

Optimal Therapeutic Options for Complex Walled-Off Necrosis: Endoscopic and Percutaneous Drainage / 대한췌담도학회지

Up to 15% of acute pancreatitis can develop to acute necrotizing pancreatitis characterized by necrosis of the pancreas parenchyma and/or the peripancreatic tissue. It is associated with high rates of morbidity and mortality compared to interstitial edematous pancreatitis. A collection of fluid and necrotic tissue is called acute necrotic collections (ANC) and may form an enhancing wall consisting of reactive tissue after 4 weeks, which is called walled-off necrosis (WON). ANC and WON could be either sterile or infected. WON is often complex and septated, and when it gets infected or causes other serious complications, drainage or resection is indicated. The traditional approach is to surgically remove all the infected necrotic tissue, but this invasive approach carries high rates of complications and death. The recent advance of percutaneous and/or endoscopic approaches has enabled a stepup method for the management of necrotizing pancreatitis. Herein, the authors focused on the endoscopic and percutaneous approaches for the care of patients with necrotizing pancreatitis.

Aseptic Meningitis and Acute Kidney Injury after Immunoglobulin Infusion in a Patient with Systemic Lupus Erythematosus and Immune Thrombocytopenic Purpura

A 36-yr-old woman with systemic lupus erythematosus was admitted in our center because of thrombocytopenia that was being treated with corticosteroids. She was prescribed a four-day course of intravenous immunoglobulin (IVIG) infusion. After three days of IVIG infusion, she developed aseptic meningitis with severe pleocytosis in the cerebrospinal fluid, followed by acute kidney injury. These complications resolved completely with conservative management. Here, we report these rare complications of IVIG and the outcome.

Differential Diagnosis of a Left Atrial Mass after Surgical Excision of Myxoma: a Remnant or a Thrombus?

Echocardiographic diagnosis of atrial myxoma may not always be straightforward, and the distinction between myxoma and thrombi is not easy, especially when we observe a mass after successful surgery. Our report describes a 72-year-old woman who presented with right upper limb hemiparesis and was subsequently diagnosed as having transient ischemic attack due to a left atrial myxoma. One month after successful surgical resection of the tumor, the patient developed left-sided weakness. Echocardiography revealed a left atrial mass attached to the interatrial septum. Intravenous heparin was administered as a therapeutic trial for postoperative thrombi, which resulted in a decrease in mass size within a week. Anticoagulation with warfarin was continued, and complete resolution was demonstrated on a 4-month follow-up transesophageal echocardiography. This case highlights the fact that thrombus formation at the surgical site should be considered an unusual but potential complication after surgical resection of left atrial myxomas.

A Fulminant Case of Clostridium perfringens Septic Shock caused by a Liver Abscess with Massive Hemolytic Anemia / 대한내과학회지

A 65-year-old female visited the emergency room for severe back pain radiating to the neck. Aortic dissection computed tomography revealed a ruptured liver abscess and large pneumoperitoneum. Although emergent percutaneous drainage of the liver abscess and aggressive resuscitation were performed, massive hemolytic anemia and disseminated intravascular hemolysis developed and she subsequently died, 11 hours after her visit to the emergency room. Clostridium perfringens was identified in a blood culture obtained at the emergency room. We report this case because refractory septic shock due to a liver abscess and massive intravascular hemolytic anemia caused by Clostridium perfringens in a healthy female is rare.