Relapsed Esophageal Web in a Patient with Plummer-Vinson Syndrome

Plummer-Vinson syndrome is characterized by dysphagia, iron deficiency anemia, and upper esophageal web. The associated symptoms can be resolved by administering iron supplements as well as by endoscopic intervention. Relapse in patients with Plummer-Vinson syndrome is very rare. We describe a case of a 42-year-old woman with Plummer-Vinson syndrome whose symptoms were successfully treated with endoscopic dilatation and iron supplementation at first admission; however, 1 year later, she revisited our hospital because of dysphagia. On second admission, investigations revealed esophageal web relapse in Plummer-Vinson syndrome. She was again successfully treated with endoscopic dilatation and iron supplementation. After first admission, her anemia was not normalized due to poor compliance and loss of follow-up. We experienced a case of esophageal web relapse due to uncorrected iron deficiency anemia in a patient with Plummer-Vinson syndrome. This experience indicates that continuous iron supplementation and long-term follow-up is important in patients with Plummer-Vinson syndrome.

Relapsed Esophageal Web in a Patient with Plummer-Vinson Syndrome

Plummer-Vinson syndrome is characterized by dysphagia, iron deficiency anemia, and upper esophageal web. The associated symptoms can be resolved by administering iron supplements as well as by endoscopic intervention. Relapse in patients with Plummer-Vinson syndrome is very rare. We describe a case of a 42-year-old woman with Plummer-Vinson syndrome whose symptoms were successfully treated with endoscopic dilatation and iron supplementation at first admission; however, 1 year later, she revisited our hospital because of dysphagia. On second admission, investigations revealed esophageal web relapse in Plummer-Vinson syndrome. She was again successfully treated with endoscopic dilatation and iron supplementation. After first admission, her anemia was not normalized due to poor compliance and loss of follow-up. We experienced a case of esophageal web relapse due to uncorrected iron deficiency anemia in a patient with Plummer-Vinson syndrome. This experience indicates that continuous iron supplementation and long-term follow-up is important in patients with Plummer-Vinson syndrome.

A Case of a Jejunal Ectopic Pancreas Presenting as Obscure Gastrointestinal Bleeding / 대한소화기학회지

A jejunal ectopic pancreas, where pancreatic tissue is found outside of the usual anatomical location, is a rare submucosal tumor that may cause obscure gastrointestinal (GI) bleeding. After initial negative endoscopic evaluation of the obscure GI bleeding, including colonoscopy and/or upper endoscopy, it is reasonable to proceed with further evaluation of the small bowel. Diagnostic options for the evaluation of the small bowel may include capsule endoscopy, push enteroscopy, or barium contrast small bowel studies. Here, we report a case of obscure GI bleeding caused by a jejunal ectopic pancreas, diagnosed through capsule endoscopy and barium contrast small bowel studies, which was treated successfully with single incision access laparoscopy.

Usefulness of SPAIR Image, Fracture Line and the Adjacent Discs Change on Magnetic Resonance Image in the Acute Osteoporotic Compression Fracture

OBJECTIVE: Osteoporotic compression fracture is an increasing issue in this community and its diagnosis depends on the magnetic resonance images (MRI). Although T1- and T2-weighted images (T1WI and T2WI) have high sensitivity and specificity, the fat suppression technique gives more clear delineation of this abnormalities. Accordingly, we re-evaluated its exact sensitivity and specificity for the imaging diagnosis of osteoporotic compression fractures in our cases. For additional information about the osteoporotic compression fractures, we evaluate the fracture lines, fluid sign and adjacent discs change on the MRI. METHODS: Retrospectively, total 85 patients who had been diagnosed with acute osteoporotic compression fracture were enrolled. They all had been underwent MRI including T1WI, T2WI and T2- Spectral Adiabatic Inversion Recovery (SPAIR) sequence. RESULTS: In this study, the incidence of high signal intensity on T2-SPAIR image was very high (0.9917). The fluid sign was seen in 56.7% on the SPAIR image. The fracture lines were more observed on the T2WI than T1WI (p=0.0062). The adjacent discs change on T2WI and T2-SPAIR image were higher than T1WI (p<0.001). CONCLUSION: For the acute osteoporotic compression fracture, T2-SPAIR image is the most specific sequence of the all sequences. The fluid sign is another suggestive finding when considered other studies. T2WI is more useful to find the fracture line than T1WI. Abnormal signal intensity on the adjacent discs may provide additional information for the acute osteoporotic compression fractures.

Cavernous Hemangioma Occurred Between the Trapezius and Splenius Capitis Muscle

Hemangiomas are the most common benign tumor of soft tissue. They are frequently seen on the trunk and extremities. In addition, most of them exist at the skin and subcutaneous layer, but fewer than 1% does in the intramuscular layer. For the diagnostic images of the intramuscular cavernous hemangioma, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are used currently. Multiple therapeutic methods are used, but surgical excision is considered as the most ideal treatment. We describe the recurred cavernous hemangioma occurred between the trapezius and splenius capitis muscle. The mass was well demarcated but scattered and infiltrated into the adjacent muscle layer, therefore, extensive resection was unavoidable. When determining a treatment regime for the hemangioma, it is essential to consider the size of the mass, cosmetic and functional aspects of the patient.

Cavernous Hemangioma Occurred Between the Trapezius and Splenius Capitis Muscle

Hemangiomas are the most common benign tumor of soft tissue. They are frequently seen on the trunk and extremities. In addition, most of them exist at the skin and subcutaneous layer, but fewer than 1% does in the intramuscular layer. For the diagnostic images of the intramuscular cavernous hemangioma, ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are used currently. Multiple therapeutic methods are used, but surgical excision is considered as the most ideal treatment. We describe the recurred cavernous hemangioma occurred between the trapezius and splenius capitis muscle. The mass was well demarcated but scattered and infiltrated into the adjacent muscle layer, therefore, extensive resection was unavoidable. When determining a treatment regime for the hemangioma, it is essential to consider the size of the mass, cosmetic and functional aspects of the patient.

Pneumopericardium as a Complication of Pericardiocentesis

Pneumopericardium is a rare complication of pericardiocentesis, occurring either as a result of direct pleuro-pericardial communication or a leaky drainage system. Air-fluid level surrounding the heart shadow within the pericardium on a chest X-ray is an early observation at diagnosis. This clinical measurement and process is variable, depending on the hemodynamic status of the patient. The development of a cardiac tamponade is a serious complication, necessitating prompt recognition and treatment. We recently observed a case of pneumopericardium after a therapeutic pericardiocentesis in a 20-year-old man with tuberculous pericardial effusion.

A Bowel Perforation That Developed during the Transanal Extraction of a Large Rectal Foreign Body / 대한소화기내시경학회지

Rectal foreign bodies are rare clinical problem in South Korea. Although many foreign bodies can be extracted safely using endoscopic procedures, some patients require surgery. Here we describe the case of a 35-year-old male who presented with a rectosigmoid foreign body, a large carrot measuring 28x7 cm. Sigmoidoscopy revealed a carrot in the upper rectum extending to the sigmoid colon. Endoscopic removal failed. The surgeon unsuccessfully attempted to extract the carrot using various tools without spinal anesthesia. During the extraction attempt, the patient complained of sudden abdominal pain, and a simple x-ray revealed pneumoperitoneum. An emergency colotomy and removal of the foreign body was performed, followed by primary repair of the perforation and a colostomy. Three months later, the colostomy was repaired.

A Case of Fishbone-induced Esophageal Perforation Closed by Endoscopic Clipping / 대한소화기내시경학회지

Esophageal perforation continues to be associated with high mortality - 20% to 30% - despite advances in surgical techniques. Traditional surgery has been the mainstay of treatment for perforation, but recent advances in endoscopic closure devices has increased therapeutic options for selected patients. Our patient had a fishbone-induced esophageal perforation. He was treated successfully with endoscopic clipping, antibiotics and parenteral nutrition. We report this case and provide a review of the relevant literature.

A Case of Ankylosing Spondylitis Accompanied by Chronic Myelogenous Leukemia / 대한류마티스학회지

Ankylosing spondylitis (AS) is occasionally accompanied by hematological malignancies such as myelodysplastic syndrome, acute myelogenous leukemia, or multiple myeloma. Chronic myelogenous leukemia (CML) is a myeloproliferative disorder associated with Philadelphia chromosome and is usually treated with imatinib, which inhibits tyrosine kinases. Although there have been reports of CML cases accompanied by several rheumatic diseases such as rheumatoid arthritis, Behcet's disease, systemic sclerosis, or undifferentiated spondylopathy, no studies have reported a case of CML with AS. We experienced a 50-year-old male patient who presented with buttock and low back pain and was diagnosed with both AS and CML. Magnetic resonance imaging showed sacroiliitis along with abnormal marrow infiltration, and a bone marrow biopsy confirmed the CML diagnosis. He was treated with imatinib, which was effective for the CML but not for the AS. This is the first case report of AS accompanied by CML.

A Case of Chronic Lymphocytic Leukemia Coexisting with Basal Cell Carcinoma and Lung Cancer

Chronic lymphocytic leukemia (CLL) can be characterized by the accumulation of small mature lymphocytes in the peripheral blood, bone marrow and other lymphoid tissues. It is well known that the risk of secondary malignancy is high in patients with CLL. A secondary malignancy in a patient with CLL may influence the prognosis as well as the treatment of CLL. As CLL is a rare disease in Korea, there have been only a few reported Korean cases of CLL with secondary malignancy. We experienced the case of a 73-year-old man who suffered from CLL with basal cell carcinoma of the skin and non-small cell lung cancer. At first, he presented with excessive lymphocytosis (>100,000/mm3), anemia, thrombocytopenia and splenomegaly, and he was diagnosed with CLL according to the bone marrow biopsy. Simultaneously he had basal cell carcinoma on his face. Seven months later, he began to feel chest discomfort and his chest X-ray showed a mass like lesion on the left upper lung. It was proven to be non-small cell lung cancer by bronchoscopic biopsy.

A Case of Dysphagia Lusoria Caused by an Aberrant Right Subclavian Artery in an Adolescent / 대한소화기내시경학회지

Dysphagia lusoria is used to describe the symptomatic compression of the esophagus from an anomalous vessel of the aortic arch. A right aortic arch with an aberrant left subclavian artery is the most common type of aortic arch abnormalities, followed by double aortic arch, and then an aberrant right subclavian artery. These anomalous vessels may cause dysphagia from the compression of the esophagus in adults, but they usually do not produce symptoms and they are usually found incidentally. Several cases of adult dysphagia lusoria have been reported in Korea, but there has been no reported case in an adolescent. We experienced a case of a 17-year-old female who suffered from dysphagia. We evaluated the possible causes of her dysphagia by performing esophagogastroduodenoscopy, esophagoraphy, esophageal manometry and chest computed tomography. We finally diagnosed this case as dysphagia lusoria caused by an aberrant right subclavian artery.