A Case of Boerhaave's Syndrome developed during bowel preparation using PEG solution (Colyte(R)) / 대한내과학회지

Boerhaave's syndrome, spontaneous esophageal rupture, is very rare but fatal disease and commonly associated with alcohol induced vomiting. Polyethylene glycol solution is useful for colonic bowel preparation necessary for colonic examination or surgery. There was no report on polyethylene glycol solution associated Boerhaave's syndrome. We report a case of Boerhaave's syndrome, a patient who present chest pain, fever, and dyspnea after several violent vomitings during colonic bowel preparation with polyethylene glycol solution, and review the relevant literature.

A Case of Syndrome of Inappropriate Antidiuretic Hormone Secretion and Pneumomediastinum Complicated by Bougienation in Malignant Esophageal Stricture / 대한소화기내시경학회지

Bougienation is generally an effective method providing temporary relief of obstruction to facilitate stent insertion in patients with malignant esophageal stricture. The complicated by after bougienation such as esophageal perforation, mediastinitis, bronchoesophageal fistula, pneumomediastinum, pneumothorax were reported. However, syndrome of inappropriate antidiuretic hormone secretion (SIADH) complicated by bougienation has rarely been reported. Thus, we report a case of SIADH and pneumomediastinum complicated by bougienation in a patient with malignant esophageal stricture.

Pyogenic Liver Abscess by Proteus vulgaris Complicated with Acute Purulent Pericarditis: A Case Report and Review of Korean Literature / 감염과화학요법

Pyogenic liver abscess causes various clinical manifestations and resulted in complications in 30-50 % of cases. Pericarditis due to pyogenic liver abscess is a very rare complication, the result of which is usually fatal without treatment. We report a case of 60-year-old female who had pyogenic liver abscess by Proteus vulgaris complicated with acute purulent pericarditis. Another 3 cases in previous Korean literature were also reviewed.

Pyogenic Liver Abscess by Proteus vulgaris Complicated with Acute Purulent Pericarditis: A Case Report and Review of Korean Literature / 감염과화학요법

Pyogenic liver abscess causes various clinical manifestations and resulted in complications in 30-50 % of cases. Pericarditis due to pyogenic liver abscess is a very rare complication, the result of which is usually fatal without treatment. We report a case of 60-year-old female who had pyogenic liver abscess by Proteus vulgaris complicated with acute purulent pericarditis. Another 3 cases in previous Korean literature were also reviewed.

The Clinical Study on Spontaneously Ruptured Hepatocellular Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Spontaneous rupture of hepatocellular carcinoma (HCC) is known as a rare but life- threatening condition because of massive blood loss into the peritoneal cavity. In the countries with high prevalence, the reported incidence of spontaneous rupture and hemorrhage ranged from 10.2% to 14.5% of patients with HCC. This study was aimed to analyze the risk factors for spontaneous rupture and prognosis in the patients with ruptured HCC. METHODS: Among 642 consecutive patients with HCC who had admitted to Gyeongsang National University Hospital from January 1998 to September 2003, spontaneous rupture of HCC occurred in 83 patients (12.9%). The medical records of the 83 patients were reviewed retrospectively, and the clinico-laboratory parameters and radiologic findings were analyzed. RESULTS: Sixty-nine out of the 83 patients were male, the mean age was 57.7 +/- 13.2 years (male, 56.8 +/- 12.9 years; female, 62.3 +/- 13.5 years). Location of tumor, Child-Pugh class and Okuda stage were the risk factors influencing spontaneous rupture of HCC, whereas the TNM stage, presence of portal vein thrombosis, and size of the tumor were not. Among the 83 patients with ruptured HCC, 51 were treated by transarterial embolization (TAE), 31 by supportive measures, and 1 by operation. The median survival time was 3.4 +/- 4.5 months in all patients with ruptured HCC, 4.9 +/- 5.1 in successful TAE, and 2.1 +/- 3.4 in supportive measure groups. CONCLUSIONS: Advanced Child-Pugh class, advanced Okuda stage, and peripheral location were the risk factors for spontaneous rupture of HCC. The prolonged survival could be achieved in patients eligible for successful transarterial embolization rather than supportive measures.

Endoscopic Treatment of Esophageal Foreign Bodies in Adult: Management of 257 Cases / 대한소화기내시경학회지

BACKGROUND/AIMS: The majority of foreign body ingestions occur in pediatric population. We assessed the characteristics and endoscopic treatment outcome of esophageal foreign bodies in adults. METHODS: Medical records of consecutive 257 patients who received trial of endoscopic treatment for esophageal foreign bodies, from January 1998 through November 2003 in Gyeongsang National University Hospital, were analyzed retrospectively. RESULT: Among 257 cases, 132 were male. The incidence was highest in 5th decade, and mean age was 54.6 years. Most common location was upper esophagus (84.6%). Accidental ingestion accounted for 92.2%. Twenty cases (7.8%) of voluntary ingestion were all prisoners or in psychiatric problems. Fish bone was the most common type. Endoscopic treatment was successful in 253 cases (98.4%) and 4 were managed with rigid esophagoscopy. Four cases who complicated by acute mediastinitis or pneumomediastinum at presentation had sharp-pointed or long objects lodged in upper esophagus, and almost presented at 48 hours after the ingestion. Full esophagogastroduodenoscopy could find 37 organic lesions in 35 cases. CONCLUSIONS: Majority of esophageal foreign bodies in adults developed accidentally during meals. Voluntary ingestion of foreign bodies was not related to meals, and developed by prisoners or psychiatric patients. The sharp-pointed or long objects lodged in upper esophagus with delayed presentation may cause complication. Endoscopic treatment is safe and beneficial, and a full endoscopic evaluation should be recommended for the evaluation of a synchronous organic disease.

Endoscopically Removed Granular Cell Tumor of the Esophagus: A Case Report and Review of Korean Literature / 대한소화기내시경학회지

Granular cell tumor is a benign tumor, commonly found in the skin, tongue, and breast but rarely in the esophagus. A 44-year-old man was referred from the private clinic because of an esophageal lesion found on endoscopy. Esophagoscopy revealed a white-yellowish polypoid lesion covered with normal looking mucosa in the upper esophagus. It was movable within the wall by pushing with forceps. Endoscopic polypectomy after ligation with elastic "O" band was performed without complication. Histologic diagnosis of granular cell tumor was made. It was stained strongly positive for S-100 protein. Another 20 cases of esophageal granular cell tumors reported in Korean literature were reviewed.

Acute Phlegmonous Gastritis Diagnosed Early Endoscopically and Treated Successfully with Antibiotics / 대한소화기내시경학회지

Phlegmonous gastritis is a rare disorder caused by suppurative bacterial infection of the gastric wall. The mortality rate remains extremely high and the gastrectomy has been thought to be an effective form of treatment. We report a case of acute phlegmonous gastritis developed in a patient with advanced alcoholic liver cirrhosis, and recovered with early endoscopic diagnosis and antibiotics alone.

True cyst of the spleen with high level of CA19-9 in cystic fluid / 대한내과학회지

Nonparasitic true splenic cyst is a rare disease and the epidermoid cyst accounts for the majority of the cases. And the epidermoid cyst producing CA19-9 is extremely rare. We present a case of true splenic cyst with high cystic fluid CA19-9 level. A 26-year-old woman complained left upper quadrant abdominal pain. Abdominal ultrasonography and CT depicted a 17 x 13 cm sized cystic lesion in the left upper abdomen. The aspirated cystic fluid showed high concentration of CA19-9, but serum CA19-9 level was normal. Spleen with huge unilocular cyst was removed surgically. The cyst was lined with single layered cuboidal epithelial cells and negative for immunohistochemical staining with anti-CA19-9 antibody.

A case of intraabdominal abscess cured by transrectal catheter drainage / 대한내과학회지

Intraabdominal abscess, resulting from primary intraperitoneal disease such as appendicitis, diverticulitis or as a complication of surgery, remains a serious problem with high mortality if not treated early and adequately. In the case of acute bowel perforation, surgery is the treatment of choice, but radiologically guided percutaneous drainage is very effective for the subacute and localized abscess within the peritoneal cavity. However, perirectal abscesses located deep within the pelvis are unapproachable percutaneously because of interposed structures such as the urinary bladder, loops of bowel. Transrectal drainage overcomes these limitations. We present here a case of perirectal abscess treated successfully and safe with transrectal catheter drainge.

A Case of Rhabdomyolysis with Acute Renal Failure in the Course of Interferon Therapy for Chronic Active Hepatitis B / 대한신장학회잡지

Interferon has been tried as a drug of choice in patients with chronic active hepatitis by hepatitis B virus infection since Greenberg has reported the effectiveness of interferon in 1976. The effects of interferon therapy have been reported variably and various complications such as fever, myalgia, arthralgia, flu-like symptoms, temporary leukopenia and thrombocytopenia, alopecia, cardiovascular symptoms and autoimmune diseases have been reported. But rhabdomyolysis has been rarely reported in the interferon therapy of chronic hepatitis B. There were some cases of rhabdomyolysis with acute renal failure in the interferon therapy which was designed for chemotherapy of malignant melanoma and for chronic active hepatitis C virus infection. We reported a case of rhabdomyolysis with acute renal failure developed during the interferon therapy in a patient with chronic active hepatitis B.