The Clinical Significance of Transforming Growth Factor (TGF) beta1, TGF beta Receptor beta II, p53 Protein and K-ras Point Mutation in Pancreatic Cancer

PURPOSE: Many cancers, including pancreatic cancer, harbor defects in TGF beta signaling and are resistant to TGF beta mediated growth inhibition. In addition, the expression of the p53 gene and mutations in K-ras might play an important role in the multistep carcinogenesis of pancreatic cancer. This study examined the expression level of TGF beta 1, TGF beta receptorII (T beta RII), p53 protein and K-ras mutation in pancreatic cancer, along with their role and clinical significance. METHODS: The overexpression of TGF beta 1, T beta RII and p53 protein was evaluated using an immunohistochemical assay. The K-ras mutation was analyzed by PCR-RFLP in the surgical resected pancreatic tissue from 26 pancreatic ductal adenocarcinomas and 5 normal pancreases. RESULTS: Immunohistochemical analysis of TGF beta 1 and T beta RII revealed positive immunostaining in 73.1% and 76.9% of the tumors, respectively, which were significantly higher than the normal pancreas (P=0.008). The p53 protein was positive in none of the 5 normal ducts and 16 out of 26 (61.5%) pancreatic carcinoma specimens. The K-ras mutation was positive in none of the 5 normal ducts, and in 20 of the 26 pancreatic carcinoma specimens (76.9%). The presence of TGF beta1 and T beta RII in the cancer samples was significantly associated with node metastasis, advanced tumor stage (P<0.01), and a short survival time (P<0.05). The p53-positive pancreatic cancers showed a significantly lower survival rate than those with p53-negative tumors (P<0.05). There was no correlation between K-ras mutations and the survival rates. CONCLUSION: The detection of K-ras mutations and TGF beta 1, T beta RII and p53 protein overexpression can predict the prognosis of pancreatic carcinoma patients.

A Case of Complete Agenesis of Dorsal Pancreas / 대한소화기내시경학회지

Agenesis of dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas. It may be associated with diabetes mellitus, pancreatic exocrine dysfunction, or abdominal pain. Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case is herein described involving a complete agenesis of dorsal pancreas and diabetes mellitus. A 38-year-old man with a 7-months history of non-insulin dependent diabetes mellitus was admitted due to weight loss and abdominal pain. Abdominal ultrasonography and computed tomography showed a normal biliary tree and enlarged head of the pancreas without visualization of the pancreatic body and tail. Endoscopic retrograde cholangiopancreatography (ERCP) revealved the short duct of Wirsung in the uncinate process and a head without opacification of any ducts in the pancreatic body or tail. The patient underwent explo-laparotomy for evaluation of the suspected pancreatic cancer. The patient was diagnosed as having complete agenesis of the dorsal pancreas by ERCP, CT, and surgery.

A Case of carcinoid tumor of ampulla of vater presenting as asthmatic symptoms / 대한내과학회지

The carcinoid tumor of the ampulla of Vater is extremely rare. We report a case of 57-year old male with carcinoid tumor of ampulla of Vater. This patient had been presented with bronchial asthma for one year. Abdominal CT finding revealed diffuse dilatation of common bile duct and pancreatic duct, and also ampullary soft mass protruded into duodenal lumen. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsy. Pancreatico- duodenectomy with lymph nodes dissection was performed. Malignant carcinoid tumor originating from ampulla of Vater was diagnosed with pericholedochal lymphatic metastasis. Surgical removal led to complete resolution of asthmatic symptoms.

Changes of the Gastric Motility after Pylorus Preserving Pancreaticoduodenectomy

BACKGROUND: To evaluate delayed gastric emptying after a pylorus-preserving pancreaticoduodenectomy, we studied gastric motility in 11 normal volunteers and 11 patients who had undergone a pylorus-preserving pancreaticoduodenectomy. Additionally, the 24 hour esophageal Ph recordings were examined to evaluate gastroesophageal reflux after a pylorus-preserving pancreaticoduodenectomy. METHODS: Gastric motility was evaluated by using the gastric-emptying time and electrogastrograms. The gastric-emptying time was measured using a solid meal containing 99mTc-tin colloid. The half gastric-emptying time (GET1/2) was defined as the half time (T1/2) of the fall of gastric isotopic activity from the peak. Electrogastrogram (EGG) signals were detected from the surface electrodes on the skin overlying the gastric antrum. The 24-hour esophageal Ph was monitored by using a nasoesophageal probe placed in the distal esophagus 5 cm above the lower esophageal sphincter. RESULTS: In our study, the normal volunteers showed a 99+/-35 minute half gastric-emptying time. The patients were divided into two groups by a time of 2 months after the operation, early and late postoperative groups. Delayed gastric emptying after a pylorus-preserving pancreaticoduodenectomy in the early postoperative period (272+/-176 minutes) was normalized in the late period (106+/-37 minutes), p=0.020. Abnormal early EGG patterns also normalized in the late postoperative period. There was no significant difference of total Ph<4-time % between patients in the early (0.1+/-0.1%) and the late postoperative periods (0.4+/-0.4%), p=0.064. CONCLUSIONS: It is supposed that anatomical and functional preservation of the stomach and the proximal part of the duodenum after a pylorus-preserving pancreaticoduodenectomy enabled gastric motor activity to be normal in the late postoperative period.

The Occlusions of both Femoral Artery Bifucations by Myxomas: A case report

We describe a patient with an unusual cause of the occlusions of both femoral arteries by myxomas. A 41-year-old man presented with sudden onset of both leg pain and paresthesia. His hematological and cardiological status was normal. Lower peripheral angiography was performed and demonstrated thrombotic occlusion, both common femoral artery and superficial femoral and proximal portion of deep femoral artery. He was successfully treated with surgical and forgaty catheter extraction. Histologic finding was myxoma probably from cardiac origin. Cardiac investigations to determine the source of the myxoma, including 2-D echocardiography and Transesophageal echocardiogram (TEE) of the heart, failed to demonstrate residual myxoma in heart. No residual tumor or potential source of the tumor was found. The cause of both leg pain was the occlusions of the both common femoral arteries by myxomas. An entire cardiac tumor might have embolized with no detectable residual tumor in the heart; alternatively a myxoma might have originated as a primary tumor in the femoral artery.

Detection of Helicobacter DNA in bile from bile duct diseases

Several species of Helicobacter colonize the hepatobiliary tract of animals and cause hepatobiliary diseases. The aim of this study is to investigate Helicobacter found in the biliary tract diseases of humans. Thirty-two bile samples (15 from bile duct cancer, 6 from pancreatic head cancer, and 11 from intrahepatic duct stone) were obtained by percutaneous transhepatic biliary drainage. Polymerase chain reaction analysis using Helicobacter specific urease A gene and 16S rRNA primers, bile pH measurement, and Helicobacter culture were performed. Helicobacter DNA was detected in 37.5%, and 31.3% by PCR with ureA gene, and 16S rRNA, respectively. The bile pH was not related to the presence of Helicobacter. The cultures were not successful. In conclusion, Helicobacter can be detected in the bile of patients with bile duct diseases. The possibility of pathogenesis of biliary tract diseases in humans by these organisms will be further investigated.

Prostaglandin E1 Inhibits CD64 (Fc gamma RI) Expression on Monocyte in Cultured Peripheral Blood Mononuclear Cells / 대한이식학회지

CD64 (Fc gamma RI) is the one of the three Fc gamma receptors on monocytes and represents a high affinity immunoglobin G receptor. CD64 is rapidly upregulated on monocyte in response to gamma interferone. X-linking of CD64 triggers an oxidative burst as well as antibody dependent cytotoxicity. In this experiments, peripheral blood mononuclear cells (PBMC) were separated and incubated with or without gamma interferone and PG E1. The samples were divided into four groups, the first was PBMC alone, the second was PBMC with gamma interferone 100 U/ml, the third was PBMC with gamma interferone 100 U/ml and Prostaglandin E1 1 micro M/L, and the fourth was PBMC with gamma interferone 100 U/ml and Prostaglandin E1 10 micro M /L. Flow cytometric measurements of CD64 on monocyte were performed at 0, 3, 6, and 9 hours after incubation and the mean fluorescence intensities (MFI) and the mean percentages of CD64(+) cell in monocytic gated area were obtained. After 6 hours of incubation, although there is no statistical significance, all gamma interferone added groups show the higher mean fluorescence intensity than PBMC alone group. Furthermore, at 6 and 9 hours of incubation, the mean percentages of CD64(+)cells between the PBMC with gamma interferone group and the PBMC with gamma interferone and PG E1 10 micro M/L group showed 74.83 +/- 9.72% vs. 34.07 +/-12.98%, 80.04 +/- 11.30% vs. 29.42 +/- 19.86% respectively, and there are statistical significances, p=0.05, p=0.05 respectively. It appears that PG E1 inhibits the expression of CD64 on monocyte.

Postrenal Transplantation Cyclosporine Associated Hemolytic Uremic Syndrome in End Stage Renal Failure Patient Caused by Systemic Lupus Erythematosus / 대한이식학회지

Although the outcome and the possibility of renal recurrence of disease in systemic lupus erythematosus is still a matter of controversy, kidney transplantation is generally regarded as a proper indication for the treatment of patients with end stage renal failure caused by systemic lupus erythematosus. Hemolytic uremic syndrome is characterized by the symptoms of sudden onset of hemolytic anemia, thrombocytopenia, and deteriorating renal function. Many patients with postrenal transplantation hemolytic uremic syndrome have lost their grafts because of no known established treatment modality. Although the substitution of cyclosporine to FK506 is reported as a successful strategy for the treatment of cyclosporine associated hemolytic uremic syndrome in many reported cases, we cannot find the constant reports because FK506 or even OKT3 is also known as the cause of postrenal transplantation hemolytic uremic syndrome. But cyclosporine associated hemolytic uremic syndrome can be treated by the proper choice of immunosuppressant and conservative treatment. In this report, a patient with end stage renal failure caused by systemic lupus erythematosus experienced cyclosporine associated postrenal transplantation hemolytic uremic syndrome. He has recovered from the symptoms by withdrawal of cyclosporine and reduced dose of FK506 and at the same time, conservative treatment. We report this case with literature review.

Involvement of Oxidative Stress in Sodium Taurocholate-Induced Acute Necrotizing Pancreatitis in Rats

Oxidative radicals are regarded as a major factor in the pathogenesis of both acute and chronic pancreatitis. Because oxygen radicals react most readily with polyunsaturated fatty acids, resulting in peroxidation of lipids, several studies have been performed to determine the development of lipid peroxidation in pancreatitis. The purpose of this study was to evaluate the effects of free radicals and decision of the experimental model in acute necrotizing pancreatitis. Acute necrotizing pancreatitis was induced in 18 rats by retrograde injection into the bilopancreatic duct of 2%, 3%, and 5% sodium taurocholate. After a 12-hour observation time, the pancreas / the body weight, the serum amylase and the malondialdehyde content in tissue, as well as the reduced glutathione were measured in resected tissue samples. In addition, to determine the pathologic damage grade, tissue samples were examined by light microscopy. According to the amount of sodium taurocholate injected, the serum amylase and tissue malondialdehyde concentration were significantly increased. The reduced glutathione was significantly decreased, suggesting glutathione depletion due to oxidative stress. During the 12 hours after injection the pancreatic lesions were immediate and were characterized by interstitial edema, atrophy and extensive necrotic changes of the acinar cells, and hemorrhage. The pathologic damage grade increased according to the amount of sodium taurocholate injected. This study created an experimental model for studying the pathogenesis of acute necrotizing pancreatitis by using bile acid. In acute necrotizing pancreatitis, the increased levels of lipid peroxidation products in tissues and the change in glutathione metabolism suggest ongoing peroxidation of lipids due to an enhanced generation of oxygen radicals. Therefore, antioxidant treatment can reduce tissue damage, biochemical alterations, and extrapancreatic complications, thus improving the final outcome.

In vivo Assessment for the Antioxidant Activity of the Calcium Channel Blocker Nicardipine in 3% Sodium-Taurocholate-induced Acute Pancreatitis

BACKGROUND: Although several pathophysiological sequences, such as protease activation, free radical generation, and inflammatory mediator release, have been described in acute pancreatitis, the precise mechanism by which acute pancreatitis is initiated is unkown. Cellular calcium, a key function and also a crucial pathological intracellular messenger in cell injury, appears to be involved in the initiation and development of acute pancreatitis. The aim of this study is to evaluate the role of cellular calcium and therapeutic effect of administering the Ca++ channel blocker nicadipine as an antioxidant. METHOD:Nicardipine, known to be a calcium channel blocker and a most potent antioxidant, was wed as a pretreatment 1 hour before induction of pancreatitis by intraductal infusion of 3% sodium taurocholate or as a post-treatment 1 hour after induction of aucte pancreatitis by retrograde infusion of sodium taurocholate. The net weight of the pancrease, the amounts of s-amylse, GSH and MDA in the pancreatic tissue, and the histologic damage were examined 12 hours after the induction of pancreatitis. RESULTS: Nicardipine administration ameliorated pancreatic edema and reduced the amount of s-amylase compare to untreated necrotizing pancreatitis group. Also, pre- or post-treatment with nicardipine had beneficial protective effect with respect to free radical-induced injury; in particular, pre-treatment with nicardipine was much better. With respect to the histologic findings, pancreatic necrosis, hemorrhage, and neutrophil infiltration were prominent in the necrotizing group, however, in the group treated with nicardipine, the necrosis and hemorrhage were ameliorated remarkably. CONCLUSION:The free oxygen radicals and the intracellular calcium influx were major elements in the pathogenesis of acute pancreatitis, and nicardipine ameliorated pancreatic necrosis and hemorrage and exerted an antioxidant effect. The administration of nicardipine should be considered in the early stage of pancreatitis or in case of risk of pancreatitis.

Changes of Cardiac Function by the Arteriovenous Fistula in End Stage Renal Failure Patients

A hemodialysis arteriovenous fistula may cause high output cardiac state by volume overload and decreased systemic vascular resistance. Arteriovenous fistulas for hemodialysis consist usually of either a radiocephalic fistula at the wrist or a more proximal brachiocephalic fistula at the antecubital fossa. In this study the contribution of arteriovenous fistula to cardiac function has been evaluated by comparing cardiac performance before and after the point occlusion of the anastomotic site. The results suggest that the occlusion of arteriovenous fistula may decrease end-diastolic left ventricular volume (VOLd), increase end-systolic left ventricular volume (VOLs), decrease stroke volume (SV), decrease ejection fraction (EF) and decrease cardiac output (CO). This study shows that arteriovenous fistula influences directly to cardiac performance, so careful determination of dialysis option is required for the end stage renal failure patients with marginal heart function.

Mycotic Aneurysm of the Superior Mesenteric Artery Secondary to Infectious Endocarditis : A case report

Aneurysms of the superior mesenteric artery are rare, accounting for 8% of visceral artery aneurysms. About 60% of all superior mesenteric artery aneurysms have a mycotic origin. The only helpful clinical manifestations are episodes of previous abdominal pain and a history of valvular heart disease. In this case, a 66-year-old female patient with mitral regurgitation and aortic regurgitation presented with pain in the upper abdominal area. A superior mesenteric artery aneurysm was diagnosed at the time of impending rupture. Since excellent collateral circulation was present, an aneurysmectomy without revascularization was performed, and no ischemic symptom occurred. The patient presented no major complications during the postoperative course.

Gastrointestinal Injuries from Blunt Abdominal Trauma

Hollow visceral injuries are far less commom in blunt abdominal trauma than in penetrating abdominal trauma. From June 1994 to Sep. 1996, we treated 46 patients with blunt injuries to the gut, defined as perforation or devascularization. Thirty five patients(76.1%) were injured in motor vehicle collisions. Of these, 22 were not using constraints; 13 were wearing seat belts. Small bowel injuries were the most frequent injuries, followed by colonic injuries, duodenal injuries, rectal injury and gastric perforation. Mortality rates were the lowest in small bowel injuries(11.1%) and higher in less common colonic(22.2%) and duodenal(20.0%) injuries. Except for those patients with perforations of the small bowel, most patients had associated injuries to the head, chest or abdominal solid organs that were largely responsible for morbidity and mortality. Injuries to the abdominal hollow viscera are unusual following blunt trauma, but are the result of very high energy truncal trauma and are associated with multiple additional injuries. Most alert patients had physical findings suggestive of peritoneal irritation, but when diagnostic testing was necessary, peritoneal lavage was superior to CT scanning ( false negative=10.5% versus 88.5% respectively). A high index of suspicion is necessary to avoid diagnostic delays that can lead to severe complications and death.

hernia Repair in Patients with Ascites

The hospital records of 7 patients with ascites and hernias ( 6 patients had inguinal, 1 patient had umbilical) were reviewed restrospectively. The causes of ascites were liver cirrhosis in 7 patients. Among the 7 patients with liver cirrhosis and ascites, 6 were Child C and 1 was Child B. Among the 7 patients, 5 of them underwent ascites control with diuretics and 2 underwent ascites control with large volume paracentesis. All patients underwent hernia repair as elective surgery. The only complication was primary peritonitis because of insufficient control during the preoperative period, and there were no perioperative deaths or ascites leaks. All patients were available for follow-up. In this group, recurrence did not occurr for a mean 14.3 months after repair. From this retrospective study, we suggest that surgeons should repair hernias with ascites if patients suffer from their hernias because elective hernia repair can be performed safely without any complications or ascites leaks. Child C hepatic dysfunction or uncontrolled ascites can not be contraindications.

A Bacteriologic Investigation of the Acute Appendicitis

A study on the microbiology of appendiceal tissue or peritoneal fluid was carried out by the authors. A total of 40 specimens were examined, 21 of them(52.5%) were found to be positive, of which 13(61.9%) were polymicrobial and 8(38.1%) were monomicrobial. The most represented species were Escherichia coli (37.8%), Klebsiella (16.2%), Streptococcus (10.8%), and Bacteroides (8.1%). The most active drugs in vitro were found to be aminoglycosides (gentamycin, amikacin, tobramycin) and cefotaxime. The infectious complication developed in 6 patients and consisted of wound infection only. In view of relation of presence or absence of perforation of appendix with infectious complication, 4 of them arose from perforative appendicitis(36.4%) and 2 of them arose from nonperforative appendicitis(6.9%). On the other hand, in view of relation of presence or absence of organism cultured from appendiceal tissue or peritoneal fluid with infectious complication, all of them arose from positive cultures(28.6%) and none arose from negative cultures. The most represented bacterias from wound infection were Escherichia coli(40%) and Bacteroides(20%). Therefore, we suggest that an agent against anaerobes should be recommended when the appendix is perforative.

DNA Variation of Helicobacter Pylori in the Gastroduodenal Disease / 대한내과학회지

BACKGROUND: The evidence for H. pylori as a gastrointestnal pathogen is now very strong, if not overwhelming. Among the pathogenic factors of H. pylori, flagella and urease are considered to be major factors causing the gastrododenal disease. We observed the gene diversity of H. pylori using the PCR-amplified 1.4Kb fla A gene and 0.9Kb ure B gene and examined the relationship between the gene pattern and the gastroduodenal disease. METHOD: Fifty-one cases of isolated strains were cultured at the Helicobacter-selective blood agar plates. To compare the gene diversity among the isolates of gastroduodenal disease genotypes was analyzed by PCR-based RFLP. 1.4Kb fla A gene and 0.9Kb ure B genes from isolates were amplified by PCR and digested with Hae 3 restriction enzymes to observe the restriction fragment length polymophysm. Protein patterns were also compared to examine the antigenic variations. Total cell proteins, and octyl-glucose extracts from isolates were analyzed by SDS-PAGE gel electrophoresis. RESULTS: 41 cases (80.4%) of H. pylori were isolated in the 51 cases of gastroduodenal diseases. We could classify theses isolates 3 types of PCR-RFLP in the fla A gene, 900+500bp, 500+500+400bp, 600+800bp, and 9 types in the ure B gene. PCR-RFLP in the fla A gene and ure B gene of the isolates was different from the standard strain of Australia and the genetic diversity was not related to the types of the gastroduodenal disease. We demonstrated variations in the protein pattern and antigenic profiles among the isolates by SDS-PAGE analysis. These data also did not show any relationship between protein pattern and types of gastroduodenal diseases. CONCLUSION: Tese studies showed many different gene diversity in the flagella and urease gene without any relationship with the types of gastoduodenal disease. And variable protein pattern were noted among the strains of H. pylori. Further studies to demonstrate the pathgenecity of H. pylori should be continued even if there was no relationship between the genomic diversity of the flagella or urease and the types of gastroduodenal disease.

The Effect of Growth Hormone on TNF-alpha Level in Zymosan: A Induced Multiorgan Failure

The pathogenesis of sepsis is not clearly understood. In animal models, the association of a high plasma TNF-alpha level with the frequent development of adult respiratory distress syndrome in septic conditions suggests that TNF-alpha plays a major role in the pathogenesis of the lung injury. Also, oxygen free radicals are known to participate in the pathogenesis of multiorgan failure. However, the relations between those factors have not been elucidated clearly. In pharmacological dosage, growth hormone (GH) promotes positive nitrogen balance and anabolic metabolism. There have been many studies about the therapeutic effects of GH in sepsis; However, the exact mechanism is not known. The purpose of this study is to evaluate the mechanism of the therapeutic action of GH in sepsis induced by intraperitoneal injection of Zymosan-A in an animal model. The experimental animals were female Sprague-Dawley rats which were devided into three groups: a control group, a group injected intraperitoneally with Zymosan-A, and a group injected intraperitoneally with Zymosan-A and intramurally with growth hormone. After the lapse of time of 6, 12, 24, 48, and 72 hrs., the rats were sacrificed; then the histopathologic findings for the lung tissue were examined, and the levels of malondialdehyde(MDA) in the lung tissue and TNF-alpha in the blood were measured. In the Zymosan-A-injected group, an increment of infiltration by lymphocytes and neutrophils was observed, the MDA levels in the lung tissue were remarkably increased and reached a peak level 24 hrs. after Zymosan-A injection, and the TNF-alpha levels in the plasma were markedly increased. In the Zymosan-A-plus GH-injected group, there were less infiltration of inflammatory cells and less interstitial edema, and significantly suppressed increments of TNF-alpha and MDA. It can be concluded that GH inhibits the production of TNF-alpha and MDA in sepsis and protect against systemic tissue injury. However, the mechanism for the inhibition of the TNF-alpha production was not elucidated by this study. Further experiments are required.

Biliary Tract & Pancreas; Effectiveness of Endoscopic Ultrasonography in Detecting the Extrahepatic Choledocholithiasis / 대한소화기내시경학회지

BACKGROUND/AIMS: Ultrasonography is the easiest, fastest procedure for the diagnosis of choledocholithiasis, but the diagnostic failure are mostly because of the intrapancreatic level of this condition and the absence of bile duct dillatation. Endoscopic ultrasonography is a promising procedure for the diagnosis of extrahepatic cholestasis due to noninvasiveness and accuracy in the digestive gas interposition. The aim of this study was to prospectively compare the diagnostic accuracy of endoscopie ultrasonography with abdominal ultrasonography and endoscopic retrograde cholangiography in 66 patients with suspected choledocholithiasis. METHODS: All of the patients had abdominal ultrasonography, endoscopic ultrasonography ~and endoscopie retrograde cholangiography within 72 hours and final diagnosis was determined by endoseopic retrograde cholangiography with sphincterotomy. RESULTS: (l) Choledocholithiasis was confirmed in 45 patients: Thirteen patients had nondilated common bile ducts and 20 patients had stones with diamerer < 1 cm. (2) Endoscopic ultrasonography was more sensitive(95.5%) than abdominal ultrasonography (44.4%: P<0.0001) and similar to endoscopic retrograde cholangiography (97.8%). Specificity was same as 100% in 3 diagnostic tools. (3) Endoscopic ultrasonography was superior to abdommal ultrasonography for the diagnosis of choledocholithiasis with nondilated common bile duct(100% vs 15.3%, P<0.0001) and with less than 1cm sized small stone(100% vs 10.0%, P<0.0001). Endoscopic ultrasonography results did not depend on stone diameter or common bile duct dilatation. CONCLUSIONS: Endoscopic ultrasonography could be an accurate and safe diagnostic tool for the diagnosis of choledocholithiasis and could be promising especially in the cases with difficult cannulation of bile duct and gal1 stone pancreatitis.

Mucin - secreting Villous Adenoma of The Common Hepatic Duct Causing Mucoid Biliary Obstruction / 대한소화기내시경학회지

Obstructive jaundice of the bile duct resulting from tumor-producing copious, thick mucin, causing ductal obstruction and dilatation, has been reported very rarely. Also, the benign bile duct neoplasm is extremely rare. We report a case of a mucin-secreting villous adenoma of common hepatic duct causing obstructive jaundice and cholangitis. The patient was a 72-year-old male and had a 3 yeared history of common hepatic mass unchanged remarkably in size. The abdominal ultrasonogram and computed tomography revealed well circumscribed, more than 2cm sized mass on the CHD and ductal dilatation. We were able to get an interesting cholangioram showing irregular, nodular, ill defined filling defect in the extrahepatic bile duct, different from US and CT findings, And it was just caused by thick, copious mucin from the tumar. This case was confirmed as mucin-secreting villous adenoma after surgery.

A Case of Spontaneous Perforation of the Right Intrahepatic Duct - An ERCP Diagnosis / 대한소화기내시경학회지

Spontaneous perforation of bile duct in adults is very rare, with less than 30 cases described in the literature to date. We repoit a case of a 65-year-old man who presented with severe colicky abdominal pain and fever, just like symptoms of peritonitis. ERCP provided a preoperative noninvasive confirmation of the diagnosis of the rupture of right intrahepatic duct. The patient was performed T-tube choledochotomy and drainage of retroperitoneal bile collection. The etiolgy, diagnosis, and treatment of spontaneous perforation of bile duct is discussed.