Poster Session:PS 1154 ; Gastroenterology (Pancreatobilliary) : Biliary Ascariasis Infestation after Endoscopic Sphincterotomy

( Su Sie Rah ),( Seug Won Jung ),( Dong Chul Lee ),( Geum Soo Lee ),( Hyeung Chul Moon ),( Sang Wook Park ),( Gun Young Hong ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Ascarias lumbricoides is a common parasitic infestation in gastrointestinal tract. Migration of adult worm to biliary system implicates biliary complication. Interestingly, biliary ascariasis is known as one of the complication of EST in endemic area. But biliary ascariasis after endoscopic sphicterotomy is rarely reported in Korea. We report the case of biliary ascariasis caused after performing EST for treatment of common bile duct stones. 58- year-female Combodian from South East Asia visited our hospital for epigastric pain from 2 weeks ago. Laboratory fi nding revealed AST 122 IU/L, ALT 35 IU/L, ALP 122 IU/L, GGT 244 IU/L. CT scan showed multiple large stones in common bile duct. We extracted multiple brown stones by basket after endoscopic sphincterotomy and endoscopic papillary large balloon dilatation. Next day, we performed follow up ERCP for removal of remnant CBD stones. On cholangiogram, giant roundworm with remnant stone was noted in CBD, which wasn`t seen at prior ERCP. We caught the worm by snare and successfully pulled it out from common bile duct. The worm, 30cm long, round, whitish-pink colored, was identified as ascariasis lumbricoides. We detected round worm after performing endoscopic sphincterotomy which wasn`t noticed at fi rst ERCP. The worm seems to migrate to common bile duct easily because opening of major papilla was widened after EST. As the demand for organic food and immigration from endemic area increase in Korea, biliary ascariasis should be considered a diagnostic possibility especially in patient from the tropics.

악성위궤양으로 오인된 거대세포바이러스 위염: AIDS 진단으로 이어진 초기 발현양상으로서의 증례 1예

나수지 ( Su Sie Rah ),권혁춘 ( Hyeok Choon Kwon ),최승준 ( Sung Jun Choi ),남승우 ( Seong Woo Nam ),박상민 ( Sang Min Park ),최한섭 ( Han Seop Choi ),문가슬 ( Ga Seul Moon ),이승훈 ( Seung Hun Lee ),박성균 ( Sung Kyun Park ) 전북대학교 의과학연구소 2011 全北醫大論文集 Vol.35 No.1

CMV 감염은 주로 면역기능이 저하된 환 자에서 흔한 기회감염으로 상부 위장관에서 의 내시경 소견은 경미한 발적에서부터 궤 양까지 다양하다. 저자들은 흑색변을 주소로 내원한 환자에서 내시경적으로는 악성궤양 의 소견을 보였으나 궤양부위 조직검사상 거대세포바이러스 봉입체를 관찰하여 CMV 감염에 의한 궤양으로 진단되었고 면역억제 의 원인을 추적하여 HIV 감염을 확인한 증례가 있어 보고하는 바이다. Cytomegalovirus (CMV) causes a wide spectrum of disorders in immunocompetent and immunocompromised patients, however it is more frequent and raises more clinical concerns in immunocompromised patients due to its severity. Moreover, suspicion or recognition of gastrointestinal CMV infection by routine laboratory tests and endoscopy with biopsy is difficult since blood tests and pathology do not always reveal the clues for immune deficiency such as leukopenia or inclusion bodies-the hallmark of CMV infection and also due to the lack of specific endoscopic findings. We report a case of an HIV infection without leukopenia whose initial presentation was a solitary CMV gastric ulcer, which initially was suspected as an advanced gastric cancer with melena.

흉부 대동맥류에 의한 주기관지 폐쇄로 발생한 무기폐 1예

문가슬 ( Ga Seul Moon ),나수지 ( Su Sie Rah ),이승훈 ( Seug Hun Lee ),차혁환 ( Hyuk Whan Cha ),이다현 ( Da Hyun Lee ),조준성 ( Jun Sung Jo ),전용덕 ( Yong Duk Jeon ) 전북대학교 의과학연구소 2011 全北醫大論文集 Vol.35 No.2

흉부 대동맥류에 의한 기관지 압박에 의한 증상은 대부분 무증상이나 호흡곤란, 기침, 흉통, 쉰소리 등으로 나타날 수도 있다. 저자들은 고열과 전신 쇠약감을 주소로 내원한 만성신부전 환자에서 폐렴 진단 하에 항생제 치료 후 증상 호전되던 중 갑자기 발생한 흉부대동맥류의 팽창으로 인한 주기관지 폐쇄에 의한 폐쇄성 무기폐 소견이 관찰되었고 흉부 대동맥류 혈관 내 스텐트 그라프트 삽입술을 시행하였지만 흉부대동맥스텐트 삽입 후 발생한 복부대동맥 파열로인한 사망으로 추정되는 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Obstructive atelectasis is the most common type in pulmonary atelectasis and results from reabsorption of gas from the alveoli when communication between the alveoli and the trachea is obstructed. Causes of obstructive atelectasis include foreign body, bronchogenic tumor, and mucous plugging and extrinsic compression of an airway by neoplasm, lymphadenopathy, aortic aneurysm, or cardiac enlargement. We report a 64-year-old female patient who had saccular aneurysmal dilatation of the thoracic descending aorta and bronchial obstruction due to compression of a rapidly expanding thoracic aortic aneurysm, as a result, had been presented atelectasis of left whole lung.

Poster Session:PS 1153 ; Gastroenterology (Pancreatobilliary) : A Case of Foreign Body Induced Intrahepatic Bile Duct Stones after Lt.lobectomy with Hepaticojejunostomy

( Seung Gi Moon ),( Seung Won Jung ),( Dong Choel Lee ),( Su Sie Rah ),( Geum Soo Lee ),( Sang Wook Park ),( Gun Young Hong ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Introduction: After surgery of liver or biliary tract, bile congestion is easily happened because of anatomical change of bile duct. We experienced relatively rare case of intrahepatic bile duct stones caused by foreign body left behind bile duct after previous bile duct surgery. Case report: A 84-year-old male patient came to our hospital due to two weeks of fever and chill. He underwent left lobectomy with hepaticojejunostomy for treatment of cholangiocarcinoma 10 years ago. Abdominal CT revealed multiple intrahepatic duct stones complicated with cholangitis and long, wire-like materials lied from IHBD to jejunum. Cholangitis were improved after PTBD and antibiotic treatment. Percutaneous transhepatic cholangioscopy was performed for treatment of bile duct stones. Endoscopic fi nding revealed numerous black stones occupying intrahepatic bile ducts and two black colored, long tube-like foreign bodies along the bile duct and jejunum. After removing stones with PTCS directed electrohydraulic lithotripsy, the foreign body was extracted with dormia basket through PTBD tract. The foreign body was identifi ed long plastic catheter. Conclusion: Foreign body in bile duct can induce abnormal fiow of bile juice and consequently the gallstone or sludge can be made. In this case, plastic catheter, the responsible cause of IHBD stone, thought to be placed from IHBD to jejunum for bile drainage after hepaticojejunostomy. But after clogging of the stent, the catheter caused the bile stasis and stone formation. So we report a rare case of foreign body induced intrahepatic bile duct stone treated by percutaneous transhepatic cholangioscopy.

Primary signet ring cell carcinoma of the gallbladder: a case report

( Seo Joon Eun ),( Ah Lon Jung ),( Se Mi Kim ),( Moo Woong Kim ),( Ui Sin Lee ),( Su Sie Rah ),( Geum Soo Lee ),( Hyeung Chul Moon ),( Sang Wook Park ),( Gun Young Hong ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Carcinoma of the gallbladder is the most common biliary tract tumor. Signet ring cell carcinoma of the gallbladder is a rare form of mucinous adenocarcinoma and has a worse prognosis. Since very few cases have been reported, information regarding the behavior and prognosis of gallbladder signet ring cell carcinoma is limited. Only eight cases of signet ring cell carcinoma of the gallbladder have been reported so far. Four cases of these had lymph node metastasis and died within 3 months. The other cases had no information of outcome. We present a rare case of primary signet ring cell carcinoma of the gallbladder. A 58-year-old male presented to our hospital with complaints of epigastric pain. Abdominal computed tomography showed multiple gallbladder stones with diffuse wall thickening, cystic duct enhacement and CBD stone. Removing CBD stone through ERCP, laparoscopic cholecystectomy was performed. The histopathologic finding revealed that diffusely growing adenocarcinoma of signet ring cell type was noted in the surface epithelium with intracellular mucin (Fig. 1). The immunohistochemical stain for cytokeratin was positive for tumor cells (Fig. 2). The final pathologic result was signet ring cell carcinoma of the gallbladder. There was no metastasis in the retroperitoneum and mesenteric lymph node. The tumor was stage IIIA (according to TNM staging). As Esophagogastroduodenoscopic finding showed no evidence of malignancy. He is planning to perform extended radical cholecystectomy and post-operative chemotherapy.

특발성 혈소판 감소성 자반증으로 나타난 폐결핵 1예

이승훈 ( Seung Hun Lee ),이다현 ( Da Hyun Lee ),문가슬 ( Ga Seul Moon ),나수지 ( Su Sie Rah ),김상용 ( Sang Yong Kim ),조한나 ( Han Na Cho ),조준성 ( Joon Sung Joh ) 전북대학교 의과학연구소 2011 全北醫大論文集 Vol.35 No.2

Tuberculosis accompanied by idiopathic thrombocytopenic purpura is uncommon worldwide. A 77-year-old woman who presented with hemorrhage was diagnosed with idiopathic thrombocytopenic purpura and tuberculosis. The patient was unresponsive to steroid and high dose IV γ-globulin, however both diseases improved with anti-tuberculosis medication. Although the correlation between the two diseases is not clear, an immunological mechanism is thought to be involved. A patient diagnosed with idiopathic thrombocytopenic purpura in an area with a high prevalence of tuberculosis may also require an evaluation for tuberculosis.

Poster Session:PS 1152;Gastroenterology (Pancreatobilliary):A Case of Peroral Cholangioscopic Management of Impacted Common Bile Duct Stone During Emergent Mechanical Lithotripsy

( Dong Cheol Lee ),( Sang Wook Park ),( Gun Young Hong ),( Hyeung Chul Moon ),( Geum Soo Lee ),( Seung Won Jung ),( Su Sie Rah ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Introduction: Difficult common bile duct(CBD) stone often requires mechanical lithotripsy for successful extraction. But we can experience several complications such as trapped or broken basket, wire fracture, broken handle during the mechanical lithotripsy. These complications can be managed by additional endoscopic procedure or emergent mechanical lithotripsy. But peroral direct choledochoscopic treatment of complicated stone during mechanical lithotripsy have not be reported. We present a case of impacted CBD stone with basket in distal CBD successfully treated with peroral cholangioscopy-directed elctrohydraulic lithotripsy(EHL). Case report: A 79-year-old female visit out hospital due to abdominal pain. Abdominal computed tomography(CT) revealed large stone in CBD. About 3x4cm sized large fi lling defect was noted in CBD on ERCP. Endoscopic papillary large balloon dilatation after endoscopic sphinterectomy(EST), We tried mechanical lithotripsy. But the stone was too hard to crushed by mechanical lithotripsy. During additional emergent mechanical lithotripsy the wire was broken at 30cm away from mouth with the dormia basket entrapped in the distal CBD with the stone. We performed peroral direct cholangioscopy with ultra-slim endoscopy. The endoscopic fi nding showed basket-captured large brown stone at distal CBD, just above papillary orifi ce. We tried peroral cholangioscopy-directed elctrohydraulic lithotripsy and succeeded in breaking the stone. After removing the trapped basket from the fragmented stones, We extracted the stone successfully. Conclusion: Several clinical studies reported the utility of peroral cholaniograpy for the diagnosis and management of bile duct disease. We suggest that electrohydraulic lithotripsy under direct peroral cholangioscopy can be an effective and safe therapeutic option for treatment of impacted stone during mechanical lithotripsy.