증례 : 소화기 ; 수술의 과거력이 없는 환자에서 항문직장 내압검사 후 발생한 직장 손상

정상수 ( Sang Su Jung ),명승재 ( Seung Jae Myung ),김이랑 ( Yi Rang Kim ),정훈용 ( Hwoon Yong Jung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.6

항문직장 내압검사는 관련된 합병증에 대한 보고가 많지않아 비교적 안전한 검사로 여겨져 왔다. 저자들은 수술의 기왕력이 없는 환자에서 내압검사 중 일어난 직장 천공을 포함한 2예의 직장 손상을 경험하였으며, 2예 모두 수술 없이 보존적 치료로 호전되었다. 항문직장 내압검사는 비교적 안전한 검사이나 직장감각능 평가시 가해지는 풍선의 팽창 압력에 의해 직장 점막 손상이나 천공 등이 발생할 수 있으므로 검사 시행시 세심한 주의가 필요하다. Colorectal injury related to anorectal manometry is very rare and is mostly associated with previous rectal surgery. We experienced two cases of colorectal injury related to anorectal manometry in patients without a history of surgery. The anorectal manometry finding of the first patient suggested rectal hyposensitivity, and the maximum tolerable volume was measured as 350 mL. After anorectal manometry, she complained of hematochezia. Sigmoidoscopy showed a deep 5 cm ulcer with vessel exposure at the rectum. She recovered after conservative treatment. In the second case, rectal bleeding occurred while measuring the maximal tolerable rectal volume. A 2.5 cm mural defect and 4 cm mucosal defect were detected in the rectosigmoid area at sigmoidoscopy. Computed tomography showed intraperitoneal free air around the distal sigmoid colon. She improved after conservative management. We suggest that anorectal manometry be performed with great caution, even in patients without a history of surgery. (Korean J Med 78:732-736, 2010)

유년형 당뇨병의 임상적 관찰

이성환 ( Sung Hwan Lee ),신순현 ( Soon Hyun Shin ),최일영 ( Ill Young Choi ),이철의 ( Cheul Ie Lee ),육증언 ( Jeung Un York ),김명승 ( Myung Sung Kim ) 대한내과학회 1977 대한내과학회지 Vol.20 No.11

급성 췌장염의 합병증으로 발생한 대장 협착 2예

변대근 ( Dae Keun Pyun ),김경조 ( Kyung Jo Kim ),예병덕 ( Byong Duk Ye ),변정식 ( Jeong Sik Byeon ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ),윤상남 ( Sang Nam Yoon ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.3

Several forms of colonic complications are rarely observed during the clinical course of acute pancreatitis, and potentially fatal in some cases. Colonic lesions associated with acute pancreatitis can be divided into several groups from a pathogenic point of view. Possible pathogenesis includes 1) spread of pancreatic enzymes through the retroperitoneum to mesocolon, causing pericolitis, 2) external inflammatory compression by mesocolic mass secondary to necrosis of fatty tissue, and 3) hypotension due to shock, and thrombosis of mesenteric arteries. These might lead to colonic infarction, fistula formation, perforation, and obstruction during follow-up. We report two cases of colonic obstruction following acute pancreatitis with possible different mechanisms and review Korean cases. One patient developed colonic obstruction due to severe necrotizing pancreatitis, possibly as a result of pericolitis, and the other developed stenosis as a result of ischemic colitis induced by acute pancreatitis. (Korean J Gastroenterol 2009;54:180-185)

직장 유암종의 내시경 절제: 효능과 추적 임상경과

김광운 ( Gwang Un Kim ),예병덕 ( Byong Duk Ye ),변정식 ( Jeong Sik Byeon ),박환성 ( Hwan Sung Park ),옥태진 ( Tae Jin Ok ),양동훈 ( Dong Hoon Yang ),정기욱 ( Kee Wook Jung ),김경조 ( Kyung Jo Kim ),명승재 ( Seung Jae Myung ),양석 대한장연구학회 2011 Intestinal Research Vol.9 No.3

Background/Aims: With the growing volume of screening colonoscopies, the incidence of rectal carcinoids and the number of endoscopic resections for rectal carcinoids are also increasing. However, the prognosis including recurrence and metachronous lesions after endoscopic resection is unclear. Methods: The medical records of 255 patients who had undergone endoscopic resection for rectal carcinoids between October 1999 and April 2010 were retrospectively reviewed. Results: The number of males was 150 (58.8%), and the mean age was 54.1 years (range, 27-85 years). Mean tumor size was 6.9 mm. In total, 162 cases (63.5%) were treated with endoscopic mucosal resection and 93 (36.5%) were treated with endoscopic submucosal dissection. Although endoscopic complete resections were achieved in all cases, the histological examination showed 47 cases with a positive resection margin (18.4%) and three with lymphovascular invasion (1.2%). In the 54 patients with a free resection margin, who were followed for more than 12 months, abdominopelvic computed tomography and endoscopy did not show recurrence after a median of 30.5 and 36 months, respectively. Three patients with lymphovascular invasion did not show recurrence during follow-up period of 13, 30, and 37 months, respectively. Metachronous rectal carcinoids were detected in four patients at 23, 58, 61, and 89 months, respectively, after initial endoscopic resection, leading to a second endoscopic treatment. Conclusions: Small rectal carcinoids completely resected grossly and pathologically without lymphovascular invasion appear to have low probability of short-term recurrence. However, considering the slow growth rate of carcinoids, long-term follow-up for recurrence and metachronous carcinoids is required. (Intest Res 2011;9:217-224)

무증상 한국인에서 근위부 대장용종의 예측 인자로서 원위부 대장용종의 의미

김진호,최재원,주광로,민영일,김해경,김영민,박의련,홍원선,김도하,정성애,명승재,김석균,양석균,정훈용,조문경,심기남,김기락 대한소화기학회 2000 대한소화기학회지 Vol.36 No.5

Background/Aims: The aim of this study was to examine whether rectosigmoid polyps could be a marker for proximal lesions. Methods: A total of 367 asymptomatic patients with distal colonic polyps (314 adenomatous; 53 hyperplastic) noted on sigmoidoscopy and 134 asymptomatic controls without distal colonic polyps were evaluated with total colonoscopy. No one had risk factors of colorectal cancers or polyps. Results: Incidence of synchronous proximal adenomas was higher in the patients with distal adenomas than in the patients with distal hyperplastic polyps and the controls (30.3% vs 17.0% and 15.7%, p$lt;0.05). It was also higher in the patients with multiple distal adenomas than in the patients with single distal adenoma. Patients with distal adenomas bigger than 5 mm in diameter had a higher risk of synchronous proximal adenomas (42.4% vs 25.8%, p$lt;0.005). Patients with advanced distal adenomas had a higher prevalence of advanced adenomas in the proximal colon than those with non-advanced distal adenomas (9.1% vs 2.1%, p$lt;0.05). Conclusion: Rectosigmoid polyps detected on flexible sigmoidoscopy can be a predictor of proximal neoplasia according to their morphologic characteristics and pathology.

십이지장 유두주위 게실과 담석의 연관성

김현숙,김태형,김해경,김명환,이성구,서동완,남승우,민영일,유혜승,김도하,명승재,김연석 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.4

Background/Aims: Several endoscopie studies found an association between periam- puilary diverticula and biliary calculi, however, the results of the reports are inconsistent when considering the anatomical location of the stones. The aims of our study are to evaluate the association between periampullary diverticula and gallstones according to their location iand to clarify the origin of the common bile duct stones by analyzing the composition of the stones. Methods: During a period of 10 months, 611 of 632 consecutive cases of endoscopic retrograde cholangiopancreatography(ERCP) were prospectively en-rolled. The data of periampullary diverticula and gallstones were analyzed according to the location of the stones. The stones available were initially grouped on the basis of their grass marphology and cross-sectional appearance, and finally analyzed by quantitative infrared spectroscopy. Results: Diverticula were found in 165 of 611 cases(27.0%) and there was a positive relationship between age ad duodenal diverticula(p$lt;0.01). The prevalence of biliary lthiasis was higher in patients with periampullary diverticula(95/165, 57.69b) than without(189/446, 42.4%)(p$lt;0.01). Considering the location of the gallstones, this significance was found only in patients with cotunon bile duct stones not associated with gallbladder or inttahepatic duct stones(p $lt; 0.001). Of these 40 cases with gallstones only in commion bile duct, 32 had had a history of cholecystectomy with more than a two year asymptomatic period following their surgery, and on analysis, most of the stones(30/36, 839b) were classified as brown pigmenlt stones. Therefore, these stones were presumed to be primacy common bile duct stones. On the contrary, the common bile duct stones with associated gallbladder or intrahepatic stones were identical with their paired gallbladder or intrahepatic stones in gross and cross-sectional appearance and chemical composition. They were assumed to be secondarey common bile duct stones and the difference in prevalence of calculi according got the presence of diverticula was not significant. Conclusion : The prevalence of gallstones was significantly higher in periampullary diverticula, and considering the location and the origin of the gallstones the association between diverticula and gallstones Is significant in patients with primary common bile duct stones but not with the secondary ones.

Oddi 괄약근 운동 이상 환자 16예의 임상 양상

김명환,이성구,서동완,유병무,민영일,이근찬,정훈용,장윤혜,정성애,명승재,이미화,방혜승,김삼정 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.4

We evaluated the clinical characteristics of patients with SO dyskinesia(n=16) who were confirmed by ERCP manometry during past 5 years. They were 14 male and 2 female and mean age was 52-year-old(range, 32-75). According to the criteria suggested by Hogan and Geenen, 13 patients were classified into biliary type and 3 patients into pancreatic type. Among the patients with biliary type(n=13), 12 patients fulfilled the criteria for group II dysfunction of SO and 1 patient for group III. Among the patients with pancreatic type(n=3), all fulfilled the criteria for group II. The manometric abnormalities were increased basal pressure(n=4), tachyoddia(n=7), increased retrograde propagation(n=3), tachyoddia and increased retrograde propagation(n=l), and tachyoddia and increased basal pressure(n=l). As treatment, 12 patients received conventional endoscopic sphincterotomy and 3 patients received endoscopic pancreatic sphincterotomy in addition to conventional endoscopic sphincterotomy. Satisfactory results (complete absence or marked reduction of pain) were obtained in 13(87%) out of 15 patients by endoscopic treatment. In conclusion, SO dyskinesia is not so common disease and the detection of patients with SO dyskinesia may increase by frequent application of ERCP manometry.

청소년형 당뇨병의 임상적 관찰

이철의,육증언,김명승,신순현,최일영,이성환 대한적십자사 1977 적십자병원지 Vol.4 No.1