Effect of Rowachol on Prevention of Postcholecystectomy Syndrome after Laparoscopic Cholecystectomy

In Woong Han,O Choel Kwon,Min Gu Oh,Yoo Shin Choi,Seung Eun Lee 한국간담췌외과학회 2014 한국간담췌외과학회 학술대회지 Vol.2014 No.4

A Case of Endoscopic Treatment for Gastrocolocutaneous Fistula as a Complication of Percutaneous Endoscopic Gastrostomy

황종호,김형욱,강대환,Choel Woong Choi,Soo Bum Park,Tae Ik Park,Woo Sung Jo,Dong Hyuk Cha 대한소화기내시경학회 2012 Clinical Endoscopy Vol.45 No.1

As a rare complication of percutaneous endoscopic gastroscopy (PEG), a gastrocolocutaneous fistula may occur after PEG placement. This paper reports an interesting case which PEG tube unintentionally penetrated transverse colon during PEG. A 72-year-old female patient who suffered from medullary infarction underwent PEG procedure for enteral nutrition, and fecal materials were observed 6 days after the procedure. Transverse colon located in antero-superior site of stomach was observed through abdominal computed tomography, and also the wrong inserted tube was found through gastroscopy and colonoscopy. Endoscopic treatment for the fistula was performed by the use of hemo-clip and detachable snare, closure of the fistula was finally confirmed 6 days after the endoscopic procedure. Therefore, the gastrocolocutaneous fistula should be considered as one of the complications of PEG when fecal material is observed through PEG tube in a few days after PEG procedure and endoscopic treatment can be feasible in this case.

CASE REPORT : A Case of Sarcomatoid Carcinoma Arising from Mucinous Cystadenocarcinoma of Appendix

( San Kim ),( Hyung Wook Kim ),( Dae Hwan Kang ),( Choel Woong Choi ),( Soo Bum Park ),( Tae Ik Park ),( Woo Sung Jo ),( Dong Hyuk Cha ) 대한장연구학회 2013 Intestinal Research Vol.11 No.1

Sarcomatoid carcinoma or carcinosarcoma is a very rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. The pathogenesis of sarcomatoid carcinoma is not fully elucidated and the guideline of treatment has not been established yet. Although the upper aerodigestive tract, lung and female urogenital system are known to be the most frequently affected, this tumor also can occur in various sites, including the digestive tract. Since sarcomatoid carcinoma in colon was firstly reported in 1986, 24 cases have been reported to date. We report a rare case with sarcomatoid carcinoma of appendix. Interesting histologic feature of our case was the presence of mucinous cystadenocarcinoma with morphological “transition” between carcinomatous and sarcomatous tissue. To our knowledge, this is the first case of sarcomatoid carcinoma arising from mucinous cystadenocarcinoma of the appendix. (Intest Res 2013;11:60-65)

The efficacy and safety of minor endoscopic sphincterotomy for biliary stenting

( Hyeong Seok Nam ),( Dae Hwan Kang ),( Hyung Wook Kim ),( Choel Woong Choi ),( Su Bum Park ),( Su Jin Kim ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Objective: Endoscopic sphincterotomy (ES) is performed to reduce the risk of post-ERCP pancreatitis (PEP) and facilitate the stent placement. But there is still debate the necessity of ES due to potential complications like bleeding. In this study, we evaluated efficacy and safety of minor ES for self-expandable metal stent (SEMS) placement. Methods: From December 2008 to December 2014, we reviewed 244 consecutive patients with malignant biliary obstruction, diagnosed as unresectable malignancies who received SEMSs with minor ES, retrospectively. Early post-ERCP complications including such as PEP and bleeding rate were evaluated. Results: There were 244 subjects with 118 patients from cholangiocarcinoma, 79 patients from pancreatic cancer, 47 patients from non-pancreaticobiliary malignancy. Overall earlypost-ERCP complications occurred among 10 patients (4.1%), including PEP in 7 patients (2.9%, 6 mild and 1 moderate), mild bleeding in 2 patient (0.8%), and mild cholangitis in 1 patient (0.4%). No significant difference in cancer type (cholangiocarcinomaversus pancreatic cancer versus others, p=0.696) and SEMS type (uncovered versus covered, p =1.000) were noted in frequency of post-ERCP complications. Comparison with no complication group (n=234) and complication group (n=10), statistically significant differences were only found in the number of inserted SEMS (p=0.014). Conclusions: The strategy of minor ES could be feasible, safe and effective to facilitate the SEMS placement as not increasing severe bleeding or other complications in patients with malignant biliary obstruction.

A Case of Endoscopic Treatment for Gastrocolocutaneous Fistula as a Complication of Percutaneous Endoscopic Gastrostomy

Hwang, Jong Ho,Kim, Hyung Wook,Kang, Dae Hwan,Choi, Choel Woong,Park, Soo Bum,Park, Tae Ik,Jo, Woo Sung,Cha, Dong Hyuk The Korean Society of Gastrointestinal Endoscopy 2012 Clinical Endoscopy Vol.45 No.1

<P>As a rare complication of percutaneous endoscopic gastroscopy (PEG), a gastrocolocutaneous fistula may occur after PEG placement. This paper reports an interesting case which PEG tube unintentionally penetrated transverse colon during PEG. A 72-year-old female patient who suffered from medullary infarction underwent PEG procedure for enteral nutrition, and fecal materials were observed 6 days after the procedure. Transverse colon located in antero-superior site of stomach was observed through abdominal computed tomography, and also the wrong inserted tube was found through gastroscopy and colonoscopy. Endoscopic treatment for the fistula was performed by the use of hemo-clip and detachable snare, closure of the fistula was finally confirmed 6 days after the endoscopic procedure. Therefore, the gastrocolocutaneous fistula should be considered as one of the complications of PEG when fecal material is observed through PEG tube in a few days after PEG procedure and endoscopic treatment can be feasible in this case.</P>

소화기 ; 아스피린 복용 환자에서 내시경 유두 괄약근 절개술에 따른 출혈의 위험성

황종호 ( Jong Ho Hwang ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),최철웅 ( Choel Woong Choi ),박수범 ( Soo Bum Park ) 대한내과학회 2011 대한내과학회지 Vol.81 No.2

목적: 내시경 유두 괄약근절개술(endoscopic sphicterotomy, EST)은 현재 췌장과 담도 질환에서 널리 사용되는 내시경적 치료방법이나 출혈, 천공, 췌장염의 합병증이 동반될 수 있다. 외국 문헌에 따르면 EST 시행 전 아스피린(aspirin)을 중단할 필요가 없다고 제시하고 있다. 최근 국내에서도 아스피린의 복용자가 늘어나고 있음에도 불구하고 현재 이에 대한 적절한 지침이 없는 실정이다. 따라서 EST를 시행한 환자들에서 아스피린 복용 군과 비 복용 군의 출혈에 대한 빈도와 안전성에 대해 비교 평가하고자 하였다. 방법: 2005년 2월부터 2008년 9월까지 본원에서 EST를 시행한 1,003명을 대상으로 하였고, 13명이 시술 전 지속적으로 아스피린을 복용한 군이었으며 나머지 990명이 아스피린을 복용하지 않은 군이었다. 각 그룹 간에 EST 시행 후 출혈 빈도를 후향적으로 비교 분석하였다. 결과: 아스피린 복용 군과 비복용 군 간에 연령, 성별에서는 통계학적 차이를 보이지 않았다. EST 적응증으로 담관담석이 아스피린 복용 군에서 12예(92.3%, 12/13예), 비 복용 군에서 706예(71.3%, 706/990예)였으며(p=0.124) 동반된 질환으로 담도염이 아스피린 복용 군에서 11예(84.6%, 11/13예), 비 복용 군에서 815예(82.3%, 815/990 예)로 (p=0.974)두 군 간에 별다른 차이를 보이지 않았다. 임상적으로 의미 있는 출혈은 아스피린 복용 군에서는 발견되지 않았으며 아스피린 비 복용 군에서 3예(0.3%, 3/990예)가 관찰되었다. 결론: 본 연구에서는 아스피린을 복용하는 것이 EST 후 임상적으로 의미 있는 출혈을 증가시키지는 않았다. 따라서EST를 시행하기 전에 아스피린의 복용을 반드시 중단할 필요는 없을 것으로 생각한다. Background/Aims: Endoscopic sphincterotomy (EST) is a common therapeutic technique for biliary and pancreatic disease, but itcan cause several complications. Although the literature suggests that there is no need for patients to stop taking aspirin beforeundergoing EST, there are no definite guidelines on this in Korea. Consequently, we compared the frequency of bleeding and safety between aspirin users and nonusers undergoing EST. Methods: This retrospective study recruited 1003 patients who underwent EST at our hospital between 1 February 2005 and 30 September 2008. Thirteen patients continued to take aspirin until the day of the sphincterotomy (group 1), and 990 patients had not taken aspirin before the sphincterotomy (group 2). The incidence of post?sphincterotomy bleeding was compared between the two groups retrospectively. Results: There was no significant difference in age or gender between the two groups. The indications for EST included common bile duct stones in 12 patients (92.3%, 12/13) in group 1 and 706 patients (71.3%, 706/990) in group 2 (p=0.124). Regarding combined disease, cholangitis was observed in 11 patients (84.6%, 11/13) in group 1 and 815 patients (82.3%, 815/990) in group 2(p=0.974). Clinically significant post?sphincterotomy bleeding was observed in three patients in group 2 (0.3%, 3/990) versus none in group 1.Conclusions: Taking aspirin does not appear to clinically increase bleeding after EST. Therefore, there is no definite need to stopaspirin before undergoing EST. (Korean J Med 2011;81:193-198)

달리 분류되지 않는 자가면역성 췌장염에 동반한 심낭삼출액

장형하 ( Hyung Ha Jang ),강대환 ( Dae Hwan Kang ),김형욱 ( Hyung Wook Kim ),최철웅 ( Choel Woong Choi ),박수범 ( Soo Bum Park ),송병준 ( Byung Jun Song ),김수진 ( Su Jin Kim ) 대한내과학회 2014 대한내과학회지 Vol.86 No.6

자가면역성 췌장염은 자가 면역기전의 이상에 의한 만성 췌장염의 한 형태이다. 자가면역성 췌장염 두 가지 아형으로 나눠진다. 1형 자가면역성 췌장염은 림프형질세포 침윤 경화성 췌장염이라고도 불리며 IgG4 연관 질환의 스펙트럼에 속한다. 2형 자가면역성 췌장염은 특발성 췌관 중심 췌장염이라고도 하며 전신 IgG4 연관 질환의 스펙트럼에 속하지 않는다. 이번 증례는 ‘달리 분류되지 않는 자가면역성 췌장염’과 병발한 심낭 삼출액에 대한 첫 보고이다. 52세 여자환자가 호흡곤란을 주소로 내원하여 시행한 심초음파에 다량의 심낭삼출액이 관찰되었다. 복부 전산화 단층촬영에서 소시지 모양으로 췌장 실질의 종대와 췌장 가장자리에 저음영의 띠가 관찰되었고 내시경 역행성 담췌관조영술에서는 췌장 미부에서 췌관은 더 이상 조영되지 않았다. 혈청 검사에서 항핵항체는 양성이었으며 IgG4 수치는 정상이었다. 내시경 초음파 유도하 총생검술을 통한 병리 소견은 중성구와 림프구의 침윤은 많지 않았으며 섬유화가 두드러진 소견이었다. 환자는 스테로이드로 치료 후 추적 영상 검사에서 췌장의 종대는 호전을 보이고 내시경적 역행성 담체관조영술 소견상 이전에 관찰되지 않던 췌관 미부는 조영되었으며 불규칙한 협착의 소견이 관찰된 증례이다. Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis characterized by an autoimmune inflammatory process. This is the first case report of AIP, not otherwise specified, accompanied by pericardial effusion. A 52-year-old female visited our hospital due to dyspnea. Echocardiography showed a large amount of pericardial thickening. Abdominal computed tomography revealed diffuse enlargement of the pancreas body and tail with a sausage-shaped appearance, surrounded by a thick hypodense rim. Endoscopic retrograde cholangiopancreatography could not identify the tail portion of the pancreas, despite forceful contrast injection. Serology was positive for antinuclear antibody and IgG4 was normal. Endoscopic ultrasound-guided core biopsy of the pancreas was performed. Histologic examination revealed a fibrous connective tissue with inflammatory infiltration. The patient was treated with steroids. In the follow-up images, abnormal findings of pericardial effusion were improved, although an irregular long stricture of the pancreas tail portion remained. (Korean J Med 2014;86:733-738)

충수돌기에 발생한 암육종(Sarcomatoid carcinoma) 1예

( San Kim ),( Hyung Wook Kim ),( Dong Hyuk Cha ),( Woo Sung Jo ),( Tae Ik Park ),( Jong Ho Hwang ),( Dae Hwan Kang ),( Choel Woong Choi ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

A sarcomatoid carcinoma or carcinosarcoma is very rare biphasic tumor characterized by a combination of malignant epithelial and mesenchymal cells. Our case was a-51-year-old female, with palpable mass on rt. lower abdominal lesion. At first, we checked her abdominal CT &diagnosed mucocele /c adenocarcinoma on rt. colon. Then, laparoscopic hemicolectomy &lymph node dissection was performed. But histollogically, the tumor was Sarcomatoid carcinoma, arising in mucinous cystadenocarcinoma in the appendix. The mass size was 9.5cm length approximately &infiltrated the appendix. Immunohistochemically, the tumor cell showed a positive immunoreactions for vimentin &pancytokeratin. It means the tumor has two potential cells; epithelial and mesenchymal cell elements. Scarcomatoid carcinoma of colon is malignant tumor with poor prognosis. The patient was treated with doxorubicin &cisplatin therapy, but we lost the patient. A sarcomatoid carcinoma of colon is extremely rare tumor. We found one case &present it with review of the literatures.

충수돌기에 발생한 암육종(Sarcomatoid carcinoma) 1예

( San Kim ),( Hyung Wook Kim ),( Dong Hyuk Cha ),( Woo Sung Jo ),( Tae Ik Park ),( Jong Ho Hwang ),( Dae Hwan Kang ),( Choel Woong Choi ) 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-