항혈소판제를 복용한 환자에서 내치핵에 의한 생명을 위협하는 다량의 하부위장관 출혈

김미연 ( Mi Yeon Kim ),송현주 ( Hyun Joo Song ),김성현 ( Sung Hyun Kim ),조유경 ( Yoo Kyung Cho ),김흥업 ( Heung Up Kim ),송병철 ( Byung Cheol Song ),장원영 ( Weon Young Chang ),김승형 ( Seung Hyoung Kim ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.4

A Dieulafoy lesion in the rectum is a very rare and it can cause massive lower gastrointestinal bleeding. An 83-year-old man visited our hospital. He had chronic constipation and had taken aspirin for about 10 years because of a previous brain infarction. He was admitted because of a recent brain stroke. On the third hospital day, he had massive hematochezia and suddenly developed hypovolemic shock. Abdominal computed tomography showed active arterial bleeding on the left side of the mid-rectum. Emergency sigmoidoscopy showed an exposed vessel with blood spurting from the rectal wall. The active bleeding was controlled successfully by an injection of epinephrine and two hemoclippings. On the fourth day after the procedure, he had massive recurrent hematochezia, and his vital signs were unstable. Doppler-guided hemorrhoidal artery band ligation was performed urgently at two sites. However, he rebled on the third postoperative day. Selective inferior mesenteric angiography revealed an arterial pseudoaneurysm in a branch of the superior rectal artery, as the cause of rectal bleeding, and this was embolized successfully. We report a rare case of life-threatening rectal bleeding caused by a Dieulafoy lesion combined with pseudoaneurysm of the superior rectal artery which was treated successfully with embolization.

알코올성 간경화증에 동반된 상행 결장의 정맥류 출혈 1예

김흥업 ( Heung Up Kim ),허규희 ( Kyu Hee Her ),김승형 ( Seung Hyoung Kim ),김봉수 ( Bong Soo Kim ),강영준 ( Young Joon Kang ),이재천 ( Jae Chun Lee ),김광식 ( Kwang Sik Kim ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2

간경변증이나 문맥 고혈압에 의한 정맥류 출혈은 주로 식도와 위에 발생하나 일부에서는 소장과 대장 등에서도 발생할 수 있다. 대장의 정맥류 출혈은 주로 직장과 맹장에 발생하며 국내에서는 좌측 대장에 발생된 소수의 예만 보고되었고, 아직 상행 결장의 정맥류 출혈은 보고된 바 없다. 알코올성 간경변증으로 의심되는 43세 남자 환자가 대량의 혈변으로 내원하였고, 복부 전산화단층촬영 및 혈관조영술로 상행 결장의 정맥류를 확인하고 우 결장반절제술을 시행하였고, 수술 후 지혈되었으며 수술 검체에서 정맥류에 의한 출혈이 확인되었다. 저자는 43세 남자 환자에서 발생한 알코올성 간경화증에 의한 상행 결장의 정맥류 출혈을 문헌고찰과 함께 보고하는 바이다. We report a very rare case of colonic varix with massive bleeding. A 43-year-old male patient was transferred to our hospital for hematochezia. The patient had a history of chronic liver disease associated with alcohol use. The initial blood pressure was 93/73 mmHg, and the hemoglobin level was 8.4 g/dL. Severe hepatomegaly and periportal fatty infiltration were seen on abdominal computed tomography. Markedly ectatic veins protruded from the luminal side of the proximal ascending colon and drained to the dilated ileocecal and retroperitoneal veins. Emergent colonoscopy failed because of continuous hematochezia and hypovolemic shock, despite massive transfusion. Markedly dilated colonic varices were noticed around the ileocecal and ascending colon on superior mesenteric arteriography. An emergent right hemicolectomy was performed. The presumed bleeding focus was a protruding varix with a red clot on the top of a denuded vein on the anteromedial wall of the proximal ascending colon. (Korean J Med 75:215-220, 2008)

진행성 간세포암종의 성공적 외과적 절제술 및 장기 생존 예 수술 후 재발된 간세포암종의 성공적 치료에 의한 장기 생존

이진형 ( Jin Hyoung Lee ),김자경 ( Ja Kyung Kim ),김화숙 ( Hwa Sook Kim ),안상훈 ( Sang Hoon Ahn ),전재윤 ( Chae Yoon Chon ),문영명 ( Young Myoung Moon ),이우정 ( Woo Jung Lee ),박영년 ( Young Nyun Park ),김승형 ( Seung Hyoung 대한간암학회 2006 대한간암학회지 Vol.6 No.-

외상 후 단독 상장간막동맥박리 후에 국소적으로 진행된 박리성 동맥류와 심한 진강의 압박이 있는 환자에서 혈관내 스텐트설치술 1례

김영규 ( Young Kyu Kim ),허규희 ( Kyu Hee Her ),김승형 ( Seung Hyoung Kim ),김광식 ( Kwangsik Kim ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.4

Reports on a posttraumatic isolated superior mesenteric artery (SMA) dissection are rare. Recently, endovascular stent placement via percutaneous access, instead of vascular surgery, has been widely accepted as the initial treatment for a patient with an isolated SMA dissection or its complications. A 60-year-old female patient was transferred to our hospital due to an isolated SMA dissection after a car accident. The SMA dissection was 8.5 cm in length, and it involved the true lumen, which was severely compressed by the thrombosed false lumen. The patient was closely observed because she did not complain of any specific visceral pain. On the seventh hospital day, she underwent computed tomography (CT) to decide on a further treatment plan, irrespective of the presence of the abdominal symptom. The findings of the follow-up CT showed no difference compared to those of the previous CT. She was discharged with anticoagulants. One month later, the follow-up CT revealed focally progressing dissecting aneurysms in the false lumen of the dissected SMA and a more severely compressed true lumen. Two self-expandable metallic stents were successfully placed in the true lumen of the dissected SMA, covering two aneurysmal lesions. Herein, we report a successful endovascular treatment with stent placement for treating focally progressing dissecting aneurysms and a severely compressed true lumen in a patient with a posttraumatic isolated SMA dissection. [ J Trauma Inj 2015; 28: 266-271 ]

위장관 ; 원인 미상의 위장관 출혈에서 역동적 조영증강 다중검출 전산화단층촬영술의 임상적 유용성

조재민 ( Jae Min Jo ),송현주 ( Hyun Joo Song ),부선진 ( Sun-jin Boo ),나수영 ( Soo-young Na ),김흥업 ( Heung Up Kim ),김승형 ( Seung Hyoung Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.4

목적: 원인 미상의 위장관 출혈은 전체 위장관 출혈 환자의5%를 차지한다. 역동적 조영증강 다중검출 전산화단층촬영술은 낮은 민감도 때문에 원인 미상의 위장관 출혈에서 일반적으로 권고되지 않지만, 일부 가이드라인에 따라 쉽고 빠른 진단을 위하여 사용이 되기도 한다. 이번 연구는 원인 미상의 위장관 출혈 환자에서의 역동적 조영증강 다중검출 전산화단층촬영술의 임상적 유용성을 평가하고자 진행하였다. 대상 및 방법: 2009년 3월부터 2014년 1월까지 역동적 조영증강 다중검출 전산화단층촬영술을 시행한 362명의 환자의 의무기록을 후향적으로 분석하였다. 총 45명의 환자들이 원인 미상의 위장관 출혈로 진단되어 연구에 포함되었다. 그들의 기저 특성과 치료과정을 후향적으로 분석하였고, 역동적조영증강 다중검출 전산화단층촬영술의 양성률과 이와 관련된 변수들을 평가하였다. 결과: 환자들의 평균 나이는 59세였고 남성이 51.1%를 차지하였다. 흑색변이 가장 흔한 증상이었다(44.4%). 역동적 조영증강 다중검출 전산화단층촬영술의 양성률은 20.0% (9/45)였고 장관내강 조영제 일혈 5명(55.6%), 장관내강 고음영의 혈종 또는 종괴 유사성 병변이 각각 2명(22.2%)이었다. 39명의 환자(86.7%)는 보존적 치료를 받았고 6명(13.3%)의 환자는 내시경 지혈술, 색전술, 또는 수술과 같은 특정 치료를 받았다. 역동적 조영증강 다중검출 전산화단층촬영술 양성 환자들은 특정 치료를 받는 경우가 많았다(44.4% vs. 5.6%, p=0.010).결론: 역동적 조영증강 다중검출 전산화단층촬영술은 낮은 양성률(20.0%)을 보였지만, 양성 소견을 보인 경우는 특정 치료로 시행하는 경우가 많았다. 역동적 조영증강 다중검출 전산화단층촬영술의 양성 소견은 원인 미상의 위장관 출혈 환자치료에 유용한 역할을 한다. Background/Aims: Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastrointestinal (GI) bleeding cases. Dynamic contrast-enhanced multidetector-row CT (DCE-MDCT) is not generally recommended in OGIB patients due to its low sensitivity. However, it can be used to quickly and simply diagnose OGIB according to some guidelines. The aim of this study was to evaluate the clinical efficacy of DCE-MDCT in OGIB patients. Methods: We retrospectively analyzed the medical records of 362 patients who underwent DCE-MDCT between March 2009 and January 2014. A total of 45 patients diagnosed with OGIB were included in this study. Their baseline characteristics and treatment procedure were analyzed retrospectively. The positive rates of DCE-MDCT for the detection of bleeding and associated factors were assessed. Results: The mean age of the patients was 59 years, and males represented 51.1%. Melena was the most common symptom (44.4%). Positive rate of DCE-MDCT findings was 20.0% (9/45). Among these patients, intraluminal contrast extravasation was found in 5 patients (55.6%) and intraluminal hematoma or mass lesions were found in 2 patients each (22.2%). Thirty nine patients (86.7%) underwent conservative management, and 6 patients (13.3%) underwent specific treatment, such as endoscopic treatment, embolization, or surgery. Patients who showed positivity in DCE-MDCT more frequently received specific treatment compared with those who were negative (44.4% vs. 5.6%, p=0.010). Conclusions: Although DCE-MDCT showed a low positive rate (20.0%), positive findings of DCE-MDCT could lead to specific treatment. Positive DCE-MDCT findings play a useful role in the management of patients with OGIB. (Korean J Gastroenterol 2016;67:198-206)