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췌장외 점액누출을 동반한 췌관내 유두상 점액종양에 의한 복막 가성점액종 1예
김해수 ( Hae Su Kim ),원영웅 ( Young Woong Won ),최정혜 ( Jung Hye Choi ),유교상 ( Kyo Sang Yoo ),여유미 ( Yoo Mi Yeo ),이지영 ( Ji Young Yhi ),표주연 ( Ju Yeon Pyo ),박훤겸 ( Hwon Kyum Park ) 대한췌담도학회 2013 대한췌담도학회지 Vol.18 No.4
복막 가성점액종은 원발병소에 관계없이 복막표면과 대망 등에 점액성 물질이 침착되면서 점액성 복수가 복강 내에 축적되는 상태를 말하는 임상적 질환이다. 원인질환으로 매우 드물지만 췌관내 유두상 점액종양이 보고되고 있으며, 시술과 관련된 점액의 누출, IPMN 파열 및 샛길 형성에 의한 복강내 점액누출 등이 유발기전으로 제시되고있다. 저자들은 췌장의 악성 IPMN 점액누출에 의해 발생한 복막 가성점액종 1예를 경험하였기에 문헌고찰과 함께보고하는 바이다. Pseudomyxoma peritonei (PMP) is a rare clinical entity characterized by gelatinous tumor implants within the peritoneal cavity and a large amount of mucinous ascites. Although most PMP cases originate in the appendix, few are associated with pancreatic intraductal papillary mucinous neoplasm (IPMN). IPMNs secrete thick mucin; therefore, they usually present with pancreatic duct dilatation. The presence of IPMN with extra-pancreatic mucin could be a marker of the eventual seeding of tumor outside the primary site. PMP associated with mucin leakage from pancreatic IPMN has been rarely reported. Here, we report the case of a patient with PMP that originated from pancreatic IPMN.
원위부 십이지장 정맥류의 대량 출혈에 대한 풍선-폐쇄 역행 경정맥 폐쇄술의 장기적인 치료 성공 1예
황순우 ( Soon Woo Hwang ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),김지연 ( Ji Yeoun Kim ),이지영 ( Ji Young Yhi ),곽동신 ( Dong Shin Kwak ),김해수 ( Hae Su Kim ),송순영 ( Soon Young Song ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.4
Duodenal variceal bleeding in patients with portal hypertension due to cirrhosis or other causes is uncommon. We report on a case of a 55-year-old male with an ectopic variceal rupture at the distal fourth part of the duodenum who presented with massive hematochezia and shock. Shortly after achievement of hemodynamic stability, due to the limitation of an endoscopic procedure, we initially attempted to find the bleeding focus by abdominal computed tomography, which showed tortuous duodenal varices that drained into the left gonadal vein. He was treated with first-line balloon-occluded retrograde transvenous obliteration (BRTO), resulting in a favorable long-term outcome without rebleeding three years later. This case suggests that BRTO may be a first-line therapeutic option for control of ruptured duodenal varices, especially at a distal location.