항혈소판제 단독 혹은 병합요법이 상부위장관 출혈에 미치는 영향

배서은 ( Suh Eun Bae ),김성은 ( Seong Eun Kim ),정성애 ( Sung Ae Jung ),윤소윤 ( So Yoon Yoon ),심기남 ( Ki Nam Shim ),정혜경 ( Hye Kyung Jung ),김태헌 ( Tae Hun Kim ),유권 ( Kwon Yoo ),문일환 ( Il Hwan Moon ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.4

Background/Aims: The increasing incidence of cardiovascular disease has led to an increase in the frequency of upper gastrointestinal (GI) hemorrhage due to the use of antiplatelet agents. This study examined the clinical characteristics of patients with upper GI hemorrhage who were administered aspirin alone or a combination treatment of antiplatelet agents. Methods: A 656 patients who underwent drug-eluting coronary stenting at Ewha Mokdong Hospital in 2008 were divided into three groups according to the antiplatetlet agents used after the intervention; groups of aspirin alone, aspirin plus clopidogrel, and aspirin, and clopidogrel plus another antiplatelet agent, respectively. Patients admitted with GI hemorrhage in the same period without a medication history of antiplatelet or nonsteroidal anti-inflammatory drugs were used as the control hemorrhage group. The medical records were reviewed. Results: Significant GI symptoms were observed in 21.1% of total patients, of whom 48.2% had ulcers. The upper GI hemorrhage rate was 3.8%. There was no significant difference in the hemorrhage rate between three groups. Compared to the control hemorrhage group, the endoscopic variables of the antiplatelet-related hemorrhage group were not significantly different. However, the Helicobacter pylori infection rate was lower, the admission period was longer, and the mortality rate was higher in the antiplatelet-related hemorrhage group (p<0.05, respectively). There was no direct association between restarting or discontinuance of antiplatelets after the hemorrhage event and mortality. Conclusions: Adding other antiplatelet agents to aspirin did not increase the hemorrhage rate. However, active diagnostic and therapeutic efforts are recommended in patients with GI symptoms during antiplatelet therapy. (Korean J Gastroenterol 2011;57:213-220)

Gastrointestinal Hemorrhage after Concurrent Chemoradiotherapy in Locally Advanced Pancreatic Cancer

( Kyong Joo Lee ),( Hee Man Kim ),( Joo Won Jung ),( Moon Jae Chung ),( Jeong Youp Park ),( Seungmin Bang ),( Seung Woo Park ),( Woo Jung Lee ),( Jin Sil Seong ),( Si Young Song ) 대한소화기학회 2013 Gut and Liver Vol.7 No.1

Background/Aims: While chemoradiotherapy (CRT) is considered to be a reasonable treatment for locally advanced pancreatic cancer (LAPC), there is little information about the associated risk of gastrointestinal (GI) hemorrhage. We investigated the clinical features of GI toxicity after CRT in patients with LAPC and examined the effect of GI hemorrhage on survival. Methods: Patients enrolled in this study had received CRT for pathologically proven LAPC. Their medical records were retrospectively reviewed. Results: A total of 156 patients with LAPC (median age, 65 years; range, 39 to 90 years) who received treatment between August 2005 and March 2009 were included in this study. The most common GI toxicities were ulcer formation (25.6%) and hemorrhage (25.6%), and the most common grade 3 to grade 5 GI toxicity was hemorrhage (65%). The origins of GI hemorrhage were gastric ulcer (37.5%), duodenal ulcer (37.5%), and radiation gastritis (15.0%). The independent risk factor for GI hemorrhage was tumor location in the pancreatic body. The median overall survival of the patients with a GI hemorrhage was 13.8 months (range, 2.8 to 50.8 months) and was not significantly different from that of patients without GI hemorrhage. Conclusions: GI hemorrhage was common in patients with LAPC after CRT. Although GI hemorrhage was controlled with endoscopic hemostasis, preventive measures should be investigated to reduce needless suffering. (Gut Liver 2013;7:106-111)

췌장염에서 발생한 가성동맥류에 의한 하부 소화관 출혈

유권(Kwon Yoo),문정섭(Jeong Seop Moon),전영빈(Young Bin Jeon),양대원(Dae Won Yang),정성광(Sung Kwang Chung) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.2

Gastrointestinal hemorrhage is an infrequent but well recognized complication in patients with pancreatitis. Pancreatitis, peripancreatic inflammation and established pseudocysts can lead to pseudoaneurysm formation of contiguous splanchnic arteries which may cause significant gastrointestinal hemorrhage. Hemorrhage from a ruptured pseudoaneurysm may occur into various parts of gastrointestinal tract and present major clinical problems, both in terms of timely diagnosis and appropriate surgical therapy. Lower Gastrointestinal hemorrhage caused by ruptured pseudoaneurysm is extremely rare and has a worse prognosis, mainly because of the high incidence of fulminating sepsis and massive bleeding. We experienced a case of massive lower gastrointestinal bleeding caused by pseudoaneurysrnal rupture of splenic artery into colon in a patient with chronic pancreatitis. (Korean J Gastroenterol 1997; 30:268-272)

Gastrointestinal Hemorrhage after Concurrent Chemoradiotherapy in Locally Advanced Pancreatic Cancer

이경주,김희만,정주원,정문재,박정엽,방승민,박승우,이우정,성진실,송시영 거트앤리버 소화기연관학회협의회 2013 Gut and Liver Vol.7 No.1

Background/Aims: While chemoradiotherapy (CRT) is considered to be a reasonable treatment for locally advanced pancreatic cancer (LAPC), there is little information about the associated risk of gastrointestinal (GI) hemorrhage. We investigated the clinical features of GI toxicity after CRT in patients with LAPC and examined the effect of GI hemorrhage on survival. Methods: Patients enrolled in this study had received CRT for pathologically proven LAPC. Their medical records were retrospectively reviewed. Results: A total of 156 patients with LAPC (median age, 65 years; range, 39 to 90 years) who received treatment between August 2005 and March 2009 were included in this study. The most common GI toxicities were ulcer formation (25.6%) and hemorrhage (25.6%), and the most common grade 3 to grade 5 GI toxicity was hemorrhage (65%). The origins of GI hemorrhage were gastric ulcer (37.5%), duodenal ulcer (37.5%), and radiation gastritis (15.0%). The independent risk factor for GI hemorrhage was tumor location in the pancreatic body. The median overall survival of the patients with a GI hemorrhage was 13.8 months (range, 2.8 to 50.8 months) and was not significantly different from that of patients without GI hemorrhage. Conclusions: GI hemorrhage was common in patients with LAPC after CRT. Although GI hemorrhage was controlled with endoscopic hemostasis, preventive measures should be investigated to reduce needless suffering

편도절제술 후 출혈로 오인된 위장관 출혈 1예

홍종의,김홍중,정수진,심상열 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.4

Tonsillectomy, with or without adenoidectomy, remains the most frequently performed surgical procedure by otolaryngologists. Postoperative hemorrhage, which is classified as primary (<24 h) or secondary (>24 h) hemorrhage, is recognized as a rare but potentially life-threatening complication. Although most oral bleedings occuring after tonsillectomy are considered as post-tonsillectomy hemorrhages, there could also be other origins such as gastrointestinal hemorrhage. We recently experienced a case of gastrointestinal hemorrhage that was misdiagnosed as secondary post-tonsillectomy hemorrhage. We report this case with a review of the literature.

췌장염에서 발생한 가성동맥류에 의한 하부 소화관 출혈 1예

양대원,정성광,문정섭,전영빈,유권 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.30 No.2

췌장의 가성낭종 파열에 의한 하부 위장관 출혈 1예

장성종,김병수,부귀범,김동규,박찬국,김만우,김정용,박상헌 조선대학교 부설 의학연구소 2000 The Medical Journal of Chosun University Vol.25 No.1

Pancreatic pseudocysts usually develop as a complication of acute pancreatitis or repeated attacks of chronic pancreatitis. Pseudocysts may also develop as a result of traumatic injuries or neoplasms. An uncommon complication is massive hemorrhage inside the pancreatic pseudocyst. The exact mechanism of hemorrhage is unknown. Enzymatic digestion, pressure erosion from the cyst mass or a combination of these processes may play an important role. Gastrointestinal hemorrhage associated with a pancreatic pseudocyst can occur in 10 percent of cases. When hemorrhage occurs because of erosion into a blood vessel involved in the pseudocyst, surgery is indicated since the episodes of hemorrhage are often severe and may even be fatal. When there is colonic involvement, various complications may occur. The most dangerous one is spontaneous rupture into the colon, which requires immediate surgical treatment because of high incidence of fulminating sepsis or massive hemorrhage. We examined a sixty eight-year-old man complaining of hematochezia and dizziness, and reported that it was a case of massive lower gastrointestinal hemorrhage caused by pseudocyst of the pancreas ruptured into the colon associated with chronic pancreatitis. On operative findings, the peripancreatic fatty tissue had severe adhesions to transverse colon and tail portion of pancreas, where the pseudocyst had formed. A distal pancreatectomy, splenectomy and resection of transverse colon were performed. By microscopic examination, hemorrhagic necrosis and inflammatory change were observed in the pancreas specimen. The tail portion of pancreas had a 6×6 cm sized cystic mass and was proven to be a pseudocyst with no epithelial lining.

급성 하부위장관 출혈로 인하여 진단된 급성 화농성 충수염 1예

김대하 ( Dae-ha Kim ),이주한 ( Ju Han Lee ),김동우 ( Dongwoo Kim ),황수현 ( Suhyun Hwang ),강규호 ( Kyuho Kang ),구자설 ( Ja Seol Koo ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.1

A 49-year-old man visited the emergency room of Korea University Ansan Hospital with hematochezia starting the day before the visit. Recently, he was on anti-platelet medication due to hypertension. The patient had no definite symptoms other than hematochezia. Digital rectal exam was positive and laboratory tests showed severe anemia. Sigmoidoscopy was initiated and almost no fecal material was observed in the intestinal tract, allowing insertion into the cecum. Active bleeding from the appendiceal opening was noted. On abdominal CT, contrast enhancement was observed at the tip of the appendix. Under suspicion of acute appendicitis, we consulted with a surgeon. The patient underwent appendectomy with partial cecal resection. Pathologic examination revealed a diagnosis of appendix bleeding due to acute suppurative appendicitis. The patient had no further bleeding after surgery and was discharged in a stable state. Careful observation by the endoscopist is necessary for accurate diagnosis of lower gastrointestinal hemorrhage. Appendiceal hemorrhage is very rarely reported, but it has various pathophysiologies. CT scan is useful when appendiceal hemorrhage is confirmed by endoscopic findings. Surgical treatment was needed in almost all cases reported worldwide. If bleeding from the appendix is confirmed, surgical treatment should be considered for both therapeutic and diagnostic purposes. (Korean J Gastroenterol 2019;73:45-49)

하부위장관 출혈로 나타난 급성 호산구성 충수염

안소라 ( So Ra Ahn ),이주현 ( Joo Hyun Lee ) 대한소화기학회 2021 대한소화기학회지 Vol.78 No.2

Acute eosinophilic appendicitis (AEA) is defined as eosinophilic infiltration of the muscular layer of the appendix instead of neutrophils. The symptoms of this disease are similar to those of acute suppurative appendicitis. On the other hand, it can present as a lower gastrointestinal hemorrhage. This paper reports a case of an elderly man with an appendiceal hemorrhage due to AEA. The diagnosis was made by colonoscopy during an evaluation of hematochezia. The patient underwent a laparoscopic partial cecectomy. The histology findings revealed ulceration and marked eosinophilic infiltration of the muscularis propria of the appendix with accompanying edema. Although appendiceal hemorrhage due to AEA is extremely rare, clinicians should consider it in a differential diagnosis. (Korean J Gastroenterol 2021;78:134-137)

A case of gastrointestinal hemorrhage during aspirin therapy in a patient with Kawasaki disease

Yo-Eon Shin,Yong Wook Kim,Kyoung Sim Kim,Eun Young Kim,Young Kim,Hae In Jang,Hyoung Min Cho 조선대학교 의학연구원 2021 Medical Bilogical Science and Engineering Vol.4 No.1

Kawasaki disease (KD) is an acute febrile multisystem vasculitis and has been recognized to be one of the most common causes of acquired heart disease in children. KD with gastrointestinal bleeding is quite rare. We report a 12-month-old boy with KD complicated by gastrointestinal hemorrhage after using of high-dose of aspirin. Physicians caring for patients with KD should mindful on the signs and symptoms of aspirin toxicity including gastrointestinal hemorrhage. Starting or early switching to a low-dose aspirin treatment on KD should be considered.