대량의 혈변을 동반한 원발성 대동맥-십이지장루 1예

김병연 ( Byung Yen Kim ),김기배 ( Ki Bae Kim ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.3

A primary aortoenteric fistula is defined as the spontaneous development of communication between the gastrointestinal tract and the native aorta. This is unlike a secondary aortoenteric fistula that occurs after surgery, such as a vascular graft. A primary aortoenteric fistula is an extremely rare cause of upper gastrointestinal bleeding. The condition is often overlooked because of its extremely low incidence. This paper reports a case of a 75-year-old man who presented with massive melena. Esophagogastroduodenoscopy revealed an ulcer measuring approximately 1.3 cm with a huge pulsating vessel in the third portion of the duodenum. Later, the diagnosis of primary aortoduodenal fistula was confirmed. The patient died in the preoperative stage due to massive bleeding. The findings of this case suggest that the endoscopists should recognize aortoenteric fistula as a potential cause of gastrointestinal bleeding. (Korean J Gastroenterol 2021;77:132-135)

상부위장관 출혈을 동반한 담낭-위-대장 누공

박민규 ( Min Kyu Park ),정윤진 ( Yun Jin Chung ),백인엽 ( In Yub Baek ),김형석 ( Hyeong Seok Kim ),배상수 ( Sang Soo Bae ),이수옥 ( Su Ok Lee ),이경숙 ( Kyoung Suk Lee ),권종규 ( Jong Kyu Kwon ) 대한소화기학회 2013 대한소화기학회지 Vol.61 No.5

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.

상부위장관 출혈을 동반한 담낭-위-대장 누공 1예

박민규,정윤진,백인엽,김형석,배상수,이수옥,이경숙,권종규 대한소화기학회 2013 대한소화기학회지 Vol.61 No.5

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.

Gastrointestinal Tract Involvement of Gorham’s Disease with Expression of D2-40 in Duodenum

최봉석,홍석진,주미애,이석종,이종민,배한익,최병호 대한소아소화기영양학회 2014 Pediatric gastroenterology, hepatology & nutrition Vol.17 No.1

We present a case of a 13-year-old boy with Gorham’s disease involving the thoracic and lumbar spine, femur, and gastrointestinal (GI) tract, which was complicated by recurrent chylothorax and GI bleeding. The presenting symp-toms were intermittent abdominal pain, back pain, and melena. Esophagogastroduodenoscopy and colonoscopy showed no abnormal lesions, but duodenal biopsy showed marked dilation of the lymphatics in the mucosa and submucosa, which revealed positive staining with a D2-40 immunohistochemical marker. In cases of GI bleeding with osteolysis, the expression of a D2-40 marker in the lymphatic endothelium of the GI tract may help to diagnose GI involvement in Gorham’s disease. To the best of our knowledge, this is the first case report to pathologically demon-strate intestinal lymphatic malformation as a cause of GI bleeding in Gorham’s disease.

Gastrointestinal Tract Involvement of Gorham's Disease with Expression of D2-40 in Duodenum

Choi, Bong Seok,Hong, Suk Jin,Chu, Mi Ae,Lee, Seok Jong,Lee, Jong-Min,Bae, Han Ik,Choe, Byung-Ho The Korean Society of Pediatric Gastroenterology 2014 Pediatric gastroenterology, hepatology & nutrition Vol.17 No.1

We present a case of a 13-year-old boy with Gorham's disease involving the thoracic and lumbar spine, femur, and gastrointestinal (GI) tract, which was complicated by recurrent chylothorax and GI bleeding. The presenting symptoms were intermittent abdominal pain, back pain, and melena. Esophagogastroduodenoscopy and colonoscopy showed no abnormal lesions, but duodenal biopsy showed marked dilation of the lymphatics in the mucosa and submucosa, which revealed positive staining with a D2-40 immunohistochemical marker. In cases of GI bleeding with osteolysis, the expression of a D2-40 marker in the lymphatic endothelium of the GI tract may help to diagnose GI involvement in Gorham's disease. To the best of our knowledge, this is the first case report to pathologically demonstrate intestinal lymphatic malformation as a cause of GI bleeding in Gorham's disease.

소장출혈 및 장중첩증을 유발한 폐암의 소장 전이

윤일선 ( Il Seon Yun ),이지영 ( Jee Young Lee ),이재성 ( Jae Sung Lee ),이주영 ( Ju Young Lee ),변진명 ( Jin Myung Byun ),김은정 ( Eun Jung Kim ),박진영 ( Jin Young Park ),박진경 ( Jean Kyung Park ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.6

Intestinal intussusception caused by metastatic tumor is uncommon. Symptomatic small bowel metastases from lung cancer have been rarely reported. Here we report a case of intussusception with gastrointestinal bleeding induced by jejunal metastasis of non-small cell lung cancer with a review of the literature. A 52-year-old man was admitted to our hospital because of melena. He had underwent right pneumonectomy and received systemic chemotherapy with radiotherapy for squamous cell lung cancer. Esophagogastroduodenoscopy and colonoscopy failed to reveal bleeding focus. Abdominal CT scan revealed jejunal intussusception and histologic examination of resected jejunum showed metastatic mass from lung cancer. In patients with small bowel obstruction and history of malignancies, possibility of small bowel metastatic tumor should be considered. (Korean J Gastroenterol 2008; 51:377-380)

Availability of Blood Urea Nitrogen/Creatinine Ratio in Gastrointestinal Bleeding with Melena in Children

Kyu Seon Kim,Chan Ho Kang,Jae Young Kim 대한소아소화기영양학회 2015 Pediatric gastroenterology, hepatology & nutrition Vol.18 No.1

Purpose: The aims of our study were to evaluate the blood urea nitrogen to creatinine ratio (BUN/Cr ratio) for dis-tinguishing between an upper and lower gastrointestinal bleeding (GIB), and differentiating between the two most common causes of upper gastrointestinal bleeding (UGIB) presenting with melena in children.Methods: Retrospective data of patients with GIB presenting with melena were analyzed. The data from 60 cases were reviewed including demographics, laboratory findings, diagnostic modalities and results, treatments, and transfusions.Results: Among the 60 cases, UGIB and lower gastrointestinal bleeding (LGIB) were found in 35 cases (58.3%) and 14 cases (23.3%), respectively. The two common causes of UGIB were varices (37.1%), and peptic ulcer dis-eases (PUD) (31.4%). The BUN/Cr ratio of 30 or greater was higher in UGIB than LGIB (odds ratio [OR], 6.9; 95% confidence interval [95% CI], 1.3-37.2). In UGIB, the BUN/Cr ratio of the varices group was higher than that of the PUD group (p=0.015). The OR for the BUN/Cr ratio appeared as 1.2 per unit increase in the varices group than the PUD group (95% CI, 1.03-1.3). There was no difference between the PUD group and Meckel’s diverticulum group.Conclusion: The BUN/Cr ratio was not uneven in differentiating UGIB from LGIB of children with melena in our study. This suggests that BUN/Cr ratio should be interpreted carefully.

Availability of Blood Urea Nitrogen/Creatinine Ratio in Gastrointestinal Bleeding with Melena in Children

Kim, Kyu Seon,Kang, Chan Ho,Kim, Jae Young The Korean Society of Pediatric Gastroenterology 2015 Pediatric gastroenterology, hepatology & nutrition Vol.18 No.1

Purpose: The aims of our study were to evaluate the blood urea nitrogen to creatinine ratio (BUN/Cr ratio) for distinguishing between an upper and lower gastrointestinal bleeding (GIB), and differentiating between the two most common causes of upper gastrointestinal bleeding (UGIB) presenting with melena in children. Methods: Retrospective data of patients with GIB presenting with melena were analyzed. The data from 60 cases were reviewed including demographics, laboratory findings, diagnostic modalities and results, treatments, and transfusions. Results: Among the 60 cases, UGIB and lower gastrointestinal bleeding (LGIB) were found in 35 cases (58.3%) and 14 cases (23.3%), respectively. The two common causes of UGIB were varices (37.1%), and peptic ulcer diseases (PUD) (31.4%). The BUN/Cr ratio of 30 or greater was higher in UGIB than LGIB (odds ratio [OR], 6.9; 95% confidence interval [95% CI], 1.3-37.2). In UGIB, the BUN/Cr ratio of the varices group was higher than that of the PUD group (p=0.015). The OR for the BUN/Cr ratio appeared as 1.2 per unit increase in the varices group than the PUD group (95% CI, 1.03-1.3). There was no difference between the PUD group and Meckel's diverticulum group. Conclusion: The BUN/Cr ratio was not uneven in differentiating UGIB from LGIB of children with melena in our study. This suggests that BUN/Cr ratio should be interpreted carefully.

흑색변을 보인 다발성 위 중복 낭종 1예

강석형,심기남,태정현,정혜경,정성애,이선화,이주호,성순희 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.6

A gastric duplication cyst is a rare congenital anomaly. Among gastrointestinal duplication cysts, gastric duplication cyst account for only 3.8%. They tend to be symptomatic in early childhood, but asymptomatic during adulthood. So its diagnosis is incidental. Abdominal pain is the most common complaint in adults, and most cases are discovered incidentally by radiological examination or endoscopic gastroduodenoscopy. Preoperative diagnosis of gastric duplication cyst is difficult, and definitive diagnosis requires pathological examination of the lesion. So far, about 8 cases of gastric duplication cyst have been reported in adults in the Korean literature. We report here a case of multiple gastric duplication cysts presenting with melena in a 14-year-old man, which were detected by endoscopic gastroduodenoscopy, abdominal computed tomography and endoscopic ultrasonography. They were treated by complete excision of the multiple gastric duplication cysts by laparoscopic wedge resection. 위장관 중복 낭종은 드문 선천성 질환으로 위장관 어느 부위에나 발생하며, 위에서 발생하는 중복 낭종은 전체의 3.8% 정도를 차지한다. 유아기에서는 증상이 있으나, 그 이후에 발견되는 경우에는 무증상인 경우가 많다. 위 중복 낭종은 수술전의 진단이 어렵고 최종 진단을 위해서는 병변부의 조직검사가 필요하다. 본 저자들은 흑색변을 주소로 내원한 14세 남자에서 상부위장관 내시경, 복부 전산화 단층촬영 및 내시경 초음파 검사로 분문부, 상부 위체부 대만부와 중부 위체부 대만부의 다발성 위 중복 낭종을 진단하고 복강경적 쐐기 절제술로 치료한 1예를 경험하여 보고한다.

만성 빈혈과 재발성 흑색변으로 발견된 수입각에 발생한 원발성 십이지장암 1예

전백규,이태훈,조현욱,이세환,이석호,정일권,김홍수,박상흠,김선주,조현득 순천향대학교 순천향의학연구소 2011 Journal of Soonchunhyang Medical Science Vol.17 No.1

Obscure gastrointestinal bleeding accounts for approximately 5% of all gastrointestinal bleeding. Angioectasia of the small bowel is the most common form of obscure gastrointestinal bleeding, while small bowel tumors are the second. Among small bowel tumors,primary duodenal cancer is uncommon and represents 0.3% of gastrointestinal tumors. However, primary duodenal cancer at the duodenal stump following Billroth II gastrectomy for stomach cancer is extremely rare, and have not been reported yet in Korea. We report the first case of a 74-year-old man with chronic anemia and recurrent melena, which was diagnosed as a primary duodenal adenocarcinoma developed in afferent loop. The primary lesion was successfully accessed under cap-fitted endoscopy, however final diagnosis was delayed due to the unusual anatomical site.