The most common cause of acute pancreatitis is gallstones. However, idiopathic causes comprise about 10 to 15% of all cases of acute pancreatitis. Biliary sludge is thought to be a cause of idiopathic acute pancreatitis and mainly via obstruction of the common bile duct. Cholesterol polyps of the gallbladder, cholesterolosis and hemobilia can be associated with biliary pain. Fragments of the gallbladder polyps and blood clots can lead to acute pancreatitis in a way similar to that of biliary sludge. Yet it has never been reported that the necrotic tissue of gallbladder cancer can lead to acute pancreatitis. Herein, we report on the case of a 52-year-old man with acute pancreatitis that was caused by the necrotic tissue of gallbladder cancer. The necrotic tissue in the bile duct was revealed on endoscopic retrograde cholangiopancreatography (ERCP). The patient was successfully treated by laparoscopic cholecystectomy along with liver segmentectomy.
Bile ; Bile Ducts ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Cholesterol ; Common Bile Duct ; Gallbladder ; Gallbladder Neoplasms ; Gallstones ; Hemobilia ; Humans ; Liver ; Mastectomy, Segmental ; Middle Aged ; Pancreatitis ; Polyps

Most tumors affecting Vater's ampulla are adenocarcinomas, but a neuroendocrine carcinoma in the ampulla of Vater is extremely rare. The coexistence of these two tumors has been reported in only a few cases. Here, we report a rare case of a collision tumor of the ampulla of Vater with an adenocarcinoma and a large cell neuroendocrine carcinoma.
Adenocarcinoma ; Ampulla of Vater ; Carcinoma, Neuroendocrine

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition in which submucosal or subserosal gas cysts are present within the bowel wall. We report a case of a 37-year-old man with no medical history. He underwent a colonoscopy for screening purposes, which revealed multiple and variably sized submucosal tumors in the ascending colon. Endoscopic ultrasonographic (EUS) finding showed multiple hyperechogenic regions with distal acoustic shadowing within the submucosa of the ascending colon. A computed tomography scan showed multiple air-filled cystic masses in the ascending colon. EUS appears to be effective for the diagnosis of PCI.
Acoustics ; Adult ; Colon, Ascending ; Colonoscopy ; Endosonography ; Humans ; Mass Screening ; Pneumatosis Cystoides Intestinalis ; Shadowing (Histology)

Even though percutaneous transhepatic gallbladder drainage (PTGBD) is performed prior to ERCP or following ERCP because of the patients' medical condition or failed bile duct cannulation, there are no definite endoscopic landmarks that are useful for successful bile duct cannulation in some cases. We report here on 4 patients in whom selective bile duct cannulation, as guided by the endoscopic landmarks, was successful following indigocarmine injection via PTGBD.
Bile ; Bile Ducts ; Catheterization ; Cholangiopancreatography, Endoscopic Retrograde ; Drainage ; Gallbladder ; Humans

Endoscopic retrograde cholangiopancreatography has become a standard procedure for the diagnosis and treatment of pancreatobiliary disease. Like any invasive procedure, it carries a small, but significant rate of serious complications such as duodenal perforation. Primary surgical closure is the treatment of choice for the cases of duodenal perforation. However, there have been some case reports in which endoscopic metal clip closure of an iatrogenic duodenal perforation was successful. We experienced three cases of successful treatment of the iatrogenic duodenal perforation using endoscopic clipping and fibrin glue injections during a duodenoscope insertion.
Cholangiopancreatography, Endoscopic Retrograde ; Duodenoscopes ; Fibrin Tissue Adhesive

Percutaneous radiologic gastrostomy (PRG) is an enteral nutritional method that can be applied to a patient with dysphagia due to cerebrovascular accident, Parkinsonism, dementia, or head and neck cancer. PRG is a safe and cost-effective method with low morbidity and mortality rates compared with surgical gastrostomy, because it require less sedation and less invasive placement technique. PRG complications include wound infections, peritonitis, tube malfunctions, peristomal leakage, bleeding, ileus, pneumoperitoneum, aspiration pneumonia, and bowel perforation. But, bowel perforation after PRG is rare. We recently experienced a case of transverse colon penetration and tube displacement, which occurred as a PRG complication in a 60-year-old male with a cerebrovascular accident.
Colon, Transverse ; Deglutition Disorders ; Dementia ; Displacement (Psychology) ; Gastrostomy ; Head and Neck Neoplasms ; Hemorrhage ; Humans ; Ileus ; Male ; Middle Aged ; Parkinsonian Disorders ; Peritonitis ; Pneumonia, Aspiration ; Pneumoperitoneum ; Stroke ; Wound Infection

Metastasis from lung cancer to the small bowel is rare and this accounts for 0.2% to 0.5% of all the cases of metastasis from lung cancer. In most cases, the patients are asymptomatic and they can show signs of bleeding, intestinal obstruction, perforation and so on. A better diagnostic approach to the small bowel has recently been made possible through capsule endoscopy and double balloon enteroscopy (DBE), and they have a higher diagnostic rate for small bowel bleeding compared with that of the previous diagnostic tests. DBE makes it possible to diagnose precisely due to the high quality endoscopic images and biopsy specimens. In addition, therapeutic DBE with a 2.8 mm channel enables performing more kinds of therapeutic procedures than diagnostic DBE with a 2.2 mm channel. If small bowel metastasis is suspected on 18FDG-PET/CT, then DBE can be considered for making a pathologic diagnosis. We report here on a case of small bowel metastasis from non small cell lung cancer in a 39-year-old woman who complained of hematochezia and we review the relevant literature.
Adult ; Biopsy ; Capsule Endoscopy ; Carcinoma, Non-Small-Cell Lung ; Diagnostic Tests, Routine ; Double-Balloon Enteroscopy ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestinal Obstruction ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Small Cell Lung Carcinoma

Colonic phytobezoars are defined as conglomerate masses of fruit or vegetable matter in the colon, and these have rarely reported as a cause of colon obstruction. Because it is extremely rare, its correct diagnosis might be delayed even with the aid of abdominal computed tomography. We report here on a case of diagnosed colonic obstruction due to colonic phytobezoars in a 67-year-old female with diabetic end stage renal disease and chronic constipation. Although abdomino-pelvic computed tomography did not demonstrate the presence of phytobezoars, multiple phytobezoars impacted in the colon were found and these were removed by colonoscopy. This is a rare case in that colonic obstruction due to phytobezoar was diagnosed early and it was treated by colonoscopy.
Aged ; Colon ; Colonoscopy ; Constipation ; Female ; Fruit ; Humans ; Kidney Failure, Chronic ; Vegetables

A colonoscopic perforation is rare but can cause a fatal outcome. A perforation can be intraperitoneal or retroperitoneal. Air in the retroperitoneal space by perforation can spread to the mediastinum, pleura, and subcutaneous tissue through the visceral space. Therefore, a colonoscopic perforation may manifest as a pneumomediastinum, a pneumothorax, or subcutaneous emphysema without a peritoneal irritation sign. Although a colonoscopic perforation is treated mainly with an operation, medical treatment may be possible in selected cases, especially for a perforation to the retroperitoneal area or that under peritoneal reflexion. Clipping of a perforation is effective for medical treatment. We experienced a case of pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumoretroperitoneum without peritoneal irritation following a diagnostic colonoscopy, which was diagnosed after 3 days because of atypical symptoms but was successfully managed with medical treatment and clipping.
Colonoscopy ; Fatal Outcome ; Mediastinal Emphysema ; Mediastinum ; Pleura ; Pneumothorax ; Retroperitoneal Space ; Retropneumoperitoneum ; Subcutaneous Emphysema ; Subcutaneous Tissue

Cytomegalovirus (CMV) infection is associated with significant morbidity and mortality in immunocompromised patients. It may cause serious illness including bleeding, ulceration and perforation of the gastrointestinal tract. However, bowel perforation, toxic megacolon, and massive lower gastrointestinal bleeding caused by CMV in one patient is not common. In this report, we present a case of CMV colitis causing cecal perforation and massive lower gastrointestinal bleeding in a patient with lupus nephritis. In our case, severe lower gastrointestinal bleeding developed during successful treatment of CMV infection with ganciclovir. Even though the outcome of CMV colitis has improved since ganciclovir has been available for immunocompromised patients, reductions in gastrointestinal bleeding from colonic ulcers of CMV colitis may be possible during successful treatment with ganciclovir. This case suggests the possibility of lower gastrointestinal bleeding from a colon ulcer of CMV colitis should be considered during successful treatment with ganciclovir in immunocompromised patients.
Colitis ; Colon ; Cytomegalovirus ; Ganciclovir ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Immunocompromised Host ; Lupus Nephritis ; Megacolon, Toxic ; Ulcer