Duodenal diverticulitis is difficult to diagnose because it can mimic other common diseases such as cholecystitis and perforated ulcer. Recently, we experienced a rare case of duodenal diverticulitis that was initially suspected on abdominal computed tomography as focal pancreatitis. Although duodenal diverticulitis has been increasingly recognizable before surgery, with the advent of multi-detector computed tomography, misdiagnosis remains problematic since duodenal diverticulitis is commonly not considered in the differential diagnosis of acute abdominal pain. We have to consider this rare disease entity because delayed diagnosis might be a cause of substantial morbidity and mortality.
Abdominal Pain ; Cholecystitis ; Delayed Diagnosis ; Diagnosis, Differential ; Diagnostic Errors ; Diverticulitis ; Diverticulum ; Duodenum ; Hydrazines ; Pancreatitis ; Rare Diseases ; Ulcer

Acute pancreatitis can result in many vascular complications in both artery and vein. Venous complication usually occurs as a form of splenic or portal vein thrombosis, and also can simultaneously occur in superior mesenteric vein as well. Rarely, isolated superior mesenteric vein thrombosis occurs as a venous complication. Although it is uncommon, mesenteric vein thrombosis is an important clinical entity because of the possibility of mesenteric ischemia and infarction of small bowel. The treatments of mesenteric venous thrombosis include anticoagulation therapy, transcatheter therapy and surgical intervention. We report a case of 45-year-old man who had acute pancreatitis with isolated superior mesenteric vein thrombosis, which was spontaneously dissolved with the resolution of underlying inflammation without anticoagulation or surgical intervention.
Acute Disease ; Humans ; Male ; *Mesenteric Veins ; Middle Aged ; Pancreatitis/complications/*diagnosis ; Tomography, X-Ray Computed ; Venous Thrombosis/*diagnosis/etiology/radiography

Choledochal cyst is an uncommon premalignant anomaly. The morphology and pathogenesis of the premalignant lesion of cholangiocarcinoma arising from the choledochal cyst has not been well described. Herein, we report a rare case of bile duct adenoma arising from choledochal cyst with anomalous union of pancreaticobiliary duct (AUPBD). 50-year-old woman was admitted to our hospital with the complaint of epigastric pain. She had received common bile duct (CBD) exploration and choledocholithotomy and cholecystectomy 3 months earlier under the diagnosis of multiple CBD stones. Intraoperalive cholangiogram was not remarkable except CBD dilatation at that time. Endoscopic retrograde cholangiopancreatography revealed choledochal cyst with AUPBD and round filling defect which disappeared easily on the balloon cholaniogram. On magnetic resonance cholangiopancreatography, the filling defect was confirmed as 2 cm polypoid mass attached to the distal bile duct wall. At laparotomy, a soft whitish mass was palpable on the lower CBD. On histological examination, adenoma with focal carcinoma change arising from choledochal cyst was diagnosed.
Adenoma, Villous/*diagnosis/pathology/radiography ; Bile Duct Neoplasms/*diagnosis/pathology/radiography ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst/*radiography/secretion/surgery ; Female ; Humans ; Middle Aged ; Tomography, X-Ray Computed

48-year-old woman was admitted to emergency room due to left flank pain. It was diagnosed with left ureteral stone and underwent extracorporeal shock wave lithotripsy (ESWL). However, 12 hours later, the patient complained acute upper abdominal pain with pulmonary edema and low blood pressure. A diagnosis of moderate acute pancreatitis with local complication was considered and we decided conservative therapy including fluid resuscitation, inotropics and antibiotics. It was suggested that ESWL was responsible for the acute pancreatitis. The patient gradually recovered and was discharged on 13th day of admission. ESWL is considered the standard treatment for urolithiasis. Although, it has proved to be safe and effective, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and cardiac arrhythmia. Although the possibility of post-ESWL acute pancreatitis is extremely low, physicians should take care of this complication.
Abdominal Pain ; Anti-Bacterial Agents ; Arrhythmias, Cardiac ; Diagnosis ; Emergency Service, Hospital ; Female ; Flank Pain ; Hematoma ; Humans ; Hypotension ; Lithotripsy* ; Lung Injury ; Middle Aged ; Pancreatitis* ; Pulmonary Edema ; Resuscitation ; Shock* ; Ureter ; Urolithiasis* ; Venous Thrombosis

Limy bile is characterized by excessive precipitation of calcium carbonate, and generally preceded by gallbladder obstruction. Three case reports have been found in the domestic literatures. It is rare that limy bile syndrome associates cholangitis or calcified gallbladder. We report the case of a patient with limy bile, located in the gallbladder, common bile duct, and intrahepatic duct, with association of calcified gallbladder. This case showed characteristic radiologic and endoscopic findings. The patient was treated by endoscopic sphincterotomy and laparoscopic cholecystectomy.
Bile* ; Calcium Carbonate ; Cholangitis* ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Gallbladder* ; Humans ; Sphincterotomy, Endoscopic

Portal vein thrombosis is an uncommon cause for presinusoidal hypertension, which results from inherited thrombotic disorder, neoplasm, and intra-abdominal inflammation like pancreatitis. It could develop portal hypertension, culminating in variceal bleeding from esophagus or stomach. One of the medical management of portal vein thrombosis is intravenous heparinization followed by long term oral anticoagulation. Intravenous heparinization using unfractionated heparin requires aPTT monitoring for dose adjustment which is not needed for low molecular weight heparin, and has higher risk of bleeding than using low molecular weight heparin. However, the standard protocol for anticoagulation in portal vein thrombosis has not been determined yet. We experienced a case of portal vein thrombosis in acute necrotizing pancreatitis, which was successfully treated with low molecular weight heparin, as herein reported.
Anticoagulants ; Esophageal and Gastric Varices ; Esophagus ; Hemorrhage ; Heparin ; Heparin, Low-Molecular-Weight* ; Hypertension ; Hypertension, Portal ; Inflammation ; Pancreatitis* ; Pancreatitis, Acute Necrotizing ; Portal Vein* ; Stomach ; Venous Thrombosis*

Sixteen cases of male breast cancer seen over a 20-year period were reviewed. The causes of cancer of the male breast are no better understood, but major alterations in hormonal environment could be a significant factor. Some clinical characteristics correspond well with the results of other series. The median age at presentation was 61.7 years. The most frequent initial symptom was a painless mass, and the incidences of nipple discharge, central tumor location, and axillary node involvement were high. Males also had a higher incidence of local advancement which was associated with a longer delay in seeking treatment and small breast tissue. The pathologic type was infiltrating ductal type in all cases except one, and all cases showed favorable nuclear grade. Estrogen receptor analysis was performed from the tumor of 2 patients. Both of them showed a high receptor level. There was no locoregional relapse in 5 patients who received adjuvant radiotherapy in contrast to the 2 relapses in 3 patients who underwent surgery alone. And three of the five patients who received radiotherapy suffered from systemic metastasis which suggested the important role of adjuvant chemotherapy as well as radiotherapy. In light of the encouraging results about adjuvant chemotherapy in the treatment for female breast cancer with axillary lymph node involvement, it would be desirable to extend this policy to male breast cancer.
Adenocarcinoma/epidemiology ; Adult ; Aged ; Breast Neoplasms/*epidemiology/pathology/therapy ; Carcinoma, Intraductal, Noninfiltrating/*epidemiology/pathology/therapy ; Combined Modality Therapy ; Human ; Korea/epidemiology ; Lymphatic Metastasis ; Male ; Middle Age ; Neoplasms, Multiple Primary ; Retrospective Studies

Small bowel diseases comprised of neoplasm, inflammatory disease, vascular abnormality, absorption dysfunction, and iatrogenic causes. Among those, vascular abnormality is perhaps the most important clinical disease entity. Obscure gastrointestinal bleeding accounts for 5% of chronic gastrointestinal bleeding, but conventional endoscopy and radiologic study may fail to diagnose the cause in certain cases. Patients with neurofibromatosis type 1 have a lot of gastrointestinal tumor, with a high incidence of small bowel involvement. We experienced a case presenting with chronic bleeding due to jejunal gastrointestinal stromal tumor diagnosed by capsule endoscopy in a seventy-two year old female patient with sporadic neurofibromatosis type 1.
Absorption ; Capsule Endoscopy* ; Endoscopy ; Female ; Gastrointestinal Stromal Tumors ; Hemorrhage* ; Humans ; Incidence ; Neurofibromatoses* ; Neurofibromatosis 1* ; Vascular Diseases

PURPOSE: To investigate the role of adjuvant chemoradiotherapy in adenocarcinoma of the rectum, we retrospectively compared the treatment results between postoperative adjuvant radiotherapy alone and combined chemoradiotherapy. MATERIAL AND METHODS: From October 1989 to May 1994, 141 patients with rectal carcinoma were treated by postoperative adjuvant therapy in Yonsei Cancer Center. Sixty eight patients were treated by radiation therapy alone. Seventy three patients were treated by combined chemoradiotherapy. Radiation therapy was delivered with 10 MV linear accelerator, 180cGy fraction/5 days per week. Total radiation doses were 5400cGy in the postoperative radiotherapy alone group. Three to twelve cycles of Fluorouracil (mean dose 393.9mg/m2) with Leucovorin (20mg/m2) and 5040cGy of radiation were delivered in the combined chemoradiotherapy group. Third and 4th cycle of chemotherapy were administrated during the radiation treatment in the combined group. The median follow up was 38 months with a range of 3 to 81 months. RESULTS: The 5 year overall survival rate of radiation alone group and combined group were 60.1% and 66.3%, respectively. The 5 year disease free survival rate of radiation alone group and combined group were 54.2% and 65.5%, respectively. There was no significant difference of overall survival and disease free survival between RT alone group and combined group (P<0.05). But the 5 year Local failure free survival rate of combined group was significantly better than radiotherapy alone group (65.8% vs. 50.3%, P=0.04). CONCLUSION: There was no significant difference in overall survival, disease free survival, and distant metastasis free survival between postoperative adjuvant radiotheray alone group and combinded chemoradiotherapy group. Only the Local failure free survival rate was superior in the combined treatment group. These results confirm the radiosensitizing effect of the chemotherapeutic agent in the combined chemoradiotherapy treatment.
Adenocarcinoma* ; Chemoradiotherapy* ; Chemoradiotherapy, Adjuvant ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Neoplasm Metastasis ; Particle Accelerators ; Radiation-Sensitizing Agents ; Radiotherapy ; Radiotherapy, Adjuvant ; Rectal Neoplasms ; Rectum* ; Retrospective Studies ; Survival Rate

Choledocho-duodenal fistula is a rare condition. It is usually developed as a complication of the gallstone disease, and rarely developed by penetrating peptic ulcer, trauma and neoplasm. Tuberculosis as a etiology of choledocho-duodenal fistula is very rare, and only a few cases were reported. We experienced a case of choledocho-duodenal fistula due to tuberculous lymphadenitis in a 26 year-old man presented with epigastric pain. After 6 months of anti-tuberculous medication, He was free of symptom and the fistula was closed spontaneously. We report the case with a review of literatures.
Adult ; Fistula* ; Gallstones ; Humans ; Peptic Ulcer ; Tuberculosis* ; Tuberculosis, Lymph Node