Intraductal papillary mucinous neoplasms (IPMNs) are premalignant lesions that require a surgical resection. IPMN can cause abdominal pain or pancreatitis as a result of either mucin production or a papillary growth, resulting in a ductal obstruction. Most IPMNs arise from the main pancreatic duct. However, IPMNs arising from the accessory pancreatic duct are extremely rare. Pancreatic divisum occurs when the ventral and dorsal ducts of the pancreas fail to fuse during organogenesis. It is the most common congenital variant of pancreatic-ductal development, and occurs in approximately 10~14% of individuals. Although pancreatic divisum has no clinical relevance, some patients present with acute recurrent or chronic pancreatitis. In most cases, it is discovered incidentally during an examination of pancreatitis, and is occasionally accompanied by a pancreatic tumor. We report the first case of IPMN in a patient with an incomplete pancreatic divisum in Korea.
Abdominal Pain ; Humans ; Korea ; Mucins* ; Organogenesis ; Pancreas ; Pancreatic Ducts ; Pancreatitis ; Pancreatitis, Chronic

Congenital anomalies of the pancreaticobiliary structure may go undetected until adulthood, and they can be the cause of unexplained jaundice, abdominal pain, nausea and vomiting. In addition to such associated disease, as cholangitis, gallstone, cholangiocarcinoma and pancreatitis, recognition of these variant anatomies is clinically important for planning surgery and for preventing inadvertent surgical injury. Although congenital abnormalities and variations of the biliary ducts are common, and variations in the drainage and course of the cystic duct are also frequently seen, variation of the cystic duct opening into the right hepatic duct is rare; further, it is important to avoid erroneous ligation of the hepatic duct during surgery. We report here on a case of aberrant cystic duct opening into the right hepatic duct along with acute pancreatitis.
Abdominal Pain ; Cholangiocarcinoma ; Cholangitis ; Congenital Abnormalities ; Cystic Duct* ; Drainage ; Gallstones ; Hepatic Duct, Common* ; Intraoperative Complications ; Jaundice ; Ligation ; Nausea ; Pancreatitis* ; Vomiting

Fascioliasis is a zoonotic helminthiasis caused by the trematode Fasciola hepatica, which is a parasite that infects the hepatobiliary system of herbivorous animals such as cattle and sheep. Humans are accidentally infected after ingestion of the water, raw aquatic plants and raw liver of herbivorous animals that are all contaminated by metacercaria. Fascioliasis produces no symptoms in most patients, but adult Fasciola hepatica occasionally gives rise to intestinal obstruction or pancreatobiliary disease. The metacercaria can migrate along the vessels or lymphatic ducts, and they can induce disease of the liver, lung and heart. We report here on a rare case of a 68-year-old male who presented with acute abdominal pain. He was diagnosed as acute pancreatitis associated with Fasciola hepatica.
Abdominal Pain ; Adult ; Aged ; Animals ; Cattle ; Eating ; Fasciola hepatica* ; Fasciola* ; Fascioliasis ; Heart ; Helminthiasis ; Humans ; Intestinal Obstruction ; Liver ; Lung ; Male ; Pancreatitis* ; Parasites ; Sheep ; Water

A primary carcinoma of the cystic duct is extremely rare, accounting for 2.6% of all biliary carcinomas. However, the prognosis is better than other biliary carcinomas. The median survival is 20.4 months. In Korea, three cases have been reported and there is no case where a pre-operative MRI has been performed. We report a case of a primary carcinoma of the cystic duct with hepatic duct invasion, which presented as a painless right upper quadrant mass, that was diagnosed by MRCP in a pre-operative situation.
Cystic Duct* ; Hepatic Duct, Common* ; Korea ; Magnetic Resonance Imaging ; Prognosis

Hemobilia is a cause of obscure gastrointestinal hemorrhage. Most cases have an iatrogenic or traumatic origin but cases of hemobilia with non-traumatic causes are rare. The non-traumatic causes of hemobilia are inflammation, gallstones, neoplasm and vascular lesions. Currently, various therapeutic options are available for hemobilia, and transarterial embolization is now the first line of intervention used to stop the bleeding of hemobilia, which shows a high success rate of approximately 80% to 100% with a lower morbidity and mortality rate than with surgery. We report a rare case of non-traumatic hemobilia caused by a pseudoaneurysm of the hepatic artery that was successfully treated with transarterial embolization.
Aneurysm, False* ; Gallstones ; Gastrointestinal Hemorrhage ; Hemobilia* ; Hemorrhage ; Hepatic Artery* ; Inflammation ; Mortality

Secondary esophageal carcinoma usually originates from a primary site in either the lung or breast. Only one case of metastatic esophageal cancer with a radiologic evidence that it was originated from the rectal cancer had been reported. We report an unusual case of a 80-year-old man with secondary esophageal carcinoma originated from the rectal cancer. It was diagnosed by histopathologic confirmation using immunohistochemical staining including CK20 and CK7 by comparing the histopathologic findings of surgical specimen of rectal cancer and endoscopic biopsy tissue from the esophagus. To the best of our knowledge, this is the first case of secondary esophageal cancer arising from rectum in Korea.
Aged, 80 and over ; Biopsy ; Breast ; Esophageal Neoplasms* ; Esophagus ; Humans ; Korea ; Lung ; Rectal Neoplasms* ; Rectum

BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is now accepted as an essential tool for the diagnosis and the therapy of various gastrointestinal diseases. With regard to the biliary system, its high diagnostic sensitivity and specificity were reported recently. We assessed the clinical usefulness of EUS for the diagnosis of diseases of the liver, biliary tree, gallbladder and distal common bile duct. METHODS: We sent questionnaires about the clinical usefulness of EUS to the doctors who requested EUS examination for 32 patients with suspected diseases of the liver, gallbladder and around extrahepatic biliary tree from Aug. 2001 to Aug. 2002. We evaluated the answers and clinical characteristics of the patients. RESULTS: Patients were 17 males and 15 females with mean age of 61.8 years old. All received abdominal computed tomography (CT) before EUS and some had abdominal ultrasonography (USG) or endoscopic retrograde cholangiopancreatography (ERCP). EUS was more accurate and informative than other imaging modalities and gave definite final diagnosis for 31.2%. In 40.6%, EUS was helpful as an additional diagnostic tool. CONCLUSIONS: EUS was useful in 71.8% of the cases for the diagnosis of diseases of the liver, biliary tree, gallbladder and around distal common bile duct. EUS can be used as an important adjunct to USG, CT and ERCP.
Biliary Tract* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct* ; Diagnosis* ; Endosonography* ; Female ; Gallbladder* ; Gastrointestinal Diseases ; Humans ; Liver* ; Male ; Sensitivity and Specificity ; Ultrasonography ; Surveys and Questionnaires

BACKGROUND/AIMS: Colorectal cancer occurs more frequently in old age. Therefore, it is important to understand the clinical characteristics of colon cancer in old age. There have been some reports stating that frequency of right side colon cancer increased with aging. Therefore, we conducted a study about the distribution of colorectal cancer according to difterent age group. METHODS: We retrospectively reviewed medical records of colorectal cancer patients diagnosed by colonoscopy between January 1999 to September 2003. The location of colorectal cancer was categorized into 2 groups: right-sided colon cancer (proximal to and including the splenic flexure), left-sided colon cancer (descending, sigmoid and rectum). RESULTS: Total 185 colorectal cancer patients were included in this study: 103 (55.7%) in men and 82 (44.3%) in women. The median age was 60.7+/-14.0 years. The proportion of patients with right-sided colon cancer increased with aging: <60 years, 20.3% (15/74); 60~69 years, 35.9% (23/64); 70~79 years, 43.3% (13/30); 80~89 years, 47.1% (8/17). CONCLUSIONS: The frequency of right-sided colon cancer increases with age. Therefore, we think that, in screening colorectal cancer, colonoscopy should be preferred to sigmoidoscopy, especially in old age group.
Aging ; Colon, Sigmoid ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms* ; Female ; Humans ; Male ; Mass Screening ; Medical Records ; Retrospective Studies ; Sigmoidoscopy

BACKGROUND/AIMS: Capsule endoscope (CE) is a new method of investigating entire small bowel (SB). Some reported that current battery time was sufficient for observing entire SB, but others reported negatively. The aims of this study were to determine the factors influencing the entire SB transit rate. METHODS: From Sep. 2002 to Aug. 2003, CE was performed in 197 cases and they were devided into complete/incomplete transit according to getting ileocecal valve image within battery time. sixteen cases were excluded due to anatomical abnormality or artificial procedure. one hundred eighty one cases were analyzed with multiple logistic regression. RESULTS: The complete SB transit rate was 63.5%. Mean battery time was 7 and 1/2 hrs. Gastric transit time (GTT) was significantly shorter in complete group than in incomplete group but the other factors (age, sex, preparation, symptom) were not significant. Mean small bowel transit time in complete group was 4 and 1/2 hrs and ranged from 1 to 8 hrs. In incomplete group (66 cases), 2 cases were reached to distal jejunum, 11 cases to proximal ileum, and the other 53 cases to distal ileum. CONCLUSIONS: Complete SB transit rate of CE was 63.5% in the 181 cases under current battery time. GTT was the only significant factor influencing gastrointestinal transit rate of CE.
Capsule Endoscopes ; Capsule Endoscopy* ; Gastrointestinal Transit* ; Ileocecal Valve ; Ileum ; Jejunum ; Logistic Models

No abstract available.
Endoscopes*