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Endoscopic Removal of a Severed, Impacted Lithotomy Basket in the Pancreatic Duct in a Patient with Pancreas Divisum: Endoscopic Removal of Severed, Impacted Basket.

Soo Jung PARK ; Sung Koo LEE ; Jeung Hye HAN ; Kyung Uk JO ; Sang Soo LEE ; Dong Wan SEO ; Myung Hwan KIM

Korean Journal of Gastrointestinal Endoscopy.2007;34(5):286-290.

Therapeutic endoscopy in patients with pancreas divisum has continued to evolve with the availability of minor papilla endoscopic sphincterotomy, stenting, or sphinteroplasty. A combination of a sphincterotomy followed by balloon/basket deployment and emergency mechanical lithotripsy had facilitated the removal of impacted or large stones in the pancreatic and biliary ducts. The impaction of the basket with captured stones or rupture of the basket traction-wire during mechanical lithotripsy are rare complications. We report the successful retrieval of a center-severed and impacted lithotomy basket in the duct of Santorini in a 47-year-old patient with pancreas divisum. Endobiliary biopsy forceps were introduced into minor papilla, the basket was drawn and the stone was removed successfully after 2 months. To the best of our knowledge, this is a first report of the removal of a center-severed and impacted lithotomy basket in the pancreatic duct.
Biopsy ; Emergencies ; Endoscopy ; Humans ; Lithotripsy ; Middle Aged ; Pancreas* ; Pancreatic Ducts* ; Rupture ; Sphincterotomy, Endoscopic ; Stents ; Surgical Instruments

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A Case of Tension Pneumothorax Complicating Duodenal Microperforation after ERCP.

Ho Hak LEE ; Sang Hyub LEE ; Sang Myung WOO ; Ji Won YOO ; Joo Kyoung PARK ; Ji Kon RYU ; Yang Tae KIM ; Yong Bum YOON

Korean Journal of Gastrointestinal Endoscopy.2007;34(5):282-285.

Endoscopic retrograde cholangiopancreatography (ERCP) has become a commonly performed endoscopic procedure for the diagnosis and treatment of pancreatobiliary disease. ERCP is a relatively safe procedure. However, there are chances of potentially severe complications such as pancreatitis, hemorrhage, infection and perforation. Duodenal perforation is an uncommon, but serious complication of ERCP, and this has occurred in 0.3 to 1.1% of most of the previous series. There are various clinical course and treatments depending on the cause of perforation. However, the development of pneumothorax in patients undergoing ERCP is rare. There are no reports of tension pneumothorax complicating ERCP in Korea. We experienced a case of tension pneumothorax with complicating duodenal microperforation following ERCP, and the patient (a 77 year old female with suspicious dysfunction of the sphincter of Oddi) was treated with conservative treatment.
Aged ; Cholangiopancreatography, Endoscopic Retrograde* ; Diagnosis ; Female ; Hemorrhage ; Humans ; Korea ; Pancreatitis ; Pneumothorax*

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A Case of Choledocho-Duodeno-Colonic Fistula.

Jeong Sook SEO ; Sung Yeun YANG ; Jae Hwan KIM ; Su Kyoung KWON ; Sang Bun CHOI ; Su Kyoung JO ; Yang Cheon HAN ; Eun Ju LEE

Korean Journal of Gastrointestinal Endoscopy.2007;34(5):278-281.

Biliary-enteric fistula is a rare disease, and the common causes of biliary-enteric fistula are gallstone, peptic ulcer, malignancy and trauma. It is known that the most common type of biliary-enteric fistula is the cholecysto-duodenal fistula, yet the combination of choledocho-duodeno-colonic fistula is a rare finding. A 78-year-old woman was admitted because she had suffered with right upper quadrant pain, a febrile sense and chills for 2 days. We confirmed the choledocho-duodeno-colonic fistula by performing gastroduodenoscopy, abdominal CT and an upper GI series. So, we report here on an usual case of choledocho-duodeno-colonic fistula, along with a review of the relevant literatures.
Aged ; Biliary Fistula ; Chills ; Female ; Fistula* ; Gallstones ; Humans ; Peptic Ulcer ; Rare Diseases ; Tomography, X-Ray Computed

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A Case of Metastatic Adenocarcinoma of the Appendix from Stomach Adenocarcinoma.

Gyoung Jun NA ; Chae Yong YI ; Hyun Choul BAEK ; Jeong Hoon KIM ; Sang Hoon BAE ; Dong Hyun KIM ; In Soo JE ; Byung Pyo KWON ; Tae Yeong LEE ; Sang Hyun KIM ; Chul Soo SONG ; Min Seok KIM ; Jin Suk LEE

Korean Journal of Gastrointestinal Endoscopy.2007;34(5):274-277.

Adenocarcinoma of the appendix is a rare neoplasm. Metastatic adenocarcinoma of the appendix from stomach adenocarcinoma is also a very rare finding. A 72-year-old man complained of right lower quadrant abdominal pain for 10 days, and he was diagnosed with acute appendicitis. Appendectomy was performed by a general surgeon. Adenocarcinoma was found on the postoperative biopsy. Subsequently, gastric adenocarcinoma was diagnosed on the gastroscopy with biopsy, and this was proven to be the original site of the appendiceal adenocarcinoma.
Abdominal Pain ; Adenocarcinoma* ; Aged ; Appendectomy ; Appendicitis ; Appendix* ; Biopsy ; Gastroscopy ; Humans ; Stomach*

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A Case of Duodenal Intramural Hematoma and Hemoperitoneum after Therapeutic Endoscopy in a Patient with Chronic Renal Failure.

Dong Seon PARK ; Woon Geon SHIN ; Min Kwan KIM ; Jeang A LEE ; Gyeong Mi HEO ; Hak Yang KIM

Korean Journal of Gastrointestinal Endoscopy.2007;34(5):269-273.

Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. It is also less commonly reported as a complication of anticoagulation therapy or as a blood dyscrasia, and as a complication of diagnostic/ therapeutic endoscopy. The presentation of these patients is abdominal pain, vomiting, fever and hematochezia, and this is rarely accompanied with intestinal obstruction, severe pancreatitis and acute peritonitis as its complications. The diagnosis is made clear by performing abdominal ultrasonography and abdominal computed tomography. We reported here on one case of intramural duodenal hematoma and hemoperitoneum after performing endoscopic hemostasis in a chronic renal failure patient who was on maintenance hemodialysis.
Abdominal Pain ; Diagnosis ; Duodenum ; Endoscopy* ; Fever ; Gastrointestinal Hemorrhage ; Hematoma* ; Hemoperitoneum* ; Hemostasis, Endoscopic ; Humans ; Intestinal Obstruction ; Kidney Failure, Chronic* ; Pancreatitis ; Peritonitis ; Renal Dialysis ; Ultrasonography ; Vomiting

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A Case of Gastroesophageal Amyloidosis with Upper Gastrointestinal Bleeding in a Patient with Multiple Myeloma.

Sang Ok LEE ; Young Sook LEE ; Sung Hee JUNG ; Yun Jung LEE ; Hoon GO ; Gi Young CHOI ; Anna KIM ; Hyeon Woong YANG ; Sang Woo CHA ; Seong Ho KIM ; Sung Soo CHANG

Korean Journal of Gastrointestinal Endoscopy.2007;34(5):263-268.

Amyloidoses are disorders for which homogeneous amorphous fibrillar proteins accumulate in multiple organs. These diseases are classified into systemic and localized disease by their extent, the primary disease and their association with multiple myeloma, and the secondary and familial disease are classified by their association with the underlying diseases. Amyloidoses can develop in association with multiple myeloma, but only rare cases have been reported on that involve the gastroesophageal tract. Amyloidosis can involve the kidney, heart, liver, skin, gastrointestinal tract and nervous system, and they can involve the small intestine, duodenum, stomach, colon, rectum and esophagus when there is disease of the gastrointestinal tract. We may overlook gastrointestinal involvement of amyloidoses if there are few symptoms and laboratory abnormalities because of the diverse clinical courses and features. Amyloidoses can manifest abdominal pain, diarrhea, vomiting and perforation, but gastrointestinal hemorrhages are rare. We report here on a case of gastroesophageal amyloidosis with upper gastrointestinal hemorrhage and paralytic ileus due to multiple myeloma.
Abdominal Pain ; Amyloidosis* ; Colon ; Diarrhea ; Duodenum ; Esophagus ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Heart ; Hemorrhage* ; Humans ; Intestinal Pseudo-Obstruction ; Intestine, Small ; Kidney ; Liver ; Multiple Myeloma* ; Nervous System ; Rectum ; Skin ; Stomach ; Vomiting

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Comparison of Complication between Automatically Controlled Cut System (Endocut) and Conventional Blended Cut Current over Endoscopic Sphincterotomy.

Woo Jin JEONG ; Sang Soo LEE ; Tae Yoon LEE ; Hyoung Chul OH ; Dong Wan SEO ; Sung Koo LEE ; Myung Hwan KIM

Korean Journal of Gastrointestinal Endoscopy.2007;34(5):256-262.

BACKGROUND/AIMS: Endoscopic sphincterotomy (EST) is a common therapeutic technique for biliary and pancreatic diseases. However, it is associated with complications such as bleeding, pancreatitis, and perforation. Automatically controlled cut system (Endocut) is known to reduce the level of hemorrhage but lead to pancreatitis. This study examined whether or not the Endocut can reduce the rate of complications of EST compared with that of the conventional blended cut current. METHODS: From September 2005 to July 2006, 519 patients were treated with EST using either Endocut (ERBE VIO 300D, 144 patients) or the conventional blended cut current (Olympus UES-30, 375 patients). Two groups were compared retrospectively for the complications of EST. RESULTS: There were no significant differences in age, gender, and the indications for EST between the two groups. Endoscopically observed bleeding and clinically evident bleeding occurred in 6.9% (10/144), 1.4% (2/144) in the Endocut group and 8.5% (31/375), 2.2% (8/375) in the conventional blended cut current group, respectively (p=0.62 and 0.58, respectively). Clinical bleeding occurred in 2 patients in the Endocut group but it was mild and easily controlled by endoscopic treatment. Mild, moderate, and severe clinical bleeding occurred in 3, 4, and 1 patient in the blended group, respectively. Pancreatitis was encountered in 6.0% (8/134) of the Endocut group and in 5.7% (21/352) of the blended group (p=0.83). Perforation only occurred in 2 patients in the blended group. CONCLUSIONS: There were a similar number of complications from EST in the Endocut and conventional blended cut current groups.
Hemorrhage ; Humans ; Pancreatic Diseases ; Pancreatitis ; Retrospective Studies ; Sphincterotomy, Endoscopic*

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The Identification of Superior Mesenteric Artery Syndrome Established by Endoscopic Ultrasound in a Patient with Severe Gastroptosis.

Sung Jun KIM ; Woo Chul CHUNG ; Sung Hoon JUNG ; Jae Wuk KWAK ; Myung Hyun LEE ; Chang Nyol PAIK ; Kang Moon LEE

Korean Journal of Gastrointestinal Endoscopy.2010;40(2):121-125.

Superior mesenteric artery (SMA) syndrome is caused by compression of the transverse part of the duodenum between the SMA and the aorta, where the distance between these vessels decreases with loss of mesenteric fat. It occurs most frequently in patients with rapid weight loss. Conventionally, the diagnosis is established by digital fluoroscopy and contrast-enhanced spiral computed tomography (CT). A 17-year old woman was admitted via the emergency department with postprandial fullness, nausea, and bile stained vomiting. The initial radiological examination revealed severe gastroptosis. Fluoroscopic evaluation after barium swallowing failed due to a markedly distended stomach. The diagnosis of SMA syndrome was made by endoscopic ultrasound (EUS) using a mini-probe. EUS findings were in good agreement with the CT angiogram. A conservative trial was attempted, but symptoms remained refractory. Surgery was an alternative option and we treated the patient successfully with laparoscopic duodeno-jejunostomy.
Aorta ; Barium ; Bile ; Deglutition ; Duodenum ; Emergencies ; Female ; Fluoroscopy ; Humans ; Mesenteric Artery, Superior ; Nausea ; Stomach ; Superior Mesenteric Artery Syndrome ; Tomography, Spiral Computed ; Vomiting ; Weight Loss

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A Case of Malignant Duodenocolic Fistula Treated with Covered Metallic Stents.

Jeong Ah KIM ; Chang Whan KIM ; Chang Hoon LIM ; Seok Ju LEE ; Dong Hoon KO ; Tae Ho KIM ; Sok Won HAN ; Hiun Suk CHAE

Korean Journal of Gastrointestinal Endoscopy.2010;40(2):116-120.

Malignant duodenocolic fistula is a rare complication of colon cancer, and this usually develops as the right-side colon cancer that invades the duodenal bulb. The fistula often results in watery diarrhea, weight loss and feculent vomiting. A barium enema or duodenography have been the most useful diagnostic procedures, and the fistula is directly confirmed by an endoscopic examination. Curative resection is not possible in many cases due to metastasis or local invasion, so a palliative operation can be performed to relieve symptoms, but it cannot completely prevent the vomiting or diarrhea. Seven Korean cases of malignant duodenocolic fistula have been previously reported on, and an operation was performed in six cases. We report here on a case of duodenocolic fistula with intestinal obstruction that arouse from a right-side colon cancer, and this was successfully managed by placing covered metallic stents at the duodenum and hepatic flexure.
Barium ; Colonic Neoplasms ; Diarrhea ; Duodenum ; Enema ; Fistula ; Intestinal Obstruction ; Neoplasm Metastasis ; Stents ; Vomiting ; Weight Loss

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Post-extubation Negative Pressure Pulmonary Edema Complicating ESD under General Anesthesia.

Ji Hye KWEON ; Tae Hyeon KIM ; Hyo Jeong OH ; Eun Young CHO ; Jin Soo CHUNG ; Hyeong Cheol CHEONG ; Yong SON

Korean Journal of Gastrointestinal Endoscopy.2010;40(2):111-115.

Negative pressure pulmonary edema is a recognized complication of airway obstruction, particularly after endotracheal extubation. The application of oxygen therapy and continuous positive airway pressure with the administration of diuretics under a rapid diagnosis usually clears pulmonary edema. We report a case of 61-year-old man who developed negative pressure pulmonary edema following extubation after an endoscopic submucosal dissection under general anesthesia.
Airway Extubation ; Airway Obstruction ; Anesthesia, General ; Continuous Positive Airway Pressure ; Diuretics ; Humans ; Middle Aged ; Oxygen ; Pulmonary Edema

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