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Abdominal Compartment Syndrome in Severe Acute Pancreatitis Treated with Percutaneous Catheter Drainage.

Soonyoung PARK ; Seungho LEE ; Hyo Deok LEE ; Min KIM ; Kyeongmin KIM ; Yusook JEONG ; Seon Mee PARK

Clinical Endoscopy.2014;47(5):469-472. doi:10.5946/ce.2014.47.5.469

Acute pancreatitis is one of the main causes of intra-abdominal hypertension (IAH). IAH contributes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induces multiorgan failure. We report a case of ACS in a patient with severe acute pancreatitis. A 44-year-old man who was admitted in a drunk state was found to have severe acute pancreatitis. During management with fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotropes, and oliguria developed in the patient, with his abdomen tensely distended. With a presumptive diagnosis of ACS, abdominal decompression through percutaneous catheter drainage was performed immediately. The intraperitoneal pressure measured with a drainage catheter was 31 mm Hg. After abdominal decompression, the multiorgan failure was reversed. We present a case of ACS managed with percutaneous catheter decompression.
Abdomen ; Acidosis, Respiratory ; Adult ; Catheters* ; Decompression ; Diagnosis ; Drainage* ; Humans ; Intensive Care Units ; Intra-Abdominal Hypertension* ; Lower Body Negative Pressure ; Oliguria ; Pancreatitis* ; Resuscitation ; Shock ; Transcutaneous Electric Nerve Stimulation

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Primary Fallopian Tube Carcinoma Diagnosed with Endoscopic Ultrasound Elastography with Fine Needle Biopsy.

Eui Bae KIM ; Tae Hee LEE ; Jeong Sig KIM ; In Ho CHOI

Clinical Endoscopy.2014;47(5):464-468. doi:10.5946/ce.2014.47.5.464

Primary fallopian tube carcinoma (PFTC) is a rare gynecological cancer that is very difficult to diagnose preoperatively. Here, we report the case of a 66-year-old female patient with PFTC that was diagnosed preoperatively on the basis of the characteristic features on endoscopic ultrasound (EUS) elastography and fine needle biopsy (FNB). EUS showed a sausage-shaped hypoechoic mass, 8 cm in size, with irregular margins and heterogeneous internal echoes extending to both adnexa. EUS elastography revealed that the mass had a blue color pattern, representing hard stiffness, and a heterogeneous green/red color pattern distributed outside the tumor, representing intermediate stiffness. Histopathologic analysis of the FNB and operative specimens confirmed the diagnosis of fallopian tube carcinoma. This is the first reported case of a combined EUS elastography and FNB of an adnexal mass leading to a preoperative diagnosis of fallopian tube carcinoma.
Aged ; Biopsy, Fine-Needle* ; Diagnosis ; Elasticity Imaging Techniques* ; Endosonography ; Fallopian Tube Neoplasms ; Fallopian Tubes* ; Female ; Humans ; Ultrasonography*

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Endoscopic Ultrasound-Guided Sampling of a Metastatic Mucinous Adenocarcinoma Mimicking a Gastric Subepithelial Tumor.

Dae Chul SEO ; Tae Hee LEE ; Yoon Mi JEEN ; Hyun Gun KIM ; Eui Bae KIM ; Sang Cheol LEE

Clinical Endoscopy.2014;47(5):460-463. doi:10.5946/ce.2014.47.5.460

Metastatic mucinous adenocarcinoma of appendix origin and mimicking a gastric subepithelial tumor (SET) is very rare. Endoscopic ultrasound (EUS)-guided sampling is a useful diagnostic method for SETs. However, the cytologic findings of metastatic mucinous adenocarcinoma are unfamiliar to many pathologists and gastroenterologists. These findings present a diagnostic challenge because the introduction of gastric epithelium and mucin into the specimen during the procedure can be misleading. This is the first reported experience of an EUS-guided sampling of a gastric SET in a patient with suspected appendiceal tumor, to make the diagnosis of a mucinous adenocarcinoma.
Adenocarcinoma, Mucinous* ; Appendix ; Biopsy, Fine-Needle ; Diagnosis ; Endosonography ; Epithelium ; Humans ; Mucins ; Stomach ; Ultrasonography

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Acute Ectopic Pancreatitis Occurring after Endoscopic Biopsy in a Gastric Ectopic Pancreas.

Seong Jun LEE ; Gwang Ha KIM ; Do Youn PARK ; Sang A CHOI ; Sang Hee LEE ; Yu Yi CHOI ; Moo Song JEON ; Geun Am SONG

Clinical Endoscopy.2014;47(5):455-459. doi:10.5946/ce.2014.47.5.455

Ectopic pancreas is a congenital anomaly and the most common type of ectopic tissue in the gastrointestinal tract. Most patients with an ectopic pancreas are asymptomatic and rarely have complications. Ectopic pancreatitis after an endoscopic biopsy has not been reported. We report a patient who developed acute ectopic pancreatitis in the stomach after an endoscopic biopsy. A 71-year-old male patient presented with a subepithelial tumor (SET) in the stomach and had no symptoms. Endoscopic ultrasonography demonstrated a 30-mm hypoechoic mural mass, lobulated margins, and anechoic duct-like lesions. To obtain proper tissue specimen, endoscopic biopsy was performed through the opening on the surface of the mass. The pathologic results confirmed an ectopic pancreas. One day after the endoscopic biopsy, he developed persistent epigastric pain. His serum amylase and lipase elevated. Computed tomography of the abdomen showed swelling of the SET and diffuse edema of the gastric wall. His condition was diagnosed as acute ectopic pancreatitis occurring after endoscopic biopsy.
Abdomen ; Aged ; Amylases ; Biopsy* ; Choristoma ; Edema ; Endosonography ; Gastrointestinal Tract ; Humans ; Lipase ; Male ; Pancreas* ; Pancreatitis* ; Stomach

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Rifampin-induced Pseudomembranous Colitis with Rectosigmoid Sparing.

Sun Young YIM ; Ja Seol KOO ; Ye Ji KIM ; Sang Jung PARK ; Jin Nam KIM ; Sung Woo JUNG ; Hyung Joon YIM ; Sang Woo LEE ; Jai Hyun CHOI ; Chang Duck KIM

Clinical Endoscopy.2011;44(2):137-139. doi:10.5946/ce.2011.44.2.137

Pseudomembranous colitis (PMC) is known to be associated with antibiotic treatment, but is not commonly related to antitubercular (anti-TB) agent, rifampin. PMC is frequently localized to rectum and sigmoid colon, which can be diagnosed with sigmoidoscopy. We report a case of rifampin-induced PMC with rectosigmoid sparing in a pulmonary tuberculosis patient. An 81-year-old man using anti-TB agents was admitted with a 30-day history of severe diarrhea and general weakness. On colonoscopy, nonspecific findings such as mucosal edema and erosion were found in sigmoid colon, whereas multiple yellowish plaques were confined to cecal mucosa only. Biopsy specimen of the cecum was compatible with PMC. Metronidazole was started orally, and the anti-TB medications excluding rifampin were readministerred. His symptoms remarkably improved within a few days without recurrence. Awareness of rectosigmoid sparing PMC in patients who develop diarrhea during anti-TB treatment should encourage early total colonoscopy.
Aged, 80 and over ; Biopsy ; Cecum ; Colon, Sigmoid ; Colonoscopy ; Diarrhea ; Edema ; Enterocolitis, Pseudomembranous ; Humans ; Metronidazole ; Mucous Membrane ; Rectum ; Recurrence ; Rifampin ; Sigmoidoscopy ; Tuberculosis, Pulmonary

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Adult Intussusception Caused by an Appendiceal Mucocele and Reduced by Colonoscopy.

Jong Kyoung PARK ; Tae Ho KWON ; Hyun Kyu KIM ; Jeong Bae PARK ; Kang KIM ; Jeong Ill SUH

Clinical Endoscopy.2011;44(2):133-136. doi:10.5946/ce.2011.44.2.133

Appendiceal intussusception is a very rare disease that is found in only 0.01% of patients who have undergone an appendectomy. Clinical symptoms vary but include acute appendicitis symptoms such as right lower quadrant abdominal pain or repetitive right lower quadrant crampy pain. Some patients are asymptomatic. Operative treatment is necessary to reduce an appendiceal intussusception in adults, but there is a debate about how to perform the reduction. Successful colonoscopic reductions have been recently reported for some cases. We report a case of appendiceal intussusception that was diagnosed, reduced by colonoscopy, and histologically confirmed as a mucinous cystadenoma after the operation.
Abdominal Pain ; Adult ; Appendectomy ; Appendicitis ; Colonoscopy ; Cystadenoma, Mucinous ; Humans ; Intussusception ; Mucocele ; Rare Diseases

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A Case of Oral-contraceptive Related Ischemic Colitis in Young Woman.

Choon Sik SEON ; Young Sook PARK ; Se Hwan PARK ; Sang Ryol RYU ; Yun Ju JO ; Seong Hwan KIM ; Byoung Kwan SON ; Sang Bong AHN

Clinical Endoscopy.2011;44(2):129-132. doi:10.5946/ce.2011.44.2.129

Ischemic colitis is generally considered a disease of the elderly. The causes of ischemic colitis include low-flow states due to cardiac dysfunction or hypovolemia and certain medications including estrogen. Here we report a case of ischemic colitis in a 26-year-old woman. She had no specific medical history except taking oral-contraceptives for a long time. The mechanism of estrogen-induced ischemic colitis is not clearly understood. But we recommend that oral-contraceptives should be considered as a cause of ischemic colitis in young women.
Adult ; Aged ; Colitis, Ischemic ; Contraceptives, Oral ; Estrogens ; Female ; Humans ; Hypovolemia

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Short-term Clinical Outcomes Based on Risk Factors of Recurrence after Removing Common Bile Duct Stones with Endoscopic Papillary Large Balloon Dilatation.

Jung Ho KIM ; Yeon Suk KIM ; Dong Kyu KIM ; Min Su HA ; Young Jun LEE ; Jong Joon LEE ; Sang Jin LEE ; In Sik WON ; Yang Suh KU ; Yun Soo KIM ; Ju Hyun KIM

Clinical Endoscopy.2011;44(2):123-128. doi:10.5946/ce.2011.44.2.123

BACKGROUND/AIMS: Recurrence is an important late complication of endotherapy of bile duct stones. Endoscopic papillary large balloon dilation (EPLBD) can be used as an alternative method of removing difficult bile duct stones. The aim of this study was to evaluate short term clinical outcomes after removing common bile duct (CBD) stones using EPLBD. METHODS: A retrospective review was performed based on the medical records of 141 patients who received EPLBD, with or without endoscopic sphincterotomy, between September 2008 and February 2010. Of these, 50 patients, were enrolled in the study. Clinical and endoscopic parameters were analyzed to identify risk factors for CBD stones recurrence. RESULTS: Male:Female ratio was 22:28 (mean age, 67.4+/-14.4 years). Recurrence rate was 24.0% (12/50). Mean follow-up period was 10.8+/-4.5 months. Nineteen (38.0%) had a history of surgery and 20 (40.0%) were comorbid with periampullary diverticula. Mean diameters of the stones and CBD were 13.8+/-4.3 mm and 20.1+/-7.2 mm, respectively. In univariate analysis, large CBD stones (> or =12 mm) and angulated CBD (angle < or =145degrees) were identified as the significant predictors of recurrence. In multivariate analysis, angulated CBD (angle < or =145degrees) was the significant independent risk factor for recurrence. CONCLUSIONS: Close follow-up seems necessary in patients with angulated CBD (angle < or =145degrees).
Bile Ducts ; Common Bile Duct ; Dilatation ; Diverticulum ; Follow-Up Studies ; Humans ; Medical Records ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Risk Factors ; Sphincterotomy, Endoscopic

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Clinical Outcomes of Endoscopic Submucosal Dissection for Undifferentiated or Submucosal Invasive Early Gastric Cancer.

Pyung Gohn GOH ; Hyun Yong JEONG ; Min Jung KIM ; Hyuk Soo EUN ; Hye Jin KIM ; Eui Sik KIM ; Yun Jeung KIM ; Soo Youn LEE ; Hee Seok MOON ; Eaum Seok LEE ; Seok Hyun KIM ; Jae Kyu SUNG ; Byung Seok LEE

Clinical Endoscopy.2011;44(2):116-122. doi:10.5946/ce.2011.44.2.116

BACKGROUND/AIMS: Early gastric cancer (EGC) that is undifferentiated or shows submucosal invasion has not been generally accepted as an indication for endoscopic treatment. But recently, experiences with endoscopic submucosal dissection (ESD) for undifferentiated EGC or submucosal invasive (SM) EGC have increased. The aim of this study was to evaluate clinical outcomes of ESD for EGC with undifferentiation or submucosal invasion. METHODS: Between August 2005 and August 2009, among 210 EGCs treated using ESD at our hospital, 18 lesions were diagnosed as undifferentiated gastric cancer and 41 as SM gastric cancer. A retrospective analysis was done on the medical records of these patients. RESULTS: Mean follow-up periods were 19.39+/-11.2 months. During the follow-up period, local recurrence was noted in 4 lesions. Local recurrence rates of the EGC groups (group 1, mucosal cancer with undifferentiation; group 2, SM cancer with differentiation; group 3, SM cancer with undifferentiation) were 10%, 4.5%, and 50%, respectively. Groups 1 and 2 were not significantly different in local recurrence rates compared to the mucosal cancer with differentiation group (p=0.061, p=0.125, respectively). The undifferentiated EGC group was significantly lower in curability using ESD than the differentiated EGC group (55.6% vs. 89.6%, p=0.000). The curability of the SM EGC group was lower than the mucosal EGC group (36.6% vs. 98.9%). CONCLUSIONS: Complete resection using ESD is difficult in undifferentiated and SM gastric cancers. SM cancer with undifferentiation should be treated immediately by salvage operation. For mucosal cancer with undifferentiation or SM cancer with differentiation, one should consider careful short-term follow-up.
Follow-Up Studies ; Medical Records ; Recurrence ; Retrospective Studies ; Stomach Neoplasms

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Comparison on the Efficacy of Disinfectants Used in Automated Endoscope Reprocessors: PHMB-DBAC versus Orthophthalaldehyde.

Sun Young KIM ; Hong Sik LEE ; Jong Jin HYUN ; Min Ho SEO ; Sun Young YIM ; Ha Young OH ; Hye Sook KIM ; Bora KEUM ; Yeon Seok SEO ; Yong Sik KIM ; Yoon Tae JEEN ; Hoon Jai CHUN ; Soon Ho UM ; Chang Duck KIM ; Ho Sang RYU

Clinical Endoscopy.2011;44(2):109-115. doi:10.5946/ce.2011.44.2.109

BACKGROUND/AIMS: Since endoscopes are reusable apparatus classified as semicritical item, thorough reprocessing to achieve high-level disinfection is of utmost importance to prevent spread of infection. To improve disinfection efficacy and safety, disinfectants and endoscope reprocessors are continuously evolving. This study aimed to compare the efficacy of the combination of polyhexamethylenebiguanide hydrochloride-alkyldimethylbenzylammonium chloride (PHMB-DBAC) and orthophthalaldehyde (OPA) used respectively in ultrasonographic cleaning incorporated automated endoscope reprocessors: COOLENDO (APEX Korea) or OER-A (Olympus Optical). METHODS: A total of 86 flexible upper endoscopes were randomly reprocessed with either COOLENDO/PHMB-DBAC or OER-A/OPA. Culture samplings were done at two sites (endoscope tip and working channel) which were later incubated on blood agar plate. Bacterial colonies were counted and identified. RESULTS: The culture-positive rate at the endoscope tip and working channel was 0% and 2.33% for COOLENDO/PHMB-DBAC and 4.65% and 0% for OER-A/OPA. Staphylococcus hominis was cultured from one endoscope reprocessed with COOLENDO/PHMB-DBAC and Pseudomonas putida was isolated from two endoscopes reprocessed with OER-A/OPA. CONCLUSIONS: The reprocessing efficacy of COOLENDO/PHMB-DBAC was non-inferior to that of OER-A/OPA (p=0.032; confidence interval, -0.042 to 0.042). During the study period, significant side effect of PHMB-DBAC was not observed.
Agar ; Disinfectants ; Disinfection ; Endoscopes ; Pseudomonas putida ; Staphylococcus hominis

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