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A Case of Pancreatic Neuroendocrine Tumor Mimicked Intraductal Papillary Mucinous Neoplasm.

Sung Birm SOHN ; Hyo Jung KIM ; Jae Seon KIM ; Baek Hui KIM ; Sang Hun KIM ; Ji Hyoung KIM ; Ji Young SONG ; Taehyun KIM

Korean Journal of Pancreas and Biliary Tract.2014;19(4):210-214. doi:10.15279/kpba.2014.19.4.210

Neuroendocrine tumors of the pancreas are exremely rare tumors, but recent imaging examination advances, diagnostic frequency is also increasing. However, there is difficulty of diagnosis of pancreatic serotonin producing neuroendocrine tumors, because tumors grow slowly and clinical symptoms are not significant. A 60-year-old male patient with pancreatic duct dilatation progresses gradually during the seven years without obstructing lesion in imaging studies, we suspected the mass as intraductal papillary mucinous neoplasm. However, we diagnosed his case as neuroendocrine tumor after surgery and report here with literature review.
Diagnosis ; Dilatation ; Humans ; Male ; Middle Aged ; Mucins* ; Neuroendocrine Tumors* ; Pancreas ; Pancreatic Ducts ; Serotonin

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A Case of Ampullary Neuroendocrine Tumor Treated by Endoscopic Papillectomy.

Hong Jin YOON ; Young Hak JUNG ; Sung Eun CHOI ; Jung Soo PARK ; Yong Hoon KIM ; Hae Won KIM ; Sung Ill JANG ; Dong Ki LEE

Korean Journal of Pancreas and Biliary Tract.2014;19(4):204-209. doi:10.15279/kpba.2014.19.4.204

Ampullary neuroendocrine tumor is rare but requires total resection for treatment. Traditionally, pancreatic duodenal resection has been recommended for treatment of ampullary neuroendocrine tumor. Because of the morbidity and mortality associated with surgical resection, endoscopic papillectomy is increasingly used in selected cases with low grade, no metastasis, and no invasion of the pancreatic or bile duct. We present a case of an ampullary neuroendocrine tumor which was successfully and completely resected via endoscopic papillectomy. Endoscopic papillectomy can be a viable alternative for the resection of neuroendocrine tumor at the major duodenal papilla in cases with high surgical risks.
Ampulla of Vater ; Bile Ducts ; Carcinoid Tumor ; Endoscopy ; Mortality ; Neoplasm Metastasis ; Neuroendocrine Tumors*

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Endoscopic Treatment of a Case of Post-cholecystectomy Mirizzi Syndrome.

Jeong Min LEE ; Jin Seok PARK ; Seok JEONG ; Don Haeng LEE ; Seong Huan CHOI ; Shin Il KIM ; Min Ju KIM ; Gwang Seok YOON

Korean Journal of Pancreas and Biliary Tract.2014;19(4):199-203. doi:10.15279/kpba.2014.19.4.199

Mirizzi's syndrome (MS) caused by the retention of a stone in the cystic duct stump after cholecystectomy is rare. Most cases of MS are treated by surgical intervention. However, developments of endoscopic accessories and techniques have resulted in the recent introduction of endoscopic treatments for MS. Furthermore, in view of the postoperative morbidity caused by post-operative scarring, the endoscopic approach should be preferred to the surgical approach. In the described case, the authors were able to remove a remnant cystic duct stone endoscopically because the cystic duct stump was wide and non-tortuous. This case shows endoscopic retrograde cholangiopancreatography with mechanical lithotripsy can be utilized in suitable cases of type I MS development after cholecystectomy.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cicatrix ; Cystic Duct ; Lithotripsy ; Mirizzi Syndrome*

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A Large Hemorrhagic Pseudocyst in Patient with Valproic Acid-Induced Severe Acute Pancreatitis: A Case Report.

Mi Kang KIM ; Kwangtaek KIM ; Jae Eun LEE ; Jun Jae YOO ; Gye Yeon LEE ; Se Woo PARK ; Dong Hee KOH ; Jin LEE

Korean Journal of Pancreas and Biliary Tract.2014;19(4):194-198. doi:10.15279/kpba.2014.19.4.194

The occurrence of valporic acid (VPA)-induced pancreatitis is a rare condition, predominantly observed in adolescent. Also, the occurrence of VPA-associated with hemorrhagic pseudocyst is extremely rare. We report the case of a 54-year-old man who had been taking VPA for uncontrolled seizures. He was admitted to our hospital with complaints of abdominal pain and diagnosed with acute on chronic pancreatitis. There were no other causes explaining pancreatitis, and it was thought to be due to VPA therapy. Despite of cessation of VPA, there was ongoing severe abdominal pain with fever. The patient underwent follow-up CT, which revealed a large loculated fluid collection that was observed with intra-cystic hemorrhage. After treatment with percutaneous catheter drainage, he was discharged with regression of the pancreatic pseudocyst. VPA-associated pancreatitis with hemorrhagic pseudocyst is rare but possible. Therefore, this possibility should be considered in the cause of hemorrhagic pseudocyst in a patient taking VPA.
Abdominal Pain ; Adolescent ; Catheters ; Drainage ; Fever ; Follow-Up Studies ; Hemorrhage ; Humans ; Middle Aged ; Pancreatic Pseudocyst ; Pancreatitis* ; Pancreatitis, Chronic ; Seizures ; Valproic Acid

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A Case of Acute Cholecystitis Caused by Stenotrophomonas maltophilia Bacteremia.

Jae Eun LEE ; Kwang Taek KIM ; Jun Jae YOO ; Mi Kang KIM ; Min Ho CHOI ; Hyun Joo JANG ; Sea Hyub KAE ; Jin LEE

Korean Journal of Pancreas and Biliary Tract.2014;19(4):189-193. doi:10.15279/kpba.2014.19.4.189

Stenotrophomonas maltophilia is an ubiquitous aerobic Gram-negative bacillus. Hospitalization and prior antibiotic therapy are risk factors for S. maltophilia infection. This organism is isolated with increasing frequency from hospitalized patients and may cause therapeutic problems because of its intrinsic resistance to common antibiotics and the immunodeficiency status of the affected host. S. maltophilia has been reported to be commonly associated with pneumonia and urinary tract infection. However, biliary infection caused by S. maltophilia is very rare. Herein, we report on a case of acute cholecystitis that developed secondary to S. maltophilia bacteremia in a patient with hepatitis-B related liver cirrhosis and gallbladder stone.
Anti-Bacterial Agents ; Bacillus ; Bacteremia* ; Cholecystitis, Acute* ; Gallbladder ; Hospitalization ; Humans ; Liver Cirrhosis ; Pneumonia ; Risk Factors ; Stenotrophomonas maltophilia* ; Urinary Tract Infections

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A Comparison Study of Ballooning Time between Immediate and Conventional Deflation Method of Endoscopic Papillary Large Balloon Dilation for the Extraction of Difficult Bile Duct Stone.

Seung Ik LEE ; Seung Jun JANG ; Song Yi HAN ; Pyung Hwa PARK ; Yeon Hee LEE ; Pil Kyu JANG ; Ju Hyeon KIM ; Jae Hee CHO ; Yeon Suk KIM

Korean Journal of Pancreas and Biliary Tract.2014;19(4):182-188. doi:10.15279/kpba.2014.19.4.182

BACKGROUND/AIMS: The ballooning time in endoscopic papillary large balloon dilation (EPLBD) remains controversial. The aim of this study was to evaluate the significance of the ballooning time comparing an immediate balloon deflation method with a conventional ballooning time of > 45 seconds. METHODS: Between January 2010 and December 2010, 126 patients with bile duct stones treated with EPLBD and endoscopic sphincterotomy were divided according to the ballooning time: the immediate deflation group (n=56) and the conventional inflation group (ballooning time 45s to < 60s) (n=70). RESULTS: The overall success rate and the success rate of the first attempt of ERCP (endoscopic retrograde cholangio-pancreatography) were 96.4% (54/56) and 80.4% (45/56) in the immediate group and 97.1% (68/70) and 77.1% (54/70) in the conventional inflation group. There were no statistically significant differences in the overall success and the first attempt of ERCP success rate (p=0.99, p=0.66). The frequency of mechanical lithotripsy was 0% in the immediate deflation group and 7.1% in the conventional inflation group (p=0.065). Complications occurred in 3.6% (2/56) patients in the immediate deflation group and 8.6% (4/70) patients in the conventional inflation group (p=0.298). CONCLUSIONS: The ballooning time in EPLBD does not affect the outcomes of the treatment for bile duct stones. And the feasibility of the immediate deflation method in EPLBD is acceptable.
Bile Ducts* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Humans ; Inflation, Economic ; Lithotripsy ; Sphincterotomy, Endoscopic

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Medication, Nutrition, and Diet in Chronic Pancreatitis.

Chang Hwan PARK

Korean Journal of Pancreas and Biliary Tract.2014;19(4):176-181. doi:10.15279/kpba.2014.19.4.176

Chronic pancreatitis (CP) is an inflammatory disease of the pancreas characterized by progressive fibrotic destruction of the pancreatic parenchyma and resulting in severe pain with pancreatic exocrine and endocrine insufficiency. The clinical manifestations of CP include abdominal pain as well as exocrine and/or endocrine insufficiency. Most patients with CP have abdominal pain. Physicians usually focus on treating pain in CP as opposed to exocrine insufficiency, despite the fact that malabsorption and maldigestion can result in nutrition deficiency. Nutrition deficiency negatively affect outcome if they are not treated. Most important step for early diagnosis of pancreatic exocrine insufficiency in CP is special attention to nutritional status of patients. Abdominal pain, pancreatic exocrine and endocrine insufficiencies should be managed with multidisciplinary approach to prevent complications and to maintain good quality of life. The mainstay of treatment is abstinence of alcohol and smoking, pain treatment, dietary modifications and pancreatic enzyme replacement.
Abdominal Pain ; Diet* ; Early Diagnosis ; Food Habits ; Humans ; Nutritional Status ; Pancreas ; Pancreatitis, Chronic* ; Quality of Life ; Smoke ; Smoking

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Medication, Nutrition and Diet in Acute Pancreatitis.

Eun Taek PARK

Korean Journal of Pancreas and Biliary Tract.2014;19(4):170-175. doi:10.15279/kpba.2014.19.4.170

Acute pancreatitis is an inflammatory disease of the pancreas. Acute abdominal pain is the most common symptom, and increased concentrations of serum amylase and lipase confirm the diagnosis. Pancreatic injury is mild in 80% of patients, who recover without complications. The remaining patients have a severe disease with local and systemic complications. Acute pancreatitis is a hypercatabolic state resulting in rapid loss of body weight, fat and protein. Nutritional support is an integral part of patient care and is started early in the course of disease. Patients with mild to moderate disease (80% of patients) do not require enteral nutrition (EN) or parenteral nutrition(PN), as they will begin oral feeding within 4 days of presentation. Nutritional support is needed for severe disease, EN is preferred over PN, and use PN when EN is contraindicated or not feasible. Most groups have used nasojejunal feeding, which has difficulties in maintenance of the tube position and patency. Nasogastric feeding in severe AP has shown little difference in terms of clinical outcome from nasojejunal feeding. In this review, we review the role, methods, and clinical implications of nutritional supports in acute pancreatitis and also present recently recommended standard guidelines.
Abdominal Pain ; Amylases ; Body Weight ; Diagnosis ; Diet* ; Enteral Nutrition ; Humans ; Lipase ; Nutritional Support ; Pancreas ; Pancreatitis* ; Parenteral Nutrition ; Patient Care

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Medication and Diet in Gallstone Diseases.

Sang Woo CHA

Korean Journal of Pancreas and Biliary Tract.2014;19(4):164-169. doi:10.15279/kpba.2014.19.4.164

Gallstone disease represents one of the most common gastroenterological disorders. Several risk factors for cholesterol gallstone formation in the general population have been identified. There is a strongly increased risk of gallstone disease during prolonged fasting, rapid weight loss, total parenteral nutrition, and somatostatin analogue treatment. Cholecystectomy is the most frequently recommended conventional treatment for symptomatic gallstones. In asymptomatic and symptomatic gallstone carriers, treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) has been claimed to reduce the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. However, randomized, double-blind, placebo-controlled trials are lacking. There is evidence that dietary factors influence the risk of developing cholesterol gallstones. Dietary factors that may increase risk include cholesterol, saturated fat, trans-fatty acids, refined sugar, and possibly legumes. Obesity is also a risk factor for gallstones. Dietary factors that may prevent the development of gallstones include polyunsaturated fat, monounsaturated fat, fiber, and caffeine. Consuming a vegetarian diet is also associated with decreased risk. In addition, identification and avoidance of allergenic foods frequently relieves symptoms of gallbladder disease, although it does not dissolve gallstones. Nutritional supplements that might help prevent gallstones include vitamin C, soy lecithin, and iron. In addition, a mixture of plant terpenes (Rowachol(R)) has been used with some success to dissolve radiolucent gallstones.
Ascorbic Acid ; Bile ; Caffeine ; Cholecystectomy ; Cholecystitis, Acute ; Cholesterol ; Colic ; Diet* ; Diet, Vegetarian ; Fabaceae ; Fasting ; Gallbladder Diseases ; Gallstones* ; Iron ; Lecithins ; Obesity ; Pancreatitis ; Parenteral Nutrition, Total ; Plants ; Risk Factors ; Somatostatin ; Terpenes ; Trans Fatty Acids ; Ursodeoxycholic Acid ; Weight Loss

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Practical Use of Antibiotics in Pancreatobiliary Diseases.

Yong Seok KIM

Korean Journal of Pancreas and Biliary Tract.2014;19(4):157-163. doi:10.15279/kpba.2014.19.4.157

Therapy with appropriate antimicrobial agents is an important component in the management of patients with liver, biliary and pancreatic infection. Acute cholangitis and cholecystitis are common conditions that may result in progressively severe infection. Infectious complications, both pancreatic (infected necrosis) and extrapancreatic (pneumonia, cholangitis, bacteremia, urinary tract infections, and so on), are a major cause of morbidity and mortality in patients with acute pancreatitis. Antimicrobial agents appropriate for initial therapy (empirical therapy or presumptive therapy) for various grades of severity of infections should be used. Local antimicrobial susceptibility patterns should be considered for use.
Anti-Bacterial Agents* ; Anti-Infective Agents ; Bacteremia ; Cholangitis ; Cholecystitis ; Cholecystitis, Acute ; Humans ; Liver ; Mortality ; Pancreatitis ; Urinary Tract Infections

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