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Gastric Outlet Obstruction arising from Xanthogranulomatous Cholecystitis accompanied by both Cholecystoduodenal and Cholecystocolonic Fistulas.

Hyo Jin CHO ; Ju Sang PARK ; Jung Hee KIM ; Dong Ok JEON ; Ki Ho KIM ; Kye Won KWON

Korean Journal of Pancreas and Biliary Tract.2015;20(3):156-161. doi:10.15279/kpba.2015.20.3.156

Xanthogranulomatous cholecystitis (XGC) is a rare type of chronic inflammation of the gallbladder characterized by focal or diffuse destructive inflammatory responses. Although it is a benign condition, its destructive course may lead to more aggressive outcomes of the gallbladder, such as local infiltration, fistula, stricture, and perforation as compared with other gallbladder inflammations. There are reports about XGC accompanied by cholecystoenteric fistula. However, XGC accompanied by more than one cholecystoenteric fistula is rare. We report a case of a 54-year-old man with gastric outlet obstruction arising from XGC, accompanied by cholecystoduodenal fisula and cholecystocolonic fistula, but without impacted gallstones.
Cholecystitis* ; Constriction, Pathologic ; Fistula* ; Gallbladder ; Gallstones ; Gastric Outlet Obstruction* ; Humans ; Inflammation ; Intestinal Fistula ; Middle Aged

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A Case of Solitary Relapsed Diffuse Large B-cell Lymphoma of the Gallbladder.

Hong Shik SHIN ; Sang Sun KIM ; Byeong Gwan KIM ; A Young CHO ; Seong Hee LEE ; Meyoung CHO ; Jin Woong CHO ; Ji Woong KIM

Korean Journal of Pancreas and Biliary Tract.2015;20(3):151-155. doi:10.15279/kpba.2015.20.3.151

Secondary involvement of the gallbladder by systemic lymphoma is exceedingly rare and relapsed diffuse large B cell lymphoma of the gallbladder has not been reported. A 78-year-old man was admitted to the hospital due to epigastric pain and jaundice. His past medical history was remarkable for diagnosis with diffuse large B-cell lymphoma of the ileum 5 years ago. He underwent right hemicolectomy and three cycles of adjuvant chemotherapy and had complete remission. Abdominal computed tomography showed choledocholithiasis and focal thickening at fundus of the gallbladder. The patient underwent open cholecystectomy. Pathologic examination revealed diffuse large B-cell lymphoma. We report a case of solitary, relapsed diffuse large B-cell lymphoma of the gallbladder with literature review.
Aged ; B-Lymphocytes* ; Chemotherapy, Adjuvant ; Cholecystectomy ; Choledocholithiasis ; Diagnosis ; Gallbladder* ; Humans ; Ileum ; Jaundice ; Lymphoma ; Lymphoma, B-Cell* ; Lymphoma, Non-Hodgkin ; Recurrence

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A Case of Suspected Intrahepatic Bile Duct Perforation after Direct Peroral Cholangioscopy.

Dae Won PARK ; Sang Wook PARK ; Du Jin KIM ; Kyoung Wan YOU ; Geum Soo LEE ; Jong Taek KIM ; Seok Ho SEO ; Seung Hyun LEE

Korean Journal of Pancreas and Biliary Tract.2015;20(3):146-150. doi:10.15279/kpba.2015.20.3.146

Direct peroral cholangioscopy (POC) which permits direct visualization of the biliary tree has recently gained widespread clinical use for diagnosis and treatment of various pancreatobiliary diseases. But, there is currently little reliable data on evaluating the complications of POC. POC is associated with complications such as pancreatitis, cholangitis, hemorrhage, rarely air embolism, and ductal perforation. The incidence of complication during POC is 2.9-12%. However, pneumoperitoneum due to intrahepatic bile duct perforation after POC has not yet been reported in Korea. We report a case of pneumoperitoneum after POC which has been successfully managed with endoscopic nasobiliary drainage and antibiotics.
Anti-Bacterial Agents ; Bile Ducts, Intrahepatic* ; Biliary Tract ; Cholangitis ; Diagnosis ; Drainage ; Embolism, Air ; Hemorrhage ; Incidence ; Korea ; Pancreatitis ; Pneumoperitoneum

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A Case of Direct Peroral Cholangioscopy-Guided Intraductal Radiofrequency Ablation for Malignancy Biliary Obstruction via Choledochoduodenostomy Orifice.

Jin Suk KANG ; Dong Uk KIM ; Jeong Eun LEE ; Min Ji KIM ; Geun Am SONG ; Jeong HEO ; Dong Hoon BAEK ; Tae Wook KIM

Korean Journal of Pancreas and Biliary Tract.2015;20(3):140-145. doi:10.15279/kpba.2015.20.3.140

BAlthough intraductal radiofrequency ablation (RFA) has been reported to be a feasible treatment of malignancy biliary obstruction in unresectable cholangiocarcinoma, endoscopic retrograde cholangiopancreatography (ERCP)-guided intraductal RFA has a disadvantage that cannot be directly visualize the biliary tract using the fluoroscopic image. On the other hand, direct peroral cholangioscopy-guided intraductal RFA is easy to insert catheter and apply treatment by visualizing the bile duct lesions. We present a case of direct peroral cholangioscopy-guided intraductal RFA without biliary stent in 67-year-old woman patient with cholangiocarcinoma for treatment of malignancy biliary obstruction. In the past, she underwent choledochoduodenostomy for intrahepatic stones. She underwent direct peroral cholangioscopy-guided intraductal RFA via choledochoduodenostomy orifice, and biliary patency was preserved for 90days without additional treatment such as biliary stent and severe complication. Direct peroral cholangioscopy-guided intraductal RFA is expected to be able to reduce the complications of the procedure by ensuring the bile duct lesions. Prospective studies with long term follow up are warranted.
Aged ; Bile Ducts ; Biliary Tract ; Catheter Ablation* ; Catheters ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochostomy* ; Female ; Hand ; Humans ; Stents

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A Case of Acute Pancreatitis Caused by Bortezomib in a Patient with Multiple Myeloma.

Jae Hong LIM ; Kyo Bum HWANG ; Byung Hun LIM ; Young Hoon JEONG ; Ki Chang SOHN ; Tae Hyeon KIM

Korean Journal of Pancreas and Biliary Tract.2015;20(3):136-139. doi:10.15279/kpba.2015.20.3.136

Bortezomib is a proteasome inhibitor used for the treatment of patients with multiple myeloma. Recently, several case reports about acute pancreatitis caused by Bortezomib were published in the international literature. But Bortezomib induced pancreatitis case was not reported in Korea. Herein, we report a case of acute pancreatitis caused by Bortezomib therapy in a 76-year-old female with multiple myeloma. On three months after the first administration of Bortezomib, the patient visited the hospital with symptoms of acute pancreatitis. The common etiological factors for acute pancreatitis were all excluded. Then the patient was diagnosed as Bortezomib-induced pancreatitis. After cessation of Bortezomib, she showed clinical and laboratory improvement.
Aged ; Female ; Humans ; Korea ; Multiple Myeloma* ; Pancreatitis* ; Proteasome Inhibitors ; Bortezomib

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A Solitary Pancreatic Actinomycosis Mimicking Pancreatic Cancer.

Min Chul KIM ; Hyeungkyeung LEE ; Jinoh PARK ; Jin Seok PARK ; Dongwook OH ; Hyo Jeong KANG ; Eunsil YU ; Myung Hwan KIM

Korean Journal of Pancreas and Biliary Tract.2015;20(3):130-135. doi:10.15279/kpba.2015.20.3.130

Actinomycosis is a chronic, slowly progressive, and suppurative disease caused by filamentous anaerobic bacteria Actinomyces, which results in characteristic sulfur granules. Clinically, actinomycosis can present with a mass-like lesion, and this bacterial nidus has been frequently mistaken for a malignancy. For that reason many patients undergo surgical resection before the correct diagnosis is established. We report a case of a 63-year-old man with a solitary, asymptomatic pancreatic actinomycosis that masqueraded as pancreatic cancer. He did not have any other concurrently infected organs and did not have any signs or symptoms of infection. All radiologic images of the patient favored a malignancy to a great extent rather than an inflammatory mass. He was finally diagnosed with actinomycosis by endoscopic ultrasound (EUS)-guided fine needle aspiration biopsy without surgery. After one month of treatment with antibiotics, the pancreatic head mass was completely resolved on the follow-up computed tomography (CT).
Actinomyces ; Actinomycosis* ; Anti-Bacterial Agents ; Bacteria, Anaerobic ; Biopsy ; Biopsy, Fine-Needle ; Diagnosis ; Follow-Up Studies ; Head ; Humans ; Middle Aged ; Pancreas ; Pancreatic Neoplasms* ; Sulfur ; Ultrasonography

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Overview of the Immunoglobulin G4-related Disease Spectrum.

Sung Hoon MOON ; Tae Jun SONG ; Myung Hwan KIM

Korean Journal of Pancreas and Biliary Tract.2015;20(3):124-129. doi:10.15279/kpba.2015.20.3.124

Immunoglobulin G4 (IgG4)-related disease is a newly named fibroinflammatory condition characterized by tumefactive lesions that contain dense lymphoplasmacytic infiltrates rich in IgG4-positive cells. Elevated serum IgG4 concentrations also often accompany IgG4-related disease. Many medical conditions that were long viewed as diseases confined to single organs (e.g., Mikulicz disease, type 1 autoimmune pancreatitis, Riedel's thyroiditis, multifocal fibrosclerosis, inflammatory pseudotumor, mediastinal fibrosis, retroperitoneal fibrosis, and etc.) are now designated as part of the spectrum of IgG4-related disease. The preferred nomenclature suggested by a committee of international experts uses the prefix "IgG4-related-" for individual organ involvement, regardless of the organ system affected. One exception is type 1 autoimmune pancreatitis (IgG4-related pancreatitis). Comprehensive diagnostic criteria for IgG4-related disease and organ-specific diagnostic criteria (e.g., IgG4-related dacryoadenitis and sialadenitis, type 1 autoimmune pancreatitis, IgG4-related kidney disease and IgG4-related sclerosing cholangitis) can aid clinicians in the diagnosis of this erratic condition.
Autoimmune Diseases ; Dacryocystitis ; Diagnosis ; Fibrosis ; Granuloma, Plasma Cell ; Immunoglobulin G ; Immunoglobulins* ; Kidney Diseases ; Mikulicz' Disease ; Pancreatitis ; Retroperitoneal Fibrosis ; Sialadenitis ; Thyroid Gland ; Thyroiditis

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Mechanism of Severe Acute Pancreatitis: Focusing on Development and Progression.

Jae Hyuk DO

Korean Journal of Pancreas and Biliary Tract.2015;20(3):115-123. doi:10.15279/kpba.2015.20.3.115

Acute pancreatitis (AP) is an inflammatory disorder and the severity range from mild to severe form. The mortality of severe form of AP is still high despite of tremendous improvement of diagnostic modalities and therapeutic options. Although pathogenesis of AP is still not fully understood, autodigestion theory is regarded as an initial common pathophysiologic mechanism of AP for about 2 centuries. However, it is obscure which mechanisms are involving the disease severity. Upregulation of adhesion molecules, leukocytes, proinflammatory cytokines and chemokines are also concerned local injury, systemic exacerbation of inflammation and ultimately organ failure. In addition, transcription factor Nuclear factor-kappa B is also influence the severity through upregulate the proinflammatory genes. The patterns of acinar cell death are closely correlated with disease severity of AP. The degree of acinar cell apoptosis is reversed correlated whereas necrotic cell death is proportionate to severity.
Acinar Cells ; Apoptosis ; Cell Death ; Chemokines ; Cytokines ; Inflammation ; Leukocytes ; Mortality ; Pancreatitis* ; Transcription Factors ; Up-Regulation

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A Case of Duodenal Intramural Hematoma Caused by Acute Alcoholic Pancreatitis.

Yong Eun PARK ; Yong Joon LEE ; Chi Young KIM ; Ji Yeon LEE ; Seohyun PARK ; Ji Hye PARK ; Byung Hyo CHA

Korean Journal of Pancreas and Biliary Tract.2014;19(3):132-136.

Intramural duodenal hematoma (IDH) is a rare disease which defined a hematoma formation localized within the wall of the duodenum. The most common cause of IDH is due to blunt abdominal trauma while most of other cases of IDH are more related to the use of anticoagulants or coagulation disorders such as haemophilia and Von Willebrand disease. We report a very rare case of a large IDH caused by acute alcoholic pancreatitis without any kind of anticoagulation therapies nor coagulopathies. The patient was recovered by only medical treatment and observation without surgical intervention.
Anticoagulants ; Duodenum ; Hematoma* ; Hemophilia A ; Humans ; Pancreatitis, Alcoholic* ; Rare Diseases ; von Willebrand Diseases

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Anatomy and Surgical Management of Ampullary Neoplasm.

Sung Sik HAN

Korean Journal of Pancreas and Biliary Tract.2014;19(3):128-131.

Ampulla is a common channel where biliary and pancreatic duct join. The reason why it is called ampulla is that this area is enlarged where it penetrates the duodenal wall. As it protrudes into the duodenal lumen, it is also called papilla. Ampulla is surrounded by sphincter muscles which control the secretion of bile and pancreatic juice. Ampullary tumor includes broad spectrum of benign and malignant tumors which need different treatment options - Endoscopic papillectomy (EP), surgical ampullectomy (SA), and pylorus-preserving pancreatoduodenectomy (PPPD). There is a consensus that benign tumors need EP and malignant tumors need PPPD. However, there are controversies regarding how to treat high-grade dysplasia (HGD), carcinoma in-situ, or T1 cancer. Surgical treatment includes SA and PPPD. The indication of SA is usually benign tumors which extend to bile duct or pancreatic duct or too big tumors to snare completely by endoscopy. Compared to EP, SA is less likely to leave remnant tumor which results in re-resection. In some limited cases of early carcinoma, SA can be attempted. Oncologically, however, SA is not recommended because there might be incomplete resection, lymph node metastasis, lymphovascular invasion, or perineural invasion. As PPPD still has high morbidity, prolonged length of stay, and relatively high post-op mortality, SA can be recommended in old patients with co-morbidity that can be exacerbated after surgery. Technically important points of SA are as follows; first, resecting the whole layer of duodenum, second, re-implanting the bile duct and pancreatic duct with duodenal mucosa to keep the mucosal continuity. PPPD is a standard operation of malignant tumor because it can completely remove the tumor as well as regional lymph nodes.
Bile ; Bile Ducts ; Consensus ; Duodenum ; Endoscopy ; Humans ; Length of Stay ; Lymph Nodes ; Mortality ; Mucous Membrane ; Muscles ; Neoplasm Metastasis ; Pancreatic Ducts ; Pancreatic Juice ; Pancreaticoduodenectomy ; SNARE Proteins

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