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Acute Cholecystitis Associated with Gallbladder Metastasis of Gastric Cancer.

Sung Hyun PARK ; Chang Don KANG ; Jin Myung PARK ; Ji Hyun KIM ; Jae Hoon JUNG ; Jin Seon JEONG ; Do Jun KIM ; Da Hye MOON

Korean Journal of Pancreas and Biliary Tract.2017;22(2):98-101. doi:10.15279/kpba.2017.22.2.98

Gastric cancer mainly spreads to the liver, peritoneum, and lymph nodes and rarely metastasizes to the gallbladder. The prognosis of gastric cancer with metastasis to the gallbladder is reported to be very poor, and presentation with cholecystitis is a prognostic factor. Herein, we present a case of gastric cancer with metastasis to the gallbladder, accompanied by acute cholecystitis.
Cholecystitis ; Cholecystitis, Acute* ; Gallbladder* ; Liver ; Lymph Nodes ; Neoplasm Metastasis* ; Peritoneum ; Prognosis ; Stomach Neoplasms*

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Symptomatic Choledochal Cyst in Association with Pregnancy Managed with EUS-guided Choledochoduodenostomy without Fluoroscopic Guidance.

Kyoung Min LEE ; Ji Eun KANG ; Hyeung Kyeung LEE ; Soyeon AN ; Seung Mo HONG ; Hyun Woo LEE ; Do Hyun PARK ; Myung Hwan KIM

Korean Journal of Pancreas and Biliary Tract.2017;22(2):92-97. doi:10.15279/kpba.2017.22.2.92

Choledochal cyst has only rarely been encountered in association with pregnancy. The clinical manifestations are nonspecific and variable that makes it difficult to differentiate from physiologic changes in pregnancy. Consequently, diagnosis is often delayed until patients present with life-threatening complications. During pregnancy, symptoms of choledochal cyst may be developed by hormonal changes and the enlarged uterus. Because of the risk of fetal mortality and maternal morbidity, definitive surgical treatment should be delayed and step-by-step management should be carefully implemented to avoid complication until delivery. Herein, we report a case of enlarged, symptomatic choledochal cyst that developed in a 26-year-old pregnant woman. The temporal relationship between pregnancy and symptom development, as well as the biliary sludge formation in the enlarged cyst, suggest that the choledochal cyst was influenced by pregnancy. In order to buy time for fetal maturation, endoscopic ultrasonography-guided choledochoduodenostomy was performed for biliary decompression as a bridge to surgical excision.
Adult ; Bile ; Choledochal Cyst* ; Choledochostomy* ; Decompression ; Diagnosis ; Endosonography ; Female ; Fetal Mortality ; Humans ; Pregnancy* ; Pregnant Women ; Uterus

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Acute Pancreatitis Induced by Compression of Main Pancreatic Duct due to Large Stones and Catheter in the Common Bile Duct.

Young Min CHOI ; Seung Uk JEONG ; Hwa Young LEE ; Hoe Soo JANG ; Eun Kwang CHOI

Korean Journal of Pancreas and Biliary Tract.2017;22(2):87-91. doi:10.15279/kpba.2017.22.2.87

Acute pancreatitis is occasionally caused by endoscopic treatments or radiologic interventions of the pancreatobiliary tract. However, no reports indicate that acute pancreatitis resulted from the insertion of a percutaneous transhepatic cholangiography (PTCS) catheter in the common bile duct (CBD). A 65-year-old woman visited our hospital with acute cholangitis due to about 3 cm-sized CBD stones. We planned to perform PTCS because of the large stones and altered anatomy (Billroth II). The patient was discharged after tract dilatation and insertion of a PTCS catheter in the distal CBD without manipulations of Ampulla of Vater (AOV). However, she visited the emergency room due to acute pancreatitis at three days after discharge. Computed tomography revealed upstream dilation of the main pancreatic duct following the compressed area of a large stone and catheter. Thus, we report a case that presented with acute pancreatitis induced by insertion of a PTCS catheter without manipulations of AOV.
Aged ; Ampulla of Vater ; Catheters* ; Cholangiography ; Cholangitis ; Common Bile Duct* ; Dilatation ; Emergency Service, Hospital ; Female ; Humans ; Pancreatic Ducts* ; Pancreatitis*

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Pancreatic Choriocarcinoma with Multiple Metastases: a Case Report and Literature Review.

Hyun Jin YOUN ; Sungjo PARK ; Sang Woo CHA ; Young Deok CHO ; So Young JIN

Korean Journal of Pancreas and Biliary Tract.2017;22(2):82-86. doi:10.15279/kpba.2017.22.2.82

Non-gestational, extragonadal choriocarcinoma is a rare disease and pancreatic choriocarcinoma is an extremely rare disease. Choriocarcinoma of non-placental origin is a highly malignant carcinoma with poor prognosis. It is characterized by high serum human chorionic gonadotropin levels. There is no standard therapy for extragonadal choriocarcinoma. Herein, we report a 47-year-old woman who presented with acute pancreatitis and left hemianopsia and was diagnosed with pancreatic choriocarcinoma with multiple metastases in liver, lung, and brain. Although the patient was treated with best supportive care, she succumbed to cerebral edema and hypernatremia on the fifteenth day of hospitalization.
Brain ; Brain Edema ; Choriocarcinoma* ; Chorionic Gonadotropin ; Female ; Hemianopsia ; Hospitalization ; Humans ; Hypernatremia ; Liver ; Lung ; Middle Aged ; Neoplasm Metastasis* ; Pancreas ; Pancreatitis ; Pregnancy ; Prognosis ; Rare Diseases

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Surgical Management of Chronic pancreatitis: What Can Surgeons Do?.

Seohee CHOI ; Joon Seong PARK

Korean Journal of Pancreas and Biliary Tract.2017;22(2):77-81. doi:10.15279/kpba.2017.22.2.77

Chronic pancreatitis (CP) is an inflammatory disease and causes chronic pain, exocrine and endocrine function failure. Pain is major indication for surgical procedure indication in CP. Advances in noninvasive treatment now allow for better therapeutic options at an early stage of CP. However, many data show that surgical procedure may produce superior results to endoscopic treatment in CP management. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. There are many surgical options to control chronic pain in CP, therefore preoperative assessment is important to choose optimal surgical management. Effective surgical procedures and timing of surgery for chronic pancreatitis remain unclear. This review comprehensively assesses the evidence for these different approaches to surgical intervention in chronic pancreatitis.
Chronic Pain ; Pancreatitis ; Pancreatitis, Chronic* ; Surgeons*

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Medical Management of Chronic Pancreatitis: What Can Physicians Do?.

Kwang Hyuck LEE

Korean Journal of Pancreas and Biliary Tract.2017;22(2):72-76. doi:10.15279/kpba.2017.22.2.72

Chronic pancreatitis is characterized by the progressive inflammation and irreversible fibrosis of pancreas causing pancreatic dysfunctions and various complications. The most common symptom is abdominal pain. In addition various complications such as pseudocyst, biliary or duodenal obstruction, pancreatic ascites, splenic vein thrombosis and pseudoaneurysm can develop according to the degree of inflammation or the progression of disease. So, management of chronic pancreatitis needs multidisciplinary approach in many cases. The treatment method can be divided into life style modifications, medications, endoscopic or radiological interventions and surgeries. In most cases, the specific treatments are recommended not only by the evidence-based guidelines but also by the experts' opinions due to the lack of randomized controlled trials with sufficient number of patients. Life style modifications and medication for the pain and the pancreatic exocrine insufficiency will be addressed in this section.
Abdominal Pain ; Aneurysm, False ; Ascites ; Duodenal Obstruction ; Fibrosis ; Humans ; Inflammation ; Life Style ; Methods ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic* ; Splenic Vein ; Thrombosis

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Clinical Features, Natural History, and Complications of Chronic Pancreatitis.

Jin Woo CHOO ; Sung Hoon MOON

Korean Journal of Pancreas and Biliary Tract.2017;22(2):63-71. doi:10.15279/kpba.2017.22.2.63

Chronic pancreatitis is a debilitating disease characterized by abdominal pain, exocrine insufficiency, and diabetes mellitus and has had great social, economic, and psychological impacts. Traditional definition of chronic pancreatitis has been based on irreversible histological findings such as self-sustaining chronic inflammation, fibrosis, and eventual destruction of ductal, exocrine, and endocrine tissues. In contrast, the traditional characteristics of acute pancreatitis have been thought as a complete recovery of pancreatic function and morphology during the convalescence period. Acute and chronic pancreatitis have been considered separated disease entities. However, the current idea regarding the natural course of pancreatitis is that acute pancreatitis can progress to the intermediate step of recurrent acute pancreatitis, and finally to chronic pancreatitis. This evolution can be characterized by a sequence of necrotic and fibrotic events, or described by sentinel acute pancreatitis event (SAPE) hypothesis. Therefore, chronic pancreatitis is better defined as a progressive inflammatory and fibrotic disease of the pancreas with clinical features of abdominal pain, malnutrition, diabetes mellitus and imaging features of pancreatic parenchymal/ductal calcifications. The complications of chronic pancreatitis include pseudocyst, pseudoaneurysm, fistula, biliary stricture, and duodenal stricture. This review describes the progression from acute to chronic pancreatitis, the mechanisms and nature of abdominal pain, steatorrhea, pancreatogenic diabetes mellitus, pseudocyst, pseudoaneurysm, and biliary stricture associated with chronic pancreatitis.
Abdominal Pain ; Aneurysm, False ; Biliary Fistula ; Constriction, Pathologic ; Convalescence ; Diabetes Mellitus ; Fibrosis ; Inflammation ; Malnutrition ; Natural History* ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic* ; Steatorrhea

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Etiology and Diagnosis of Chronic Pancreatitis.

Hyoung Woo KIM ; Jaihwan KIM

Korean Journal of Pancreas and Biliary Tract.2017;22(2):57-62. doi:10.15279/kpba.2017.22.2.57

Chronic pancreatitis is an irreversible inflammatory disease of the pancreas characterized by progressive inflammation and fibrosis resulting in loss of exocrine and endocrine function. Chronic pancreatitis is a wide spectrum of fibro-inflammatory disorders of the pancreas that includes calcifying, obstructive, and steroid-responsive form. Chronic pancreatitis without specific comment generally refers to calcifying or obstructive chronic pancreatitis. The well-known traditional causes of chronic pancreatitis are alcohol and smoking. Recently, environmental effects and the importance of genes such as genetic variation or interaction have been highlighted. Computerized tomography or magnetic resonance cholangiopancreatography have been used for diagnosis of chronic pancreatitis. However, endoscopic ultrasound has been recently used for diagnosis, too.
Cholangiopancreatography, Magnetic Resonance ; Diagnosis* ; Fibrosis ; Genetic Variation ; Inflammation ; Pancreas ; Pancreatitis ; Pancreatitis, Chronic* ; Smoke ; Smoking ; Ultrasonography

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Unexpectedly Discovered Duodenal Perforation.

Hye Min PARK ; Min Young DO ; Sei Myung CHOI ; Kyung Ho YANG ; Chang Jae HUR ; Kwang Bum CHO

Korean Journal of Pancreas and Biliary Tract.2015;20(4):241-245. doi:10.15279/kpba.2015.20.4.241

Duodenal perforation can occur due to complications caused by ulcers, other inflammation or by the instrument used during the procedure such as endoscopy, endoscopic retrograde cholangiopancreatography (ERCP); however, its incidence is not high. Most cases of perforation of the lateral wall of the duodenum are acute and require immediate surgical or endoscopic treatment. Cases of chronic duodenal perforation are rarely reported. This report presents the case of a previous perforation that was discovered unexpectedly during ERCP in a patient with cholangitis due to common bile duct stones. The time of occurrence of the perforation was unknown. After medical treatment, the patient was able to return to daily life. We have reported this case along with a literature review.
Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Common Bile Duct ; Duodenum ; Endoscopy ; Humans ; Incidence ; Inflammation ; Ulcer

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Hypereosinophilic Syndrome Presenting as Eosinophilic Cholangiopathy and Cystitis.

Gye Yeon LEE ; Sun Hyung KIM ; Seung Youn LEE ; Hyung Do PARK ; Hong Suk CHANG ; Dong Hee KOH ; Jin LEE ; Young Hee CHOI

Korean Journal of Pancreas and Biliary Tract.2015;20(4):234-240. doi:10.15279/kpba.2015.20.4.234

Eosinophilic cholangiopathy is a rare disease characterized by dense transmural eosinophilic infiltration of the gallbladder and bile duct. It's clinical and laboratory manifestations are not different from those of other causes of cholangiopathy, and the diagnosis is usually made based on pathologic findings after cholecystectomy. Moreover, the occurrence of eosinophilic cystitis accompanied by cholangiopathy is extremely rare. We report a rare case of hypereosinophilic syndrome manifested as eosinophilic cholangiopathy accompanied with eosinophilic cystitis, for the first time in Korea, in a 49-year-old woman who presented with persistent right upper quadrant pain. After performing imaging study to validate the diagnosis of acute acalculous cholecystitis and cholangitis, an urgent cholecystectomy was performed. Pathologic examination of the excised gallbladder was consistent with eosinophilic cholecystitis. The patient underwent bladder biopsy because there was persistant irritative voiding symptoms combined with constant mild peripheral eosinophilia even after cholecystectomy, and the pathologic findings revealed eosinophilic cystitis. Symptoms and peripheral eosinophilia were improved after steroid therapy for an indicated period.
Acalculous Cholecystitis ; Bile Ducts ; Biopsy ; Cholangitis ; Cholecystectomy ; Cholecystitis ; Cystitis* ; Diagnosis ; Eosinophilia ; Eosinophils* ; Female ; Gallbladder ; Humans ; Hypereosinophilic Syndrome* ; Korea ; Middle Aged ; Rare Diseases ; Urinary Bladder

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