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A Case of Malignant Biliary Stricture Mimicking Benign Stricture coincided with Clonorchis sinensis.

Hyun KIM ; Joung Ho HAN ; Seon Mee PARK ; Jeong Tae KIM ; Jong Soon JANG ; Hee Seung LEE ; Seungho LEE ; Myeongho YEON

Korean Journal of Pancreas and Biliary Tract.2015;20(1):51-56. doi:10.15279/kpba.2015.20.1.51

Accurate and early diagnosis of indeterminate bile duct stricture is difficult. There are numerous cases suggesting similarity between benign tumors and malignancy. Therefore, meticulous evaluation with endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound and computed tomography (CT) is necessary. A 50 year-old male presented with painless jaundice. Abdominal CT scan showed distal biliary stricture without definite pancreatic mass. Repeated brush cytology and endobiliary biopsy during ERCP did not reveal malignancy except for eggs of Clonorchis sinensis. The patient declined surgical resection without definite evidence of malignancy. Abdominal CT scan one month later showed progressive parenchymal atrophy and pancreatic duct dilatation. The patient underwent pylorus preserving pancreatoduodenectomy. Pathology revealed pancreatic adenocarcinoma in the head portion. Since accurate preoperative diagnosis of malignant biliary obstruction can be evasive, patients with biliary stricture should undergo evaluation with high index of suspicion.
Adenocarcinoma ; Atrophy ; Bile Ducts ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Clonorchis sinensis* ; Constriction, Pathologic* ; Diagnosis ; Dilatation ; Early Diagnosis ; Eggs ; Head ; Humans ; Jaundice ; Male ; Ovum ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Pathology ; Pylorus ; Tomography, X-Ray Computed ; Ultrasonography

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A Case of Hemosuccus Pancreaticus Associated with Pseudoaneurysm of Splenic Artery.

Yang Hyun CHO ; Chang Il KWON ; Sun Mi JIN ; Sang Hee SONG ; Hyun Jung PARK ; Dae Kyu SHIN ; Pil Won PARK

Korean Journal of Pancreas and Biliary Tract.2015;20(1):46-50. doi:10.15279/kpba.2015.20.1.46

Splenic artery pseudoaneurysm (SAP) is a rare condition, occurring from many causes like pancreatitis, peptic ulcer, surgery, abdominal trauma and iatrogenic origins. SAP poses a great challenge to clinicians because it can lead to a variety of symptoms from abdominal pain, nausea, vomiting to massive bleeding into gastrointestinal tracts as well as abdominal cavity. A 43-year-old female who had previously been managed for alcoholic chronic pancreatitis and thrombotic thrombocytopenic purpura was admitted with hematochezia and dizziness. Patient went into shock from bleeding, however, there was no bleeding focus on initial CT scan and gastroduodenoscopy. Shock occurred repeatedly due to the severe blood loss from gastrointestinal tracts. On the 4th day in hospital, duodenal bleeding was suspected on gastrointestinal bleeding scan and bleeding from ampulla of Vater was found on follow-up gastroduodenoscopy. SAP which causes hemosuccus pancreaticus was diagnosed on angiography and it was treated successfully by embolization.
Abdominal Cavity ; Abdominal Pain ; Adult ; Alcoholics ; Ampulla of Vater ; Aneurysm, False* ; Angiography ; Dizziness ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Nausea ; Pancreatitis ; Pancreatitis, Chronic ; Peptic Ulcer ; Purpura, Thrombotic Thrombocytopenic ; Shock ; Splenic Artery* ; Tomography, X-Ray Computed ; Vomiting

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Common Bile Duct Stone Caused by Migrated Surgical Clip 10 Years after Laparoscopic Cholecystectomy.

Sung Sam HA ; Yoo Ri LIM ; Ji Hyeon LEE ; Jeong Han SIM ; Jin Sae YOO ; Kyong Joo LEE ; Dong Hyun KIM ; Jae Woo KIM

Korean Journal of Pancreas and Biliary Tract.2015;20(1):42-45. doi:10.15279/kpba.2015.20.1.42

Rarely, surgical clips can migrate into the biliary tract after laparoscopic cholecystectomy and work as a nidus for biliary stone formation. We report a case of the development of a common bile duct (CBD) stone induced by surgical clip in a 57-year-old man who underwent laparoscopic cholecystectomy 10 years ago. On computed tomography, a CBD stone with a metallic material was found, and endoscopic retrograde cholangiopancreatography (ERCP) revealed a CBD stone including a metallic clip. The stone was removed completely by ERCP, and the surgical clip was found along with the stone.
Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Common Bile Duct* ; Gallstones ; Humans ; Middle Aged ; Surgical Instruments*

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A Case of Xanthogranulomatous Cholecystitis Decreased in Size after Steroid Treatment and Avoided Extended Resection.

Jinwoo KANG ; Sang Hyub LEE ; Jae Woo LEE ; Jooyoung LEE ; Jae Yong PARK ; Ban Seok LEE ; Ji Kon RYU ; Yong Tae KIM

Korean Journal of Pancreas and Biliary Tract.2015;20(1):37-41. doi:10.15279/kpba.2015.20.1.37

Xanthogranulomatous cholecystitis is an uncommon destructive inflammatory disease with accumulation of lipid-laden macrophages, fibrous tissue, and inflammatory cells. It is often mistaken for gallbladder cancer due to diffuse wall thickening of gallbladder and infiltration into neighboring organs. And it is usually difficult to distinguish xanthogranulomatous cholecystitis from gallbladder cancer based on clinical, radiographic, or laboratory testing. Patients with xanthogranulomatous cholecystitis often undergo cholecystectomy to confirm the diagnosis, and to exclude gallbladder cancers. We report a case of 69-year-old woman with xanthogranulomatous cholecystitis who had been treated with steroid and avoided extended resection.
Aged ; Cholecystectomy ; Cholecystitis* ; Diagnosis ; Female ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Macrophages

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A Case of an Accessory Cystic Duct Draining into the Right Intrahepatic Duct.

Chung KANG ; Dong In NAM ; Il Hyung JUNG ; Hyun Gee MOON ; Boram YOUN ; Joon Seung YANG ; Nam Hun LEE ; Young Ho SEO

Korean Journal of Pancreas and Biliary Tract.2015;20(1):33-36. doi:10.15279/kpba.2015.20.1.33

Anatomic variations in the biliary tree may not be detected until adulthood and they can cause unexplained jaundice and biliary pain. Recognition of these anatomic variations is important to avoid an incorrect diagnosis and significant ductal injury during biliary surgery. Although there are numerous anatomic bile duct variations, an accessory cystic duct draining into the right hepatic duct is rare. We report a case of an accessory cystic duct draining into the right hepatic duct with cholelithiasis, in which the abnormality was identified by endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography and confirmed by laparoscopic cholecystectomy.
Bile Ducts ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Choledocholithiasis ; Cholelithiasis ; Cystic Duct* ; Diagnosis ; Hepatic Duct, Common ; Jaundice

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Predictive Factors of Malignant Potential in Gallbladder Polyps.

Yeonmi JU ; Yoon Chae LEE ; Mi Hee KANG ; Seung Young SEO ; Seong Hun KIM ; Baik Hwan CHO ; Hee Chul YU ; Jae Do YANG ; Seung Ok LEE

Korean Journal of Pancreas and Biliary Tract.2015;20(1):27-43. doi:10.15279/kpba.2015.20.1.27

BACKGROUND/AIMS: Although the incidence of GB polyps is increasing with improved surveillance, the study of predictive factors of malignant potential has not been sufficient. The aim of this retrospective study is to investigate the predictive factors of malignant potential in GB polyps. METHODS: Among 3,159 patients with laparoscopic cholecystectomy in Chonbuk National University hospital January 2009 to December 2013, 437 patients confirmed GB polyps pathologically were enrolled. The patients were divided into two groups; one with benign GB polyp and another with GB adenoma and incidental GB cancer. RESULTS: Group I with benign GB polyp was seen in 359 patients. On the other hand, 53 patients with GB adenoma and 25 patients with GB cancer in gourp II were identified. The patients in group II had shown a significantly higher incidence of age older than 50 years (53/78, 67.9% vs. 163/359, 45.4%, p=0.001), size larger than 10mm (40/78, 51.3% vs. 37/359, 10.3%, p<0.001), and GB wall thickening (36/78, 46.2% vs. 77/359, 21.5%, p<0.001). The presence of GB stone had not shown significant differences between two groups (26/78, 33.3% vs. 96/359, 26.7%, p=0.378). CONCLUSIONS: Cholecystectomy should be considered for the patients with GB polyp with these predictive factors.
Adenoma ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Gallbladder Neoplasms ; Gallbladder* ; Hand ; Humans ; Incidence ; Jeollabuk-do ; Polyps* ; Retrospective Studies ; Risk Factors

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Pain Control, Nutritional and Emotional Support.

Dong Hee KOH

Korean Journal of Pancreas and Biliary Tract.2015;20(1):22-26. doi:10.15279/kpba.2015.20.1.22

Pancreatic cancer is one of the most lethal malignancies. Despite the availability of newer and better antineoplastic combinations, the 5-year survival rate for all stages of pancreatic cancer remains only 6%. Palliative care represents an important aspect of care in patient with pancreatic cancer. Thus, optimal palliation of symptoms to maximize remaining quality of life is of primary importance to most patients. This review discusses highlights the most significant problems faced when caring for patients with advanced pancreatic cancer. Common problems include pain, pancreatic insufficiency, anorexia-cachexia and depression. To provide optimal and meaningful supportive care for patients with advanced pancreatic cancer is complex and requires ongoing close monitoring of the physical and emotional aspects of the patient. Prompt management of the many symptoms and problems associated with pancreatic cancer is essential to minimize distress and improve quality of life for patients with this fatal disease. Recognizing end-of-life concerns and patient preferences during the dying process helps clinicians find ways to alleviate suffering for patients and families.
Depression ; Exocrine Pancreatic Insufficiency ; Humans ; Palliative Care ; Pancreatic Neoplasms ; Patient Preference ; Quality of Life ; Survival Rate

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Management of Borderline Resectable Pancreatic Cancer and Local Treatment of Locally Advanced Pancreatic Cancer.

Byoung Kwan SON

Korean Journal of Pancreas and Biliary Tract.2015;20(1):14-21. doi:10.15279/kpba.2015.20.1.14

With the advances in the imaging techniques, it is now possible to more accurately diagnose and stage pancreatic cancer. However, there is no uniform definition of "borderline resectable pancreatic cancer (BRPC)" and consensus on this terminology has not been reached yet. Although there has been much progress in the therapeutic strategies for pancreatic cancer, the optimal treatment scheme for BRPC is still under debate. In order to overcome these problems, prospective studies using multidisciplinary approaches are warranted. This article is intended to review the currently available definitions and management of BRPC. Promising novel ablative methods that are used as local treatments for locally advanced pancreatic cancer are also introduced. In the near future, these ablative methods might prove to be invaluable for those with BRPC.
Consensus ; Pancreatic Neoplasms*

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Chemotherapy and Targeted Therapy with Management of Related Complications in Pancreatic Cancer.

Kwang Hyuck LEE

Korean Journal of Pancreas and Biliary Tract.2015;20(1):5-13. doi:10.15279/kpba.2015.20.1.5

Prognosis of pancreatic ductal adenocarcinoma is exceptionally poor because timely diagnosis in resectable stages is rare and there is no curative treatment for unresectable cases. Numerous researches to overcome these obstacles resulted in statistically significant but small progress. Recently two randomized controlled trial reported combination chemotherapy with 5-FU, irinotecan, leucovorin and oxaliplatin or Nab-paclitaxel plus gemcitabine was better survival than gemcitabine monotherapy. Many novel biological agents targeting the pancreatic cancer itself and surrounding micro-environment has been reported to be promising in preclinical investigations and phase 1/2 clinical studies. However, only erlotinib - a small molecular inhibitor of the epidermal growth factor receptor pathway - was approved for the targeted therapy for metastatic pancreatic cancer. In this review, we discuss briefly about recent advances in the combination chemotherapy and the targeted therapy including several complications related with these drugs.
Adenocarcinoma ; Biological Factors ; Diagnosis ; Drug Therapy* ; Drug Therapy, Combination ; Fluorouracil ; Leucovorin ; Pancreatic Ducts ; Pancreatic Neoplasms* ; Prognosis ; Receptor, Epidermal Growth Factor ; Erlotinib Hydrochloride

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Surveillance and Early Diagnosis of Pancreatic Cancer.

Seungmin BANG

Korean Journal of Pancreas and Biliary Tract.2015;20(1):1-4. doi:10.15279/kpba.2015.20.1.1

Pancreatic cancer is still one of the most dreadful malignancies with 5-year survival of 5%. The lack of effective diagnostic tools for early detection of pancreatic cancer is the major factor for the poor prognosis of pancreatic cancer. Considering the relatively lower incidence of pancreatic cancer, it seems to be reasonable to find and investigate the high risk group of pancreatic cancer rather than to screen general population. During the last 2 decades, several epidemiologic and genetic high risk groups of pancreatic cancer were found. Especially, western countries including US have been taking care of genetic high risk group and reported several meaningful outcomes. With advances of understanding molecular carcinogenesis and progression of pancreatic cancer, the effort to find specific biomarkers for both detection and treatment of pancreatic cancer has been overwhelmed. Various types of biomarkers including protein, microRNA, exosomes or circulating tumor cells itself have been under investigations. Although there has been no single biomarker which can overcome CA19-9 in serum to date. It will be worthwhile to wait for more potent biomarker which can be used for early diagnosis and treatment of pancreatic cancer in near future.
Biomarkers ; Carcinogenesis ; Early Diagnosis* ; Exosomes ; Incidence ; MicroRNAs ; Neoplastic Cells, Circulating ; Pancreatic Neoplasms* ; Prognosis

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