BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is the most frequent cause of noncardiac chest pain (NCCP) in Western countries. Gastroduodenal disease has a high prevalence in Korea; thus, it is important to evaluate the stomach/duodenum. We retrospectively reviewed the findings in patients with chest pain who were diagnosed by coronary angiography (CAG) to be normal or who had minimal coronary lesions to evaluate the necessity of performing esophagogastroduodenoscopy (EGD) in patients with NCCP. METHODS: A total of 565 patients with chest pain underwent CAG followed by EGD from February 2000 to March 2011 at Konyang University Hospital. We excluded patients who underwent EGD more than 3 days after CAG or had significant coronary lesions. We retrospectively reviewed the EGD findings of the remaining 349 patients. RESULTS: Of the 349 patients, 151 were male, and the average age of the patients was 57.7+/-11.44 years. After performing EGD, GERD was diagnosed in 35 patients (10.0%; LA [Los Angeles classification]-A, 30; LA-B, three; LA-C, two) and peptic ulcer was diagnosed in 48 patients (13.8%; gastric ulcer, 34; duodenal ulcer, 10; gastric and duodenal ulcer, four). Gastritis was diagnosed in 253 patients (72.5%; erosive, 89; erythematous, 90; hemorrhagic, 10; mixed, 64). Duodenitis, esophagitis, Barrett's esophagus, hiatus hernia, and gastric cancer was diagnosed in 36 (10.3%), three (0.9%), two (0.6%), three (0.9%), and one patient, respectively. CONCLUSIONS: Unlike the situation in the west, stomach/duodenal lesions other than GERD are common causes of NCCP in Korea, Therefore, prior to proton pump inhibitor testing or empirical therapy, EGD is necessary to evaluate NCCP and to rule out gastroduodenal lesions.
Barrett Esophagus ; Chest Pain ; Coronary Angiography ; Duodenal Ulcer ; Duodenitis ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal ; Esophagitis ; Gastritis ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Korea ; Male ; Peptic Ulcer ; Prevalence ; Proton Pumps ; Retrospective Studies ; Stomach Neoplasms ; Stomach Ulcer ; Thorax

Colorectal fecaloma is a mass of accumulated feces that is much harder in consistency than a fecal impactation. The rectosigmoid area is the common site for fecalomas and the cecum is the most unusual site. Diagnosis is usually made by distinctive radiographic findings of a mobile intraluminal mass with a smooth outline and no mucosal attachment. Most of the fecalomas are successfully treated by conservative methods such as laxatives, enemas and rectal evacuation. When conservative treatments have failed, endoscopic procedures or a surgical intervention may be needed. We report here that a cecal fecaloma caused by intestinal tuberculosis scar was successfully removed by endoscopic procedures.
Cecum ; Cicatrix ; Enema ; Feces ; Laxatives ; Tuberculosis

BACKGROUND/AIMS: The endoscopic findings and clinical relevance of portal hypertensive colopathy are not well described in Korea. We aimed to do a retrospective study of mucosal changes in the colon of patients with liver cirrhosis and to find their association with clinical characteristics. METHODS: We reviewed the clinical data and endoscopic findings of 48 patients with liver cirrhosis and 48 patients, matched for age and sex, with irritable bowel disease (IBS) who underwent colonoscopy over a 5 year span. RESULTS: Patients with liver cirrhosis were more likely to have colitis-like lesions and vascular abnormalities than IBS patients. Low platelet count (p=0.005) and severe esophageal varices (p=0.011) were associated with portal hypertensive colopathy, whereas the etiologies and severity of cirrhosis were not associated with these findings. CONCLUSIONS: Portal hypertensive colopathy can be defined with colitis-like lesions or vascular lesions. These lesions are more frequently present in patients with more severe esophageal varices and thrombocytopenia.
Adult ; Aged ; Colonoscopy ; Esophageal and Gastric Varices/etiology ; Female ; Humans ; Hypertension, Portal/complications/*pathology ; Intestinal Mucosa/pathology ; Irritable Bowel Syndrome/complications/*pathology ; Liver Cirrhosis/complications/*pathology ; Male ; Middle Aged ; Platelet Count ; Retrospective Studies ; Severity of Illness Index ; Thrombocytopenia/etiology

A 71-year-old man presented at the emergency department with an acute onset of hematochezia and abdominal pain that had developed 1 day previously. He had no history of surgery and was taking aspirin (100 mg) and clopidogrel (75 mg). CT revealed a short segmental concentric lower density bowel wall thickening at the proximal sigmoid colon. Sigmoidoscopy showed blue-colored elevated lesions and ruptured intramural hematomas with submucosal bleeding in the sigmoid colon. These findings correspond to intramural hematomas of the sigmoid colon. His symptoms were reduced with conservative treatment stopping aspirin and clopidogrel for 20 days. Here we report a case of non-traumatic intramural hematoma of the colon in a patient receiving dual antiplatelet agents. This had never been reported.
Abdominal Pain ; Aged ; Aspirin ; Colon ; Colon, Sigmoid ; Emergencies ; Gastrointestinal Hemorrhage ; Hematoma ; Hemorrhage ; Humans ; Platelet Aggregation Inhibitors ; Sigmoidoscopy ; Ticlopidine

BACKGROUND/AIMS: Cystic lymphangioma is an uncommon disease, and rarely develops in the intraabdomen. The aim of this article was to discuss about clinical characteristics of intraabdominal cystic lymphangioma developed in Korea. METHODS: Age, sex, symptoms, locations and size of the lesions, diagnostic methods, treatments, complications and recurrence were analyzed in 13 pathologically confirmed cases of intraabdominal cystic lymphangioma and 18 cases of literature consideration reported in Korea. RESULTS: Intraabdominal cystic lymphangioma commonly developed in adults compared to the other lymphangioma, and frequently located in the mesentery. Abdominal pain was the most common symptom, but it was a non-specific finding. Tenderness and abdominal mass were not significantly associated. The size of mass was diverse. Abdominal ultrasonography and abdominal CT were diagnostic tools most commonly used, but preoperative diagnosis was possible only in 22.6%. All patients were discharged without any complications, and no recurrence was reported. CONCLUSIONS: Preoperative diagnosis of intraabdominal cystic lymphangioma is difficult and symptoms and signs are not specific. Intra-abdominal cystic lymphangioma should be suspected in patients with non specific abdominal pain and intraabdominal mass and active diagnostic evaluation is mandatory.
Abdominal Pain/etiology ; Adult ; Aged ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Humans ; Lymphangioma, Cystic/*diagnosis/pathology/ultrasonography ; Male ; Mesentery/pathology ; Middle Aged ; Omentum/pathology ; Peritoneal Neoplasms/*diagnosis/pathology/ultrasonography ; Prognosis ; Republic of Korea ; Tomography, X-Ray Computed

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasm of the gastrointestinal tract. They are preferentially located in the stomach and small intestine. However, the duodenum is an unusual location for GIST. Here we present a case of a 67-year-old woman with a GIST of the 3rd portion of duodenum mimicking vascular neoplasm as an obscure acute gastrointestinal bleeding. The upper gastrointestinal endoscopy and colonoscopy failed to find the lesion. Finally, a large protruded lesion with ulcer was found at the 3rd portion of duodenum using a colonoscope through the oral approach. A spurting bleeding was developed during hypertonic saline epinephrine injection for treatment of oozing bleeding at the margin of the ulcer. Abdominal 3D CT-angiography showed a round and hypervascular structure at the posterior wall of duodenum. A wedge resection of the third portion of the duodenum was performed. Microscopic findings revealed GIST.
Aged ; Colonoscopes ; Colonoscopy ; Duodenum ; Endoscopy, Gastrointestinal ; Epinephrine ; Female ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Intestine, Small ; Stomach ; Ulcer ; Vascular Neoplasms

BACKGROUND/AIMS: Pyogenic liver abscess remains a major diagnostic and therapeutic challenge, despite advances in diagnostic technology and new strategies for treatment. This study was conducted to compare the differences in clinical features and outcomes of pyogenic liver abscess according to age. METHODS: In total, 166 patients were enrolled and included 63 (<65 years old, group I), 62 (65-74 years old, group II), 41 (>75 years old, group III) patients in each group. We reviewed the medical records retrospectively including etiology, underlying diseases, characteristics of the liver abscess, laboratory and microbiologic findings, treatment, and outcome of the patients. RESULTS: Group I had higher prevalence rates of male patients and chronic alcoholics, but lower prevalence rates of biliary disease, hypertension, and malignancy. In laboratory findings, group II had higher incidence of thrombocytopenia, elevated blood urea nitrogen and creatinine. There were no differences in symptoms and microbiologic findings in blood and pus among the three groups. Liver abscesses were more common in right liver in Group I. The lengths of stay and the treatment modalities were similar in three groups. CONCLUSIONS: Although there were differences in sex ratio, etiology, underlying disease among the different age groups, they did not cause difference in treatment and clinical outcome of pyogenic liver abscess. Thus, we recommend active treatments in patients of all age.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Bacteria/isolation & purification ; Blood Cell Count ; Blood Chemical Analysis ; Female ; Humans ; Liver Abscess, Pyogenic/*diagnosis/microbiology/therapy ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Sex Factors ; Urinalysis

Percutaneous endoscopic gastrostomy (PEG) is used for nutritional support in patients who require prolonged tube feeding. However, numerous complications have been reported since its introduction. Buried bumper syndrome is an uncommon, but well-documented, complication of PEG placement. The condition often results from excessive pressure exerted on the gastric mucosa by the tight anchorage between the internal and external bumpers. This leads to mucosal erosion and embedding of the internal bumper in the gastric wall, which obstructs feeding. We report two cases of buried bumper syndrome: one was corrected using the push technique and the other was removed surgically.
Enteral Nutrition ; Gastric Mucosa ; Gastrostomy ; Humans ; Nutritional Support

BACKGROUND/AIMS: The detection of iatrogenic Mallory-Weiss syndrome during the course of upper GI endoscopy is apparently rare. The aim of this study was identify the clinical features of the disease and associated medical conditions. METHODS: We retrospectively analyzed 46 cases (0.08%) of iatrogenic Mallory- Weiss syndrome identified from 54,188 consecutive upper GI endoscopies performed at our institution during a period of 85 months. RESULTS: A total of 36 patients (78.2%) had retching or belching during the procedure. Hiatal hernias were noted in 20 patients (43.5%). We identified a difference of the attack rate by sex and age for iatrogenic Mallory-Weiss syndrome; the disorder developed predominantly in men. All of the patients had a mucosal tear and oozing and 16 patients underwent endoscopic hemostasis. After being diagnosed with iatrogenic Mallory-Weiss syndrome, 17 patients underwent follow- up endoscopy and all of the patients showed good results without rebleeding. No patient showed a complicated clinical course. CONCLUSIONS: A small number of patients had iatrogenic Mallory-Weiss syndrome and most of the patients showed a good prognosis. If there is a predictable risk factor identified during an upper GI endoscopy or an associated medical condition, special care needs to be taken to minimize belching or retching.
Endoscopy ; Eructation ; Hemostasis, Endoscopic ; Hernia, Hiatal ; Humans ; Male ; Mallory-Weiss Syndrome ; Prognosis ; Retrospective Studies ; Risk Factors

Bleeding in patients with liver cirrhosis is primarily caused by gastroesophageal varix in association with extensive collateral circulation, portal hypertensive gastropathy, a Mallory-Weiss tear and peptic ulcer disease. The spontaneous rupture of an artery, as a result of coagulopathy, is extremely rare in patients with liver cirrhosis; however, we recently observed a case of a spontaneous rupture of the lateral thoracic artery in a 47 year-old male patient with alcoholic liver cirrhosis. The patient expired despite repeated transcatheter arterial embolization of the lateral thoracic artery and best supportive care. This is, to our knowledge, the first documented case of the spontaneous rupture of the lateral thoracic artery in a patient with liver cirrhosis.
Aneurysm, Dissecting/*etiology ; Fatal Outcome ; Humans ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Rupture, Spontaneous/*etiology ; Thoracic Arteries/*pathology ; Time Factors