Primary sclerosing cholangitis is a cholestatic liver disease characterized by fibroobliterative inflammation of the entire biliary tree. It is a slowly progressive disease with an undulating course, resulting in biliary cirrhosis. The gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricturing and beading. We exprienced a case of primary sclerosing cholangitis by Endoscopic retrograde cholangiopancreatography (ERCP) demonstration. ERCP findings revealed multiple luminal narrowing, stricture and beaded dilatation of the intrahepatic duct. We report a case of primary sclerosing cholangitis localizing at intrahepatic bile duct, which is confused with cholangiocarcinoma.
Bile Ducts, Intrahepatic* ; Biliary Tract ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing* ; Constriction, Pathologic ; Diagnosis ; Dilatation ; Inflammation ; Liver Cirrhosis, Biliary ; Liver Diseases ; Phenobarbital

Hamartomatous polyps in the stomach have been described as gastric lesions of familial polyposis coli or not associated with polyposis coli. However, submucosal tumor-like lesion of the gastric hamartoma is very rare. We have experienced an unusual hamartoma in the stomach in a 69-year-old man. He was hospitalized with epigastric discomfort. Endoscopy revealed a submucosal mass at the greater curvature of the high body of the stomach. The resected mass measured 3 X 2 X 1.5 cm and was characterized by cystic dilation of glandular structures. The glandular structures consisted of various types of lining cells, including surface foveolar cell types, pyloric cell types and parietal-like cells, and irregularly arranged smooth muscle bundles and collagen fibers were noted. We report this unusual gastric hamartoma presenting as a submucosal tumor with a review of literatures.
Adenomatous Polyposis Coli ; Aged ; Collagen ; Endoscopy ; Hamartoma* ; Humans ; Muscle, Smooth ; Polyps ; Stomach

BACKGROUND/AIMS: The duodenal intubation test (duodenal secretin test; DST) is now considered the 'gold standard' test of exocrine pancreatic function in detecting exocrine pancreatic dysfunction in patients with chronic pancreatitis. However, the DST has not been widely used, because it is time-consuming, invasive, and labor-intensive. On the other hand, intraductal secretin test (IDST) with endoscopic retrograde cannulation of the main pancreatic duct has been showed similar diagnostic efficiency compared with DST. We assessed the clinical usefulness of IDST and investigated parameters for assessing impaired pancreatic function of IDST. METHODS: Pure pancreatic juices were collected from 12 patients with chronic pancreatitis by endoscopic cannulation after a bolus intravenous injection of secretin 100 U, for 15min in three 5-min intervals. Five parameters of IDST were measured, and the sensitivity, specificity, and accuracy of IDST evaluated compared with ERP. RESULTS: When we regarded mean-1.5 SD as the lower limits of IDST, the diagnostic sensitivity, specificity, and accuracy of five parameters to detect chronic pancreatitis were 91.7-100%, 75-87.5%, and 85-90%, respectively. Among five parameters, pancreatic juice secretory volume, bicarbonate concentration, and amylase output showed the highest diagnostic accuracy, followed by lipase output and bicarbonate output. A 10-min collection showed as much information as a 15-min collection. CONCLUSIONS: 10-min intraductal secretin test is useful as the conventional exocrine pancreatic function test in detecting exocrine pancreatic dysfunction in patients with chronic pancreatitis and the most discriminatory parameters are pancreatic juice secretory volume, bicarbonate concentration, and amylase output.
Amylases ; Catheterization ; Hand ; Humans ; Injections, Intravenous ; Intubation ; Lipase ; Pancreatic Ducts ; Pancreatic Function Tests ; Pancreatic Juice ; Pancreatitis, Chronic* ; Secretin* ; Sensitivity and Specificity

The occurrence of papillary restenosis following endoscopic sphincterotomy is uncommon and usually reported as a late complication. Its frequency varies from 0.8% to 3% and at present, only a few reports describe the late complication rate for a mean follow-up exceeding 10 years. The diameter of the sphincterotomy opening diminishes by about 30% in the first year without further narrowing, suggesting that restenosis occurs mainly during the first post-sphincterotomy year. Papillary restenosis may be promoted by insufficient cutting and may depend on the indication for EST such as common bile duct stones, papillary stenosis, duodenal diverticular, sphincter of Oddi dysfunction. A bleeding sphincterotomy requiring a sclerosing injection is considered a potential risk factor for papillary stenosis. However, stenosis may develop in the absence of specific predisposing factors. A case of papillary restenosis following endoscopic sphincterotomy for gollstone pancreatitis in a 33-year-old female patient is herein reported.
Adult ; Causality ; Common Bile Duct ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Pancreatitis ; Risk Factors ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic

Pancreatic pseudocysts are a well-recognized complication of pancreatitis. Most occur in or adjacent to the pancreas. Occasionally, duodenal involvement may occur due to the nonperitonealized posterior surface of the duodenum is in direct contact with the head of the pancreas. But there is little awareness of the intramural and major extrinsic involvement of the duodenum with also occurs. A case was recently experienced involving an intramural pancreatic pseudocyst of the duodenum.
Duodenum* ; Head ; Pancreas ; Pancreatic Pseudocyst* ; Pancreatitis

Pancreatic pseudocysts were complicated in 10-27% of acute pancreatitis and 11-41% of chronic pancreatitis. Asymptomatic pseudocysts require no treatment, but symptomatic pseudocysts should be decompressed. Surgical management had been the traditional approach to treating pancreatic pseudocysts. Endoscopic transpapillary or transduodenal cystoenterostomy were recently suggested as an alternative to surgery in order to avoid surgical complications. The success rates of endoscopic treatment was 65-94%, procedure related morbidity was 6-21% and mortality was 0-5%. We reported two cases of patients with pancreatic pseudocysts which were treated with endoscopic cystogastrostomy and proceeded to drain through stent and ENPD catheter.
Catheters* ; Humans ; Mortality ; Pancreatic Pseudocyst* ; Pancreatitis ; Pancreatitis, Chronic ; Stents*

Bleeding duodenal varices are a rare complication in patients with portal hypertension. Cirrhosis followed by portal vein obstruction and splenic vein obstruction are the most common causes. Although the prognosis of bleeding duodenal varices is usually poor, an awareness of its characteristic presentation may enable diagnostic and therapeutic proce- dures to be performed rapidly with an increased likelihood of a reaching successful out- come. In this study, we report a case of bleeding duodenal varices in a 23-year-old woman with idiopathic portal hypertension who was also suffering with recurrent melena. Panendoscopy identified prominant tortuous varices with central erosion in the 3rd portion of the duodenum and no esophageal and gastric varices. The varices were successfully treated by distal splenorenal shunt.
Duodenum ; Esophageal and Gastric Varices ; Female ; Fibrosis ; Hemorrhage* ; Humans ; Hypertension, Portal* ; Melena ; Portal Vein ; Prognosis ; Splenic Vein ; Splenorenal Shunt, Surgical ; Varicose Veins* ; Young Adult

The web of the common bile duct is an extremely rare anomaly and the cause of the obstructive jaundice. We experienced a case of the congenital web of common bile duct in a 42 years old male who complained of jaundice for 10 days prior to admission without choledocholithiasis and cholangitis. An endoscopic retrograde cholangiopancreatography revealed a common bile duct web (transverse, diaphragmatic type) and the diagnosis was confirmed by an endoscopic forcep biopsy. We reported a case of the congenita1 web of the common bile duct which was treated with a stent insertion and balloon dilatation.
Adult ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledocholithiasis ; Common Bile Duct* ; Diagnosis ; Dilatation* ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Stents ; Surgical Instruments

A choledochocele is a cyst like herniation of the intramural segment of the distal common bile duct protruding into the duodenal lumen. It is controversial whether this disease entity represents a type III variation of a choledochal cyst or an acquired lesion due to a calculus, papillitis or sphincter of Oddi dysfunction. The choledochocele is the rarest form of choledochal cysts and represents only 1.4-5.0% of all choledochal cysts. The diagnosis of choledochocele can be confirmed with certainly using a cholangiography. During a side viewing duodenoscopy followed by retrograde cholangiopancreatography, the mucosa appears normal but the papilla may be larger than usual. When probing the choledochocele with a cannulating catheter, its surface may be appear to be soft and compressible, similar to the pillow sign. After contrast dye is instilled into the bile duct, a round, cyst-like contrast filled structure can be identified adjacent to the terminatian of the common bile duct and an air halo sign may be visible around it. The established treatment of choledochocele is surgical resection of the cyst with anastomosis of the common bile duct to the small intestine, but transduodenal sphincteroplasty or endoscopic sphincterotomy has been advocated as an alternative to excision because of the very low risk of malignant degeneration, operative complications and morbidity. The choice of therapy for the patients with symptomatic choledochchocele is to establish effective drainage of the common bile duct and pancreatic duct. The objective can be achieved using an endoscopic sphincterotomy or transduodenal sphinateroplasy. It has been determined in recent years that endoscopic sphincterotomy is v effective and often followed by a positive prognosis. We report two patients with reicurrent pancreatitis and the common bile duct dilatation secondary to a choledochoce]e, who were treated effectively by endoscopic sphincterotomy.
Bile Ducts ; Calculi ; Catheters ; Cholangiography ; Choledochal Cyst* ; Common Bile Duct ; Diagnosis ; Dilatation ; Drainage ; Duodenoscopy ; Humans ; Intestine, Small ; Mucous Membrane ; Pancreatic Ducts ; Pancreatitis ; Papilledema ; Prognosis ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic* ; Sphincterotomy, Transhepatic

Tetrodotoxin is a neurotoxin produced by about 90 species of puffer fish and causes paralysis of central nervous system and peripheral nerves by blocking the movement of all monovalent cations. Ingestion of tetrodotoxin produces clinical manifestations such as paresthesias(within 10-45 min), vomiting, lightheadedness, salivation, muscle twitching, dysphagia, difficulty in speaking, convulsion and death that expressed by cardiopulmonary arrest with loss of brain stem reflex sometimes. Tetrodotoxin prevents or delays ischemia induced neuronal death by way of following 3 mechanisms. Firstly, it reduces the energy demand of the brain tissues. Secondly, it delays or even prevents anoxic depolarization. Finally, it diminishes ischemia induced cell swelling and cerebral edema. We report a case of puffer fish poisoning which presented with cardiopulmonary arrest and loss of brain stem reflex, but completely recovered by aggressive cardiopulmonary resuscitation.
Brain ; Brain Edema ; Brain Stem ; Cardiopulmonary Resuscitation ; Cations, Monovalent ; Central Nervous System ; Deglutition Disorders ; Dizziness ; Eating ; Heart Arrest ; Ischemia ; Neurons ; Paralysis ; Peripheral Nerves ; Poisoning* ; Reflex ; Salivation ; Seizures ; Tetraodontiformes* ; Tetrodotoxin ; Vomiting