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Volume 31(2); August 2005
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The Clinical Features of Upper Gastrointestinal Bleeding after Acute Burn Injury
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Geun Sook Kim, M.D., Hyun Joo Jang, M.D., Chang Soo Eun, M.D., Sea Hyub Kae, M.D.,Woo Jung Park, M.D., Wook Chun, M.D.*, Jong Hyun Kim, M.D.* and Jin Lee, M.D.
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Korean J Gastrointest Endosc 2005;31(2):77-83. Published online August 30, 2005
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Abstract
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- Background
/Aims: Upper gastrointestinal (UGI) bleeding is one of the most common and serious complications in major burns. However, the clinical features of UGI bleeding have rarely been studied, and no report of UGI bleeding after burn injury has been presented in Korea. The aim of this study was to evaluate the clinical features of the UGI bleeding after acute burn injury. Methods: Among 2,340 patieats with acute burn injury who have admitted from January 2000 to June 2004, 33 patients had UGI bleeding. We retrospectively reviewed the medical records of these 33 patients. Results: The causes of bleeding were gastric ulcer (45.5%), duodenal ulcer (36.4%), esophageal ulcer (6%), Mallory-Weiss tear (6%), hemorrhagic gastritis (3%), and gastric varix (3%). Endoscopic intervention and medical treatment were taken in 13 patients (39.4%), and 20 patients (60.6%) were managed with medical treatment only. Mortality rate of post-burn UGI bleeding patients was 30.3%. In logistic regression analysis, burn size (p=0.047) and Rockall score (p=0.019) were independent risk factors of mortality in patients with UGI bleeding. Conclusions: The most common cause of UGI bleeding in burn patients is peptic ulcer. Treatment of systemic complications of burn as well as UGI bleeding itself may be important in clinical course of UGI bleeding after burn. Large, randomized, and prospective study of prophylactic proton pump inhibitor for the prevention of post-burn UGI bleeding is needed. (Korean J Gastrointest Endosc 2005;31:7783)
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Results of Histoacryl-Lipiodol Sequential Injection Using Specific Gradient Difference for Bleeding Gastric Varices
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Tae Oh Kim, M.D., Jeong Heo, M.D., Seong Hun Lee, M.D., Dae Sik Gwon, M.D.,Gwang Ha Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.
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Korean J Gastrointest Endosc 2005;31(2):84-89. Published online August 30, 2005
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Abstract
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/Aims: Histoacryl forms hard substances in an instance after a brief exposure to polar liquid, blood or body temperature. This often causes obstruction of injector and endoscopic channel. Furthermore, splashed Histoacryl during injection can lead to accidental loss of vision. We propose a new convenient method of Histoacryl-lipiodol sequential injection and report the results. Methods: From May 2001 to August 2004, sequential injector method was performed in treating consecutive thirty gastric varices patients. Histoacryl (S.G. 1.0) 1 mL and lipiodol (S.G. 1.28) 1∼1.5 mL are filled in 2.5 mL disposable syringe with 16 gauge needle, which are separated into two compartments by specific gravity difference. The injector attached side of charged syringe is gently placed upward and the piston is pushed after the lesion site puncture. Then, normal saline is promptly infused to wash out and the needle is withdrawn. Results: There were 26 males and 4 females. 4 had active bleeding and 26 had the stigmata of bleeding. Varices types were Lg-c in 10, Lg-cf in 16 and Lg-f in 4 patients and the Child-Pugh classification were A in 17%, B in 53% and C in 30%. The average amount was 1.53 mL. Initial hemostasis rate was 97%, 3 of patients re-bled in 4 weeks and 2 patients later. One patient died after the procedure and a case of procedure related bacteremia has occurred. Conclusions: Histoacryl-lipiodol sequential injection by specific gravity difference is convenient and safe. Also, it carries less damage to the instruments. (Korean J Gastrointest Endosc 2005;31:8489)
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Intraductal Papillary Mucinous Neoplasm of the Pancreas: The Role of Intraductal Ultrasonography in Selection of Resection Method of Pancreas
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Seung Hoon Baek, M.D., Young Deok Cho, M.D., Jae Young Jang, M.D., Young Koog Cheon, M.D., Young Seok Kim, M.D., Jong Ho Moon, M.D., Yun Soo Kim, M.D., Moon Sung Lee, M.D., Kyung Yul Hur, M.D., Chan Sup Shim, M.D. and Boo Sung Kim, M.D.
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Korean J Gastrointest Endosc 2005;31(2):90-96. Published online August 30, 2005
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Abstract
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/Aims: The treatment of choice of intraductal papillary mucinous neoplasm (IPMN) is partial pancreatic resection with complete excision of this potentially malignant lesion, thus preserving sufficient pancreatic tissue to ensure endocrine and exocrine functions. This strategy, however, requires a reliable preoperative assessment of the highly variable extension of IPMN. We performed this study to determine the role of intraductal ultrasonography (IDUS) in predicting the extension of IPMN and selecting the resection methods of pancreas. Methods: A preoperative assessment of IPMN by IDUS was performed in 12 patients who underwent a surgical resection of IPMN. According to the preoperative localization of IPMN by IDUS, various types of limited pancreatic resections were planned. The histologic examination of the frozen section of the pancreatic cut surface was performed in all patient. In the cases of tumor involvement as cut surface margin, a modification of the planned pancreatic resection was done. Results: Technical success was achieved in all 12 cases (100%). There were positive tumor margin of cut surfaces in 2 patients. Of 10 cases whose frozen tissue evaluation of the pancreatic cut surface had been negative at first, one patieat has turned out to be margin positive in permanent section examination, finally. Overall accuracy of IDUS in predicting the continuous extension of IPMN was 75%. Conclusions: IDUS is a reliable diagnostic modality to guide the resection extent of the pancreas in patients with IPMN. (Korean J Gastrointest Endosc 2005;31:9096)
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A Case of Spontaneous Submucosal Dissection of the Esophagus Accompanying Mediastinal Abscess
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Seung Joon Choi, M.D., Kwang Jae Lee, M.D., Young Bae Kim, M.D.*, Jin Yeong Sim, M.D., Ki Meong Lee, M.D., Ki Baik Hahm, M.D., Jin Hong Kim, M.D. and Sung Won Cho, M.D.
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Korean J Gastrointest Endosc 2005;31(2):97-101. Published online August 30, 2005
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Abstract
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- Spontaneous submucosal dissection of the esophagus (SDE) is a rare disease, in which spontaneous submucosal spot bleeding or intramural hematoma leads to the tearing of the layers between submucosa and muscle of the esophageal wall without any definitive cause, and the pathogenesis of SDE has not been well documented yet. Typical symptoms of SDE are chest pain, hematemesis, dysphagia, and odynophagia. The laboratory tests are usually normal and symptoms could be mild and ambiguous, so the diagnosis of SDE is conducted with endoscopy or esophagogram in most cases. The prognosis of SDE is usually very good with just conservative cares such as fasting and fluid therapy. Esophageal perforation complicated by SDE is very rare because symptoms od SDE usually bring the patients to hospital before perforation. Recently, we experienced a case of a 54 year-old male showing the endoscopic findings of SDE and complicated mediastinal abscess probably following esophageal perforation. The patient had social history of chronic heavy alcoholic ingestion and had symptoms of substernal pain, dysphagia, and odynophagia. The patient recovered after partial esophagectomy, abscess drainage and antibiotic therapy. (Korean J Gastrointest Endosc 2005;31:97101)
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A Case of Primary Pure Squamous Cell Carcinoma of the Stomach
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Nam Hun Lee, M.D., Young Eun Joo, M.D., Geun Soo Park, M.D., Min Ho Park, M.D.,Pil Jin Jung, M.D., Im Kwan Jhu, M.D., Sang Wook Park, M.D., Chang Hwan Park, M.D.,Wan Sik Lee, M.D., Hyun Soo Kim, M.D., Sung Kyu Choi, M.D.,Jong Sun Rew, M.D. and Sei Jong Ki
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Korean J Gastrointest Endosc 2005;31(2):102-106. Published online August 30, 2005
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- Primary pure squamous cell carcinoma of the stomach is extremely rare. To date, five cases have been reported in Korea. We report an additional case of a 71-year-old male with pure squamous cell carcinoma of the stomach. Upper gastrointestinal endoscopy showed a large ulceroinfiltrating mass with irregular margin in the body of the stomach. Histologic examination of biopsy specimen confirmed moderately differentiated squamous cell carcinoma. Abdominal computed tomography showed metastatic mass in the left hepatic lobe, pancreatic body and tail. Despite the combination chemotherapy with docetaxel, cisplatin and 5- fluorouracil, the patient died from wide spread metastasis. (Korean J Gastrointest Endosc 2005;31:102106)
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A Case of Gastric Emphysema with Portal Vein Emphysema associated with the Episode of Severe Vomiting
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Hyeon Woong Yang, M.D., Jeong Sik Byeon, M.D., Gin Hyug Lee, M.D., Suk Gyun Yang, M.D., Hwoon Yong Jung, M.D., Jin Ho Kim, M.D., Weon Seon Hong, M.D. and Young Il Min, M.D.
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Korean J Gastrointest Endosc 2005;31(2):107-110. Published online August 30, 2005
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- Gastric emphysema is rare but it has a fulminant course with high mortality rate. We report a 58-year old man who visited the emergency room because of severe vomiting and nausea which had started 2 days ago. He underwent curative pylorus-preserving pancreaticoduodenectomy due to ampullary cancer 4 months ago. He was diagnosed as gastric emphysema with combined portal vein emphysema. Only with conservative treatment such as intravenous fluids infusion and decompression of the stomach by nasogastric tube, the condition of the patient slowly improved. The patient was able to discharge without surgical intervention. (Korean J Gastrointest Endosc 2005;31:107110)
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A Case of an Acute Huge Hemorrhagic Gastric Ulcer after an Endoscopic Mucosal Biopsy
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So Ri Kim, M.D., Kyung Hoon Min, M.D., Sang Woo Nam, M.D., Hyun Chul Kim, M.D.,Yong Keun Cho, M.D., In Hee Kim, M.D., Soo Teik Lee, M.D. and Deuk Soo Ahn, M.D.
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Korean J Gastrointest Endosc 2005;31(2):111-115. Published online August 30, 2005
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- Although most diagnostic upper gastrointestinal endoscopic procedures are performed on an outpatient basis with relatively low risk, complications related with these procedures can occur. The reported complications are cardiopulmonary complications, drug side effects, perforation, hemorrhage and infection. Hemorrhage may occur from the site of biopsy or polyp removal. It is usually minimal and heals spontaneously with or without endoscopic treatment and rarely requires transfusion or surgery. Acute hemorrhagic ulceration associated with endoscopic mucosal biopsy is very rare. We report a case of a 46-year-old woman with an acute hemorrhagic gastric ulcer after an endoscopic mucosal biopsy. She has been receiving upper gastrointestinal endoscopic examinations annually for the gastric polyp detected 4 years ago. Endoscopic mucosal biopsy was performed without complications. Twelve hours later, she admitted to the emergency room because of melena. Emergent upper gastrointestinal endoscopy showed an acute huge hemorrhagic ulceration along the antrum. She was treated conservatively and discharged 5 days later. (Korean J Gastrointest Endosc 2005;31:111115)
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A Case of Gastrojejunocolic Fistula as a Complication after Gastrojejunostomy
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Ji Hyun Nam, M.D., Joo Hoon Kim, M.D., Ji Eun Park, M.D., Hyoung Jun Kim, M.D.,Seung Hyun Lee, M.D.*, Byung Kwan Ahn, M.D.*, Hee Kyung Chang, M.D.† and Seun Ja Park, M.D.
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Korean J Gastrointest Endosc 2005;31(2):116-120. Published online August 30, 2005
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- Gastrocolic and gastrojejunocolic fistula are well-recongnized but rare complications of a variety of diseases, and surgical or endoscopic procedures. We had a case of gastrojejunocolic fistulae associated with marginal ulcer following gastrectomy with Billroth II gastrojejunostomy for recurrent peptic ulcer disease. He had chronic watery diarrhea, weight loss and fecal eructation and gastrojejunocolic fistula was dignosed by gastroscopy, barium enema, upper gastrointestinal series and abdominal CT scan. He underwent subtotal gastrectomy with Roux-en-Y gastrojejunal anastomosis and en-bloc resection including the fistula and surrounding colon, jejunum and gastric segments. Hereafter, he showed disappearance of diarrhea, along with slow rate of weight gain. (Korean J Gastrointest Endosc 2005;31:116120)
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A Case of Duodenal Gastrointestinal Stromal Tumor Presenting with Gastrointestinal Bleeding
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Im Kwan Jhu, M.D., Young Eun Joo, M.D., Geun Soo Park, M.D., Min Ho Park, M.D.,Sang Uk Park, M.D., Nam Hun Lee, M.D., Phil Jin Jung, M.D., Wan Sik Lee, M.D.,Chang Hwan Park, M.D., Hyun Soo Kim, M.D., Sung Kyu Choi, M.D., Jong Sun Rew, M.D. and Sei Jong Ki
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Korean J Gastrointest Endosc 2005;31(2):121-125. Published online August 30, 2005
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- Gastrointestinal stromal tumor (GIST) is the most common non-epithelial tumor of the gastrointestinal tract. GISTs are most common in the stomach, followed by small intestine, colon and rectum, and esophagus. We report a case of duodenal GIST presenting with gastrointestinal bleeding in a 53-year-old male. Upper gastrointestinal endoscopy revealed a protruded mass with central ulceration on the second portion of the duodenum. Spontaneous spurting blood was encountered from the central ulcer of the mass. Abdominal computed tomography scan and celiac angiography revealed hypervascular tumor, located in the second portion of the duodenum. Laparotomy with wedge resection was performed. Histological and immunohistochemical studies on resected specimen revealed a duodenal GIST of a combined smooth muscle and neural type. (Korean J Gastrointest Endosc 2005;31:121125)
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A Case of Duodenal Lipoma with Upper Gastrointesinal Bleeding
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Jae Bum Park, M.D., Sang Won Park, M.D., Yun Sok Yang, M.D., Ho Sup Lee, M.D.,Byung Gu Yoon, M.D., Chang Goo Lee, M.D. and Sun Young Kim, M.D.*
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Korean J Gastrointest Endosc 2005;31(2):126-129. Published online August 30, 2005
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- Duodenal lipoma is relatively rare, and usually located in the second portion of the duodenum. Most lipomas of the small intestine are asymptomatic and incidentally found. However, epigastric pain, intussusception, ulcer, intestinal obstruction and rarely severe hemorrhage can occur depending on the size or location. Duodenal lipoma is mostly confirmed by surgical removal with histopathologic valuation because it is difficult to make a differential diagnosis of duodenal lipoma from malignant tumor or other submucosal tumor based only on the findings of radiology or endoscopy. Endoscopic ultrasonography can so help for the differential diagnosis of the submucosal tumor. We report a case of duodenal lipoma accompanied by upper gastrointesinal hemorrhage, treated by both endoscopic resection and surgical operation and confirmed by histopathologic diagnosis. (Korean J Gastrointest Endosc 2005;31:126129)
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A Case of Pancreatic Duct-Portal Vein Fistulae in Pancreatic Cancer
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Hyun Jeong Kim, M.D., Young Koog Cheon, M.D., Jong Ho Moon, M.D., Young Duck Cho, M.D., June Seong Lee, M.D., Moon Sung Lee, M.D. and Chan Sup Shim M.D.
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Korean J Gastrointest Endosc 2005;31(2):130-132. Published online August 30, 2005
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- Pancreatic fistulae follows pancreatic duct disruption and may develop as a complication of pancreatic disease or injury. The escaping fluid may be walled off by the surrounding viscera to form a pseudocyst or an abscess. Fistulae may drain spontaneously into adjacent hollow viscera or communicate with the body surface externally. Although internal pancreatic fistulas that communicate with adjacent internal organs are much less common, vascular communication with the pancreatic ductal system is especially unusual and generally represents a serious clinical situation. We experienced one case of pancreatic duct-portal vein fistula in a patient with pancreatic cancer. Endoscopic retrograde cholangiopancreatography revealed a large vascular structure representing the portal vein filled at the time of the contrast injection, indicating the presence of a pancreatic duct-portal vein fistulae. (Korean J Gastrointest Endosc 2005;31:130133)
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