Clinical Endoscopy

Gastric wall abscess after endoscopic submucosal dissection: Seung Jung Yu, Sang Heon Lee, Jun Sik Yoon, Hong Sub Lee, Sam Ryong Jee; Clin Endosc 2023;56(1):114-118. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.203

Gastric wall abscess, a localized form of phlegmonous gastritis, is a rare complication of endoscopic resection. We report the first case of gastric wall abscess developing after endoscopic submucosal dissection in Korea. A 72-year-old woman visited our clinic to receive treatment for gastric adenoma. The patient successfully underwent endoscopic submucosal dissection with no complications. The final diagnosis was well-differentiated tubular adenocarcinoma. We performed follow-up endoscopy 10 weeks later and found a large subepithelial lesion on the posterior wall of the gastric antrum. Abdominal computed tomography revealed hypodense wall thickening and a 5 cm heterogenous multilobular mass in the submucosal layer of the gastric antrum. Submucosal invasion with mucin-producing adenocarcinomas could therefore not be excluded. The patient agreed to undergo additional gastrectomy due to the possibility of a highly malignant lesion. The final diagnosis was acute suppurative inflammation with the formation of multiple abscesses in the mural layers and omentum. The patient was discharged with no complications.

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Phlegmonous gastritis after biloma drainage: A case report and review of the literature
Kai-Chun Yang, Hsin-Yu Kuo, Jui-Wen Kang
World Journal of Clinical Cases.2022; 10(33): 12430. CrossRef

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Endoscopic Ultrasound-Guided Transgastric Puncture and Drainage of an Adrenal Abscess in an Immunosuppressed Patient: Carlos Andrés Regino, Jean Paul Gómez, Gabriel Mosquera-Klinger; Clin Endosc 2022;55(2):302-304. Published online November 16, 2021; DOI: https://doi.org/10.5946/ce.2021.090

Abstract PDF PubReader ePub: Adrenal gland infection is a clinical entity of great importance, but it is a largely unrecognized pathology. Immunosuppressed individuals are at a higher risk of presentation. Herein, we describe a young female patient, recently diagnosed with HIV, who presented with severe sepsis due to methicillin-resistant Staphylococcus aureus, associated with a left adrenal abscess. She was initially treated with antibiotics; however, due to the persistence of the systemic inflammatory response and bacteremia, endoscopic ultrasound-guided drainage was performed. This procedure was successful in resolving the clinical situation. Endoscopic ultrasound-guided adrenal gland drainage can be a safe, efficacious, and minimally invasive option for managing antibiotic-refractory adrenal abscesses in immunosuppressed patients.

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Outcomes of Endoscopic Management among Patients with Bile Leak of Various Etiologies at a Tertiary Care Center: Suprabhat Giri, Sridhar Sundaram, Harish Darak, Sanjay Kumar, Shobna Bhatia; Clin Endosc 2020;53(6):727-734. Published online August 21, 2020; DOI: https://doi.org/10.5946/ce.2020.017

Abstract PDF PubReader ePub

Background
/Aims: Bile leak is a common complication of cholecystectomy, and it is also observed in other conditions such as ruptured liver abscess, hydatid cyst, and trauma. Endoscopic retrograde cholangiopancreatography (ERCP) is the first-line management for such conditions. However, studies on the outcomes of endoscopic management for bile leaks with etiologies other than post-cholecystectomy injury are extremely limited.
Methods
We conducted a retrospective review of patients with symptomatic bile leak who were referred to a tertiary care center and who underwent ERCP between April 2016 and April 2019. The primary outcome was complete symptomatic resolution without extravasation of the contrast medium during the second ERCP conducted after 6 weeks.
Results
In total, 71 patients presented with symptomatic bile leak. The etiologies of bile leak were post-cholecystectomy injury in 34 (47.8%), liver abscess in 20 (28.1%), and post-hydatid cyst surgery in 11 (15.4%) patients. All patients were managed with ERCP, sphincterotomy, and stent placement for 6 weeks, except for one who underwent surgery. The primary outcome was achieved in 65 (91.5%) of 71 patients. There was no significant difference in terms of outcome in relation to the interval between the diagnosis of bile leak and ERCP.
Conclusions
Most patients with bile leak can be successfully managed with ERCP even when performed on an elective basis.

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A critical appraisal of the ISGLS definition of biliary leakage after liver resection
Svenja Sliwinski, Jan Heil, Josephine Franz, Hanan El Youzouri, Michael Heise, Wolf O. Bechstein, Andreas A. Schnitzbauer
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Progress in ERCP Treatment of Biliary Complications in Patients with Hepatic Echinococcosis
燕泽林
Advances in Clinical Medicine.2023; 13(03): 4013. CrossRef
Diagnosis and Management of Bile Leaks after Severe Liver Injury: A Trauma Association of Canada (TAC) Multicenter Study
Morgan Schellenberg, Chad G. Ball, Natthida Owattanapanich, Brent Emigh, Patrick B. Murphy, Bradley Moffat, Brett Mador, Andrew Beckett, Jennie Lee, Emilie Joos, Samuel Minor, Matt Strickland, Kenji Inaba
Journal of Trauma and Acute Care Surgery.2022;[Epub] CrossRef
Postoperative bile leakage caused by intrahepatic duct injury during right hemicolectomy
Jaram Lee, Ook Song, Hyeong-Min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
Medicine.2021; 100(46): e27877. CrossRef
The Need for a Better-Designed Study of the Outcomes of Endoscopic Management of Bile Leak
Hyung Ku Chon, Eun Ji Shin, Seong-Hun Kim
Clinical Endoscopy.2020; 53(6): 633. CrossRef

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Pyogenic Liver Abscess Caused by Endoscopic Submucosal Dissection for Early Colon Cancer: Joon Seop Lee, Yong Hwan Kwon; Clin Endosc 2019;52(6):620-623. Published online July 30, 2019; DOI: https://doi.org/10.5946/ce.2018.185

Abstract PDF PubReader ePub: Endoscopic submucosal dissection (ESD) is widely used for the treatment of colorectal neoplasia in patients who are candidates for endoscopic resection. In particular, pyogenic liver abscess (PLA), although rare, can occur. To our knowledge, there are no reports of PLA cases after ESD. Therefore, we report a rare case of PLA caused by ESD. A 76-year-old man was referred from a local clinic and admitted to our hospital for colonic ESD for a large polypoid mass. During colonoscopy, a 5-cm mass was seen in the cecum. ESD was performed. Four days after the procedure, he complained of myalgia and abdominal discomfort. Computed tomography revealed a 5.4- cm PLA in the medial segments of the liver. He was treated with antibiotics, and a percutaneous drainage catheter was inserted. Here, we report a very rare complication (PLA) after ESD. In conclusion, comprehensive awareness of the development of PLA is needed in ESD cases.

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Endoscopic Ultrasound-Guided Transgastric Drainage of an IntraAbdominal Abscess following Gastrectomy: Satoru Kikuchi, Tetsushi Kubota, Shinji Kuroda, Masahiko Nishizaki, Shunsuke Kagawa, Hironari Kato, Hiroyuki Okada, Toshiyoshi Fujiwara; Clin Endosc 2019;52(4):373-376. Published online February 15, 2019; DOI: https://doi.org/10.5946/ce.2018.134

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Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.

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A Case of Intra-abdominal Abcess following a Pancreatic Fistula after Gastrectomy Treated with Endoscopic Ultrasound-guided Transgastric Drainage
Kenichi ISHIBAYASHI, Toshikatsu TSUJI, Daisuke YAMAMOTO, Hirotaka KITAMURA, Shinichi KADOYA, Hiroyuki BANDO
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2020; 81(6): 1097. CrossRef

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Endoscopic Ultrasound-Guided Perirectal Abscess Drainage without Drainage Catheter: A Case Series: Eun Kwang Choi, Ji Hyun Kim, Seung Uk Jeong, Soo-Young Na, Sun-Jin Boo, Heung Up Kim, Byung-Cheol Song; Clin Endosc 2017;50(3):297-300. Published online April 11, 2017; DOI: https://doi.org/10.5946/ce.2016.123

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A perirectal abscess is a relatively common disease entity that occurs as a postsurgical complication or as a result of various medical conditions. Endoscopic ultrasound (EUS)-guided drainage was recently described as a promising alternative treatment. Previous reports have recommended placement of a drainage catheter through the anus for irrigation, which is inconvenient to the patient and carries a risk of accidental dislodgement. We report four cases of perirectal abscess that were successfully treated with only one or two 7 F double pigtail plastic stent placements and without a drainage catheter for irrigation.

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Pelvic abscess treatment: A novel experience with UNICO drainage
Salvatore Fazzotta, Paolo Locurto, Marco Airò Farulla, Luigi Antonio Lazzaro, Giovanni D’Ippolito, Maria Amico, Pietro Fodale, Pietro Termini, Giovanni Ciaccio
Il Giornale di Chirurgia - Journal of the Italian Association of Hospital Surgeons.2024; 44(1): e42. CrossRef
Endoscopic techniques for management of large colorectal polyps, strictures and leaks
Stuart R. Gordon, Lauren S. Eichenwald, Hannah K. Systrom
Surgery Open Science.2024; 20: 156. CrossRef
Anorectal pathology in the HIV population: a guide for radiologists
Derek Vos, Margaret Wang, Sita Ramaiya, Elias G. Kikano, Sree H. Tirumani, Daniel A. Smith
Abdominal Radiology.2022; 47(5): 1762. CrossRef
Practical approach to linear endoscopic ultrasound examination of the rectum and anal canal
Hussein Hassan Okasha, Katarzyna M. Pawlak, Amr Abou-elmagd, Ahmed El-Meligui, Hassan Atalla, Mohamed O. Othman, Sameh Abou Elenin, Ahmed Alzamzamy, Reem Ezzat Mahdy
Endoscopy International Open.2022; 10(10): E1417. CrossRef
A brief literature review of catheter-based drainage of perirectal abscesses
Vitaley Kovalev, Benjamin Hopkins
World Journal of Colorectal Surgery.2022; 11(1): 1. CrossRef
EUS-guided transrectal drainage of pelvic fluid collections using electrocautery-enhanced lumen-apposing metal stents: a case series
Andrea Lisotti, Anna Cominardi, Igor Bacchilega, Romano Linguerri, Pietro Fusaroli
VideoGIE.2020; 5(8): 380. CrossRef
Rectal Endoscopic Ultrasound in Clinical Practice
Stephen Hasak, Vladimir Kushnir
Current Gastroenterology Reports.2019;[Epub] CrossRef

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Tuberculous Prostatic Abscess with Prostatorectal Fistula after Intravesical Bacillus Calmette-Guérin Immunotherapy: Jeong Ho Eom, Jai Hoon Yoon, Seok Won Lee, Hyo Sun Kim, Tae Young Park, Chang Seok Bang, Gwang Ho Baik, Dong Joon Kim; Clin Endosc 2016;49(5):488-491. Published online March 15, 2016; DOI: https://doi.org/10.5946/ce.2015.145

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Intravesical bacillus Calmette-Guérin (BCG) immunotherapy is a common treatment modality for bladder cancer after transurethral resection of a bladder tumor. This therapy is generally safe, and development of a prostatic abscess with a prostatorectal fistula after intravesical BCG immunotherapy is a very rare complication. This finding was incidentally obtained by the authors, who examined a patient with colonoscopy for evaluation of abdominal pain. The patient was successfully treated with antitubercular drugs. To the authors’ knowledge, this is the first report of a patient with a tuberculous prostatic abscess with prostatorectal fistula after BCG immunotherapy in South Korea.

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Afebrile tuberculous prostatic abscess with rectal fistula after intravesical Bacillus Calmette‐Guérin immunotherapy
Tatsuhiro Sawada, Ayaka Igarashi, Seiji Arai, Akira Ohtsu, Yuji Fujizuka, Shun Nakazawa, Yoshitaka Sekine, Hidekazu Koike, Yosuke Furuya, Kazuhiro Suzuki
IJU Case Reports.2025; 8(1): 69. CrossRef
A case of perforation of the prostatic abscess into the rectum resulting in a rectoprostatic fistula
Yuichi Sugiyama, Atsushi Fujikawa, Shuhei Yokokawa
IJU Case Reports.2023; 6(6): 433. CrossRef
Incidental findings in and around the prostate on prostate MRI: a pictorial review
Janki Trivedi, Tom Sutherland, Mark Page
Insights into Imaging.2021;[Epub] CrossRef
Prostate abscess: A comprehensive review of the literature
Alexander J Ridgway, Angus Chin-On Luk, Ian Pearce
Journal of Clinical Urology.2019; 12(6): 441. CrossRef
Tuberculous prostatic abscess following intravesical bacillus Calmette-Guérin immunotherapy
Bin Wang, Ji-Wen Song, Hui-Qing Chen
Chinese Medical Journal.2019; 132(18): 2263. CrossRef
Diagnosis and treatment of patients with prostatic abscess in the post‐antibiotic era
Anne Lenore Ackerman, Pooja S Parameshwar, Jennifer T Anger
International Journal of Urology.2018; 25(2): 103. CrossRef
An Unusual Cause of a Prostatic Abscess
Rohit Majumdar, Nancy F. Crum-Cianflone
Infectious Diseases in Clinical Practice.2018; 26(3): 175. CrossRef
THE SIGNIFICANCE OF PATHOMORPHOLOGICAL INVESTIGATION IN THE DIAGNOSIS OF PROSTATE TUBERCULOSIS
V. V. Potapov, E. V. Brizhatuk
Herald Urology.2018; 6(2): 21. CrossRef

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Could Transgastric Endoscopic Ultrasound-Guided Aspiration Alone Be Effective for the Treatment of Pancreatic Abscesses?: Hoon-Gil Jo, Baatarnum Amarbat, Jin-Woo Jeong, Hyo-Yeop Song, Seung-Ryel Song, Tae-Hyeon Kim; Clin Endosc 2015;48(4):345-347. Published online July 24, 2015; DOI: https://doi.org/10.5946/ce.2015.48.4.345

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Drainage of pancreatic abscesses is required for effective control of sepsis. Endoscopic ultrasound (EUS)-guided endoscopic drainage is less invasive than surgery and prevents local complications related to percutaneous drainage. Endoscopic drainage with stent placement in the uncinate process of the pancreas is a technically difficult procedure. We report a case of pancreatic abscess treated by repeated EUS-guided aspiration and intravenous antibiotics without an indwelling drainage catheter or surgical intervention.

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Pancreatic abscess: a modern look at an old problem
Fedir Prytkov , Denis Yurkin
The Ukrainian Scientific Medical Youth Journal.2021; 128(1): 42. CrossRef
Infected Pancreatic Necrosis Mimicking Pancreatic Cancer
Jun Heo
Case Reports in Gastroenterology.2020; 14(2): 436. CrossRef

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A Case of Steroid Treated Amebic Colitis Misdiagnosed as Eosinophilic Colitis: Eun Sun Cheong, M.D., Yun Ju Jo, M.D., Sang Bong An, M.D., Seong Hwan Kim, M.D., Young Sook Park, M.D., Won Mi Lee, M.D.^* and Young Ok Hong, M.D.^*; Korean J Gastrointest Endosc 2011;43(1):42-46. Published online July 28, 2011

Abstract PDF: Some cases have reported that amebic colitis leads to serious complications that are caused by a misdiagnosis of an inflammatory bowel disease and consequential ill-managed steroid therapy. Therefore, it should be stressed that the differential diagnosis on such a case is very important. Eosinophilic colitis may reveal its presence as diarrhea, abdominal pain, ascites, and eosinophilic deposits in tissues. Therefore, it is highly necessary to make a differential diagnosis to distinguish eosinophilic colitis from other infectious or inflammatory bowel diseases. We report a case of amebic colitis, which was mistakenly diagnosed as eosinophilic colitis and a liver eosinophilic abscess in a young male who complained of bloody diarrhea and right upper quadrant pain. However, the misdiagnosed steroid therapy did not aggravate the progress of the amebic infection. (Korean J Gastrointest Endosc 2011;43:42-46)

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A Case of Duodenal Wall Abscess Caused by a Foreign Body: Byoung Hoon Ji, M.D., Ji Hoon Yoon, M.D., Jin Ho Lee, M.D., Hee Ryong Lee, M.D., Seong Min Yu, M.D., Min Dae Kim, M.D., Young Il Choi, M.D.^* and Il Seon Lee, M.D.^†; Korean J Gastrointest Endosc 2011;42(6):383-387. Published online June 12, 2011

Abstract PDF: Duodenal abscess is a form of phlegmonous enterocolitis and is a rarely reported disease throughout the entire world. Duodenal abscess mostly develops from complications of duodenal ulcer perforation, and may result in a clinically fatal course because it is difficult to differentiate from some diseases such as gastric ulcer, gastric cancer, hepatobiliary disorders etc.. The therapeutic gold standard is surgical intervention including abscess removal and drainage. We experienced a
case
of duodenal abscess that expressed non-specific symptoms, weight loss and epigastric pain, and diagnosed by gastrointestinal endoscopy, abdominal computed tomography. We successfully treated it through surgical intervention with intravenous antibiotics.

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A Case of Focal Intramural Abscess Due to a Fish Bone Ingestion in a Healthy Middle Aged Woman: Sang Hun Ko, M.D., Gye Sung Lee, M.D.*, Jae I Ko, M.D., Hyng Sik Yun, M.D., Sung Keun Kim, M.D., Sung Ho Kim, M.D., Chan Woo Park, M.D. and Gwan Woo Nam, M.D.*; Korean J Gastrointest Endosc 2011;42(2):105-108. Published online February 28, 2011

Abstract PDF: Gastric wall abscess is a one form of phlegmonous gastritis and there are scare reports on this. Gastric wall abscess is a purulent inflammatory disease and it is commonly caused by a focal injury to the gastric mucosa such as a penetrating trauma from an ingested foreign body or an endoscopic biopsy where by bacterial infection occurs throughout all the layers of the gastric wall. With symptoms such as abdominal pain and fever, making the diagnosis after an operation was possible in the past, but it has recently become possible to make the diagnosis before the operation via esophagogastroduodenoscopy, endoscopic ultrasonography and/or abdominal computed tomography. We recently experienced a case of gastric wall abscess that was associated with a foreign body (presumably a fish bone) in a healthy middle aged woman. By performing generalized esophagogastroduodenoscopy and abdominal computed tomography at a primary medical institution, we made an early diagnosis and treated the patient. Herein, we report on this case and we review the relevant literature. (Korean J Gastrointest Endosc 2011;42:105-108)

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Gastric Wall Abscess Caused by a Fish Bone and Treated with Endoscopic Management: Won Jung Jun, M.D., Jong Sun Rew, M.D., Yong Chan Cho, M.D., Du Young Noh, M.D., Sung Kyun Kim, M.D., Hyen Soo Kim, M.D. and Sung Kyu Choi, M.D.; Korean J Gastrointest Endosc 2010;41(2):98-101. Published online August 30, 2010

Abstract PDF: Intramural gastric abscess is a rare condition representing a localized form of suppurative gastritis. According to the extent of the disorder, suppurative gastritis is classified into diffuse and localized types. The diffuse or phlegmonous type is more common and involves the entire stomach with inflammation spreading to all layers from the submucosa. The localized form referred to as "intramural gastric abscess" accounts for 5% to 15% of cases. The pathogenic mechanism includes direct invasion by microorganisms and hematogenous spread from a distant source. Cases are usually diagnosed with a combination of imaging modalities such as ultrasound, computed tomography, endoscopic ultrasound, and esophagogastroduodenoscopy. Herein we report a case of intramural gastric abscess that developed following ingestion of a fish bone. It was successfully treated with endoscopic incision and drainage of pus. (Korean J Gastrointest Endosc 2010;41:98-101)

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A Case of a Pancreatic Abscess Complicating Endoscopic Sphincterotomy: Mi Hyun Kim, M.D., Gwang Ha Kim, M.D., Seon Kyeong Kim, M.D., Won Lim, M.D., Jin Sup Park, M.D., Seong Hoon Yoon, M.D., Dong Uk Kim, M.D. and Geun Am Song, M.D.; Korean J Gastrointest Endosc 2009;39(1):55-58. Published online July 30, 2009

Abstract PDF: Endoscopic sphincterotomy (EST) has gained wide acceptance as a valuable tool for the management of disease of the pancreas and biliary tract. Complications associated with an EST include bleeding, perforation, pancreatitis and cholangitis, and the incidence of complications is approximately 5∼10%. A pancreatic abscess can develop rarely after an EST and tends to have a more complicated course, resulting in higher morbidity and mortality. We report a case of a pancreatic abscess that complicated an EST in a 61-year-old woman with a primary common bile duct stone. The patient was successfully cured by treatment with the use of broad-spectrum antibiotics. Although a pancreatic abscess is one of the rare delayed complications that can develop after an EST, it should be considered in the differential diagnosis of patients with a complaint of abdominal pain after an EST because of a high mortality rate and the need for prompt management. (Korean J Gastrointest Endosc 2009;39:55-58)

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Endoscopic Drainage Through a Duodenal Fistula in a Patient with a Retroperitoneal Abscess that Developed after Acute Pancreatitis: Hyun Jung Chung, M.D., Seok Jeong, M.D., Don Haeng Lee, M.D., Byoung Do Park, M.D., Yoon Ah Choi, M.D., Hyung Gil Kim, M.D., Yong Woon Shin, M.D. and Young Soo Kim, M.D.; Korean J Gastrointest Endosc 2009;38(2):116-119. Published online February 27, 2009

Abstract PDF: The incidence of retroperitoneal abscess with fistula formation after acute pancreatitis is rare, but the mortality rate for patients with this condition is very high. The standard treatment for this condition has been surgical removal and drainage. However, recent studies have shown that percutaneous catheter drainage or noninvasive endoscopic abscess drainage with using endoscopic ultrasonography is effective and safe for the treatment of pancreatic and peripancreatic abscess. A retroperitoneal abscess with duodenal fistula that developed after acute pancreas and its endoscopic treatment has never been reported on in Korea. We experienced a 45-year-old man who had been treated for acute pancreatitis at other hospital, and he was then referred to our hospital and diagnosed as having a retroperitoneal abscess with fistula, which communicated with the third portion of duodenum, as assessed by abdominal CT and duodenoscopy. So we treated him with endoscopic double-pigtailed stent insertion through the fistulous tract and we drained the abscess. Endoscopic drainage may be a suitable alternative for the management of the retroperitoneal abscess with fistula that develops after acute pancreatitis. (Korean J Gastrointest Endosc 2009;38:116-120)

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A Case of a Localized Abscess in the Neck after Esophagogastroduodenoscopy: Hyun-Jae Woo, M.D., Chang Hoon Bae, M.D., Yong-Dae Kim, M.D. and Si-Youn Song, M.D.; Korean J Gastrointest Endosc 2008;37(3):203-206. Published online September 30, 2008

Abstract PDF: Perforations of the upper gastrointestinal tract are uncommon complications after performing an esophagogastroduodenoscopy (EGD). Perforations after an EGD procedure are likely to occur in the hypopharynx and cervical esophagus, where endoscope passage is anatomically difficult. Life-threatening complications including mediastinitis, a mediastinal abscess, pericarditis and sepsis can develop in most cases of a perforation. However, without such fatal complications, an abscess that is localized at the neck is extremely rare following an esophageal perforation. We experienced a case of a localized abscess in the neck after EGD and successfully treated the abscess without surgical management. We emphasize the importance of early detection for neck space infections caused by EGD-induced injuries. (Korean J Gastrointest Endosc 2008;37:203-206)

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A Case of Liver Abscess Associated with Duodenal Perforation by a Toothpick: Sang Jun Park, M.D., Chang Goo Lee, M.D., Sang Eok Kim, M.D., Jung Hyun Kim, M.D., Kwang Hee Lee, M.D., Ki Yong Kim, M.D., Jin Woo Yun, M.D. and Sun Young Kim, M.D.*; Korean J Gastrointest Endosc 2008;36(6):390-394. Published online June 30, 2008

Abstract PDF: The ingestion of foreign bodies into the gut is rather common. Most these foreign bodies are passed out spontaneously without complications. Our patient was hospitalized for fever, nausea and vomiting for one week. On the initial endoscopic examination, a toothpick was seen to be impacted in the wall of the duodenal bulb. Air bubbles were noted at the site where the toothpick was removed. The duodenal perforation was treated with endoscopic hemoclipping. Abdominal CT showed free air in the periduodenum and there was a liver abscess. Therefore, liver abscess associated with duodenal perforation by the toothpick was diagnosed. On the cytology of the aspirated materials from the liver abscess, sulfur granule formation was noted and hepatic actinomycosis was diagnosed. The liver abscess was successfully treated with CT-guided abscess drainage and antibiotics. We report here on an unusual case of a liver abscess associated with duodenal perforation by a toothpick, along with a review of the literature. (Korean J Gastrointest Endosc 2008;36:390-394)

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A Case of the Duodenal Bulb Abscess: Jae Il Chung, M.D., Hi Jong Chang, M.D., Sang Hun Lee, M.D., Dong Sik Cho, M.D., Si Woo Kim, M.D., Sung Chul Cha, M.D., Yu Gin Cho, M.D., Yun Chul Seok, M.D., Jin Hoi Ku, M.D.* and Haeng Ji Kang, M.D.^†; Korean J Gastrointest Endosc 2006;33(4):235-238. Published online October 30, 2006

Abstract PDF: Duodenal abscess is a rarely reported disease throughout the entire world. Duodenal abscesses are developed mostly from the complication of duodenal ulcer perforation, and only small percentage of duodenal abscesses are the result of cholecysto-duodenal fistula which was made by gall bladder perforation. We report a 84-year-old male patient who presented to the emergency department with severe anorexia and generalized weakness for 2 weeks. The upper gastrointestinal endoscopy done and revealed a protruding mass at the lesser curvature of the duodenal bulb. As soon as the mass was punched with a biopsy forceps, a large amount of abscess began to pour out into the intestinal lumen. Abdominal CT scan demonstrated the presence of an air-fluid level the in gall bladder and also abscess in the porta hepatitis which was located between the gall bladder and the duodenum. Because the patient refused any surgical intervention, we treated him conservatively with intravenous antibiotics. Patient's symptom of anorexia was slowly resolved, and patient was discharged 10 days later. (Korean J Gastrointest Endosc 2006;33:235⁣238)

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A Case of Liver Abscess Caused by Toothpick Penetrating Gastric Wall: Hyun Cheol Koo, M.D., Jae Pil Han, M.D., Ick Keun Kim, M.D., In Il Park, M.D., Jue Yong Lee, M.D., Kyung Min Sohn, M.D., Kwang Ho Baik, M.D., Jin Bong Kim, M.D. and Dong Jun Kim, M.D.; Korean J Gastrointest Endosc 2006;33(2):94-99. Published online August 30, 2006

Abstract PDF: The ingestion of foreign bodies into the gastrointestinal tract is common, and most are passed out spontaneously without causing any problems. However, a perforation can cause a variety of complications involving considerable morbidity and mortality. Moreover, clinical presentation of a perforation can vary and patients are often unaware of the episode. Hence, a pre-operative diagnosis is difficult under these circumstances. We report an unusual case of a liver abscess that developed secondary to a toothpick that had penetrated the gastric wall and migrated to the liver. The liver abscess was treated successfully with internal drainage by inserting an endoscopic pigtail catheter through the hepato-gastric fistula. The toothpick was removed using an endoscopic snare. (Korean J Gastrointest Endosc 2006;33:94⁣99)

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A Case of Esophageal Tuberculous Abscess: Jong Hwan Park, M.D., Hwa Mi Kang, M.D., Min Woong Kim, M.D., Chi Hoon Kim, M.D., Ji Hoon Yoon, M.D., Hyung Wook Kim, M.D., Seung Keun Park, M.D., Hee Ug Park, M.D. and Jong Han Ok, M.D.; Korean J Gastrointest Endosc 2005;31(4):252-256. Published online October 30, 2005

Abstract PDF: Primary esophageal involvement by tuberculosis is rare. Clinical symptoms are variable and nonspecific in which dysphagia is the most common presenting symptom. Endoscopic findings are also diverse and nonspecific and ulcerative form is a common manifestation. For a definite diagnosis, Endoscopic biopsies are useful but typical granuloma is seen in approximately 50% of cases and acid-fast bacilli are demonstrated in less than 25% of patients. Fine needle aspiration cytology and polymerase chain reaction are helpful for diagnosis. A 54-year-old man was presented with throat discomport. Endoscopy demonstrated hematoma like lesion with pus discharge from ulceration in the proximal esophagus. Esophageal tuberculosis was confirmed based on the biopsy and culture results, and he was treated with antituberculous medications. At the follow-up endoscopy, 6 months later, previous lesion was completely healed to scar. (Korean J Gastrointest Endosc 2005;31:252⁣256)

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A Case of Spontaneous Submucosal Dissection of the Esophagus Accompanying Mediastinal Abscess: 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.; Korean J Gastrointest Endosc 2005;31(2):97-101. Published online August 30, 2005

Abstract PDF: 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;31:97⁣101)

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A Case of Gastric Wall Abscess Associated with Gastritis Cystica Profunda: Jin Hong Park, M.D.*, Hyong Wook Kim, M.D., Won Il Park, M.D., Jong Yun Cheong, M.D., Dong Hyun Lee, M.D., Jeong Heo, M.D., Gwang Ha Kim, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D., Mong Cho, M.D. and Ung Suk Yang, M.D.; Korean J Gastrointest Endosc 2004;29(6):509-513. Published online December 30, 2004

Abstract PDF: Gastric wall abscess is a form of phlegmonous gastritis and has been very rarely reported. The pathogenesis of gastric wall abscess is thought to involve a focal injury to the gastric mucosa such as a penetrating trauma from an ingested foreign body or an endoscopic biopsy, where by bacterial infection occurs. Gastritis cystica profunda is a rare disease in which hyperplasia of mature glandular epithelium extends into the tissues beneath the submucosa. It shows multiple small cysts in the mucosa and submucosa of the stomach. To our knowledge, the association of gastric wall abscess with gastritis cystica profunda has never been reported yet. We, recently, experienced a case of gastric wall abcess associated with gastritis cystica profunda. Herein, we report it with a brief review with literatures. (Korean J Gastrointest Endosc 2004;29:509⁣513)

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Definitive Treatment of Infected Pancreatic Fluid Collection by Endoscopic Transmural Drainage: Jeong Han Kim, M.D., Jong-Jae Park, M.D., Sang Kyun Yu, M.D., Young Kul Jung, M.D., Ji Yeon Lee, M.D., Ik Yoon, M.D., Kyung Oh Kim, M.D., Hyung Joon Yim, M.D., Jin Yong Kim, M.D, Jong Eun Yeon, M.D., Jae Seon Kim, M.D., Kwan Soo Byun, M.D., Young-Tae Bak,; Korean J Gastrointest Endosc 2004;28(1):9-17. Published online January 30, 2004

Abstract PDF: Background
/Aims: Recent experience with endoscopic transmural drainage of pancreatic pseudocysts prompted the use of a similar technique for the primary treatment of infected pancreatic fluid collection (PFC) such as pancreatic abscess and infected pancreatic necrosis (IPN). The aim of this study was to determine the safety and effectiveness of endoscopic transmural drainage for the primary treatment of infected PFC complicating acute pancreatitis. Methods: In 11 patients, a total of 13 infected PFC (11 pancreatic abscesses and 2 IPNs) compressing the stomach, duodenum, or both were drained endoscopically by means of an endoscopic fistulization followed by stent (s) placement alone or additional nasopancreatic catheter insertion. Complete resolution of PFC was defined as the absence of symptoms and no residual collection on the follow-up computed tomography. Results: Complete resolution was achieved in 12 infected PFC (92%) (10 pancreatic abscesses and 2 IPNs) after stent placement for a mean duration of 31 days. For IPN and 2 pancreatic abscess, insertion of a nasopancreatic catheter was required to irrigate thick pus or necrotic debris. There was 1 case of bleeding (8%) but no mortality. Conclusions: Endoscopic transmural drainage is an effective therapy with minimal morbidity for infected pancreatic fluid collection compressing the gut lumen and is a valuable alternative to surgical drainage. (Korean J Gastrointest Endosc 2004;28:9⁣17)

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A Case of Gastric Submucosal Tumor Suspected to be Caused by Anisakis: Paul Choi, M.D., Jin Wuk Hur, M.D., Hyun Jung Lim, M.D., Jee Young Lee, M.D., Dong Wan Kim, M.D., Moo In Park, M.D., Seun Ja Park, M.D., Hee Kyung Chang, M.D.*, Kyung Seung Oh, M.D.^†and Ja Young Koo, M.D.; Korean J Gastrointest Endosc 2003;27(1):26-30. Published online July 30, 2003

Abstract PDF: Anisakiasis is a parasitic disease following eating raw fishes infected with Anisakis larvae. The endoscopic features of the gastric mucosa are edema, erosion, ulceration and hemorrhage. Gastric anisakiasis forming submucosal tumor is rare. Twenty six-year-old man who complained of severe epigastric pain was admitted. The pain began approximately three hours after eating slices of raw Astroconger myriaster. Gastric endoscopy revealed a submucosal tumor with central erosion on the gastric fundus. Endoscopic ultrasonography detected a thickening of the gastric wall made of mainly thickened submucosal layer. Abdominal CT scan showed a gastric mass lesion with hypodensity in the gastric fundus and subsequently wedge resection was performed. The pathologic finding of the resected mass was eosinophilic abscess in the submucosal layer. We report a case of gastric submucosal tumor which seems to be caused by Anisakis, with a review of relevant literature. (Korean J Gastrointest Endosc 2003;27:26⁣30)

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64세 여자, 좌하부 흉통, 체중감소: Korean J Gastrointest Endosc 2003;26(5):345-345. Published online May 30, 2003

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A Case of Gastrointestinal Stromal Tumor of the Stomach with a Gastric Fistula: Hee Joung Kim, M.D., Ho Sang Lee, M.D., Hyun Jong Oh, M.D., Chang-Whan Kim, M.D.,; Korean J Gastrointest Endosc 2003;26(4):210-213. Published online April 30, 2003

Abstract PDF: Gastrointestinal stromal tumors (GIST) are mesenchymal gut tumors that lack markers of myogenic differentiation, but express CD34 and CD117, which are products of the c-kit oncogene. They present commonly gastrointestinal bleeding and abdominal pain and/or palpable mass. The other symptoms may include anorexia, weight loss, obstruction, perforation or fever. Fever due to abscess formation is rare complaint of GIST.
We report a case of GIST of stomach with abscess and gastric fistula in a 54-year-old male who presented a three-week history of abdominal pain and fever. Fistula opening site was observed by endoscope, and abdominal CT showed multiple air pockets within the mass representing communication with bowel lumen by fistula. (Korean J Gastrointest Endosc 2003;26:210⁣213)

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A Case of Psoas Muscle Abscess in Crohn's Disease: Jin Hee Kim, M.D., Sae Kyung Jang, M.D., Ji Yong Ahn, M.D., Bong Ki Cha, M.D., Dae Won Kim, M.D., Sung Moon Jung, M.D., Yo Han Hong, M.D., Hyung Jun Kim, M.D., Jae Hyuk Do, M.D., Sill Moo Park, M.D. and Sung Il Park, M.D.*; Korean J Gastrointest Endosc 2003;26(2):94-98. Published online February 28, 2003

Abstract PDF: Psoas abscess, complicating Crohn's disease, is a rare condition. Typical symptoms and signs are fever, abdominal tenderness and limb pain. Our patient had fever and abdominal tenderness. The diagnosis is made by abdominopelvic CT scan. Medical therapy with antibiotics, surgical resection of the affected bowel segment with end to end anastomosis and surgical drainage of focus are treatment of choice. We have experienced one case of psoas abscess with Crohn's disease in 28-year-old male patient. He visited our hospital due to diarrhea and lower abdominal pain. The colonoscopy revealed active stage of Crohn's disease. Then he has taken methyl prednisolone and mesalazine. During the hospitalization, we detected anal fistula and psoas abscess on abdominal CT. He was managed with antibiotics and surgical drainage after colectomy. We present the case with brief review of the articles. (Korean J Gastrointest Endosc 2003;26:94⁣98)

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대장암 및 충수돌기 주위 농양으로 오인된 복부 방선균증 ( Abdominal Actinomycosis Initially Diagnosed As a Colorectal Cancer or Periappendiceal Abscess ): Korean J Gastrointest Endosc 2000;21(3):717-722. Published online November 30, 1999

Abstract PDF: Background
/Aims: Colonic actinomycosis is a rare disease with clinical and radiographic findings that overlap those of other inflammatory and neoplastic conditions. We performed this study to analyze clinical manifestation, characteristic radiologic findings of 5 cases of abdominal actinomycosis, which was initially diagnosed as a colorectal cancer or periappendiceal abscess. Methods: We analyzed chief complaint, predisposing factor, presence of leukocytosis and sulfur granule, involved site, presence of LN involvement and abdominal CT findings, retrospectively. Results: The most common clinical manifestation was abdominal pain. In 3 cases, predisposing factors were identifiable, which were intrauterine contraceptive device (IUD), previous appendectomy, and diabetes mellitus (DM) respectively. Leukocytosis was noted in 4 cases (80%) and sulfur granule in all 5 cases. Sigmoid colon was the most common involved site (4 cases) followed by appendix and rectum. On computed tomography, inhomogeneous mass or severe inflammation along the bowel wall or serosa was noted. Explorations were performed in 4 cases. Preoperative diagnosis was a colorectal cancer in 3 cases and periappendiceal abscess in 1 case. Conclusions: Actinomycosis should be born in mind in the differential diagnosis of patients with IUD, previous appendectomy and DM, presenting leukocytosis and CT finding of inhomogeneous mass and relatively uncommon LN involvement to eliminate unnecessary exnlorations.

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화농성 간농양 환자에서 내시경적 역행성 담도 조영술의 유용성에 관한 연구 ( A Study on the Usefulness of ERCP in Patients with Pyogenic Liver Abscess ): Korean J Gastrointest Endosc 2000;20(2):113-118. Published online November 30, 1999

Abstract PDF: Background
/Aims : This study was undertaken to evaluate the usefulness of ERCP in patients with pyogenic liver abscess. Methods: An endoscopic retrograde cholangiographic study of 70 consecutive cases of pyogenic liver abscess was conducted during the period from January, 1993 to December, 1997. Among 70 cases of pyogenic liver abscess, the male to female ratio was 1.69：1, and the peak incidence was in the sixth decade. Results : The common associated diseases were liver cirrhosis (11.4%), diabetes mellitus (8.5%), and malignancy (5.7%). The most common origins of the abscess in decreasing order of frequency were, transbiliary infection (51%), hematogenous spread, and trauma-associated causes. The ascending infection through the biliary tract as the etiology of liver abscess, has been common since the 1970's. The positive rate of abdominal US, CT, and ERCP in the diagnosis of the etiology of the liver abscess was 68, 82, 84% respectively. The treatments of the pyogenic liver abscess were, surgical drainage in 15 cases (21%) and percutaneous drainage in 51 cases (73%). Among 70 patients treated for pyogenic liver abscess, 12 patients had CBD stones and 11 patients were cured by EST. Conclusions : The most common origin of liver abscess is ascending infection through the biliary tract and ERCP may be a effective tool in the assessment and management of the etiology of pyogenic liver abscess. (Korean J Gastrointest Endosc 2000;20:113-118)

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인터페론에 의한 급성췌장염에 합병된 다발성 췌장농양 1예 ( A Case of Pancreatic Abscesses Complicating Acute Pancreatitis Associated with Interferon Therapy ): Korean J Gastrointest Endosc 2000;20(1):77-82. Published online November 30, 1999

Abstract PDF: A patient experienced a silent gallstone accompanied by acute severe pancreatitis during interferon theraphy for renal cell carcinoma. Although the gallstone was highly suspected to be the cause of the pancreatits, there were no duodenoscopic or endoscopic retrograde cholangiopancreatographic findings suggesting gallstone pancreatitis such as papillitis, impacted papillary and common bile duct stones, and/or a wider cystic or pancreatic duct, respectively. It is believed that the acute pancreatitis in the presenting case was probably caused by interferon because 1) sludge nor biliary crystal was not detected by light microscopic examination, 2) no tumors, anomalies, nor any obstructing ductal lesions in the pancreas were found, 3) this patient had no other potential causes of acute pancreatitis, and 4) there was no use of potential drugs which could be responsible for the acute pancreatitis other than interferon. In addition, trials of endoscopic drainage of complicated pancreatic abscesses were discussed. (Korean J Gastrointest Endosc 2000;20:77~82)

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증례 : 식도 위장관 ; 식도이완 불능증 환자에서 발생한 폐농양 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Lung Abscess in an Achalasia Patient ): Korean J Gastrointest Endosc 1997;17(4):523-528. Published online November 30, 1996

Abstract PDF: Esophagea1 achalasia is a disease of unkown etiology characterized by abscenee of per- istalsis in the body of the esophagus and failure of the lower esaphageal sphincter to relax in response to swallow. The cause has been suggested by the lack or abscence of ganglion cell in Auerbach's plexus. About 10% of patients with achalasis develop pulmonary complication such as aspiration pnuemonia, pulmonary fibrosis, pulmonary tuberculosis, culosis, bronchiectasis, lung abscess and bronchial asthma. Although aspiration pneumonia is the most common pulmonary complication in patients with achalasia, lung abscess is the extremely rare complication. A 48 years old female, who has experienced dysphagia and regurgitation for several years, is hospitalized because of high fever, cough and sputurn for 2 weeks. Lung abscess in apicoposterior segment of left upper lobe is observed in X-ray and chest CT. The findings of esophagogram, esophagogastroscopy and esophageal manometry are consistent with achalasia. We report a case of lung abscess associated with achalasia. (Korean J Gastrointest Endosc 17: 523-528, 1997)

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