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Case Report
Gastroduodenal intussusception of a gastrointestinal stromal tumor: a rare cause of acute pancreatitis
Pornpayom Numpraphrut, Sorachat Niltwat, Thammawat Parakonthun, Nonthalee Pausawasdi
Clin Endosc 2022;55(3):447-451.   Published online June 22, 2021
DOI: https://doi.org/10.5946/ce.2021.073
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Patients with symptomatic gastrointestinal stromal tumor (GIST) typically present with gastrointestinal bleeding and abdominal pain. This report presents an unusual case of fundic GIST complicated by gastroduodenal intussusception, manifesting as acute pancreatitis. The patient presented with epigastric pain and pancreatic enzyme elevation; thus, he was diagnosed with acute pancreatitis. Computed tomography showed evidence of pancreatitis and a 4×4.7 cm well-defined hyperdense lesion in the 2nd part of the duodenum, compressing the pancreatic head and pancreatic duct. Esophagogastroduodenoscopy revealed invagination of the gastric folds into the duodenum, causing pyloric canal blockage consistent with gastroduodenal intussusception. Spontaneous reduction of the lesion during endoscopy revealed a 4 cm pedunculated subepithelial mass with central ulceration originating from the gastric fundus. Endoscopic ultrasound demonstrated a heterogeneous hypoechoic lesion originating from the 4th layer of the gastric wall. Laparoscopic-endoscopic intragastric wedge resection of the fundic lesion was subsequently performed, and surgical histology confirmed GIST.

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  • Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor in adults: a case report and literature review
    Wenbing Zhang, Haifeng Chen, Lulu Zhu, Zhiyuan Kong, Tingting Wang, Weiping Li
    Journal of International Medical Research.2022; 50(5): 030006052211007.     CrossRef
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  • 133 Download
  • 2 Web of Science
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Original Article
Practice Patterns and Use of Endoscopic Retrograde Cholangiopancreatography in the Management of Recurrent Acute Pancreatitis
Jonathan B. Reichstein, Vaishali Patel, Parit Mekaroonkamol, Sunil Dacha, Steven A. Keilin, Qiang Cai, Field F. Willingham
Clin Endosc 2020;53(1):73-81.   Published online July 5, 2019
DOI: https://doi.org/10.5946/ce.2019.052
AbstractAbstract PDFPubReaderePub
Background
/Aims: There are conflicting opinions regarding the management of recurrent acute pancreatitis (RAP). While some physicians recommend endoscopic retrograde cholangiopancreatography (ERCP) in this setting, others consider it to be contraindicated in patients with RAP. The aim of this study was to assess the practice patterns and clinical features influencing the management of RAP in the US.
Methods
An anonymous 35-question survey instrument was developed and refined through multiple iterations, and its use was approved by our Institutional Review Board. The survey was distributed via email to 408 gastroenterologists to assess the practice patterns in the management of RAP in multiple clinical scenarios.
Results
The survey was completed by 65 participants representing 36 of the top academic/tertiary care centers across the country. Approximately 90.8% of the participants indicated that they might offer or recommend ERCP in the management of RAP. Multinomial logistic regression analysis revealed that ductal dilatation and presence of symptoms were the most predictive variables (p<0.001) for offering ERCP.
Conclusions
A preponderance of the respondents would consider ERCP among patients with RAP presenting to tertiary care centers in the US. Ductal dilatation, presence of symptoms, and pancreas divisum significantly increased the likelihood of a recommendation for ERCP

Citations

Citations to this article as recorded by  
  • Controversies in ERCP: Technical aspects
    ChristophF Dietrich, NoorL Bekkali, Sean Burmeister, Yi Dong, SimonM Everett, Michael Hocke, Andre Ignee, Wei On, Srisha Hebbar, Kofi Oppong, Siyu Sun, Christian Jenssen, Barbara Braden
    Endoscopic Ultrasound.2022; 11(1): 27.     CrossRef
  • Controversies in ERCP: Indications and preparation
    ChristophF Dietrich, NoorL Bekkali, Sean Burmeister, Yi Dong, SimonM Everett, Michael Hocke, Andre Ignee, Wei On, Srisha Hebbar, Kofi Oppong, Siyu Sun, Christian Jenssen, Barbara Braden
    Endoscopic Ultrasound.2022; 11(3): 186.     CrossRef
  • Biliary hitch and ride technique for blind pancreatic duct cannulation
    Juan J. Vila, Juan Carrascosa, Ignacio Fernández-Urién, Paul Yeaton, Gonzalo González, Leire Aburruza, José Manuel Zozaya
    Endoscopy.2021; 53(01): E29.     CrossRef
  • Endoscopic Retrograde Cholangiopancreatography in Recurrent Acute Pancreatitis: Determining the Optimal Subgroup of Patients in Whom the Procedure is Beneficial
    Tae Yoon Lee, Takuji Iwashita
    Clinical Endoscopy.2020; 53(1): 5.     CrossRef
  • 4,703 View
  • 175 Download
  • 4 Web of Science
  • 4 Crossref
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Case Reports
Two Cases of Plug or Stone in Remnant Intrapancreatic Choledochal Cysts Treated with Endoscopic Retrograde Cholangiopancreatography
Eunbee Kim, Min Ho Kang, Jisun Lee, Hanlim Choi, Jae-Woon Choi, Joung-Ho Han, Seon Mee Park
Clin Endosc 2017;50(5):504-507.   Published online February 16, 2017
DOI: https://doi.org/10.5946/ce.2017.012
AbstractAbstract PDFPubReaderePub
Incomplete resection of choledochal cysts (CCs) that extend deep into the pancreas can lead to protein plug or stone formation, pancreatitis, and cholangiocarcinoma. We encountered two cases of choledocholithiasis in remnant intrapancreatic CCs (IPCCs), in which the patients exhibited symptoms after 3 and 21 years of cyst excision. A 21-year-old woman who had undergone excision of a CC, as a neonate, presented with epigastric pain. Abdominal computed tomography (CT) revealed stones inside the remnant pancreatic cyst, which were removed by endoscopic retrograde cholangiopancreatography (ERCP), and her symptoms improved. A 33-year-old woman, who underwent cyst excision 3 years ago, presented with pancreatitis. Abdominal CT showed a radiolucent plug inside the remnant pancreatic cyst. The soft, whitish plug was removed by ERCP, and the pancreatitis improved. These cases indicate that plugs and stones in CCs have the same pathogenetic mechanism, and their form depends on the time since the incomplete excision surgery.

Citations

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  • Choledochal cysts – state of the art
    Thanh Liem Nguyen, V. S. Cheremnov, Yu. A. Kozlov
    Russian Journal of Pediatric Surgery.2021; 25(1): 37.     CrossRef
  • 6,945 View
  • 130 Download
  • 1 Crossref
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Mediastinal Pancreatic Pseudocysts
Krzysztof Dąbkowski, Andrzej Białek, Maciej Kukla, Janusz Wójcik, Andrzej Smereczyński, Katarzyna Kołaczyk, Tomasz Grodzki, Teresa Starzyńska
Clin Endosc 2017;50(1):76-80.   Published online September 13, 2016
DOI: https://doi.org/10.5946/ce.2016.089
AbstractAbstract PDFPubReaderePub
Mediastinal pseudocysts are a rare complication of acute pancreatitis. Lack of uniform treatment standards makes the management of this condition a clinical challenge. We report the case of a 43-year-old patient who presented with a left pleural effusion. Pleural fluid revealed a high amylase concentration consistent with a pancreaticopleural fistula. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a disruption of the pancreatic duct with free outflow of contrast medium into the thoracic cavity. A pancreatic stent was placed. The second day after the ERCP, the patient developed septic shock and was admitted to the intensive care unit. Computed tomography (CT) revealed mediastinal pseudocysts and bilateral pleural effusions. After bilateral drainage of the pleural cavities, the patient improved clinically, and a follow-up CT scan showed that the fluid collection and pseudocysts had resolved. We discuss the optimal strategies for diagnosing and treating patients with pancreatic thoracic pseudocysts and fistulas, as well as review the management of these conditions.

Citations

Citations to this article as recorded by  
  • Unveiling Rare Complications: Pancreatic Pseudocysts and Monomicrobial Non-neutrocytic Bacterascites in Decompensated Cirrhosis
    Harshitha Reddy, Rushikesh H Dhondge, Sunil Kumar, Sourya Acharya
    Cureus.2024;[Epub]     CrossRef
  • A Rare Cause of Peri-esophageal Cystic Lesion
    Xiying Dong, Dong Wu
    Gastroenterology.2023; 164(2): 191.     CrossRef
  • Diagnostic approach for mediastinal masses with radiopathological correlation
    Masashi Taka, Satoshi Kobayashi, Kaori Mizutomi, Dai Inoue, Shigeyuki Takamatsu, Toshifumi Gabata, Isao Matsumoto, Hiroko Ikeda, Takeshi Kobayashi, Hiroshi Minato, Hitoshi Abo
    European Journal of Radiology.2023; 162: 110767.     CrossRef
  • Mediastinal extension of pancreatic pseudocysts causing portal hypertension
    Leni Santiana, Viola Stephanie Warokko, Dikki Drajat Kusmayadi Surachman, Harry Galuh Nugraha
    Radiology Case Reports.2023; 18(11): 4226.     CrossRef
  • Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence
    Jian-Xiong Hu, Cheng-Fei Zhao, Shu-Ling Wang, Xiao-Yan Tu, Wei-Bin Huang, Jun-Nian Chen, Ying Xie, Cun-Rong Chen
    World Journal of Gastroenterology.2023; 29(37): 5268.     CrossRef
  • Mediastinal pancreatobiliary pseudocysts
    G.I. Dryazhenkov, I.G. Dryazhenkov, S.I. Balnykov, E.V. Kalashyan, A.A. Stepankov
    Khirurgiya. Zhurnal im. N.I. Pirogova.2022; (3): 56.     CrossRef
  • The Role of Endoscopic Ultrasound in the Interventional Management of Mediastinal Collections: A Narrative Review
    Julio G Velasquez-Rodriguez, Sandra Maisterra, Ricard Ramos, Ignacio Escobar, Joan B Gornals
    Cureus.2022;[Epub]     CrossRef
  • Mediastinal Extension of Pancreatic Pseudocyst: A Rare Pediatric Presentation
    Shruti Tewari, A Sushma, Rajeev Redkar
    Journal of Indian Association of Pediatric Surgeons.2021; 26(1): 44.     CrossRef
  • Predictors for external and internal pancreatic fistulas after pancreatic necrosis
    L. P. Kotelnikova, S. A. Plaksin, I. G. Burnyshev, D. V. Trushnikov
    Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery.2021; 26(2): 39.     CrossRef
  • Pancreatic Pseudocyst with Mediastinal Extension Presenting as Pseudo-Kirklin Sign—Multimodality Imaging
    Harshini Udayakumar, Venkatraman Indiran, Kalaichezhian Mariappan, Prabakaran Maduraimuthu
    Journal of Gastrointestinal and Abdominal Radiology.2020; 3(S 01): S54.     CrossRef
  • Mediastinal pancreatic cysts: review and own clinical observations
    L. P. Kotelnikova, S. A. Plaksin, L. I. Farshatova
    Khirurgiya. Zhurnal im. N.I. Pirogova.2019; (7): 80.     CrossRef
  • Isolated Mediastinal Pseudocyst of the Pancreas
    Pankaj Halder, Kartik Chandra Mandal, Bidyut Debnath, Sumedha Mukherjee
    Indian Pediatrics.2018; 55(3): 251.     CrossRef
  • Pancreaticopleural Fistula: A Review of Imaging Diagnosis and Early Endoscopic Intervention
    Ali Kord Valeshabad, Jennifer Acostamadiedo, Lekui Xiao, Winnie Mar, Karen L. Xie
    Case Reports in Gastrointestinal Medicine.2018; 2018: 1.     CrossRef
  • 7,661 View
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  • 9 Web of Science
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Acute Pancreatitis Following Endoscopic Ampullary Biopsies without Attempted Cannulation of the Ampulla of Vater
Spyridon Michopoulos, Dimitra Kozompoli, Sparti Ntai, Georgios Kalantzis, Evanthia Zampeli, Kalliopi Petraki
Clin Endosc 2016;49(6):575-578.   Published online July 20, 2016
DOI: https://doi.org/10.5946/ce.2016.043
AbstractAbstract PDFPubReaderePub
A 51-year-old man underwent diagnostic work-up for an abnormal-appearing ampulla of Vater. Three hours after biopsy of the ampulla, the patient presented with intense symptoms suggesting acute pancreatitis, which was later confirmed with laboratory and radiographic examinations. Other causes were excluded and the acute pancreatitis was considered a procedural complication. This is a rarely reported complication that must be taken into consideration when biopsies are performed in the ampulla of Vater.

Citations

Citations to this article as recorded by  
  • Readmission rate and complications following biopsy of the ampulla of Vater—A retrospective data analysis
    Sam Rosella, Leonardo Zorron Cheng Tao Pu, Jonathan Ng, Kim Hay Be, Rhys Vaughan, Sujievvan Chandran, Marios Efthymiou
    JGH Open.2023; 7(4): 299.     CrossRef
  • Acute pancreatitis following endoscopic ampullary biopsy: A case report
    Nidhi Mariam George, Nanda Amarnath Rajesh, Tharun Ganapathy Chitrambalam
    World Journal of Gastrointestinal Endoscopy.2023; 15(8): 540.     CrossRef
  • Endoscopic management of duodenal adenomatosis in familial adenomatous polyposis—A case‐based review
    E. Soons, T. M. Bisseling, M. C. A. van Kouwen, G. Möslein, P. D. Siersema
    United European Gastroenterology Journal.2021; 9(4): 461.     CrossRef
  • Two Cases of Severe Acute Pancreatitis Following Duodenal Papillary Biopsy
    Yu Ishibashi, Tomohisa Iwai, Eiji Miyata, Rikiya Hasegawa, Toru Kaneko, Koji Yamauchi, Kosuke Okuwaki, Hiroshi Imaizumi, Mitsuhiro Kida, Wasaburo Koizumi
    Progress of Digestive Endoscopy.2018; 92(1): 108.     CrossRef
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  • 3 Web of Science
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Abdominal Compartment Syndrome in Severe Acute Pancreatitis Treated with Percutaneous Catheter Drainage
Soonyoung Park, Seungho Lee, Hyo Deok Lee, Min Kim, Kyeongmin Kim, Yusook Jeong, Seon Mee Park
Clin Endosc 2014;47(5):469-472.   Published online September 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.5.469
AbstractAbstract PDFPubReaderePub

Acute pancreatitis is one of the main causes of intra-abdominal hypertension (IAH). IAH contributes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induces multiorgan failure. We report a case of ACS in a patient with severe acute pancreatitis. A 44-year-old man who was admitted in a drunk state was found to have severe acute pancreatitis. During management with fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotropes, and oliguria developed in the patient, with his abdomen tensely distended. With a presumptive diagnosis of ACS, abdominal decompression through percutaneous catheter drainage was performed immediately. The intraperitoneal pressure measured with a drainage catheter was 31 mm Hg. After abdominal decompression, the multiorgan failure was reversed. We present a case of ACS managed with percutaneous catheter decompression.

Citations

Citations to this article as recorded by  
  • Fluid Management, Intra-Abdominal Hypertension and the Abdominal Compartment Syndrome: A Narrative Review
    Rita Jacobs, Robert D. Wise, Ivan Myatchin, Domien Vanhonacker, Andrea Minini, Michael Mekeirele, Andrew W. Kirkpatrick, Bruno M. Pereira, Michael Sugrue, Bart De Keulenaer, Zsolt Bodnar, Stefan Acosta, Janeth Ejike, Salar Tayebi, Johan Stiens, Colin Cord
    Life.2022; 12(9): 1390.     CrossRef
  • A Wireless Implantable Passive Intra-Abdominal Pressure Sensing Scheme via Ultrasonic Imaging of a Microfluidic Device
    Hongjie Jiang, Ian Woodhouse, Vidhya Selvamani, Jessica L. Ma, Renxiang Tang, Craig J. Goergen, Tahereh Soleimani, Rahim Rahimi
    IEEE Transactions on Biomedical Engineering.2021; 68(3): 747.     CrossRef
  • Reduction of intra-abdominal pressure after percutaneous catheter drainage of pancreatic fluid collection predicts survival
    Anupam K. Singh, Jayanta Samanta, Saurabh Dawra, Pankaj Gupta, Atul Rana, Vishal Sharma, Praveen Kumar-M, Saroj K. Sinha, Rakesh Kochhar
    Pancreatology.2020; 20(4): 772.     CrossRef
  • Effects of HV-CRRT on PCT, TNF-α, IL-4, IL-6, IL-8 and IL-10 in patients with pancreatitis complicated by acute renal failure
    Changbo Liu, Mu Li, Shixiong Cao, Jianzhong Wang, Xiaoqiong Huang, Weizhen Zhong
    Experimental and Therapeutic Medicine.2017; 14(4): 3093.     CrossRef
  • Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management
    Elizabeth Chabot, Ram Nirula
    Trauma Surgery & Acute Care Open.2017; 2(1): e000063.     CrossRef
  • Abdominal Paracentesis Drainage Does Not Increase Infection in Severe Acute Pancreatitis
    Liye Liu, Hongtao Yan, Weihui Liu, Jianfeng Cui, Tao Wang, Ruiwu Dai, Hongyin Liang, Hao Luo, Lijun Tang
    Journal of Clinical Gastroenterology.2015; 49(9): 757.     CrossRef
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A Case of a Pancreaticogastric Fistula Following Acute Pancreatitis
Jae Sung Youn, M.D., Hyeuk Park, M.D., Min Geun Lee, M.D., Woo Jong Kim, M.D., Jang Sik Mun, M.D., Bo Hyun Myoung, M.D., Do Hyun Kim, M.D. and Ho Dong Kim, M.D.
Korean J Gastrointest Endosc 2011;42(4):245-249.   Published online April 28, 2011
AbstractAbstract PDF
A pancreatic fistula (PF) is an abnormal connection between the pancreas and adjacent or distant organs, structures, or spaces resulting from leakage of pancreatic secretions from disrupted pancreatic ducts. A PF is a rare complication that occurs during a acute and chronic pancreatitis or after traumatic or surgical disruption of the pancreatic duct. PFs are frequently classified as internal or external depending upon whether they communicate with an internal organ or the skin. Pancreatico-colonic fistulas are the most common, whereas pancreatico-gastric fistulas are the rarest. We report a rare case of a pancreatico-gastric fistula complicated by acute pancreatitis. (Korean J Gastrointest Endosc 2011;42:245-249)
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A Case of Acute Pancreatitis Caused by the Necrotic Tissue of Gallbladder Cancer
Hoe Hoon Chung, M.D., Seok Ho Dong, M.D., Jaejun Sim, M.D., Jae Young Jang, M.D., Hyo Jong Kim, M.D., Byung Ho Kim, M.D., Young Woon Chang, M.D. and Rin Chang, M.D.
Korean J Gastrointest Endosc 2011;42(2):131-134.   Published online February 28, 2011
AbstractAbstract PDF
The most common cause of acute pancreatitis is gallstones. However, idiopathic causes comprise about 10 to 15% of all cases of acute pancreatitis. Biliary sludge is thought to be a cause of idiopathic acute pancreatitis and mainly via obstruction of the common bile duct. Cholesterol polyps of the gallbladder, cholesterolosis and hemobilia can be associated with biliary pain. Fragments of the gallbladder polyps and blood clots can lead to acute pancreatitis in a way similar to that of biliary sludge. Yet it has never been reported that the necrotic tissue of gallbladder cancer can lead to acute pancreatitis. Herein, we report on the case of a 52-year-old man with acute pancreatitis that was caused by the necrotic tissue of gallbladder cancer. The necrotic tissue in the bile duct was revealed on endoscopic retrograde cholangiopancreatography (ERCP). The patient was successfully treated by laparoscopic cholecystectomy along with liver segmentectomy. (Korean J Gastrointest Endosc 2011;42:131-135)
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A Case of Successful Endoscopic Treatment for Acute Recurrent Pancreatitis Due to Pancreas Divisum with Santorinicele Masquerading as Drug Induced Pancreatitis
Yun Suk Shim, M.D., Tae Hoon Lee, M.D., Jun Ho Choi, M.D., Sang Pil Kim, M.D., Sae Hwan Lee, M.D., Il Kwun Chung, M.D., Sang Heum Park, M.D. and Sun Joo Kim, M.D.
Korean J Gastrointest Endosc 2010;40(2):139-143.   Published online February 27, 2010
AbstractAbstract PDF
There are various causes of acute pancreatitis, and accurately determining the etiology is pivotal for selecting appropriate management. Other hidden causes, such as congenital anomaly, should be considered in patients with recurrent abdominal pain or unexplained recurrent pancreatitis. A santorinicele is a focal cystic dilatation of the terminal dorsal pancreatic duct, and this is usually associated with pancreas divisum and it is a risk factor for acute pancreatitis due to the accompanying relative stenosis of the minor papilla. We present here the case of a patient who was treated for acute pancreatitis that was presumably was caused by either Rifampin or Brucellosis, and the patient recovered with conservative management. However, we eventually diagnosed pancreas divisum with santorinicele by performing MRCP and ERCP after the pancreatitis had relapsed. We report here on a case of successful endoscopic treatment for pancreas divisum with santorinicele as a cause of recurrent pancreatitis, and this was initially confused with drug or infection related pancreatitis. (Korean J Gastrointest Endosc 2009; 40:139-143)
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A Case of Pancreatic Intraepithelial Neoplasia Presenting as Aucte Pancreatitis
Dong Wook Lee, M.D., Jae Kwon Jung, M.D., Dong Yeub Eun, M.D., Jung Soo Lee, M.D., Jae Kwang Lee, M.D., Sang Man Park, M.D., Hyun Soo Kim, M.D. and Mi Jin Gu, M.D.*
Korean J Gastrointest Endosc 2010;40(1):62-67.   Published online January 30, 2010
AbstractAbstract PDF
Pancreatic intraepithelial neoplasia (PanIN) is a precancerous lesion. A 72-year old man was admitted to our hospital because of abdominal pain, and he had an elevated serum level of pancreatic amylase. ERCP showed a focal stricture of the main pancreatic duct without upstream dilatation in the body of the pancreas. Cytologic evaluation with an endoscopic brush at the stricture suggested the presence of adenocarcinoma. After subtotal pancreatectomy, the features of PanIN were observed in the branch pancreatic duct. ERCP with brush cytology seems to be a useful method for detecting PanIN at the precancerous stage. We report here on a case of PanIN associated with a stricture of the main pancreatic duct. (Korean J Gastrointest Endosc 2010;40:62-67)
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A Case of Primary Pancreatic Lymphoma That Manifested with Acute Pancreatitis and Obstructive Jaundice
Jun Eul Hwang, M.D., Chang Hwan Park, M.D., Yong Chan Cho, M.D., Sung Kyun Kim, M.D., Hyeun Soo Kim, M.D., Sung Kyu Choi, M.D., Jong Sun Rew, M.D. and Wan Sik Lee, M.D.
Korean J Gastrointest Endosc 2009;38(3):176-178.   Published online March 30, 2009
AbstractAbstract PDF
Primary pancreatic lymphoma (PPL) is a rare form of extranodal lymphoma, and this accounts for less than 0.5% of all pancreatic tumors. Differentiating PPL from pancreatic adenocarcinoma is important because the prognosis and survival of PPL is much better than those of pancreatic adenocarcinoma. Although the treatment usually consists of a combination of chemotherapy and radiation therapy, PPL patient with biliary tract or gastrointestinal obstruction should undergo biliary or gastric bypass to relieve the symptoms. Herein, we describe a case of PPL with acute pancreatitis and obstructive jaundice, and the patient was successfully managed with endoscopic retrograde pancreatic and biliary drainage. (Korean J Gastrointest Endosc 2009;38:176-179)
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A Case of Acute Pancreatitis Associated with Aberrant Cystic Duct Opening into the Right Hepatic Duct
Kyung-Phil Kang, M.D. and Won-Chung Choi, M.D.
Korean J Gastrointest Endosc 2006;33(3):187-190.   Published online September 30, 2006
AbstractAbstract PDF
Congenital anomalies of the pancreaticobiliary structure may go undetected until adulthood, and they can be the cause of unexplained jaundice, abdominal pain, nausea and vomiting. In addition to such associated disease, as cholangitis, gallstone, cholangiocarcinoma and pancreatitis, recognition of these variant anatomies is clinically important for planning surgery and for preventing inadvertent surgical injury. Although congenital abnormalities and variations of the biliary ducts are common, and variations in the drainage and course of the cystic duct are also frequently seen, variation of the cystic duct opening into the right hepatic duct is rare; further, it is important to avoid erroneous ligation of the hepatic duct during surgery. We report here on a case of aberrant cystic duct opening into the right hepatic duct along with acute pancreatitis. (Korean J Gastrointest Endosc 2006;33:187⁣190)
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A Case of Acute Pancreatitis Associated with Fasciola Hepatica
Seong Yong Woo, M.D., Hyun Jung Jung, M.D., Woo Tae Kim, M.D., Hae Seong Nam, M.D., Sung Hyun Son, M.D., Hyung Keun Kim, M.D., Young Seok Cho, M.D., Sung Soo Kim, M.D., Hiun Suk Chae, M.D. and Chang Don Lee, M.D.
Korean J Gastrointest Endosc 2006;33(3):183-186.   Published online September 30, 2006
AbstractAbstract PDF
Fascioliasis is a zoonotic helminthiasis caused by the trematode Fasciola hepatica, which is a parasite that infects the hepatobiliary system of herbivorous animals such as cattle and sheep. Humans are accidentally infected after ingestion of the water, raw aquatic plants and raw liver of herbivorous animals that are all contaminated by metacercaria. Fascioliasis produces no symptoms in most patients, but adult Fasciola hepatica occasionally gives rise to intestinal obstruction or pancreatobiliary disease. The metacercaria can migrate along the vessels or lymphatic ducts, and they can induce disease of the liver, lung and heart. We report here on a rare case of a 68-year-old male who presented with acute abdominal pain. He was diagnosed as acute pancreatitis associated with Fasciola hepatica. (Korean J Gastrointest Endosc 2006;33:183⁣186)
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The Roles of Endoscopic Sphincterotomy and Cholecystectomy in Acute Biliary Pancreatitis
Ji Bong Jeong, M.D.*, Ji Kon Ryu, M.D., Joo Kyung Park, M.D., Won Jae Yoon, M.D., Sang Hyub Lee, M.D., Jin-Hyeok Hwang, M.D., Jun Kyu Lee, M.D., Yong-Tae Kim, M.D. and Yong Bum Yoon, M.D.
Korean J Gastrointest Endosc 2006;33(3):152-158.   Published online September 30, 2006
AbstractAbstract PDF
Background
/Aims: Stone removal can prevent recurrence of acute biliary pancreatitis. This study examined the natural course of acute biliary pancreatitis and compared the results obtained using endoscopic sphincterotomy (EST) and cholecystectomy. In addition, the incidence and risk factors associated with acute cholecystitis were estimated when a cholecystectomy had not been performed. Methods: The medical records of 113 patients diagnosed with acute biliary pancreatitis in Seoul National University Hospital from January 1990 to April 2005 were reviewed retrospectively. Results: Twenty-five patients received no specific treatment of which 15 (60.0%) experienced a recurrence during a mean follow-up period of 36.0 months. Fifty-two patients received EST only and did not experience a recurrence during a mean follow-up of 29.8 months. Thirty-six patients underwent a cholecystectomy, and 1 (2.8%) patient experienced a second attack during a follow-up of 35.2 months. The clinical factors predictive of pancreatitis recurrence in patients without treatment could not be identified. Acute cholecystitis developed in 7 out of 77 (9.1%) patients who did not receive a cholecystectomy during a mean follow-up period of 33.3 months, and patients with both gallbladdor and common bile duct stones were found to be more prone to a recurrence. Conclusions: Sixty percent of patients with acute biliary pancreatitis without treatment experienced a second attack, which could be prevented by EST. A cholecystectomy is not always necessary as a routine treatment after EST for preventing pancreatitis, and is recommended for patients with both visible gallbladdor and common bile duct stones at the time of the first attack. (Korean J Gastrointest Endosc 2006;33:152⁣158)
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A Case of Clonorchiasis Presenting with Acute Pancreatitis and Cholangitis
Ki Sung Lee, M.D., Kyung Ho Kim, M.D., So Young Park, M.D., Chi Jun Park, M.D., Ja Young Lee, M.D., Myoung Kuk Jang, M.D., Joon Yong Park, M.D., Jin Heon Lee, M.D., Hak Yang Kim, M.D. and Jae Young Yoo, M.D.
Korean J Gastrointest Endosc 2006;32(3):231-234.   Published online March 30, 2006
AbstractAbstract PDF
Clonorchiasis is a parasitic disease that is often found in Japan, Korea, China, Hong Kong as well as in countries in Southeast Asia. The disease is caused by the ingestion of infected raw freshwater fish. The clinical manifestations depend on the number of flukes in a patient, the period of infestation, and the complications. In patients with a heavy infestation, extrahepatic bile duct, the gallbladder and even the pancreas are involved. We experienced a 62-year-old man who had a history of ingestion of raw freshwater fish and presented with acute pancreatitis and cholangitis. The pancreaticobiliary-associated clonorchiasis was successfully treated with endoscopic sphincterotomy, and praziquantel. (Korean J Gastrointest Endosc 2006;32:231⁣234)
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A Case of Acute Pancreatitis Caused by Ascaris Invasion of the Common Bile Duct
Jong Won Byun, M.D., Jae Woo Kim, M.D., Hoon Choi, M.D., Hye Jung Kim, M.D., Kyu Hong Kim, M.D., Myeong Gwan Jee, M.D., Yong Soon Park, M.D., Soon Koo Baik, M.D., Hyun Soo Kim, M.D., Sang Ok Kwon, M.D. and Seong Hyun Kim, M.D.*
Korean J Gastrointest Endosc 2005;31(5):348-352.   Published online November 30, 2005
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Ascaris lumbricoides is the most common intestinal parasite in less-developed countries as well as in areas with poor sanitation. Highly motile mature worms may enter the ampulla of Vater and migrate to the bile or pancreatic ducts causing cholangitis, biliary stones, cholecystitis, pancreatitis and a liver abscess. The incidence of pancreatitis due to biliary ascariasis is relatively common in endemic areas, but only a few cases have been reported in Korea since 1990. A 68-year-old woman was admitted with a sudden onset of epigastric pain. She was diagnosed with acute pancreatits due to ascaris based on computed tomography, the ampulla- impacted state of the worm and an elevated serum amylase level. The patient recovered without complications after the ascaris had been extracted using grasp forceps during endoscopy. The patient also received antihelminthic therapy. We report this case with a review of the relevant literatures.(Korean J Gastrointest Endosc 2005;31:348⁣352)
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A Case of Hepatocellular Carcinoma Invading Intrahepatic Duct Complicated by Hemobilia
Soo-Jeong Cho, M.D., Ji Kon Ryu, M.D., Sun-Jung Myung, M.D., Cheol Min Shin, M.D., Dong Won Ahn, M.D., Su Jong Yu, M.D., Ji-Won Yu, M.D., Jin Ho Paik, M.D.*, Gyeong Hoon Kang, M.D.* and Hyo-Suk Lee, M.D.
Korean J Gastrointest Endosc 2005;31(4):278-280.   Published online October 30, 2005
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A seventyone-year-old male presented with sudden epigastric pain followed by jaundice and intermittent right upper abdominal pain. He was diagnosed as hepatocellular carcinoma 7 years ago, and has been treated with transarterial chemoembolization, percuaneous ethanol injection and segmentectomy. On admission, the level of serum bilirubin, amylase and lipase were 8.7 mg/dL, 560 IU/L, and 13,297 IU/L, respectively. Stool occult blood test was positive. Abdominal computed tomography revealed newly- appeared intraductal soft tissue mass with ductal dilatation. Endoscopic retrograde cholangiography demonstrated filling defects in the common hepatic and distal common bile duct (CBD). Endoscopic sphincterotomy was performed and the clots in the distal CBD were removed. An intraductal stent was inserted at the common hepatic duct. The obstructive jaundice and pancreatitis were resolved. Our case suggests that intraductal hepatocellular carcinoma may induce hemobilia as a possible cause of acute pancreatitis. (Korean J Gastrointest Endosc 2005;31:278⁣281)
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A Case of Acute Pancreatitis Caused by Santorinicele with Incomplete Pancreas Divisum
Dong Won Lee, M.D., Dong Yup Ryu, M.D., Bo Hyun Kim, M.D., Jung Sup Kim, M.D., Young Eun Park, M.D., Seong Hun Lee, M.D., Tae Oh Kim, M.D., Suk Kim, M.D.*, Gwang Ha Kim, M.D., Jeong Heo, M.D., Dae Hwan Kang, M.D., Geun Am Song, M.D. and Mong Cho, M.D.
Korean J Gastrointest Endosc 2005;30(4):230-233.   Published online April 30, 2005
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A focal cystic dilatation of the terminal portion of the dorsal pancreatic duct at the minor papilla, termed "santorinicele", is seen in a small number of patients with pancreas divisum. Santorinicele is believed to result from a combination, either acquired or congenital, of relative obstruction and weakness of the distal ductal wall and has been suggested as a possible cause of relative stenosis of the accessory papilla, a risk factor for pancreatitis. We report a case of santorinicele associated with incomplete pancreas divisum, found in a 68-year-old woman presented with acute pancreatitis with a brief review of the literatures. (Korean J Gastrointest Endosc 2005;30:230⁣234)
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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
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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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췌장암 환자에서 ERCP 후에 발생한 중증 급성 췌장염 1예
Korean J Gastrointest Endosc 2003;27(5):494-494.   Published online November 20, 2003
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Three Case of Acute Pancreatitis Complicating Endoscopic Insertion of the Biliary Stent
Sung Gwon Kim, M.D., Jong Jae Park, M.D., Moon Gi Chung, M.D., Oh Sang Kwon, M.D.,Dong Kyun Park, M.D., Yang Suh Koo, M.D., Sun Suk Kim, M.D., You Kyung Kim, M.D.,Dong Hoon Kang, M.D., Duck Joo Choi, M.D., Hyun Chul Park, M.D. and Ju Hyun Kim, M.D.
Korean J Gastrointest Endosc 2001;22(4):233-238.   Published online April 30, 2001
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Acute pancreatitis is one of the major complications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST). Various etiology such as mechanical, chemical, hydrostatic, and thermal factor are thought to be involved for this procedure-related pancreatitis. However, acute pancreatitis can occur as a direct complication of endoscopic biliary drainage (EBD). Although the exact mechanism remains unclear, it is postulated that the stent compresses pancreatic ductal orifice and resultant pancreatic outflow obstruction actually provokes pancreatitis. Using the larger stent diameter over 10 Fr and a straight stent rather than curved one, proximal rather than distal bile duct obstruction are risk factors for stent-induced pancreatitis. We report on three cases of acute pancreatitis complicating the EBD with a plastic stent, nasobiliary catheter, and covered-metallic stent respectively. (Korean J Gastrointest Endosc 2001;22:233⁣238)
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증례 : 유두부로 개구하는 담낭관 급성 췌장염 - 증례보고 - ( Cystic Duct Insertion at the Ampulla of Vater and Acute Pancreatitis - A Case Report - )
Korean J Gastrointest Endosc 2000;20(6):496-498.   Published online November 30, 1999
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The two most common causes of acute pancreatitis are alcohol and cholelithiasis. Acute recurrent pancreatitis can result from a variety of abnormalities involving the terminal end of the distal choledochus, pancreatic duct, ampulla of Vater and the major duodenal papilla, which in turn may include a papillary stenosis, periampullary neoplasm, choledochocele, sphincter of Oddi dysfunction, and pancreatic ductal adenocarcinoma. Recently a case of recurrent acute pancreatitis associated with aberrant cystic duet insertion at the ampulla of Vater was experienced. Biliary-pancreatic reflux was speculated to be the mechanism responsible for causing this anomalous, recurrent, acute pancreatitis. Another case of acute pancreatitis associated with aberrant cystic duct insertion at the ampulla of Vater was also experienced in a 29-year-old man, 1Jnlike the previous report, our case showed cholestatic features on the initial blood chemistry. An endoscopic retrograde cholangiopancre-atography performed after recovry revealed only aberrant cystic duct insertion at the ampulla of Vater. This anomaly also seems to have played a role in causing acute pancreatitis in this patient. This interesting case is herein reported with a review of the relevant literature. (Korean J Gastrointest Endosc 2000;20:496-498)
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증례 : 재발성 급성 췌장염을 계기로 발견된 췌장의 미소 Intraducta Papillary Mucinous Tumor 1예 ( A Case of Minute Intraductal Papillary Mucinous Tumor of the Pancreas Presenting with Recurrent Acute Pancreatitis )
Korean J Gastrointest Endosc 2000;20(6):481-485.   Published online November 30, 1999
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Intraductal papillary mucinous tumors (IPMT) of the pancreas is a lesion consisting of mucin-producing cells with neoplastic potential. This unique group of tumors is characterized by duct ectasia, mucin hypersecretion, often extensive papillary intraductal growth, varying degrees of cytologic atypia, and relatively indolent growth. Now IPMT of the pancreas also includes intraductal papillary neoplasms that do not hypersecrete mucin. The clinical presentation of IPMT of the pancreas is characterized by chronic or recurrent attacks of abdominal discomfort often in association with low level pancreatic enzyme elevations. The episodes of pancreatitis due to IPMT of the pancreas are mild in severity. Recently, we was experienced a case of a minute IPMT causing repeated bouts of acute pancreatitis in a 75 year-old man. An endoscopic retrograde pancreatogram revealed a filling defect at the neck of the main pancreatic duct. A near-total pancreatectomy was performed and a minute (3×7 mm) IPMT of borderline malignancy was found in a branch duct at the pancreatic head. Surprisingly, despite the resective surgery the patient died of carcinomatosis. 8.5 months after the operation. This case of a minute but aggressive IPMT of the pancreas is herein reported with a review of the relevant literature. (Korean J Gastrointest Endosc 2000;20:481 -485)
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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
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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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원저 : 담도 췌장 ; 침형 유두절개술시 체관내인공관의 임상적 유용성 ( Case Reports : Biliary Tract & Pancreas ; The Needle - Knife Sphincterotomy over Pancreatic Stent : A Safe and Effective Technique? )
Korean J Gastrointest Endosc 1998;18(2):183-195.   Published online November 30, 1997
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Background
/Aims: Needle-knife sphincterotomy (NKS) is an alternative technique to EST when selective bile duct cannulation can not be achieved with a variety of techniques or accessories. The risk of post-procedure pancreatitis is high, however, when papillary edema, sphincter of Oddi spasm, and the resulting restriction of pancreatic juice flow are induced by both mechanical injury associated with repeated cannulation attempts and possible burn injury due to NKS itself. Recently, nasopancreatic drainage and pancreatic stenting were suggested to be effective in preventing pancreatitis in patients with high risk of postprocedure pancreatitis and in patients who underwent NKS, respectively. The purpose of this study is to evaluate the role of pancreatic stenting on the clinical outcomes in patients with high risks of postprocedure pancreatitis who undergo NKS. Methods: Of the 119 patients who had undergone NKS, pancreatic stenting with 2-4 cm, 7Fr polyethylene biliary stent was performed prior to NKS in 13 patients (pancreatic stent group), and an incision was begun without pancreatic stenting at the papillary roop avoiding trauma of the papillary orifice and thus, reducing the risks of pancreatitis in 15 patients (control group). Both groups were at high risks of pancreatitis associated with repeated, unsuccessful bile duct cannulation attempts. In the two groups, the success rate of bile duct cannulation and the incidence of pancreatitis were analyzed and compared. (Korean J Gastroint,est Endosc 18: 183-193, 1998) (continue)
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증례 : 담도 췌장 ; 가족성 선종성 용종증에 동반된 십이지장 유두부 선종에 의한 급성췌장염 1예 ( Case Reports : Biliary Tract & Pancreas ; Acute Pancreatitis as the Presenting Manifestation of an Ampullary Adenoma in a Patient with Familial Adenomatous Polyposis )
Korean J Gastrointest Endosc 1997;17(6):878-885.   Published online November 30, 1996
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Adenomatous polyps of the duodenum is uncommon in general population, but duodenal adenomas are found in the majority of patients with both familial adenomatous polypasis and Gardner's syndrome. These polyps are usually small, multiple and most commonly found in the second portion of the duodenum, and may involve ampulla of Vater. They also have malignant potential so that routine surveillance of the duodenum including ampulla of Vater has been recommended in patients with adenomatous polyposis coli. The adenoma of ampulla of Vater can be found in approximately 50% of patients with familial adenomatous polyposis and usually is asymptomatic, but sometimes, especially villous adenoma, may exhibit clinical problems including partial gastric outlet obstruction, pancreatitis, bleeding, obstructive jaundice, in addition to a high incidence of malignancy. Among the non-malignant complications of the ampullary tumor, there are only a few case reports of acute pancreatitis as the presenting manifestation of an ampullary adenoma or carcinoma in patients with familial adenomatous polyposis in the English literature, but no cases have been reported in Korea. We present here a case of symptomatic adenoma of the ampulla of Vater presenting as acute pancreatitis in a patient with familial adenomatous polyposis. (Korean J Gastrointest Endosc 17: 878-884, 1997)
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증례 : 담도 췌장 ; 급성 췌장염을 동반한 췌장의 Mucinous Ductal Ectasia 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Mucinous Ductal Ectasia of the Pancreas Presented with Acute Pancreatitis )
Korean J Gastrointest Endosc 1997;17(4):574-581.   Published online November 30, 1996
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We have experienced a case of mucinous ductal ectasia of the pancreas. The patient visited hospital with the symptoms of acute pancreatitis. The plasma levels of amylase and lipase checked at hospital were elevated. Abdominal ultrasonography and CT scan showed cystlike, intrapancreatic defects localized in the uncinate process of pancreatic head, On duodenoscopy, bulging ampulla of Vater and patulous papillary orifice were seen. Mucin leaked out of the patulous opening. Endoscopic retrograde pancreatography was performed and the localized, grape-like cyatic dilatation of the side branch of a main pancreatic duct on the uncinate process was shown. The main pancreatic duct was also dilated and had multiple filling defects in it. Whipple' s operation was performed and the histologic diagnosis was a benign intraductal papillary mucinous neoplasm of the pancreas. (Korean J Gastrointest Endosc 17: 574-580, 1997)
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원저 : 담도 췌장 ; 급성 췌장염에서 내시경적 역행성 담췌관 조영술의 임상적 의의 ( Original Articles : Biliary Tract & Pancreas ; Clinical Usefulness of ERCP in Acute Pancreatitis )
Korean J Gastrointest Endosc 1996;16(3):449-458.   Published online November 30, 1995
AbstractAbstract PDF
The safety of endoscopic retrograde cholangiopancreatography(ERCP) in patients with acute pancreatitis(AP) was confirmed in the past decade. Especially in ease of acute gallstone panereatitis, early ERCP/EST(endoscopic sphincterotomy) may reduce the incidence of complications by removing gallstone which causes acute attack of pancreatitis. To assess clinical usefulness of ERCP/EST in the setting of AP, we reviewed clinical records of 58 patients with AP who had undergone ERCP /EST during the same period of admission. (Korean J Gastrointest Endosc 16: 449~458, 1996) (continue...)
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