• Investigative Magnetic Resonance Imaging
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• 제1권1호
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• pp.148-153
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• 1997

목적: 다양한 간외담도질환에서 3차원적 자기공명췌담도조영술(MR cholangiopancreatography, MRCP)의 진단적 가치를 내시경적 역생성 췌담도조영술(ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY, ERCP)와 비교하여 알아보고자 하였다. 대상 및 방법: 간외담도질환이 의심되는 46명의 환자에 대하여 MRCP와 ERCP를 각각 시행하였다. MRCP는 reverse fast imaging with a steady-state free precession(reverse FISP:PSIF) 기법을 이용하여 얻어낸 후 MIP algorithm을 이용하여 재구성하였다. 담도확장여부와 폐쇄부위 진단에 대한 MRCP의 정확성을 ERCP를 최적기준으로 하여 평가하였다. 또한 악성 및 양성병변의 감별과 종합적인 진단정확도를 MRCP와 ERCP간에 비교하였다. 결과: MRCP의 담도확장여부 예측은 민감도 94.6%, 특이도 75.0%, 정확도 91.1%였다. 폐쇄부위 예측의 정확도는 87.0%였다. 악성과 양성병변의 감별에 있어 MRCP와 ERCP의 민감도, 특이도, 정확도는 각각 76.2%, 87.5%, 82.2%와 71.4%, 83.3%, 77.8%였다. 각각의 지롼에 대한 전체적 진단의 정확도는 MRCP가 60.0%, ERCP가 55.6%였다. 결론: 3D MRCP는 간외담도질환에 있어 ERCP와 비교하여 손색없는 진단적 가치를 가지며, 앞으로 ERCP를 대체할 수 있는 좋은 검사방법이라고 생각된다.

• 한국간담췌외과학회지
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• 제27권2호
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• pp.220-225
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• 2023

Congenital duplication of the extrahepatic bile duct (DEBD) is an unusual anomaly of the biliary system. It occurs due to inability of the embryological duplex biliary system to regress. DEBD has various subtypes depending on the morphology and opening of the aberrant common bile duct. It can have distinct complications. We encountered a 38-year-old lady who experienced pain in the right upper abdomen along with a low-grade fever. Magnetic resonance cholangiopancreatography revealed DEBD with multiple calculi in the right hepatic duct (ductolithiasis) and joining of the right hepatic duct with the left hepatic duct in the intrapancreatic region. Endoscopic retrograde cholangiography failed to clear the calculi from the right duct. They were then managed by common bile duct exploration and roux-en-Y right hepaticojejunostomy for biliary drainage. Her postoperative period was uneventful. She is currently doing well after three months of follow-up. Hence, a proper preoperative delineation of such rare anomalies is essential. It could avoid inadvertent injury to the bile duct and operative complications.

• Parasites, Hosts and Diseases
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• 제52권2호
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• pp.193-196
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• 2014

Fascioliasis is a zoonotic infection caused by Fasciola hepatica or Fasciola gigantica. We report an 87-year-old Korean male patient with postprandial abdominal pain and discomfort due to F. hepatica infection who was diagnosed and managed by endoscopic retrograde cholangiopancreatography (ERCP) with extraction of 2 worms. At his first visit to the hospital, a gallbladder stone was suspected. CT and magnetic retrograde cholangiopancreatography (MRCP) showed an intraductal mass in the common bile duct (CBD) without proximal duct dilatation. Based on radiological findings, the presumed diagnosis was intraductal cholangiocarcinoma. However, in ERCP which was performed for biliary decompression and tissue diagnosis, movable materials were detected in the CBD. Using a basket, 2 living leaf-like parasites were removed. The worms were morphologically compatible with F. hepatica. To rule out the possibility of the worms to be another morphologically close species, in particular F. gigantica, 1 specimen was processed for genetic analysis of its ITS-1 region. The results showed that the present worms were genetically identical (100%) with F. hepatica but different from F. gigantica.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권2호
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• pp.193-197
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• 2008

저자 등은 원인이 확실하지 않았던 재발성 급성 췌장염의 14세 소아 환자에서 오디 괄약근 운동 검사로 오디 괄약근 운동 이상을 진단하고, 내시경 췌관 유두 괄약근 절개술을 시행하여 치료한 증례를 경험하였기에 보고한다.

• Parasites, Hosts and Diseases
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• 제55권6호
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• pp.659-660
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• 2017

Biliary ascariasis is still the leading cause of surgical complication of ascariasis, though its incidence has been dramatically reduced. Herein, we report a case of biliary ascariasis for the purpose of enhancing awareness of parasitic infections as a possible cause. A 72-year-old male visited the emergency room of Dankook University Hospital on 12 July 2015, complaining of right-upper-quadrant pain. By endoscopic retrograde cholangiopancreatography (ERCP), a tubular filling defect in the right hepatic duct was detected. The defect was endoscopically removed and diagnosed as an adult female of Ascaris lumbricoides worm, of 30 cm length. Upon removal of the worm, the pain subsided, and the patient was discharged without any complication. When treating cases of biliary colic, physicians should not neglect biliary ascariasis as the possible cause.

• Journal of Trauma and Injury
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• 제29권2호
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• pp.51-55
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• 2016

Isolated injury to the pancreas after abdominal trauma is uncommon, and a delay in diagnosis and treatment can increase the morbidity and mortality. Therapeutic decisions with respect to pancreatic trauma are usually made based on the site of injury and the status of the pancreatic ductal system. In this report, we describe the surgical management of pancreatic head transection as an isolated injury following blunt abdominal trauma. A 55-year-old man presented with epigastric pain that radiated to the back. Abdominal computed tomography revealed a hematoma in the pancreatic head and upstream dilatation of the main pancreatic duct. Endoscopic retrograde cholangiopancreatography showed complete disruption of and contrast leakage from the main pancreatic duct in the pancreatic head region with a nonenhanced upstream duct. Emergency pancreaticoduodenectomy was successfully performed, and the patient was discharged on postoperative day 9 without any complications.

• Journal of Yeungnam Medical Science
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• 제31권1호
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• pp.56-60
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• 2014

Hepatic portal venous gas (HPVG) is a rare radiographic finding associated with severe intra-abdominal disease and fatal outcome. Most cases of HPVG are historically related to mesenteric ischemia accompanied by bowel necrosis. The current spread of computed tomography scan promotes not only the early detection of related severe diseases but also the identification of other causes of HPVG. It has been reported in many non-fatal conditions, such as inflammatory bowel disease, intra-abdominal abscess, bowel obstruction, paralytic ileus, endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy, and gastric dilatation. Among these, paralytic ileus is a very rare condition, with no case yet reported in South Korea. Reported herein is a case of HPVG in paralytic ileus, which was treated well internally and was promptly resolved.

• Advances in pediatric surgery
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• 제11권2호
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• pp.175-179
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• 2005

An 11-year-old girl with a history of two previous attacks of acute pancreatitis was admitted to another hospital. Her epigastrium was tender, and serum amylase was 657 IU/L and lipase 3131 IU/L. Abdominal computed tomography scan suggested necrosis of 30% of the pancreas. Retrograde endoscopic cholangiopancreatography showed a diverticulum covered by normal duodenal mucosa at the second portion of the duodenum, which was separated from the adjacent duodenal lumen by a radiolucent band at UGI series. The apex of the diverticulum was incised endoscopically using a needle knife papillotome. A follow-up endoscopy on the next day noticed bleeding from the incised edge of the diverticulum. Endoscopic hemostasis with hemoclipping and injection of hypertonic saline-epinephrine solution was not successful. The patient was transferred to Kyungpook National University Hospital, and open duodenotomy and excision of the diverticulum were performed. She has recovered well and remains asymptoatic.

• Anatomy and Cell Biology
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• 제57권1호
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• pp.31-44
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• 2024

The exocrine part of the pancreas has a duct system called the pancreatic ductal system (PDS). Its mechanism of development is complex, and any reorganization during early embryogenesis can give rise to anatomical variants. The aim of this study is to collect, classify, and analyze published evidence on the importance of anatomical variants of the PDS, addressing gaps in our understanding of such variations. The MEDLINE, Web of Science, Embase, and Google Scholar databases were searched to identify publications relevant to this review. R studio with meta-package was used for data extraction, risk of bias estimation, and statistical analysis. A total of 64 studies out of 1,778 proved suitable for this review and metanalysis. The meta-analysis computed the prevalence of normal variants of the PDS (92% of 10,514 subjects). Type 3 variants and "descending" subtypes of the main pancreatic duct (MPD) predominated in the pooled samples. The mean lengths of the MPD and accessory pancreatic duct (APD) were 16.53 cm and 3.36 cm, respectively. The mean diameters of the MPD at the head and the APD were 3.43 mm and 1.69 mm, respectively. The APD was present in only 41% of samples, and the long type predominated. The pancreatic ductal anatomy is highly variable, and the incorrect identification of variants may be challenging for surgeons during ductal anastomosis with gut, failure to which may often cause ductal obstruction or pseudocysts formation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제26권2호
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• pp.79-87
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• 2023

Purpose: Gastrointestinal (GI) endoscopy is an important tool for diagnosing and treating GI diseases in children. This study aimed to analyze the current GI endoscopy practice patterns among South Korean pediatric endoscopists. Methods: Twelve members of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition developed a questionnaire. The questionnaire was emailed to pediatric gastroenterologists attending general and tertiary hospitals in South Korea. Results: The response rate was 86.7% (52/60), and 49 of the respondents (94.2%) were currently performing endoscopy. All respondents were performing esophagogastroduodenoscopy, and 43 (87.8%) were performing colonoscopy. Relatively rare procedures for children, such as double-balloon enteroscopy (DBE) (4.1%), endoscopic retrograde cholangiopancreatography (ERCP) (2.0%), and endoscopic ultrasound (EUS) (2.0%), were only performed by pediatric gastroenterologists at very few centers, but were performed by adult endoscopists in most of the centers; of all the respondents, 83.7% (41/49) performed emergency endoscopy. In most centers, the majority of the endoscopies were performed under sedation, with midazolam (100.0%) and ketamine (67.3%) as the most frequently used sedatives. Conclusion: While most pediatric GI endoscopists perform common GI endoscopic procedures, rare procedures, such as DBE, ERCP, and EUS, are only performed by pediatric gastroenterologists at very few centers, and by adult GI endoscopists at most of the centers. For such rare procedures, close communication and cooperation with adult GI endoscopists are required.