A Case of Cholecysto-gastro-colonic Fistula with Upper Gastrointestinal Bleeding / 대한소화기학회지

Biliary enteric fistula is an abnormal pathway often caused by biliary disease. It is difficult to diagnose the disease because patients have nonspecific symptoms. A 67-year-old woman presented with hematemesis and melena. She was diagnosed with Dieulafoy lesion on the gastric antrum and underwent endoscopic hemostasis using hemoclips. Follow-up upper gastrointestinal endoscopy revealed an abnormal opening on a previous treated site that was suggestive of biliary enteric fistula. Abdomen simple X-ray and abdominal dynamic CT scan showed pneumobilia and cholecysto-gastric fistula. The patient had cholecystectomy and wedge resection of the gastric antrum, followed by right extended hemicolectomy because of severe adhesive lesion between the gallbladder and colon. She was diagnosed with cholecysto-gastro-colic fistula postoperatively. We report on this case and give a brief review of the literatures.

A Case of Acute Emphysematous Gastritis Associated with Invasive Aspergillosis

Emphysematous gastritis is a subtype of phlegmonous gastritis characterized by emphysematous change of the gastric wall. It is associated with infection of gas forming organism and is often fatal because of suppurative bacterial infection. Streptococci is the most commonly involved microorganism of emphysematous gastritis. Aspergillus is a very rare pathogen of this disease, because invasive aspergillosis often presents as pulmonary infections and rarely involves the gastro-intestinal tract. Treatment should be aimed to cover various organism using broad spectrum antibiotics, and sometimes aggressive surgical management may be needed to enhance survival. We report a case of severe emphysematous gastritis caused by invasive aspergillosis with a review of the literature.

A Case of Acute Emphysematous Gastritis Associated with Invasive Aspergillosis

Emphysematous gastritis is a subtype of phlegmonous gastritis characterized by emphysematous change of the gastric wall. It is associated with infection of gas forming organism and is often fatal because of suppurative bacterial infection. Streptococci is the most commonly involved microorganism of emphysematous gastritis. Aspergillus is a very rare pathogen of this disease, because invasive aspergillosis often presents as pulmonary infections and rarely involves the gastro-intestinal tract. Treatment should be aimed to cover various organism using broad spectrum antibiotics, and sometimes aggressive surgical management may be needed to enhance survival. We report a case of severe emphysematous gastritis caused by invasive aspergillosis with a review of the literature.

A Case of Pancreatic Cancer and Opioid Withdrawal after Endoscopic Ultrasound-guided Celiac Plexus Neurolysis / 대한소화기내시경학회지

Pancreatic cancer is usually unresectable upon diagnosis, and treatment aims to optimize the quality of the patient's life by managing symptoms, and, particularly, by providing adequate pain control. When the pain is refractory to opioids, interventions such as celiac plexus neurolysis (CPN) can be considered. Endoscopic ultrasound (EUS)-guided CPN has been introduced for pancreatic cancer. Reported herein is a case of a 75 year-old man with pancreatic cancer who was treated with opioids due to severe abdominal pain. EUS-guided CPN was performed for pain control, and the opioid administration was discontinued as the pain improved dramatically. However, the patient experienced opioid withdrawal symptoms, including anxiety, insomnia, nausea, and vomiting. Thus, although EUS-guided CPN successfully reduced pain in a patient undergoing such treatment and to whom opioid was administered, opioid administration should not be abruptly discontinued. Rather, the opioid dose should be reduced gradually to avoid drug withdrawal.