Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Two Cases of Unusual Infectious Peritonitis Mimicking Peritoneal Carcinomatosis of Early Gastric Cancer

조기위암의 복막 전이로 의심된 감염성 복막염 2예

  • Lee, Seung-Bum (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Ho-June (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Suk-Won (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yu, Hoon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jeong-Hoon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Hwoon-Yong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jin-Ho (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 이승범 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 송호준 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 최석원 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 유훈 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 이정훈 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 정훈용 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 김진호 (울산대학교 의과대학 서울아산병원 소화기내과학교실)
  • Received : 2010.05.13
  • Accepted : 2010.07.05
  • Published : 2010.08.30
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Abstract

Endoscopic mucosal resection is an organ-saving and minimally invasive treatment modality for early gastric cancer that is mucosa-confined, differentiated, and less than 2 cm in size. On pre-treatment cancer staging work-ups, unusual, benign, infiltrative peritoneal lesions can mimic metastasis of early gastric cancer, and thus lead to loss of an opportunity for the lesion to be properly treated by endoscopy. In the present cases, we report two unusual cases of infectious peritonitis, i.e., tuberculosis and paragonimiasis, which have been occurring sporadically in Korea. The two infectious lesions were confirmed by peritoneal biopsy and the gastric cancers were subsequently removed by endoscopic mucosectomy. These two cases remind us of 1) following indications for endoscopic mucosectomy, 2) the need for peritoneal biopsy for undetermined peritoneal lesions while avoiding laparoscopic gastrectomy, and 3) the coincidental occurrence of unusual infectious peritonitis with gastric cancer in our geographic region.

내시경 점막절제술은 점막내 국한되어 있고 크기가 작은 분화형 조기위암의 표준치료법이며, 치료 전 병기결정을 위한 검사가 필수적이다. 우리나라에서는 결핵성 복막염이나 폐흡충증이 드물지 않게 발생하며, 이러한 양성 질환이 조기위암의 복막 전이로 오인될 수 있다. 이번 증례에서 저자들은 내시경 점막절제술이 계획된 환자에서 발생한 결핵성 복막염과 폐흡충증을 경험하였으며, 복강경 검사로 전이 여부를 배제한 후 내시경 점막절제술로 조기위암을 완치하였다. 복강경 위절제술이 내시경 점막절제술과 함께 덜 침습적인 위암치료법으로 보편화되고 있고, 복강경 검사와 동시에 위절제술을 시행할 수 있는 장점이 있으나, 내시경 점막절제술의 대상이 되는 조기위암에서는 복막 전이가 의심되더라도 결핵이나 폐흡충에 의한 감염성 복막염을 반드시 감별 진단하여야 한다.

Keywords

References

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