Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

A Case of Duodenal Wall Abscess Caused by a Foreign Body

이물질에 의한 십이지장벽 농양 1예

  • Ji, Byoung-Hoon (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Yoon, Ji-Hoon (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Lee, Jin-Ho (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Lee, Hee-Ryong (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Yu, Seong-Min (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Kim, Min-Dae (Department of Internal Medicine, Bong Seng Memorial Hospital) ;
  • Choi, Young-Il (Department of General Surgery, Bong Seng Memorial Hospital) ;
  • Lee, Il-Seon (Department of Pathology, Bong Seng Memorial Hospital)
  • Published : 2011.06.30
⟨ Previous Next ⟩

Abstract

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.

십이지장 농양은 장관에서 발생하는 농양의 한 형태로 드물게 발생하는 질환으로 알려져 있으며, 상복부 통증, 식욕부진과 같은 비특이적인 증상을 보이는 경우가 많고 위궤양, 위암, 담도계 질환과의 감별이 어려워 진단과 치료가 늦어져서 치명적인 임상경과로 진행할 수 있다. 본 증례는 알코올 남용, 흡연, 스테로이드 제제 및 비스테로이드성 항염증약물의 복용과 같은 위장관 점막 손상의 복합적인 위험 인자를 가진 59세 남자환자에게서 체중감소 및 심와부 통증 등의 비특이적인 증상으로 발현된 십이지장벽 농양의 예이다. 저자들은 병리소견과 병변부 세균배양검사 결과를 종합하여 이물질로 인해 발생한 십이지장농양으로 결론을 내렸고 수술적 치료와 경피적배농술 및 항생제 투여를 통해 임상경과의 호전을 경험하여 문헌고찰과 함께 보고한다.

Keywords

References

  1. Rosen Y, Won OK. Phlegmonousenterocolitis. Am J Dig Dis 1978;23:248-256. https://doi.org/10.1007/BF01072325
  2. Albu E, Moreira D, Faltous A, Saraiya RJ, Gerst PH. Intramural abscess of the duodenum resulting from perforated peptic ulcer. South Med J 1995;88:1078-1080. https://doi.org/10.1097/00007611-199510000-00017
  3. Hashimonal M, Abrahamason J, Erlik D, Schramek A. Retroperitoneal perforation of duodenal ulcers with abscess formation. Report of four cases and survey of the literature. Ann Surg 1971;173:409-414. https://doi.org/10.1097/00000658-197103000-00012
  4. Camilleri L, Lointier P, Pezet D, Fondrinier E, Chipponi J, Mercier R. Retroperitoneal perforation of duodenal ulcer responsible for abscess. Ann Chir 1989;43:388-390.
  5. Chung JI, Chang HJ, Lee SH, et al. A case of the duodenal bulb abscess. Korean J Gastrointest Endosc 2006;33:235-239.
  6. Nevin NC, Eakins D, Clarke SD, Carson DJ. Acute phlegmonous gastritis. Br J Surg 1969;56:268-270. https://doi.org/10.1002/bjs.1800560407
  7. Gerster JC. Phlegmonous gastritis. Ann Surg 1927;85:668-682. https://doi.org/10.1097/00000658-192705000-00006
  8. Jun WJ, Rew JS, Cho YC, et al. Gastric wall abscess caused by a fish bone and treated with endoscopic management. Korean J Gastrointest Endosc 2010;41:98-101.
  9. Ko SH, Lee GS, Ko JI, et al. A case of focal intramural abscess due to a fish bone ingestion in a healthy middle aged woman. Korean J Gastrointest Endosc 2011;42:105-108.
  10. Kneafsey PD, Kelly JK, Church DL, Rapp EF, Lafreniere R. Phlegmonousduodenitis complicating multiple myeloma: a successfully treated case. Am J Gastroenterol 1987;12:1322-1325.
  11. Kharchenko DA, Balueva NI, Kovalenko EA, et al. The incidence of intramural duodenal abscess as a complication of cholelithiasis. Klin Khir 1998;6:46-47.
  12. Velitchkov NG, Grigorov GI, Losanoff JE, Kjossev KT. Ingested foreign bodies of the gastrointestinal tract: retrospective analysis of 542 cases. World J Surg 1996;20:1001-1005. https://doi.org/10.1007/s002689900152
  13. Park HC, Park CH, Cho SB, et al. Two cases of gastrointestinal perforation by foreign bodies. Korean J Gastrointest Endosc 2007;35:46-50.
  14. Perkins M, Lovell J, Gruenewald S. Life-threatening pica: liver abscess from perforating foreign body. Australas Radiol 1999;43:349-352. https://doi.org/10.1046/j.1440-1673.1999.433670.x
  15. Fernandez-Urien I, Subtil JC, Herraiz M, et al. Gastric abscess. Gastrointest Endosc 2004;59:396-397. https://doi.org/10.1016/S0016-5107(03)02589-6
  16. Choong NW, Levy MJ, Rajan E, Kolars JC. Intramural gastric abscess: case history and review. Gastrointest Endosc 2004;23:627-629.
  17. Park JH, Kim HW, Park WI, et al. A case of gastric wall abscess associated with gastritis cystica profunda. Korean J Gastrointest Endosc 2004;29:509-513.
  18. Kang BC, Kim KW, Lee SW, Kim JH. Gastric wall abscess: imaging diagnosis and endoscopic treatment. J Comput Assist Tomogr 1998;22:673-675. https://doi.org/10.1097/00004728-199807000-00032
  19. Kiil C, Rosenberg J. Gastric intramural abscess successfully drained during gastroscopy. Gastrointest Endosc 2001;53:231-232. https://doi.org/10.1067/mge.2001.111559