• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제4권2호
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• pp.256-260
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• 2001

저자들은 반복적으로 췌장염을 앓은 여아에서 상복부 동통을 주소로 내원하여 MRCP와 ERCP를 통해 다발성 췌관석이 원인인 만성 재발성 췌장염 1례를 치험하였기에 보고하는 바이다.

• 대한영상의학회지
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• 제84권2호
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• pp.512-517
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• 2023

췌공장문합술 후 췌관 내 스텐트를 삽입하는 것은 수술 후에 췌장루나 췌관 협착의 발생을 예방하기 위해 널리 시행하는 술기이다. 그러나 삽입한 스텐트가 막히거나 이동하는 등 스텐트에 의해서도 다양한 합병증이 발생할 수 있다. 저자들은 췌관에 삽입한 플라스틱 스텐트가 이동하면서 발생된 매우 드문 합병증의 예를 보고하고자 한다. 유문부 보존 췌두부십이지장 절제술 시행 후 췌장 내 삽입한 스텐트는 공장으로 이동하여 스텐트-돌 복합체의 근원으로 작용하여 공장 폐색을 일으켰다. 스텐트-돌 복합체는 탐색적 개복술로 제거되었다.

• 한국간담췌외과학회지
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• 제26권4호
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• pp.412-416
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• 2022

Although a pancreaticojejunostomy (PJ) is not required after a distal pancreatectomy in most cases, it needs to be performed to prevent atrophy of the remnant pancreas when the proximal duct is obstructed by a tumor, stone, or etc. In these conditions, the critical postoperative pancreatic fistula (POPF) gives surgeons cause to hesitate before performing a PJ. We previously presented the modified technique of Mattress PJ named "inverted mattress PJ" (IM-PJ) and published improved outcomes in the aspects of POPF after a pancreaticoduodenectomy and a central pancreatectomy. Recently, we had a case of a patient who has chronic pancreatitis with a proximal pancreatic duct obstruction, requiring a distal pancreatectomy and PJ. Based on the previous report, we decided to apply the "inverted mattress PJ" (IM-PJ) technique for a Roux-en Y PJ after a distal pancreatectomy. The patient was discharged after surgery without complications. We reviewed a case of a patient requiring PJ following a distal pancreatectomy and discussed the safety of our technique.

• 한국간담췌외과학회지
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• 제26권2호
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• pp.199-203
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• 2022

Gallstone ileus is an uncommon cause of intestinal obstruction. It may present with typical symptoms of intestinal obstruction with or without biliary sepsis. Its management strategies vary depending on the patient and operative factors. Enterotomy and stone removal alone versus synchronous cholecystectomy and fistula disconnection at the same stage, often pose a debate among surgeons. The decision for operative strategies largely depends on the surgeon's experience, patient's physiology, and operative difficulties. As literature on gall stone ileus remains insufficient at a regional level, we report four cases of gallstone ileus managed with different approaches. Three patients were managed in a staged-manner, whereas one patient received a definitive procedure performed at index surgery. Clinical challenges and associated operative strategies are discussed. Findings of the current study were compared to those of the literature. The need for a definitive fistula disconnection and repair or cholecystectomy following stone removal in these patients was subsequently discussed.

• 대한방사선기술학회지:방사선기술과학
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• 제21권1호
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• pp.40-45
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• 1998

To determine its usefulness and safety of extracorporeal shock-wave lithotripsy in common bile duct and pancreatic duct stones, we analyzed the results of 13 patients with common bile duct stones and 6 patients with pancreatic duct stones which were removed by endoscopic procedures using the balloon or basket, who was performed the extracorporeal shock-wave lithotripsy using the ultrasonography for stone localization with a spark gap type Lithotriptor(Dernier MPL 9000, Germany). Fragmentation and complete clearance of the common bile duct and pancreatic duct stones were obtained in 19 of 19 patients(100%). Apart from transient attacks of fever in 2 of 13 patients with common bile duct stones(15%) and mild elevation of serum amylase and lipase in 2 of 6 patients with pancreatic duct stones(33%), no other serious side effects were observed. In our experiences, extracorporeal shock-wave lithotripsy is a safe and useful treatment for endoscopically unretrievable common bile duct and pancreatic duct stones.

• 대한방사선기술학회지:방사선기술과학
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• 제25권2호
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• pp.65-70
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• 2002

1997년 8월부터 2002년 5월까지 서울아산병원에 내원하여 췌관결석 진단을 받은 후, 내시경적 결석제거에 실패하고 ESWL을 시행받은 59명을 대상으로 하였다. 췌관 결석의 방사선학적 특징을 결석 수, 가장 큰 결석의 최대 직경 길이, 결석의 농도, 그리고 생긴 모양으로 분류하였다. 전체대상 59예 중 45예(76.3%)에서 결석의 완전한 제거가 확인되었으며 14예(23.7%)에서는 결석의 완전한 제거에는 실패한 것으로 확인되었다. 1. 단일 결석을 가진 28예 중 21예(75.0%)에서 결석이 완전 제거되었으며, 두 개 이상의 다결석을 가진 31예 중 24예(77.4%)에서 결석이 완전 제거되었다. 2. 결석의 최대 직경이 30m 이하의 경우인 53예 중 41예(77.4%)에서 결석의 완전한 제거가 확인되었으며, 30mm 보다 큰 경우인 6예 중 4예(66.7%)에서 결석의 완전한 제거가 확인되었다. 3. 척추의 체부(body)와 비교한 결석의 농도측면에서, 척추의 체부 보다 농도가 낮은 경우, 즉 비석회화 결석 8예 중 8예(100%) 모두에서 결석이 완전 제거되었으며, 농도가 같은 경우인 43예에서는 37예(86.0%)가 결석의 완전한 제거를 보였으나, 농도가 척추 체부 보다 높은 3예 중 3예(100%) 모두에서 결석의 완전한 제거에 실패하였으며, rim calcified stone 5예 중 5예(100%) 모두에서 또한 결석의 완전한 제거에 실패하였다. 4. 각이진 모양의 결석 9예 중 2예(22.2%)에서 결석이 완전 제거되었으며, 그렇지 않은 원형이나 타원형 모양의 경우인 50예 중 43예(86.0%)에서 결석의 완전한 제거를 확인하였다.

• Advances in pediatric surgery
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• 제12권1호
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• pp.24-31
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• 2006

저자들은 만성췌장염으로 췌관결석이 합병되어 Puestow-Gillesby 췌관 공장 측측변형 문합술을 시행 받은 14 세 환아와 합병증이 발생하지 않은 만성췌장염을 앓고 있는 13세의 환아의 여자형제, 췌장암으로 사망한 외삼촌과 만성췌장염으로 배액술을 받은 26세 사촌언니를 가진 유전성 췌장염한 가계를 경험하였다. 또한 이들을 대상으로 유전자를 검사하여 R122H 변이를 관찰하였기에 보고하는 바이다.

• 한국간담췌외과학회지
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• 제27권1호
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• pp.63-69
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• 2023

Methods: Patients who underwent cholecystectomy were classified into two groups according to their GBWT status (GBWT+ vs. GBWT-). Results: Among 1,211 patients who underwent cholecystectomy, GBWT+ was seen in 177 (14.6%). The GBWT+ group was significantly older with more males, higher ASA score, higher alkaline phosphatase level, higher international normalized ratio, and lower albumin level than the GBWT- group. On ultrasound, GBWT+ patients had larger stone size, more pericholecystic fluid, more common bile duct stone, and more biliary pancreatitis. Compared with the GBWT- group, the GBWT+ group had more urgent surgeries (12.4% vs. 3.2%, p = 0.001), higher conversion rate (4.5% vs. 0.3%, p = 0.001), prolonged operative time (67 ± 38 vs. 54 ± 29 min; p = 0.001), more bleeding (3.4% vs. 0.5%, p = 0.002), and more need of drain (21.5% vs. 10.5%, p = 0.001). By multivariate analysis, factors associated with increased length of hospital stay were GBWT+ (HR: 1.97, 95% CI: 1.19-3.25, p = 0.008), urgent surgery (HR: 10.2, 95% CI: 4.07-25.92, p = 0.001), prolonged surgery (HR: 1.01, 95% CI: 1.0-1.02, p = 0.001), and postoperative drain (HR: 11.3, 95% CI: 6.40-20.0, p = 0.001). Conclusions: Variables such as GBWT ≥ 5 mm, urgent prolonged operation, and postoperative drains are independent predictors of extended hospital stay. GBWT+ patients are twice likely to stay in hospital for more than 72 hours and more prone to develop complications than GBWT- patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권4호
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• pp.332-339
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• 2022

Purpose: Although endoscopic retrograde cholangiopancreatography (ERCP) has been used for more than five decades, its applicability in Bangladeshi children has recently become more common. Therefore, this manuscript aims to describe our experience in performing ERCPs in Bangladeshi children with hepatopancreaticobiliary diseases, focusing on presenting diseases, as well as the diagnostic and therapeutic efficacy. Methods: Between 2018 and 2021, 20 children underwent 30 ERCP procedures at the Bangladesh Specialized Hospital, Dhaka. A single trained adult gastroenterologist performed all procedures using a therapeutic video duodenoscope. The indications for ERCP, diagnostic findings, therapeutic procedures, and complications were documented. Results: The median age of the study patients was 10 years (range, 1.7-15 years). Successful cannulation of the papilla was achieved in 28 procedures and failed in 2 cases. Repeated ERCP was required in seven patients. Nine patients had biliary indications and 11 had pancreatic indications. Choledocholithiasis was the most common indication for ERCP in patients with biliary disease, while chronic pancreatitis was common among patients with pancreatic indications. Pancreatic divisum was observed in only one patient. Pancreatic and biliary sphincterotomy was performed in 14 and 9 cases, respectively. A single pigtail or straight therapeutic stent was inserted in seven cases and removed in five cases. Stone extraction was performed in six procedures, and balloon dilatation was performed in five procedures. The post-procedural period for these patients was uneventful. Conclusion: We found that ERCP is a practical and successful therapeutic intervention for treating hepatopancreaticobiliary disorders in children when performed by experienced endoscopists.

• Biomolecules & Therapeutics
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• 제31권6호
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• pp.674-681
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• 2023

Bile pigment, bilirubin, and biliverdin concentrations may change as a results of biliary tract cancer (BTC) altering the mechanisms of radical oxidation and heme breakdown. We explored whether changes in bile pigment components could help distinguish BTC from benign biliary illness by evaluating alterations in patients with BTC. We collected bile fluid from 15 patients with a common bile duct stone (CBD group) and 63 individuals with BTC (BTC group). We examined the bile fluid's bilirubin, biliverdin reductase (BVR), heme oxygenase (HO-1), and bacterial taxonomic abundance. Serum bilirubin levels had no impact on the amounts of bile HO-1, BVR, or bilirubin. In comparison to the control group, the BTC group had considerably higher amounts of HO-1, BVR, and bilirubin in the bile. The areas under the curve for the receiver operating characteristic curve analyses of the BVR and HO-1 were 0.832 (p<0.001) and 0.891 (p<0.001), respectively. Firmicutes was the most prevalent phylum in both CBD and BTC, according to a taxonomic abundance analysis, however the Firmicutes/Bacteroidetes ratio was substantially greater in the BTC group than in the CBD group. The findings of this study showed that, regardless of the existence of obstructive jaundice, biliary carcinogenesis impacts heme degradation and bile pigmentation, and that the bile pigment components HO-1, BVR, and bilirubin in bile fluid have a diagnostic significance in BTC. In tissue biopsies for the diagnosis of BTC, particularly for distinguishing BTC from benign biliary strictures, bile pigment components can be used as additional biomarkers.