• Journal of Chest Surgery
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• 제5권2호
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• pp.107-112
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• 1972

Recently we experienced a case of the portal hypertension, extrahepatlc origin in the National Medical Center, Seoul. The case was a male aged 19 who was undergone the elective splenorenal shunt with splenectomy 9 years ago and emergency ligation of the coronary vein because of recurred variceal rupture 6 years later and had recurring esophageal varices with bleeding this time.At the age of 10 he had been occasionally suffering from nasal bleeding and visited to our Pediatric department, when there was encountered for the first time the splenomegaly, esophageal varices in the lower third esophagus on the esophagogram, and stenosis and kinking of the portal vein with rich collateral circulation on the splenoportography without hepatic functional impairment.The elective splenorenal shunt with splenectomy was undergone under the diagnosis of portal hypertension due to congenital anomaly of the portal vein and postoperatlvely no troubles had been obtained until postoperative 1st attack of massive hematemesis due to esophagenl variceal rupture recurred about 6 years later which was confirmed by control esophagogram and it was resulted by stenosis of previous anastomotic site of the splenorenal shunt.Then emergency ligation of the coronary vein was only made for bleeding control and no episodes of hematemesis had been encountered thereafter until April 1972 about 3 years after the 2nd operation, when hematemesis recurred again. In this time, recurring esophageal varices were noted in the lower third esophagus on the control esophagogram and he was employed side to end mesocaval shunt as the final step of portal decompression,and following results were obtained. 1] No postoperatlve troubles as leg edema or pain: Postoperatively leg elevation and elastic bandage on the both legs were employed until discharge. 2] During operation the portal pressure was 300 mm $H_2O$ and immediately lowered to 170 mm $H_2O$ after shunt.

• 대한상부위장관⦁헬리코박터학회지
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• 제18권4호
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• pp.231-234
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• 2018

Peptic ulcer bleeding (PUB) is the most common cause of non-variceal upper gastrointestinal bleeding, and its frequency has been declining over the past decades. However, mortality from PUB persists, and it is still a serious challenge in clinical practice. Although endoscopic intervention is the basic treatment modality for PUB, pharmacological therapy is an important adjunct. The emergence of proton pump inhibitors (PPIs) enables maintenance of intragastric pH >6, which greatly helps in the treatment of PUB. Continuous intravenous infusion of high-dose PPI reduces the re-bleeding rate, thereby helping avoid additional surgery in patients with high-risk stigmata. Moreover, administration of PPIs prior to endoscopy may reduce the need for additional endoscopic intervention. Recently introduced gastric acid suppressants, such as potassium-competitive acid blockers, have shown promising results in further treatment of PUB.

• 대한한방내과학회지
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• 제41권3호
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• pp.515-522
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• 2020

Objectives: This study aimed to describe whether Saenggangunbi-tang supports clinical management of a patient with decompensated liver cirrhosis without unfavorable side effects. Methods: A 78-year-old woman diagnosed with unspecified liver cirrhosis in 2014, who had undergone abdominal paracentesis twice until 2014 and variceal ligation twice until 2017, took Saenggangunbi-tang from July 25, 2019 to March 23, 2020. We observed clinical changes, such as fatigue, leg edema, and gingival bleeding, as well as laboratory findings. Results: After taking Saenggangunbi-tang for about eight months, the patient's symptoms and serum levels of liver enzymes were improved in comparison to her symptoms and serum levels at the first visit. Moreover, there was no occurrence of any complications, such as ascites and gastroesophageal variceal bleeding by portal hypertension. Conclusions: This study suggests that Saenggangunbi-tang might be effective in the treatment of decompensated liver cirrhosis.

• 대한영상의학회지
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• 제81권1호
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• pp.231-236
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• 2020

십이지장 정맥류는 간경화증에 의한 문맥압 고혈압 환자에서 발생할 수 있으며, 치명적인 심한 상부 위장관 출혈을 일으킬 수 있으나 아직까지 명확한 치료 지침이 정립되어 있지는 않다. 일차적으로 내시경으로 치료를 시도하고 지혈 실패 시 목정맥경유간속문맥전신순환연결술, 풍선 혹은 혈관 마개를 이용한 역행성 경정맥 폐색술, 피부간경유 폐색술 등과 같은 중재적 치료를 고려할 수 있다. 저자들은 내시경적 치료에 실패한 십이지장 정맥류 출혈 환자에게 저하된 간 기능과 해부학적인 구조의 제한으로 인해 코일을 이용한 역행성 경정맥 폐색술을 시행하여 성공적으로 치료한 1예를 경험하였기에 이를 보고하고자 한다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권2호
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• pp.221-225
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• 2009

저자들은 구토와 심와부 통증을 주소로 내원한 12세 여아에서 복부 전산화 단층촬영을 시행하여 급성 췌장염과 함께 동반된 비정맥 혈전증을 진단하였고, 정맥류출혈이나 비장 비대 등의 증상을 보이지 않아 보존적치료 후 추적 관찰한 증례를 경험하였기에 보고하는 바이다.

• Clinical Endoscopy
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• 제55권3호
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• pp.408-416
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• 2022

Background/Aims: Endoscopic band ligation (EBL) is used to treat colonic diverticular bleeding (CDB). An endoscopic variceal ligation device for esophageal varices is used as a conventional EBL device (C-EBL). A new EBL device (N-EBL) was developed by Sumitomo Bakelite Co. in August 2018. We aimed to evaluate the clinical outcomes of N-EBL compared with those of C-EBL. Methods: Seventy-nine patients who underwent EBL for CDB at St. Luke's International Hospital, Japan, between 2017 and 2020 were included in this retrospective study. Patients were divided into the C-EBL and N-EBL groups. Their clinical outcomes, including achieving initial hemostasis, early rebleeding, procedure time, and EBL-associated adverse events, were evaluated. Results: Of the 79 patients, 36 (45.6%) were in the C-EBL group and 43 (54.4%) were in the N-EBL group. The rate of achieving initial hemostasis was 100% in the C-EBL group and 93.0% in the N-EBL group. No significant difference was noted in the early rebleeding rate between the groups (p=0.24). The N-EBL group achieved a shorter median EBL procedure time than the C-EBL group (14.2 minutes vs. 18.2 minutes, p=0.02). No adverse events were observed in either group. Conclusions: The N-EBL device is safe and useful and may reduce EBL procedure time.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권1호
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• pp.98-101
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• 2004

Congenital hepatic fibrosis is an inherited, congenital disorder of the liver characterized by portal hypertension and hepatic fibrosis. We experienced a case of congenital hepatic fibrosis with esophageal varix in a 9-year-old male. He complained hematemesis, hematochezia, dizziness. In laboratory examination, AST/ALT was slightly increased. Esophageal varix was noted by an endoscopic examination. Hepatosplenomegaly and hypoechoic lesion of periportal area were seen by abdominal CT scanning. Histologic finding of liver biopsy showed fibrous tracts containing dilated bile ductules connecting adjacent portal spaces that were widened by mature fibrosis. Endocopic sclerotherpy and ligation was done. We summarized a case with review of literatures

• 대한영상의학회지
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• 제84권1호
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• pp.291-297
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• 2023

좌측 단독 문맥고혈압은 비장 정맥이 폐쇄되어 생기는 드문 임상 질환이다. 비장 정맥의 혈전증 혹은 외부 압박으로 인해 근위부 비장정맥의 고혈압이 발생하게 되며, 비장의 혈류는 짧은 위 정맥, 관상정맥, 위대망정맥 같은 측부혈관을 통하여 상장간막 정맥 혹은 문맥으로 흘러가게 된다. 위장관 출혈을 유발하는 좌측 단독 문맥고혈압에는 개복 비장절제술이 첫 번째 치료방법으로 추천된다. 하지만 중재시술을 통한 치료가 수술적 교정을 원치 않는 환자들에게는 임상적으로 유용한 치료 선택지가 될 수 있다. 본문에서는 위정맥류 출혈을 가진 좌측 문맥 고혈압에 대한 두 개의 증례를 다루고자 한다.

• Journal of Chest Surgery
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• 제27권2호
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• pp.140-147
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• 1994

Reconstruction of the pharynx and cervical esophagus presents a tremendous challenges to surgeons. Over the past 2 years[1990, Dec.-1993, Jun], the free jejunal graft has been performed in 17 cases in Korea Cancer Center Hospital.The indications of this procedures were almost malignant neoplasms involving neck and upper aero-digestive tract; Hypopharyngeal cancer[12 cases, including 2 recurrent cases], laryngeal cancer[2 cases], thyroid cancer[2 cases, including 1 recurrent case], cervical esophageal cancer[1 case]. There were fifteen men and two women, and the mean age was 59.6 years. The anastomosis site of jejunal artery were common carotid artery[16 cases] or external carotid artery[1 case] and that of jejunal vein were internal jegular [15 cases] or facial[1 case] and superior thyroid vein[1 case]. The length of jejunal graft was from 9 cm to 17 cm[mean 13 cm] and the mean ischemic time was 68 minutes. There was one hospital mortality which was irrelevant to procedures[variceal bleeding] and one graft failure[1/16]. Other postoperative complications were neck bleeding or hematoma[3 cases], abdominal wound infection or disruption[5 cases], anastomosis site leakage[1 case], pneumonia[2 cases], graft vein thrombosis[1 case], and food aspiration[1 case]. The function of conduit was excellent and ingestion of food was possible in nearly all cases. Postoperative adjuvant radiation therapy was also applicable without problem in 7 cases. During follow-up periods, the anastomosis site stenosis developed in four patients, and the tracheal stoma was narrowed in one case but easily overcome with dilation. In conclusion, we think that the free jejunal graft is one of the excellent reconstruction methods of upper digestive tract, especially after radical resection of malignant neoplasm in neck with a high success rate and low mortality and morbidity rate.

• Advances in pediatric surgery
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• 제5권2호
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• pp.111-115
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• 1999

The results of hepatic portojejunostomy in 34 patients with biliary atresia operated upon by one surgeon between May 1989 and December 1997 were analyzed. Eleven (32.3 %) patients were 60 days or younger, 14 patient (41.2 %) were between 60 and 90 days, and 9 (26.5 %) were over 90 days of age. Jaundice cleared in 20 cases (58.8 %). Three patients died of liver insufficiency, 2 were anicteric but died from esophageal variceal bleeding. Three patients died as a result of sepsis, heart failure and left kidney agenesis. Five patients were lost to follow-up. The five-year survival rate was 73.8 %. Two patients over 90 days of age, survived more than 5 years. Survival rates were not significantly related to the age at operation. We conclude that hepatic portojejunostomy should be considered as a primary surgical modality for biliary atresia, even at age 90 days or more. Early detection of esophageal varices and sclerotherapy may be necessary. Liver transplantation is necessary if hepatic failure develops.