WCIM 2014 SEOUL KOREA 531
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0835 Upper GI Tract
Etiology of Noncardiac Chest Pain in Negative Coronary Angiography Patients
Se Hoon Sohn1, Si Hyung Lee1, Kyeong Ok Kim1, Kook Hyun Kim1, Byung Ik Jang1, Tae Nyeun Kim1
Yeungnam University Mecical Center, Korea1
Background and Aims: Noncardiac chest pain(NCCP) is defi ned as a recurring angi- na-like or substernal chest pain which is unrelated to the heart. Gastro-esophageal refl ux disease (GERD) is the most common cause of NCCP and reported to almost 41%
of NCCP cases in Korean (up to 60% in Western countries). We aimed to evaluate the etiology of NCCP in subjects underwent coronary angiography (CAG) and showed negative fi nding.
Patients and Methods: From January 2010 to December 2013, total 524 subjects, who admitted at cariology department and showed negative CAG finding, were analyzed retrospectively. All of them got esophagogastroduodenoscopy (EGD). The patients’ characteristics, EGD fi ndings were evaluated.
Results: Mean age of the patients was 62.40 (±11.93) years and male to female ratio was 1.2:1. In EGD fi ndings, normal fi nding was noted in 249 cases (47.5%), GERD was noted in 107 cases (20.42%), gastritis was noted in 106 (20.3%) cases, gastric ulcer was noted in 77 (14.7%) cases and duodenal ulcer was noted in 14 (2.7%) cases. There were 8 (1.53%) cases of stomach cancer, 1 case of tubular adenoma with high grade dysplasia and 1 case of esophageal candidiasis.
Conclusion: The most common cause was GERD (20.42%), but gastritis (20.3%) and peptic ulcer disease (17.4%) were reported many cases. Our results indicate that EGD can identify a signifi cant number of patients with acid-peptic disease who present with noncardiac chest pain.
PS 0836 Upper GI Tract
A Case of Blue Rubber Bleb Nervus Syndrome
Junhyung Park1, YongKook Lee1, Jeong Bae Park1, Chang Heon Yang1 Dongguk University Gyongju Hospital, Korea1
Blue rubber bleb nervus syndrome (BRBNS) is a very rare disease that characterized by cutaneous and gastrointestinal venous hemangioma. We report a case of 43-year-old patient with BRBNS. He visited our hospital for dizzinesss and epigastric discomfort for a week. Iron defi cient anemia (IDA) was reported by laboratory data. Cutaneous hemangioma was found on right inguinal area. We performed EGD and colonoscopy.
We found about 0.8cm sized blue colored sessile polyps on the EGD and 0.8~2.0 sized several blue colored sessile polyps with oozing hemorrhage on the colonoscopy. We removed all polyps by endoscopic mucosal resection. Pathologic reports confirmed multiple cavernous hemangiomas. We reports this unusual IDA case due to BRBNS.
PS 0837 Upper GI Tract
Late Postoperative Anterograde Jejunojejunal Intussusception After Total Gastrectomy with Loop Esophagojejunostomy : A Case Report
Byung Moo Ahn1, Hee Seok Moon1 Chungnam National University Hospital, Korea1
Introduction: Intussusception after gastric surgery is very rare postoperative complication. The overall incidence of intussusception after gastric surgery is 0.07~2.1% and many cases are associated with Billroth II and Roux-en-Y anasto- mosis. The exact mechanism was not clear, but few mechanism suggested. Reverse peristalsis and variety of postoperative conditions(such as adhesion, shortening of the mesentery of the jejunum, size of anastomotic orifi ce, long afferent loop, increased mobility in the efferent limb, upper jejunum wider than the distal bowel, increased abdominal pressure and use of long gastrostomy tube) became the cause of postoperative intussusception. Retrograde jejunogastric intussusception is the most common type and jejunojejunal, jejunoduodenal, duodenogastric and intus- susception through braun anastomosis site is relatively rare. It is very uncommon case because most intussusception after total gastrectomy were characterized as retrograde. Added to that, anterograde jejunojejunal intussusception tends to occur at early postoperative day. To the best of our knowledge, this is the fi rst case report of late onset anterograde jejunojejunal intussusception after total gastrec- tomy and loop esophago-jejunostomy in Korea.
Case : This case is about 54-year-old man with history of total gastrectomy, uncut Roux-en-Y gastric bypass and Braun’s jejunojejunal anastomosis who presented as hematemesis and epigastric pain. An upper gastrointestinal endoscopy was attempted and showed a bulky, reddish mass in efferent loop with congestion, edema and mucosal bleeding. An emergency computed tomography revealed tar- get-like multilayered wall thickening in afferent loop jejunum with invagination of afferent proximal jejunum and distal jejunum lamellar structure arranged in a concentric circle. On surgical exploration, an anterograde intussusception of af- ferent proximal jejunum through jejunojejunostomy was found. 40~50cm manual reduction was performed gently and invaginating intestine recovered after warm saline irrigation.
