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￭ S-121 ￭
Liver abscess occurred in patient with ectopic opening of ampulla of Vater
1Internal Medicine, Sahmyook Medical Center, 2Internal Medicine, Konkuk University School of Medicine
*Yonghoon Choi1, Gyuwon Kim1, Chansup Shim2
The ampulla of Vater is normally located in the posteromedial wall of the second portion of the duodenum. But it may be ectopic and located in un- common sites such as the other parts of the duodenum and the stomach. The most common location of ectopic biliary drainage into the stomach is the body of the stomach followed by the antrum and cardia; the pylorus is very rare. An ectopic opening of the CBD is reported to be associated with biliary tract diseases or peptic ulcer diseases; In literature, duodenal ulcers are the most common complication, and gastric ulcers are the least common.
However, liver abscesses are not mentioned as a complication of ectopic opening of the CBD. A 56-year-old male was admitted to our hospital with the diagnosis of liver abscess. Pneumobilia and dilatation of the CBD were seen on computed tomography scan. ERCP was performed. But no area sugges- tingthe presence of the papilla of Vater was found within the second duodenal portion, and finally the major papilla was located in the pylorus. The CBD which should be located parallel to the portal vein and the pancreatic duct was not seen on EUS. MRCP showed narrowing and tapering of distal end of the CBD (hook-shaped). We suggest that the ectopic ampulla of Vater could be associated with liver abscess, since the most common cause of pyogenic liver abscess is known to ascending infection of biliary tract and the patient was healthy without any predisposing factor. Cautious evaluation about accompanying biliary tract anomalies may be needed in patients with liver abscess.
￭ S-122 ￭
Endoscopic treatment of Mirizzi syndrome in a low lying cystic duct and remnant cystic duct stone
을지병원 내과 소화기분과
*송치우, 손병관
Mirizzi syndrome (MS) is a rare complication for patients who underwent laparoscopic cholecystectomy for gallstone diseases. Most cases are treated by surgical intervention. However, because of its technical difficulty with laparoscopic surgery, Mirizzi syndrome underlying cystic duct anomalies is considered clinically important. We report a case of a 54-year-old male patient who presented with right upper quadrant pain, tenderness and a history of previous laparoscopic cholecystectomy. The patient also showed a CT evidence of cholangitis due to remnant cystic duct calculi. We performed an Endoscopic retrograde cholangiopancreatography (ERCP) which revealed Mirizzi syndrome with an uncommon anomalous cystic duct, namely, a low lying cystic duct. This case shows that endoscopic retrograde cholangiopancreatography with biliary stenting combined ursodeoxycholoic acid treat- ment can be utilized in suitable cases of MS caused by remnant cystic duct calculi after cholecystectomy.
