WCIM 2014 SEOUL KOREA 113
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0250 Gastroenterology
The Progression of Cholelithiasis Presenting in Recur- rent Stress Induced Cardiomyopathy : A Case Report
Young Rak CHOI1, Joung-Ho HAN1, Mi Jin KIM1, Hee Bok CHAE1, Seon Mee PARK1, Sei Jin YOUN1
Chungbuk National University Hospital, Korea1
Cholelithiasis is the most common of the biliary tract diseases and often manifested as cholecystitis or cholangitis. The symptoms vary from symptomless, typical right upper abdominal pain, jaundice, fever, and vomiting. As old age quite often combined with underlying diseases and atypical symptoms, it is diffi cult to make an exact early diagnosis. Especially when gallstone is passed out or small in size, in other words, if diffi cult to be identifi ed by radiology, it is also diffi cult to fi nd causes of pain despite repeated testing. A 66-year-old man was rushed to the emergency room due to severe chest pain with labored respiration and treated with medication under the diagnosis as cardiomyopathy with unclear causative factors. Abdominal ultrasound and liver function test observed no clear abnormal findings. After then, he repeated being hospitalized and discharged from the hospital for the same symptoms and when he visited the emergency room the third time, cholelithiasis was identifi ed as cause of recurrent stress induced cardiomyopathy. All of his symptoms improved after remov- ing common bile duct stone with endoscopic retrograde cholangiopancreatography and later did not recur. Thus, when diagnosing elderly patients for chest pain, careful approach is required in various ways and if symptoms are repeated, it is necessary to take appropriate examinations of accurate cause even after treatment and suspect continuously. In particular, considering that progression of cholelithiasis might be the causative factor of recurrent stress induced cardiomyopathy will be of great help for exact differential diagnosis.
PS 0251 Gastroenterology
Clinical Signifi cance of The Neutrophil-Lymphocyte Ratio (NLR) as an Early Predictive Marker for Adverse Outcomes in Patients with Acute Pancreatitis
Mi Jin RYU1, Ji Young PARK1, Tae Joo JEON1, Seung Suk BAEK1, Tae Hwan HA1, Ye Na CHOI1, Won Chang SHIN1
Inje University Sanggye Paik Hospital, Korea1
Background: The neutrophil-lymphocyte ratio (NLR) is known as a predictive marker for poor outcomes in diverse benign and malignant diseases. The aim of this study was to investigate the prognostic value of the NLR in patients with acute pancreatitis and to determine an optimal cut-off value for the prediction of adverse outcomes of acute pancreatitis.
Methods: We retrospectively analyzed 490 patients with acute pancreatitis diagnosed at Sanggye Paik hospital between March 2007 and December 2012. NLRs were calcu- lated at admission, and at 24, 48, and 72 hours after admission. Patients were divided into groups according to the severity of acute pancreatitis and occurrence of organ failure, and a comparative analysis was performed to assess difference in the NLR be- tween groups.
Results: Among the 490 patients, 70 were in the severe acute pancreatitis group with 31 patients experiencing organ failure. The NLR in the severe acute pancreatitis group was signifi cantly higher than that in the mild acute pancreatitis group on all 4 days (median, 6.14, 6.71, 5.70, and 4.00 vs. 4.74, 4.47, 3.20, and 3.30, respectively, P <0.05).
The NLR in the group with organ failure was significantly higher than that in the group without organ failure on all 4 days (median, 7.09, 6.72, 6.27, and 6.24 vs. 4.85, 4.49, 3.35, and 2.34, respectively, P <0.05). The optimal cut-off values of the baseline NLR from the ROC curves were 4.76 in predicting severity and 4.88 in predicting organ failure in acute pancreatitis.
Conclusions: An elevated baseline NLR is correlated with the manifestation of severe acute pancreatitis and organ failure.
PS 0252 Gastroenterology
CBD Obstruction Due to a Large Stone at the Duodenal Stump
Jae Kyoung SHIN1, Bohye KIM1, Sodam HONG1, Hui Kyong KIM1, Sae Ahm KIM1, Sung Hoon CHOI2, Kwang Hyun KO3
General Internal Medicine, Cha Bundang Medical Center, Korea1, Division of Hepatobiliary and Pancreas, Department of Surgery, Cha Bundang Medical Center, Korea2, Digestive Disease Center, Cha Bundang Medical Center, Korea3
Enterolith is a rare complication of Billroth II gastrectomy, and most cases of entero- liths have been reported in association with the diverticula, tuberculosis, and Crohn’s disease of small bowel. We report a case of a patient in whom a large enterolith de- veloped in the duodenal stump ensuing CBD obstruction and cholangitis, necessitating surgery. A 77-year-old Asian woman visited a local hospital for poor oral intake, gen- eral weakness and epigastric discomfort. The patient has undergone Billroth II subtotal gastrectomy for stomach cancer 14 years ago. At presentation, physical examination revealed tenderness on epigastric area. Laboratory tests showed an elevated ESR, CRP, procalcitonin and biliary stasis (total bilirubin 1.87mg/dL, AST/ALT: 12/69 IU/L. ALP:
1443IU/L, γ-GTP: 340 U/L). On the abdominal CT showed mild IHD and CBD dilatation upto 12mm due to distal CBD obstruction by compacted a 48mm sized, calcifi ed and large stone at duodenal stump(Fig.1). For decompression, percutaneous transhepatic cholecystostomy catheter was inserted under ultra-sonography and fluoroscopy guidance on the second hospital day. On tubogram in contrast to fi lling defects in gall bladder suggesting GB stone, cystic duct and CBD were patent. However, there was no visible contrast passage to the duodenum. Laparoscopic removal of the enterolith which located in the duodenum, not in the diverticulum was performed on the 9th hospital day (Fig.2). No intestinal obstruction was found during the operation. While the GB stones were black, small and multiple, about a 5cm-sized large brownish stone was found in the duodenum(Fig.3). Without any signifi cant complication, the patient was discharged 11 days after the operation. To the best of our knowledge, this is the fi rst case report of cholangitis occurred directly by a single large stone at a duodenal stump, not secondary to afferent loop obstruction nor by a biliary stone.
