Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization.

Gas gangrene, a subset of necrotizing myositis, is a bacterial infection that produces gas in tissues in gangrene. It is usually caused by Clostridium species, most commonly Clostridium perfringens. Streptococcus anginosus is a rare cause of gas gangrene, with very few cases reported. We report a rare case of traumatic gas gangrene caused by S. anginosus in a 57-year-old female with diabetes after being stabbed with scissors. (Korean J Med 2016;90:173-176) 서 론 가스 괴저는 세균이 감염되면서 근육이 괴사되고, 근육 내에 가스가 형성되는 전신 감염 질환이다. 주요 원인은 Clostridium species와 같은 혐기성 균으로, 외상이나 수술 후에 흔히 발 생하는 것으로 알려져 있다. 혐기성 균주 중에서 Clostridium perfrigens가 가장 흔한 원인 균이지만, 그 외에도 Clostridium novyi, Clostridium septicum, Clostridium ramnosum 등이 보고 되고 있다[1]. 그 외의 원인 균으로는 Klebsiella pneumoniae나 Escherichia coli와 같은 Enterobacteriacae 균주가 드물게 보고 되었다. Streptococcus anginosus는 viridans streptococci의 일종으로 구강과 위장관, 호흡기, 비뇨생식기의 상재균인데, 감염이 될 경우에는 연부조직 감염을 잘 일으키는 것으로 알려져 있다[2]. 그러나 S. anginosus에 의한 가스 괴저는 매우 드문 질환으로 문헌 검색을 했을 때, 국외에서 3예가 보고되었다[3-5]. 이에 저자들은 당뇨를 가진 환자에서 가위에 찔린 상처를 통해 감염된 S. anginosus에 의한 오른쪽 다리의 가스 괴저 사 례를 경험하여서 문헌고찰과 함께 보고하는 바이다. 증 례 환 자: 57세 여자 주호소: 오른쪽 무릎 통증과 부종

Brunner's gland adenoma is a rare benign small bowel neoplasm and it represents 10% of small bowel benign tumor. Most of adenoma manifest as polypoidal, multiple and size does not exceed 1 cm and mostly asymptomatic, but the lesion larger than 1 ㎝ is solitary and can cause bleeding, obstruction, intussusception and there are some reports of showing malignant transformation. Until the present, there are two cases of over 8㎝ huge Brunner's gland adenoma in Korea and each of their chief complaint was abdominal discomfort and melena, but there is no case report of over 8 ㎝ Brunner's gland adenoma accompanied with acute bleeding as seen in this case. We diagnosed an 8 ㎝ sized, huge duodenal Brunner's gland adenoma which accompanied with acute bleeding and treated it by endoscopic resection using an IT-knife, successfully.

Endoscopic retrograde cholangiopancreatography (ERCP)-related complications should be promptly and properly managed in accordance with the type and severity of the complication and the comorbidity of the patient. Neurologic complications occur very rarely, but despite of the prompt management, the patient status can severely deteriorate and sometimes result in fatality. A female patient visited SAM Medical Center for abdominal pain and yellow skin. She has taken a current medication for essential hypertension since 10 years ago. Initial laboratory findings showed obstructive jaundice and abdominal computed tomography (CT) showed two common bile duct stones with moderate dilation of bile duct. Her vital sign with oxygen saturation was stable until the first attack of seizure 12 hours later after removal of stones through the ERCP. Emergent brain CT and magnetic resonance imaging revealed multiple cerebral infarctions of both hemispheres with right predominance of middle cerebral artery territory and no evidence of air emboli. She died four days later despite of intensive care including high oxygen therapy and intravenous broad spectrum antibiotics with antiplatelet drug. We report a rare, delayed occurrence of a fatal multiple cerebral infarctions 12 hours after ERCP.