, Sun Young Yi, Sung Ae Jung, Kwon Yoo Magnetic resonance cholangiography(MRC) has emerged as an accurate and noninvasive modality for the evaluation of the biliary diseases. We performed this study to access the accuracy and efficacy of MRC for the diagnosis of obstructive biliary diseases.
From March 1999 to September 2000, 87 patients with obstructive biliary diseases(24 malignant cancers, 55 cholelithiasis, 8 other obstructive biliary diseases) underwent MRC.
MRC correctly revealed the obstructing biliary lesions and the cause of obstructions in 100% and 92% of the cases of malignancy respectively. The sensitivity and specificity of MRC were 94%, and 82% for extrahepatic bile duct stones, 94%, 100% for intrahepatic bile duct stones, and 84%, 100% for gallbladder stones retrospectively. In the other cause of biliary obstructions(3 benign biliary stricture, 2 acalculous cholecystitis, 2 xanthogranulomatous cho-lecystitis, and 1 extrinsic compression due to lymphadenopathy), MRC correctly showed the level of obstructions in all patients. But, MRC could not diagnose accurate causes of the obstruction except 3 patients(1 acalculous cholecystitis, 1 xanthogranulomatous cholecystitis, and 1 extrinsic compression due to lymphadenopathy).
This study demonstrated that MRC was able to accurately identify the level and the cause of biliary obstructions in both malignancy and cholelithiasis. MRC was easily performed for a short duration and was a noninvasive diagnostic modality for assessing the biliary tree. Therefore, MRC was very efficacious clinically for the diagnosis of obstructive biliary diseases.
, Sun Young Yi, Naranhi Lee, Jung Eun Shin, Misoon Ju, Sung Ae Jung, Ho-Seong Han, Kwon Yu A case of massive intestinal bleeding from jejunal diverticulum is describe. A 62-year-old man was refered to our hospital because of melena and anemia. After admission, he showed massive hematochezia with unstable vital sign. Esophagogastroduodenocopy and colonoscopy, selective abdominal angiography, and RBC bleeding scanning were performed to seek the cause of the intestinal bleeding, but none of these studies revealed the source of bleeding. The examination of small bowel with methylcellulose showed multiple small jejunal diverticuli and a large diverticulum. Resection of the involved portion of jejunum was performed. On pathological examination, two mucosal loss lesions were detected, but ulcer or arteriovenous malformation were not seen in the resected jejunal diverticulum. The patient showed no more intestinal bleeding after operation. Although jejunal diverticuli are rare, the careful search for this complication in a patient with intestinal bleding is important.
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