내시경 집담회 증례 서울아산병원 소화기내과 이태윤
F/57 Chief Complaint Postprandial vomiting onset: 1month ago
Present Illness 상기 환자는 내원 3개월 전 복통이 있어 본원 내원하 였고 prepyloric antrum greater curvature side의 AGC 와 peritoneal carcinomatosis, multiple bone metastasis로 진단받고 tegafur-cisplatin chemo- therapy를 2회 시행받고 RT를 시행받음. 내원 1개월 전부터 식사 후 vomiting 발생하여 시행한 CT상 gastric outlet obstruction이 의심되어 further evaluation 및 treatment 위해 입원함
Review of System Past medical history ; No history of HTN, DM, tuberculosis, hepatitis Social History ; Smoking (-) Alcohol (-) Family History; NS Review of System G-I: A/N/V (+/+/+)
Physical Examination V/S: 36.0℃ - 105/min - 18/min – 105/82mmHg General: chronically ill-looking appearance Abdomen: soft and flat normoactive bowel sound no direct or rebound tenderness not palpable liver / spleen / kidney
Initial Laboratory Data CBC 11,000/mm3 - 11.1 g/dl – 246 X 103/mm3 BUN/Cr 44 / 1.7 mg/dL glucose 81 mg/dL AST / ALT 69 / 44 IU/L ALP / r-GT 698 / 146 IU/L total / direct bilirubin 2.5 / 0.7 mg/dL protein / albumin 5.3 / 3.1 g/dL Na/K/Cl/CO2 126/1.8/49/65.7 mmol/L PT 81.6%
Initial Assessment & Plan #1 AGC with peritoneal carcinomatosis, multiple bone metastasis #2 Gastric outlet obstruction due to #1 Assessment 1. gastric outlet obstruction due to disease progression 2. Jaundice due to metastatic lymphadenopathy Plan 1. Imaging study (CT, UGI) 2. duodenal stent
Abdomen CT (before admission)
Gastroscopy on HD#1
UGI on HD #2
Duodenal stent on HD #3
HD#10 환자가 epigastric distension을 호소함
Simple abdomen on HD#10
Second Duodenal Stent Insertion
UGI after Stent Insertion