Chief Complaint FOBT positive Present Illness 61/M, 2011 년 본원 신경과에서 Dysarthria 로 언어장애 4 급 판정이외에 다른 특이병력 없는 자로, 2015 년 7 월 산업의학과에서 시행한 검진상 분변잠혈반응 검사 양성이.

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Presentation transcript:

Chief Complaint FOBT positive Present Illness 61/M, 2011 년 본원 신경과에서 Dysarthria 로 언어장애 4 급 판정이외에 다른 특이병력 없는 자로, 2015 년 7 월 산업의학과에서 시행한 검진상 분변잠혈반응 검사 양성이 확인되어 대장내시경 시행이 의뢰되어 소화기내과 외래 내원함. *2012 년, 2014 년 각각 산업 검진 상부소화기내시경 시행하였으며, Gastritis,GERD, DU 확인됨 Case 백 O 국 (M/61)

Past-medical history DM / HTN / Tb / Hepatitis ( - / - / - / - ) Op Hx (-) Personal history Smoking (+) : 20 Packyears, current Alcohol (+) : Social

Work Up Endoscopy EGD EGD CFS Image study

(S ) A. Colon, transverse, mid, endoscopic mucosal resection: Tubular adenoma with low grade dysplasia with 1) Size: 1.2 x 1.0 x 0.7 cm 2) Negative resection margin (Safety margin: 0.2 cm) B. Colon, sigmoid, colonoscopic biopsy: Tubular adenoma with low grade dysplasia C. Rectum, 10cm from anal verge, polypectomy: Tubular adenoma with low grade dysplasia D. Rectum, 7cm from anal verge, polypectomy: Tubular adenoma with low grade dysplasia

Final Diagnosis Non familial adenomatous polyposis

Chief Complaint Colono cutaneous fistula discharge onset ) 1 month ago Present Illness 50/M, C viral carrier, UC 로 20 여년전부터 상계백병원 OPD f/u 하던 자, 2015 년 2 월 처음으로 Lt.inguinal area 에 mass 가 생겼고, 점점 커지는 양상보여 2 월 상계백병원 GS 입원, excision & pus drainage 후 퇴원하였으나 excision site woozing 지속되어 ~5.8 본원 IG(Prof. 김효종 ) 입원, CT 및 내시 경 시행 후 CD with Colono cutaneous fistula 진단하에 Azathioprine 유지하며 퇴원했던 자로, 최근 1 달간 새롭게 발생한 상기 주소에 대하여 치료 위해 소화 기내과 외래 경유 다시 입원함. Case 최 O 근 (M/50)

Past-medical history DM / HTN / Tb / Hepatitis ( - / + / - / - ) Op Hx (+) : Anal fistulectomy (2005 년, 상계백병원 ) Excision & pus drainage (2015 년 2 월, 상계백병원 ) Personal history Smoking (+) : Current, 10 Packyears Alcohol (+) : Social

Work Up Endoscopy Sigmoidoscopy Sigmoidoscopy, EGD Image study Small Bowel CT Small Bowel CT Small bowel CT

Operation Lap. sigmoid segmental resection

(S ) Colon, 50cm from anal verge, colonoscopic biopsy : Chronic ulcer (S ) Colon, 50cm from anal verge, colonoscopic biopsy A. Colon, sigmoid, colonoscopic biopsy: Chronic inflammation B. Rectum, colonoscopic biopsy: Chronic inflammation

Final Diagnosis Crohn’s disease with Colono-cutaneous fistula

Chief Complaint Colon polyps Present Illness 76/M, DM, HTN, Hepatitis B viral carrier, Cerebral infarction 으로 본원 NR (Prof. 허성혁 ) f/u 하며 medication 시행중이던자. 내원 10 일전 약 1 달 전부터 지속된 RLQ abdominal pain 발생하여 Local IM 에서 시행한 대장내시경상 S colon 에서 heterogenous, ulcerofungating mass 가 발견되어 biopsy 시행후 본원 소화기내과로 의뢰되어 외래 경유 입원한 환자. Case 이 O 상 (M/76) Admission date :

Past-medical history DM / HTN / Tb / Hepatitis ( + / + / - / + ) Op Hx (+) : 과거 좌측 탈장수술 2 회 시행했다고 하나 정확한 시기는 기억못함 ( 성바오로병원 ) Personal history Smoking (+) : 소주 2 병 x 주 7 회 Alcohol (+) : Exsmoker, 12.5 Packyears

Work Up Endoscopy Colonoscopy Sigmoidoscopy & EGD Image study Colon CT Colon CT

(S ) A. Colon, descending, polypectomy: Tubular adenoma with low grade dysplasia B. Colon, sigmoid, colonoscopic biopsy: Tubular adenoma with low grade dysplasia C. Colon, sigmoid, colonoscopic biopsy: Chronic inflammation (S ) Sigmoid colon, sigmoidectomy: Fibrous adhesion with chronic inflammation

Final Diagnosis Colonic tubularadenoma with low grade dysplasia

Chief Complaint Hematochezia onset) 2 weeks ago Present Illness F/56, 20 여년전 치질 수술의 병력이 있으며, Cerebral infarction 으로 manage 받던 환자, 2 주 전부터 abdominal pain, diarrhea 및 hematochezia 발생, 본원 소화기내과 외래 방문후 시행한 EGD/ CFS 검사상 Ascending colon cancer 진 단하에 외래 경유 입원. Case 김 O 자 (F/57) Admission date :

Past-medical history DM / HTN / Tb / Hepatitis ( - / + / - / - ) Op Hx (+) : 20 년전 Hemorrhoidectomy Personal history Smoking (-) Alcohol (-)

Work Up Endoscopy EGD, CSF Image study Colon CT Abdomen general CT

(S ) Colon, ascending, proximal, colonoscopic biopsy: Diffuse large B-cell lymphoma

Final Diagnosis DLBL (Colon)

Chief Complaint Abdominal pain onset) 1 month ago Present Illness M/47, 6 년전 ulcerative colitis 진단받고, mesalazine medication 등 하며 f/u 하며 지내던 환자. 본원 소화기내과 진료를 원하여 외래 통해 further evaluation 위해 입원함. Case 최 O 수 (M/47) Admission date :

Past-medical history DM / HTN / Tb / Hepatitis ( + / - / - / - ) Op Hx (-) Personal history Smoking (-) Alcohol (-)

Work Up Endoscopy CSF Image study Rectum CT

(S ) A. Colon, 75cm from anal verge, colonoscopic biopsy: Chronic inflammation B. Colon, 72cm from anal verge, colonoscopic biopsy: Ulcer with acute and chronic inflammation C. Colon, 38cm from anal verge, colonoscopic biopsy: Chronic inflammation D. Colon, 30cm from anal verge, colonoscopic biopsy: Chronic inflammation (S ) Colon, sigmoid, colonoscopic biopsy: Dysplasia, low grade (History of ulcerative colitis)

Final Diagnosis Ulcerative colitis