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[Case: PEG in a patient with esophageal stent]

ÁøÇ༺ ½Äµµ¾ÏÀ¸·Î esophageal obstruction°ú tracheo-esophageal fistula°¡ À־ covered stent¸¦ ³ÖÀº ȯÀÚÀÔ´Ï´Ù. Stent ½Ã¼ú ÈÄ¿¡µµ Áö¼ÓÀûÀÎ aspirationÀÌ À־ °æ±¸ ½ÄÀ̼·Ãë°¡ ¾î·Æ´Ù°í ÆǴܵǾî PEG »ðÀÔÀÌ ÀǷڵǾú½À´Ï´Ù. Stent·Î ÀÎÇÏ¿© ½Äµµ°¡ ÃæºÐÈ÷ ³Ð¾îÁöÁö ¾Ê¾Ò´Ù¸é PEG tube°¡ ½Äµµ¸¦ Åë°úÇÏÁö ¸øÇÒ °¡´É¼ºÀÌ ÀÖ´Â »óȲÀ̾ú½À´Ï´Ù. ±×·¯³ª ´ÙÇེ·´°Ôµµ 9.2 mm ¿Ü°æÀÇ ³»½Ã°æÀÌ ÀúÇ×¾øÀÌ ½Äµµ¸¦ Åë°úÇÒ ¼ö À־ Åë»óÀûÀÎ ¹æ¹ýÀ¸·Î PEG ½Ã¼úÀÌ °¡´ÉÇÏ¿´½À´Ï´Ù.

½Äµµ stent¿¡ dirty whiteÇÑ exudate°¡ ÀÖ¾ú°í ÀÌ ºÎÀ§¸¦ tube°¡ Åë°úµÇ¾ú±â ¶§¹®¿¡ PEG tubeÀÇ contamination Á¤µµ´Â Åë»óº¸´Ù ³ôÀ» ¼ö ¹Û¿¡ ¾ø´Ù°í ÆǴܵǾî ÃÖ´ëÇÑ ¼Òµ¶À» ÇÏ¿´°í 1-2ÀÏ Á¤µµÀÇ IV Ç×»ýÁ¦ »ç¿ëÀ» ±ÇÇÏ¿´½À´Ï´Ù.


[amebic colitis]

Internet¿¡¼­ °¡Á®¿Â ÀÚ·á·Î ±â¾ïµÇ´Âµ¥ ÇöÀç reference¸¦ Á¤È®È÷ ¾Ë ¼ö ¾ø½À´Ï´Ù (ÀúÀÛ±ÇÀÚ¿¡°Ô ¾çÇظ¦ ±¸ÇÕ´Ï´Ù). Áø´ÜÀº amebic colitisÀÔ´Ï´Ù. Inflammatory bowel diseaseÀÇ °¨º°Áø´Ü¿¡ ²À µé¾î°¡´Â ±â»ýÃæ ÁúȯÀÔ´Ï´Ù. ¾ÆÁ÷±îÁö Á¦°¡ Á÷Á¢ Áø´Ü³»¸° ¿¹´Â ¾øÁö¸¸ Áß¿äÇÑ º´ ÁßÀÇ Çϳª·Î »ý°¢µÇ¹Ç·Î ¼Ò°³ÇÕ´Ï´Ù.

ÀÌ·± °æ¿ì´Â Ginsberg ³»½Ã°æÃ¥ÀÇ ÀϺθ¦ ¿Å±â´Â °ÍÀÌ °¡Àå Ÿ´çÇÒ °Í °°½À´Ï´Ù (page 322). ³»½Ã°æÀûÀ¸·Î´Â flask-shaped ulcer¸¦ ¸¸µå´Â °ÍÀ¸·Î ¾Ë·ÁÁ® ÀÖÁö¸¸ ¾Æ·¡ ¼³¸í¿¡ ÀÖµíÀÌ »ç½Ç flask shaped ulcer¸¦ º¸ÀÌ´Â °æ¿ì´Â ¾ø´Â °Í °°½À´Ï´Ù. Exudate°¡ ¸¹Àº multiple dirty ulcers·Î °üÂûµÇ´Â °æ¿ì°¡ ´ëºÎºÐÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.

"Amebic colitis is a protozoan infection that primarily affects the large bowel. It is most often seen in patients who recently immigrated from developing countries and who recently traveled to developing countries. Symptoms can vary from none to explosive diarrhea, tenesmus, fever and abdominal cramps.

Colonoscopic appearance during the acute phase resembles ulcerative colitis, but in the chronic phase it appears more like Crohn¡¯s disease. The most common segments involved are the cecum and right colon, with the rectum and sigmoid less often involved. Toxic megacolon may develop in severe cases of amebiasis.

Colonoscopy reveals granular, friable, and erythematous mucosa with discrete large ulcers covered by yellowish, mucopurulent exudates. Biopsies of the margins of the ulcers provide a 60% to 90% yield of trophozoites to make the diagnosis."