Chief Complaint Abdominal distension o/s) 내원 2 주전 Present Illness 52/F, 2014 년 9 월 Crohn's disease 진단받고 F/U 중인 자, 외래에서 Adalimumab(last : ) 복용 후 abdominal distension, fever 지속되어 외래 경유 입원함 *IFN-r positive check 되어 소화기내과 외래에서 2015 년 1~4 월까지 Isoniazid 300mg qd 복용함. Case 이 O 자 (F/52) Admission date :

Past-medical history DM / HTN / Tb / Hepatitis ( - / - / - / - ) Op Hx (+) : C-sec (1985) Personal history Alcohol(-) Smoking(-)

Work Up Endoscopy CFS CFS Image study Abdomen CT Abdomen CT Enterography Colon CT Small Bowel CT AP-CT

S Gross Description : Submitted for EXPRESS are 4 parts. The first and second parts are 7 and 6 discs of gray white mucosal tissue, totally embedded in 1 and 2, respectively. The third part is a 0.3x0.3x0.2-cm gray white mucosal tissue, totally embedded in 3. The fourth part is 6 discs of gray white mucosal tissue, totally embedded in 4. (PJY) Micro : Section from the ileal mucosa (A) shows ulceration, distorted cryptal architecture, patchy infiltration of acute and chronic inflammatory cells and non-caseating granulomas. Section from the colonic mucosa (B) shows ulceration, distorted cryptal architecture, patchy infiltration of acute and chronic inflammatory cells and non-caseating granulomas. Correlated with clinicopathologic findings, this case is consistent with Crohn's disease. Sections from the rectal mucosa (C) show tubular adenomatous proliferations with low grade dysplasia. Section from the rectal (D) mucosa shows hyperplastic polyp. Diagnosis : A. Terminal ileum, colonoscopic biopsy: Ulceration and chronic granulomatous inflammation B. Colon, ascending, proximal, colonoscopic biopsy: Ulceration and chronic granulomatous inflammation C. Rectum, polypectomy: Tubular adenoma with low grade dysplasia D. Rectum, colonoscopic biopsy: Hyperplastic polyp

Diagnosis 1. TB peritonitis 2. Crohn’s disease

Chief Complaint Abdominal pain onset) 2 일전 Present Illness 15/M 2012 년 Crohn’s disease 진단받고 외과에서 ileocecectomy 수술 받은 환자로 외래 경과 관찰하던 중 내원 2 일전부터 abdominal pain, vomiting, fever, chill 있어 외래 경유 입원함 Case 장 O 빈 (M/15) Admission date :

Past-medical history DM / HTN / Tb / Hepatitis ( - / - / - / - ) Crohn’s disease Malignancy Hx (-) Op Hx (+): Op Hx(+) : ileocecectomy ( ) Personal history Smoking (-) / Alcohol (-)

Work Up Endoscopy CFS Image study Retum & sigmoid MR, Small Bowel CT Abdomen CT ( 외부 ) Colon CT Small bowel CT Small bowel CT

S Gross Description : Submitted for EXPRESS are 4 parts. The first and second parts are 7 and 6 discs of gray white mucosal tissue, totally embedded in 1 and 2, respectively. The third part is a 0.3x0.3x0.2-cm gray white mucosal tissue, totally embedded in 3. The fourth part is 6 discs of gray white mucosal tissue, totally embedded in 4. (PJY) Micro : Section from the ileal mucosa (A) shows ulceration, distorted cryptal architecture, patchy infiltration of acute and chronic inflammatory cells and non-caseating granulomas. Section from the colonic mucosa (B) shows ulceration, distorted cryptal architecture, patchy infiltration of acute and chronic inflammatory cells and non-caseating granulomas. Correlated with clinicopathologic findings, this case is consistent with Crohn's disease. Sections from the rectal mucosa (C) show tubular adenomatous proliferations with low grade dysplasia. Section from the rectal (D) mucosa shows hyperplastic polyp. Diagnosis : A. Terminal ileum, colonoscopic biopsy: Ulceration and chronic granulomatous inflammation B. Colon, ascending, proximal, colonoscopic biopsy: Ulceration and chronic granulomatous inflammation C. Rectum, polypectomy: Tubular adenoma with low grade dysplasia D. Rectum, colonoscopic biopsy: Hyperplastic polyp

Final Diagnosis Crohn’s disease s/p ileocecectomy

Chief Complaint Colono-cutaneous fistula at sigmoid colon Present Illness 49/M, Chronic hepatitis C, UC 로 20 여년전부터 상계백병원 OPD f/u 중인 자, 월부터 Lt.inguinal area 에 mass 생겼고, 점점 커지는 양상보여 2 월 중순 상계백병 원 GS 입원, excision & pus drainage 후 퇴원하였으나 이후 excision site 로 woozing( 환자 표현에 의하면 김가루, 고춧가루 4~5 일에 한번씩 관찰된다고 함 ) 지 속되어 ~5.8 입원, CT 및 위대장내시경 시행 후 퇴원했던 자로, 상기 주소 에 대하여 항생제 치료 위해 소화기내과 외래 경유 입원함 Case 최 O 근 (M/50) Admission date :

Past-medical history DM / HTN / Tb / Hepatitis ( - / - / - / + ) Malignancy history (-) Op Hx(+) : L3-4 spine op Personal history Alcohol(+) : 주 2 회 소주 2 병 / Smoking(+) : 0.7 갑 * 20 년 = 14 PY

Work Up Endoscopy Sigmoidoscopy Sigmoidoscopy & EGD Image study Small bowel CT

5/25 5/28 6/1 6/6

S Gross Description : Specimen received fresh is a product of ileocecectomy, consisting of ileum (18.0x5.0 cm), cecum (5.0x3.0 cm) and appendix (5.0x0.5 cm). Serosal surface of ileum shows diffuse white exudation. The small segment of ileum is narrowed by inflammatory fibrosis. Mucosal surface of ileum shows diffuse polypoid appearance with red/brown discoloration. Mucosal surface of cecum is unremarkable. Appendix is also unremarkable. Cut surface shows white fibrotic appearance throughout the entire bowel wall. Partially embedded in 1 to 8. (NKY) Ileum in 1 to 6. Cecum in 7. Appendix in 8. Micro : Section from the ileum shows patchy transmural inflammation with many lymphoid aggregation. Several large granulomas with necrosis are identified within inflammatory foci. Appendix and cecum are unremarkable. Diagnosis : Ileum, cecum and appendix, ileocecectomy: Chronic granulomatous inflammation with necrosis, consistent with tuberculosis Immunohistochemical finding (S , 6): A.F.B (-)

Final Diagnosis #1. Colono-cutaneous fistula tracts formations at sigmoid colon #2. Crohn's disease #3. Chronic hepatitis C

Chief Complaint 신경내분비종양 이래요 Present Illness 40/M 특이병력없는 환자로 타병원에서 시행한 Colonoscopy 에서 Neuroendocrine tumor 진단되어 f/e 및 management 위해 의뢰됨 Case 김 O 홍 (M/40) Admission date :

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

Work Up Endoscopy CFS Image study Retum CT

Final Diagnosis Neuroendocrine tumor, Retum