1. Soonchunhyang University Chonan Hospital G-I Department 순천향 대학교 천안 병원 소화기내과 이재학, 이석호, 김현준, 정일권, 박상흠, 김선주 CASE PRESENTATION

2. Soonchunhyang University Chonan Hospital G-I Department  Age / Sex : 37 / Male  Chief complaints Epigastric pain for one day ago  Present illness Referred from local-clinic (R/O PUD) CASE PRESENTATION

3. Soonchunhyang University Chonan Hospital G-I Department  Past History DM (-), Hypertension (-), Hepatitis (-) Anxiety disorder (+) : 18 years ago  Social History Alcohol drinking & Cigarette smoking (-/-) Operation and Admission History Admission (+) : Scrub typhus, 1 month ago CASE PRESENTATION

4. Soonchunhyang University Chonan Hospital G-I Department  Review of system General weakness(-), Fatigue(-), Fever(-), Chill(-), Weight loss(-) Epigastic pain (+) : back radiating Nausea (-), Melena (-)  Physical examination Vital sign : stable Tenderness on epigastrium, Others non-specific CASE PRESENTATION

5. Soonchunhyang University Chonan Hospital G-I Department  Laboratory Findings CBC WBC 7,200/mm 3 - Hb 13.7g/dL- Hct 39.0% - PLT 211,000/mm 3 Chemistry Protein 6.1 g/dL, Albumin 3.9 g/dL, T-bil 0.7 mg/dL, GOT/GPT 22/15 U/L, BUN/Cr 10.1/1.0 mg/dL Amylase 427 U/L, Lipase 134 U/L Inflammatory Marker : ESR 11mm/hr Stool exam with stool microscopy (-) CASE PRESENTATION

6. Soonchunhyang University Chonan Hospital G-I Department (I) HAD # 2 EGD (I)

7. Soonchunhyang University Chonan Hospital G-I Department (II) HAD # 2 EGD (II)

8. Soonchunhyang University Chonan Hospital G-I Department HAD # 2 Initial EGD

9. Soonchunhyang University Chonan Hospital G-I Department HAD #3 Abdominal CT scan

10. Soonchunhyang University Chonan Hospital G-I Department HAD # 4 Contrast radiography

11. Soonchunhyang University Chonan Hospital G-I Department Acute pancreatitis due to Intraluminal Duodenal Diverticulum FINAL DIAGNOSIS

12. Soonchunhyang University Chonan Hospital G-I Department Iso-Tome ( isolated-tip sphincterotome ) Isolated-tip Epoxide 1.6 mm semi oval

13. Soonchunhyang University Chonan Hospital G-I Department HAD #7 Endoscopic diverticulotomy

14. Soonchunhyang University Chonan Hospital G-I Department HAD #8 Follow-up EGD

15. Soonchunhyang University Chonan Hospital G-I Department Follow-up Study