내시경 점막하 박리법으로 치료된 만성 위 호산구성 농양 1예
A Case of Chronic Gastric Eosinophilic Abscess Treated by Endoscopic Submucosal Dissection
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초록
아니사키스증은 아니사키스 유충에 감염된 어류를 생식했을 때 유발되는 기생충 질환이다. 상부 위장관 내시경 소견은 급성기에 점막의 발적과 미란, 궤양, 출혈이며, 만성 위 아니사키스증의 내시경소견은 아니사키스 유충이 점막하층에서 변성되어 호산구성 농양을 형성하여 점막하 종양의 형태를 보인다. 평소 바다회 및 붕장어를 즐겨 먹던 53세 여자가 간헐적인 상복부 동통을 주소로 내원하였다. 상부 위장관 내시경 검사에서 위 전정부에 점막하 종양의 양상을 보이며 내시경 초음파 촬영술에서 비균질한 저에코의 종괴가 점막하층에 관찰되어 병변의 진단 및 치료목적의 내시경 점막하 박리법 및 밴드결찰술을 시행하여 만성 위 아니사키스증에 의한 호산구성 농양으로 진단하였기에 문헌 고찰과 함께 보고하는 바이다.
Abstract
Anisakiasis is a parasitic disease caused by ingestion of raw fish infected with anisakis larvae. The endoscopic features of the gastic mucosa are edema, ulceration and hemorrhage. Chronic gastric anisakiasis forming a submucosal tumor is rare. A 53-year old female was diagnosed with having a 1 cm sized gastric submucosal mass-like lesion by gastroscopy. Endoscopic ultrasonography showed an inhomogenous low echoic tumor with an irregular margin in the submucosal layer. The patient underwent an endoscopic submucosal dissection and band ligation. A serological assay with an enzyme-linked immunosorbent assay for an anisakiasis specific IgG antibody were positive. The pathological finding of the resected mass was centrally denatured larvae with eosinophilic abscess in the submucosal layer. We report a case of chronic gastric anisakiasis that presented as a gastric submucosal tumor that was removed by the endoscopic submucosal dissection method, with a review of the relevant literature. (Korean J Gastrointest Endosc 2007;35:33-37)
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