Gastric volvulus is a rare surgical disorder in the pediatric population. We experienced a case of gastric volvulus. A 2-year-old boy was admitted to hospital with abdominal distension. An upper gastrointestinal series showed reversal of the greater and lesser curvatures. Surgical exploration revealed an organoaxial volvulus of the stomach, and anterior gastropexy was performed.
Child, Preschool ; Gastropexy ; Humans ; Intestinal Volvulus ; Male ; Stomach ; Stomach Volvulus*

Infantile hypertrophic pyloric stenosis (IHPS) is known to be prevalent in full-term babies, and relatively rare in prematures. The diagnosis of IHPS in premature infants may be obscured because of the lack of classical symptoms and signs and the absence of the standard criteria for ultrasonic diagnosis. The purpose of this study is to discover the clinical differences of IHPS between premature and full-term infants with pyloric stenosis, and to determine the appropriate diagnostic methods for early diagnosis in prematures. The clinical records of 52 IHPS patients who had been operated from October, 1994 to April, 1997 were reviewed. IHPS in premature infants was 25%. The onset of symptom was 4.7 weeks of age in premature, and 2.9 weeks in full-term babies. Diagnosis was established by typical symptoms, signs, and diagnostic imaging studies. In two premature infants, diagnosis was confirmed by upper gastrointestinal (GI) series, because ultrasonography did not meet the diagnostic criteria. Two premature infants diagnosed as gastroesophageal reflux by esophagography initially, were confirmed to have IHPS by upper GI series. For the diagnosis of IHPS, a new set of criteria for premature babies has to be developed.
Diagnosis ; Diagnostic Imaging ; Early Diagnosis ; Gastroesophageal Reflux ; Humans ; Infant* ; Infant, Newborn ; Infant, Premature ; Pyloric Stenosis ; Pyloric Stenosis, Hypertrophic* ; Ultrasonography

Pulmonary sequestration is a complex anomaly involving the pulmonary parenchymal tissue and its vasculature. It presents as a cystic mass of nonfunctional lung tissue without communication with the tracheobronchial system. Usually, it receives blood supply from anomalous systemic vessels. Therefore, preoperative diagnosis of the pulmonary sequestration is difficult, especially when it is located in the abdomen and combined with congenital cystic adenomatoid malformation (CCAM). We encountered such a mass(CCAM type 2) detected prenatally by ultrasonography. It was a kidney bean shaped, pinkish mass straddling the thorax and abdomen on the right side. Because of the sonographic appearance, neuroblastoma was diagnosed preoperatively. The mass was completely extirpated without difficulty.
Abdomen ; Bronchopulmonary Sequestration ; Cystic Adenomatoid Malformation of Lung, Congenital ; Diagnosis ; Lung ; Neuroblastoma ; Phaseolus ; Thorax ; Ultrasonography

This is a case report of a sliding hiatal hernia with severe gastroesophageal reflux (GER) after repair of congenital diaphragmatic hernia(CDH). It was not possible to determine whether the hiatal hernia is a de novo lesion which was missed at the original operation or a consequence of overzealous repair of the Bochdalek defect at the expense of weakening of the diaphragmatic crura. This case demonstrates that a sliding hiatal hernia can be a cause of severe gastroesophageal reflux that should be managed surgically.
Gastroesophageal Reflux ; Hernia ; Hernia, Hiatal ; Hernias, Diaphragmatic, Congenital ; Herniorrhaphy

The aims of this study were to evaluate the prognostic predictabilities of the risk classifications (Waterston, Montreal, and Spitz), preoperative treatment of pneumonia and the length of esophageal gap in esophageal atresia. Twenty-five cases of esophageal atresia were reviewed retrospectively. The data was analyzed with Likelihood ratio test for trend and Fisher's exact test. Survival rates were 100.0% in group A and B, and 60.0% in group C according to Waterston classification (p=0.027). By Montreal classification, 95.7% in group I and 50.0% in group II (p=0.086). By Spitz classification, 95.5% in group I and 66.7% in group II (p=0.159). The survival rate was 85.7% in the patients with pneumonia preoperatively treated and 94.4% in the patients without pneumonia. The difference was not significant (p=0.490). Survival rate in the patients with long gap (> or = 3cm) was 50.0% and 100.0% in patients with short gap (< 3cm) with significant difference (p=0.020). The Waterston classification could be modified into two groups because the prognosis of both group A and B were the same. Preoperative pneumonia does not seem to be a risk factor. The length of the esophageal gap showed prognostic value.
Classification ; Esophageal Atresia* ; Humans ; Pneumonia ; Prognosis* ; Retrospective Studies ; Risk Factors ; Survival Rate ; Tracheoesophageal Fistula

Strokes are responsible for major disability among its survivors, adding immense cost not only in terms of health care, but also in terms of the quality of life. The carotid endarterectomy to prevent strokes is commonly performed in Western countries. But in Asian countries, carotid endarterectomy is not commonly performed even on the symptomatic carotid stenosis patients. 26 male and 5 female patients undergoing carotid endarterectomy due to extracranial carotid stenosis from January 1995 through January 1996 were reviewed. The mean age was 67.2 +/- 6.6 years. 14 cases (45.2%) operated on right side and 17 cases (54.8%) operated on left side. The mean carotid stenosis according to luminal diameter reduction was 81.3 +/- 11.1%. Symptomatic cases, including transient ischemic attack, were 26 cases (83.9%) and five were asymptomatic cases (16.1%). Only two cases did not use carotid shunt during carotid clamping. Eight cases (25.8%) showed an abnormal intraoperative EEG pattern in the carotid shunting group. The average operation time was 173+/-36 minutes. The perioperative mortality was zero. Two postoperatively patients suffered from transient ischemic attack. One patient developed myocardial infarction. Vocal cord palsy developed in three patients. With the Westernization of Korean life style, the incidence of atherosclerosis disease has been on the rise. In this study, we report the experiences of 31 cases of carotid endarterectomy in our institute.
Asian Continental Ancestry Group ; Atherosclerosis ; Carotid Stenosis* ; Constriction ; Constriction, Pathologic ; Delivery of Health Care ; Electroencephalography ; Endarterectomy* ; Endarterectomy, Carotid ; Female ; Humans ; Incidence ; Ischemic Attack, Transient ; Korea* ; Life Style ; Male ; Mortality ; Myocardial Infarction ; Phenobarbital ; Quality of Life ; Stroke ; Survivors ; Vocal Cord Paralysis

Congenital diaphragmatic hernia (CDH) in the past was considered a surgical emergency requiring immediate operation. Several groups now advocate preoperative stabilization and delayed surgery. The treatment strategy for CDH in this institution is delayed surgery after preoperative stabilization. The aim of this study was to evaluate the results of delayed surgery. A retrospective review of 16 neonates with CDH was performed. Surfactant, conventional mechanical ventilation, high frequency oscillation, and nitric oxide were utilized for preoperative stabilization as necessary. The difference in outcome between two groups differentiated by the duration of the preoperative stabilization periods with mechanical ventilation (< or = 8 hours and >8 hours) was determined. Chi-square test was used to analyze the data. There were 7 right-sided hernias and 9 left. The average duration of stabilization was 32.4 hours. Hepatic herniation through the defect was found in 6 cases and all died. The most common postoperative complication was pneumothorax. The mortality rate of the right side hernia was higher than the left (85.7% vs. 33.3%, p=0.036). Mortality rate of the group (N=8) whose preoperative stabilization period was 8 hours or less was better than that (N=6) whose preoperative stabilization period was more than 8 hours (25.0% vs. 83.3%, p=0.031). The overall mortality rate was 56.3%. The better prognosis was noticed in left side hernia, no liver herniation, or shorter preoperative stabilization period.
Emergencies ; Hernia ; Hernia, Diaphragmatic* ; Humans ; Infant, Newborn ; Liver ; Mortality ; Nitric Oxide ; Pneumothorax ; Postoperative Complications ; Prognosis ; Respiration, Artificial ; Retrospective Studies

Early recognition and surgical treatment of Hirschsprung's disease prevents serious mortality and morbidity from enterocolitis and obstruction. Usually this disease is chractrized by a single aganglionic segment of colon extending distally to anal margin. In surgical treatment, the surgeon performs frozen biopsy to confirm whether there are ganglion cells or not. If there are intervening ganglionic area in aganglionic bowel, there are much confusion in diagnosis and treatment. The authors experienced one case of total colonic aganglionosis with skip area. A transverse loop colostomy was made to a 7 day-old male baby with colon perforation due to Hirschsprung's disease. But intestinal obstruction persisted and it took 2 more operations to find out the ture nature of the disease. There were aganglionic segments from anal margin to terminal ileum 3.7cm proximal from ileocecal valve. But the entire transverse colon and appendix were normally ganglionated.
Appendix ; Biopsy ; Colon ; Colon, Transverse ; Colostomy ; Diagnosis ; Enterocolitis ; Ganglion Cysts ; Hirschsprung Disease* ; Humans ; Ileocecal Valve ; Ileum ; Intestinal Obstruction ; Male ; Mortality

PURPOSE: Although urachal anomalies are rarely observed clinically, they often give rise to a number of problems, such as infection and late malignant changes. Because of variable clinical presentations, uniform guidlines for evaluation and treatment are lacking. The authors discuss the problems involved in both the diagnosis and the treatment of these anomalies. METHODS: We retrospectively analyzed 15 patients (9 males and 6 females) who had undergone surgery for urachal anomalies from July 1995 to December 1999. RESULTS: The age distribution ranged from 14 days to 38 years old, and the male to female ratio was 1.5:1. The 4 variants of urachal anomalies included a urachal sinus in 7 patients (47%), a urachal cyst in 4 (27%), a patent urachus in 3 (20%), and a bladder diverticulum in 1 (6%). The presenting complaint was periumbilical discharge in 6 patients, fever in 5, umbilical granuloma in 4, low abdominal mass in 3, and low abdominal pain in 1. Eight combined anomalies were seen in 7 patients; 2 umbilical hernias, 1 inguinal hernia, 1 hydrocele, 1 urachal vessel anomaly, 1 vesicoureteral reflux, 1 hydronephrosis, 1 Hirschsprung's disease, and 1 hypertrophic pyloric stenosis. Ultrasound examination disclosed a cyst or a sinus in 5 patients, and CT was performed in 1 case. Excision was performed in all patients, and there was no postoperative complication or recurrence. CONCLUSION: Urachal anomalies most frequently present in infancy or childhood, and the initial presentation is umbilical discharge with infection. Furthermore, the large number of associated genitourinary and gastrointestinal anomalies suggests that a complete work-up for these conditions should be performed. Definitive surgical excision appears to be appropriate for most patients.
Abdominal Pain ; Adult ; Age Distribution ; Diagnosis ; Diverticulum ; Female ; Fever ; Granuloma ; Hernia, Inguinal ; Hernia, Umbilical ; Hirschsprung Disease ; Humans ; Hydronephrosis ; Male ; Postoperative Complications ; Pyloric Stenosis, Hypertrophic ; Recurrence ; Retrospective Studies ; Ultrasonography ; Urachal Cyst ; Urachus ; Urinary Bladder ; Vesico-Ureteral Reflux

PURPOSE: Although urachal anomalies are rarely observed clinically, they often give rise to a number of problems, such as infection and late malignant changes. Because of variable clinical presentations, uniform guidlines for evaluation and treatment are lacking. The authors discuss the problems involved in both the diagnosis and the treatment of these anomalies. METHODS: We retrospectively analyzed 15 patients (9 males and 6 females) who had undergone surgery for urachal anomalies from July 1995 to December 1999. RESULTS: The age distribution ranged from 14 days to 38 years old, and the male to female ratio was 1.5:1. The 4 variants of urachal anomalies included a urachal sinus in 7 patients (47%), a urachal cyst in 4 (27%), a patent urachus in 3 (20%), and a bladder diverticulum in 1 (6%). The presenting complaint was periumbilical discharge in 6 patients, fever in 5, umbilical granuloma in 4, low abdominal mass in 3, and low abdominal pain in 1. Eight combined anomalies were seen in 7 patients; 2 umbilical hernias, 1 inguinal hernia, 1 hydrocele, 1 urachal vessel anomaly, 1 vesicoureteral reflux, 1 hydronephrosis, 1 Hirschsprung's disease, and 1 hypertrophic pyloric stenosis. Ultrasound examination disclosed a cyst or a sinus in 5 patients, and CT was performed in 1 case. Excision was performed in all patients, and there was no postoperative complication or recurrence. CONCLUSION: Urachal anomalies most frequently present in infancy or childhood, and the initial presentation is umbilical discharge with infection. Furthermore, the large number of associated genitourinary and gastrointestinal anomalies suggests that a complete work-up for these conditions should be performed. Definitive surgical excision appears to be appropriate for most patients.
Abdominal Pain ; Adult ; Age Distribution ; Diagnosis ; Diverticulum ; Female ; Fever ; Granuloma ; Hernia, Inguinal ; Hernia, Umbilical ; Hirschsprung Disease ; Humans ; Hydronephrosis ; Male ; Postoperative Complications ; Pyloric Stenosis, Hypertrophic ; Recurrence ; Retrospective Studies ; Ultrasonography ; Urachal Cyst ; Urachus ; Urinary Bladder ; Vesico-Ureteral Reflux