Chronic pancreatitis is a rare problem in childhood and sometimes shows pancreatic calcification. The most common symptom is recurrent upper abdominal pain with or without associated nausea or vomiting. Pancreatic calcifications are virtually pathognomonic of chronic pancreatitis. In our case, however, chronic pancreatitis caused by multiple pancreatic stones in dilated pancreatic duct, which was very rare in childhood. Endoscopic retrograde cholangiopancreaticography (ERCP) is valuable in confirming the diagnosis and decision making process for further medical or surgical management of pancreatic disease. We experienced a case of chronic relapsing pancreatitis with pancreatic stones in 13-year-old girl who presented with recurrent upper abdominal pain. She was investigated with ERCP and treated by endoscopic sphincterotomy of sphincter of Oddi and by some stone removal with endoscopic basket. We report this case and review related literatures briefly.
Abdominal Pain ; Adolescent ; Cholangiopancreatography, Endoscopic Retrograde ; Decision Making ; Diagnosis ; Female ; Humans ; Nausea ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatitis* ; Pancreatitis, Chronic ; Sphincter of Oddi ; Sphincterotomy, Endoscopic ; Vomiting

Methylmalonic acidemia is a rare congenital autosomal recessive metabolic disease. It is caused by blocking in the pathways of isoleucine, valine, threonine, methionine, cholesterol and odd-chain fatty acids to succinyl CoA, resulting in the increase of L-methylmalonyl CoA and methylmalonic acid. In most cases, there are symptoms such as recurrent vomitings, lethargy and laboratory abnormalities including metabolic acidosis and hyperammonemia from the neonatal period. We had a 6-month-old infant with methylmalonyl acidemia who presented with recurrent vomiting episodes since 3 months of age, failure to thrive and developmental delay. The laboratory findings showed hyperammoninemia and ketotic metabolic acidosis. Plasma amino acid analysis showed nonspecific finding. Urine organic acid ananysis by gas chromatography and mass spectrometry detected large amount of methylmalonic acid excreted in the urine. We restrained the supply of protein in the amount of 1~1.5 g/kg of body weight a day using leucine, isoleucine and valine-r-estrained milk and administered vitamine B12, in the amount of 1mg per day. During the follow-up in the outpatient clinic, He could control his head and showed increased muscle strength.
Acidosis ; Ambulatory Care Facilities ; Body Weight ; Cholesterol ; Chromatography, Gas ; Failure to Thrive ; Fatty Acids ; Follow-Up Studies ; Head ; Humans ; Hyperammonemia ; Infant* ; Isoleucine ; Lethargy ; Leucine ; Mass Spectrometry ; Metabolic Diseases ; Methionine ; Methylmalonic Acid ; Milk ; Muscle Strength ; Plasma ; Threonine ; Valine ; Vitamins ; Vomiting

In most cases, acute diarrhea in childhood heals spontaneously, but it may become the form of chronic diarrhea in immunodeficient children and then cause weight loss, dehydration, malabsorption and malnutrition. The immunodeficient diseases associated with chronic diarrhea include severe combined immunodeficiency syndrome, common variable immunodeficiency, acquired immunodeficiency syndrome, agammaglobulinemia or selective IgA deficiency. IgA deficiency is the most common primary immunodeficiency. Because many IgA deficient individuals seem to have compensated for their deficiency with increased IgM production and various nonimmunologic factors, the incidence of gastrointestinal involvement is not prominent. Some of those with IgA deficiency and recurrent infections have been found to also have IgG subclass deficiency. IgA deficiency with IgG2 and IgG4 subclass deficiency have high susceptability to infection and chronic diarrhea. IgG subclass deficiency, when present, is more likely to be found in association with a partial IgA deficiency rather than complete IgA deficiency. We report a 3-month-old male with intractable diarrhea accompanied by IgA, IgG2, and IgG4 deficiency.
Acquired Immunodeficiency Syndrome ; Agammaglobulinemia ; Child ; Common Variable Immunodeficiency ; Dehydration ; Diarrhea* ; Humans ; IgA Deficiency ; Immunoglobulin A* ; Immunoglobulin G* ; Immunoglobulin M ; Incidence ; Infant ; Male ; Malnutrition ; Severe Combined Immunodeficiency ; Weight Loss

Food allergy is a disease caused by an abnormal immunological reaction to specific food proteins. Whole milk and soy beans are the most frequent causes of food allergy, some studies show that 2.2~2.8% of children aged between 1 and 2 year are allergic to milk. It can be classified to acute (urticaria, asthma, anaphylaxis) or chronic (diarrhea, atopic dermatitis) allergy according to clinical symptoms, or to IgE related or non IgE related allergy by an immunological aspect. Generally, allergies invading only the GI tract are mostly due to a non IgE related reaction. These hypersensitive, immunologic reactions of the GI tract, not related to specific IgE for food, present themselves in many ways such as food protein-induced enteropathy, food protein-induced enterocolitis syndrome (FPIES), celiac disease, food induced protocolitis, or allergic eosinophillic gastroenteritis. FPIES is one kind of non IgE related allergic reaction and is manifested as severe vomiting and diarrhea in infants between 1 week and 3 months. We report a case of FPIES in a 40-day old male infant presenting with 3 times of repeated events of watery diarrhea after cow's milk feeding.
Asthma ; Celiac Disease ; Child ; Diarrhea ; Enterocolitis* ; Eosinophils ; Food Hypersensitivity ; Gastroenteritis ; Gastrointestinal Tract ; Humans ; Hypersensitivity ; Immunoglobulin E ; Infant ; Male ; Milk Proteins* ; Milk* ; Soybeans ; Vomiting

Kawasaki Disease, an acute systemic vasculitis of unknown etiology, is the leading cause of acquired heart disease in children in many parts of the world. It predominantly affects children under 5 years of age and has many clinical symptoms. We experienced a case of gas forming enterocolitis associated with Kawasaki Disease. Aeromonas hydrophilia was isolated from her stool culture. So,we report the case with a brief review of its literature.
Aeromonas ; Child ; Enterocolitis* ; Heart Diseases ; Humans ; Mucocutaneous Lymph Node Syndrome* ; Systemic Vasculitis

Gastrointestinal involvement occurs in two thirds of children with Henoch-Schonlein purpura (HSP) and intussusception is by far the most common abdominal complication. Intussusception in HSP almost originates in the small bowel, which is in contrast with idiopathic intussusception. Earlier diagnosis and prompt treatment of intra-abdominal complications can reduce the mortality and ultrasound is the imaging modality of choice in evaluation the bowel manifestations of HSP. We report a case of jejuno-jejunal intussusception associated with HSP in a 5-year-old boy who presented with diffuse abdominal pain and vomiting after a few days of HSP onset. Abdominal ultrasound demonstrated intussusception in the jejunum with well defined target appearance because of the thickened intussusceptum, which disappeared on the computerized tomographic examination checked approximately 24 hours later. A brief review of literature was made.
Abdominal Pain ; Child ; Child, Preschool ; Diagnosis ; Humans ; Intussusception* ; Jejunum ; Male ; Mortality ; Purpura, Schoenlein-Henoch* ; Ultrasonography ; Vomiting

Esophageal duplication cysts are quite uncommon benign lesions of the esophagus that have previously been described as occurring only in the thoracic cavity. We experienced a rare case of completely intra-abdominal esophageal duplication cyst in a 10-year-old boy who has suffered from epigastric abdominal pain. Surgical excision is recommended at the time of cyst discovery whether symptoms present or not.
Abdominal Pain ; Child ; Esophagus ; Humans ; Male ; Thoracic Cavity

Achalasia is a rare motor disorder of the esophageal smooth muscle in which the lower esophageal sphincter dose not relax properly with swallowing, and the normal peristalsis of the esophageal body is replaced by abnormal contractions. Achalasia has been described as party of several distinct multisystem syndromes suggesting a generalized neuromuscular disorder as the mode of origin. An 11-year-old female was admitted because of paresthesia on the trunk and both legs for 5 days. She had suffered from chest discomfort, dysphagia, postprandial vomiting, and weight loss for 6 months. She was diagnosed as having achalasia by means of the esophagography and esophageal manometry. Her chest discomfort, dysphagia and vomiting much improved after the endoscopic balloon dilatation. The authors present an 11-year-old female with achalasia complained of paresthesia and sucessfully managed by the balloon dilatation.
Child ; Deglutition ; Deglutition Disorders ; Dilatation ; Esophageal Achalasia* ; Esophageal Sphincter, Lower ; Female ; Humans ; Leg ; Manometry ; Muscle, Smooth ; Neurologic Manifestations* ; Paresthesia ; Peristalsis ; Thorax ; Vomiting ; Weight Loss

In case of Wilson's disease complicated with hemolytic anemia and fulminant hepatic failure; plasma exchange or liver transplantation should be considered. We report an 11 year-old male with fulminant Wilson's disease who developed hemolytic crisis. He was recovered by exchange transfusion after 6 times of plasma exchange.
Anemia, Hemolytic ; Child* ; Hepatolenticular Degeneration* ; Humans ; Liver Failure, Acute ; Liver Transplantation ; Male ; Plasma Exchange

Antireflux surgery has been indicated in gastroesophageal reflux disease (GERD) that does not respond to medical treatments. Although the most commonly performed operation is Nissen fundoplication, Belsey Mark IV fundoplication is indicated for more complicated cases, such as, in cases of a failed Nissen operation or a long lasting hiatal hernia. Here, we report a case of Belsey Mark IV fundoplication for a failed Nissen fundoplication. The infant developed frequent times of aspiration pneumonia after initial Nissen for a hiatal hernia with GERD during the newborn period. At 15 months of age, a 2nd Nissen operation was attempted, but fundoplication was not available because of excessive mesenteric adherence to the liver and cardia. Therefore, Belsey Mark IV fundoplication was performed via trans-thoracic approach, which can provide full esophageal mobilization and better visualization of the herniated fundus and the surrounding tissues. Subsequently, she has shown an improved general condition without GERD.
Cardia ; Fundoplication* ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Infant ; Infant, Newborn ; Liver ; Pneumonia, Aspiration