Reduction of intussusception using air or oxygen has wide acceptance as an alternative to conventional hydrostatic reduction. This study was undertaken to evaluate the results and complications of air pressure enema in 948 pediatric intussusception. One hundred and twenty nine cases had been operated because of the air reduction failure at the Department of Surgery, Masan Samsung Hospital from 1985 to 1996 were analysed. The success rate was 86.4%. Twenty-one patients (2.2%) showed perforation during air reduction. Risk factors of perforation were; age less than 3 months (42.9% vs 11.1%), duration of symtoms greater than 48 hours (66.7% Vs 33.3%), and presence of pathologic leading point (28.6% vs 3.7%). Vomitting and spontaneous rectal bleeding revealed higher prediction to the complication. In ninteen cases, pathoogy showed bowel infarction, coagulated necrosis and hemorrhage which suggest the cause of perforation tp to the preexisting strangulation. In conclusion, when doing an air pressure enema reduction, care must be taken to the young age as well as long duration gruop.
Air Pressure* ; Enema* ; Hemorrhage ; Humans ; Infant* ; Infarction ; Intussusception* ; Necrosis ; Oxygen ; Risk Factors

The entity of negative appendectomies still poses a dilemma in chlidren. Focused computed tomography (CT) scanning has become the diagnostic test of choice in many hospitals. However, the impact of CT scans on the diagnosis in children is unknown exactly. The purpose of this study was to critically evaluate CT scans for the evaluation of acute appendicitis in children, to review utilization of this diagnostic test in our appendicitis population and to determine if diagnostic accuracy has improved. A retrospective analysis of efficacy of CT scan for diagnosis of appendicitis in children was conducted. Children undergoing appendectomy for acute appendicitis were reviewed from 2007 to 2012. Perforation and negative appendectomy (removal of a normal appendix) rates were determined by the final pathologic report. Statistical comparison were made using the chi2 test and significance was assigned at p < 0.05. Five hundred four appendectomies were performed. Mean age was 10.1 +/- 3.21 years, and 62.7% were boys. Overall, 308 children (61.1%) underwent CT scanning, 100 (19.8%) had US performed, and 97 (19.2%) had no radiographic study. A pathologically normal appendix was removed in 8.7% (27 of 308) of CT patients, 9.0% (9 of 100) of US patients, and 11.3% (11 of 97) of patients without a study. The frequency of CT scanning increased from 29.7% (27 of 91) of all children in 2007 to 75.6% (59 of 78) in 2012, whereas utilization of US decreased from 30.8% (28 of 91) to 11.5% (9 of 78). During this time period the difference in the negative appendectomy rate did change significantly from 14% to 6%. Liberal use of CT scans in diagnosing appendicitis in children has resulted in a decreased negative appendectomy rate.
Appendectomy ; Appendicitis* ; Appendix ; Child* ; Diagnosis ; Diagnostic Tests, Routine ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed

A through knowledge of the anatomy of colonic mesenteric arteries is necessary to accomplish successful, uncomplicated abdominal operations, especially laparoscopic colonic resections in which the mesenteric vessels can't be palpated. Such knowledge is also important when performing a colonic resection for cancer using proximal vascular ligation and wide en bloc resection. Most surgical textbooks depict a "normal pattern" of arterial supply to the right colon as consisting of three arterial branches (the ileocolic, the right colic, and the middle colic arteries) arising independently from the superior mesenteric artery (SMA). Based on the literature, there are only two colonic arteries arising independently from the SMA in many cases. We examined the anatomy of these arteries in 50 patients who had had SMA angiographies for various diseases from January 1995 to May 1997. In all of our cases, the ileocolic artery and the middle colicartery emanated directly from the SMA, but the right colic artery originated directly from the SMA in only 54% of the cases. The right colic artery was absent in 8% of the cases. It also arose as a single trunk with the middle colic artery (22% of the cases) and from the ileocolic artery (16% of the cases). Our data, together with published anatomic studies, lead us to conclude that in many cases there are only two independent branches arising from the SMA that supply the large intestine, the ileocolic artery and the middle colic artery. This knowledge may be helpful in laparoscopic colon surgery, radical colon resections for cancer, and colon replacements after operations on the esophagus or the urinary bladder.
Angiography ; Arteries* ; Colic* ; Colon ; Esophagus ; Humans ; Intestine, Large ; Ligation ; Mesenteric Arteries ; Mesenteric Artery, Superior ; Urinary Bladder

PURPOSE: The routine use of postoperative nasogastric decompression after abdominal surgery has been challenged. Furthermore, investigators have recently shown that early postoperative oral feeding is safe and generally well tolerated. This study was aimed to determine whether or not early postoperative feeding is safe after elective colorectal surgery. METHODS: All patients who underwent elective colorectal surgeries between June 1998 and March 1999 were permitted to take oral intake one day after the operations. The patients were compared with other patients, who had underwent elective colorectal surgeries between September 1997 and June 1998 and permitted to have a meal after resolving postoperative ileus. The nasogastric tube was removed from all patients immediately after surgery. The patients were monitored for the time of ileus resolution, nausea/vomiting, abdominal distension, nasogastric tube reinsertion and complications. RESULTS: Fifty-one patients were studied, 24 patients in early feeding group and 27 patients in traditional feeding group. Eighteen patients (75.0%) in the early feeding group tolerated the early oral intake. There were no significant differences between two groups in the time for resolution of ileus (3.46 1.38 days vs 3.56 1.80 days), nausea/vomiting (33.3% vs 29.6%), abdominal distension (16.6% vs 14.8%) and nasogastric tube reinsertion (12.5% vs 7.4%). No significant difference was noted in complications such as wound infection, pulmonary problems, intestinal obstruction and anastomotic leak. CONCLUSIONS: Early oral intake after elective colorectal surgery was safe and most of the patients tolerated it. And it may become a kind of managements after elective colorectal surgery.
Anastomotic Leak ; Colorectal Surgery* ; Decompression ; Humans ; Ileus ; Intestinal Obstruction ; Meals ; Research Personnel ; Wound Infection

We performed this study to analyse the morbidity and mortality of stoma formation in infants and children over a 17-year period. Thirty-seven stoma formations were performed in 37 patients: 21 for anorectal malformation, 9 for Hirschsprung's disease, 3 for necrotizing enterocolitis, 2 for multiple ileal atresia, 1 for volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation. There were 26 boys and 11 girls with a mean age of 0.4 years. Complications after stoma formation were encountered in 12 patients(32.4%) and included stomal prolapse, stenosis, retraction, dysfunction, skin excoriation and parastomal hernia. Four patients(10.8%) required stomal revision. The incidence of complications was neither related to the age nor to the primary indication for the stoma formation, but sigmoid colostomy was associated with a lower complication rate compared to transverse colostomy(22.1% versus 42.1%, P<0.05). Five patients died, but only one(2.7%) was dead, which was directly related to stoma formation. Eighteen of these children subsequently underwent stoma closure which was associated with complications in six patients(33.3%). The most common complication after stoma closure was wound sepsis in 4 children. In conclusion, because the significant morbidity of stoma formation still exists the refinements in surgical technique may help in reducing the incidence of complications and a sigmoid loop colostomy should be used whenever possible.
Child* ; Colon ; Colon, Sigmoid ; Colostomy ; Constriction, Pathologic ; Enterocolitis, Necrotizing ; Female ; Hernia ; Hernia, Diaphragmatic ; Hirschsprung Disease ; Humans ; Incidence ; Infant* ; Intestinal Volvulus ; Mortality ; Prolapse ; Sepsis ; Skin ; Wounds and Injuries

The management of thyroid nodules, about which widely differing views have been expressed for many years, is still a controversial subject. The primary reason for concern about thyroid nodules is that they might be malignant.The incidence of carcinoma in patients with multinodular goiters has reported to be considerably lower than in patients with a single nodule. In this retrospective study of 510 cases of thyroidectomies over a 14-year period, 151 patients with factors predisposing them to neoplasia, such as Grave's disease and thyroiditis, were eliminated. The remaining 93 patients with clinically evident multinodular goiters were compared with remaining the 226 patients with a solitary cold nodule. The incidence of carcinoma in the 266 patients with a solitary cold nodule was 15.4%. In the 93 patients with clinically evident multinodular goiters, the incidence of carcinoma was 18.3%. The difference is not significant. It is of interest that male patients with multinodular goiters had the highest incidence of carcinoma at 25.0%, whereas, males with a solitary cold nodule had an incidence of only 17.9%. In conclusion, once known factors that predispose patients to neoplasia are eliminated, there does not seem to be a significant difference in the incidence of thyroid carcinoma between patients with operatively and histopathologically proved solitary cold nodules and those with multinodular goiter.
Goiter* ; Humans ; Incidence* ; Male ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy ; Thyroiditis

The clinical characteristics of fistula-in-ano in infants are different from those of older children, and its treatment remains controversial. We suggest that fistula-in-ano in infants has a congenital etiology. To verify this hypothesis and to settle the controversies regarding fistula-in ano in infants, a retrospective analysis of 29 patients less than 2 years of age with anal fistulae treated between 1994 and 2009 at Samsung Changwon Hospital were reviewed retrospectively. Twenty two patients were male and mean age at diagnosis was 7.2+/-5.2 months. Eleven out of 22 cases had previous surgical drainage for perianal abscess. 18 patients had fistulotomy (81.8%) and four had fistulectomy (18.2%). Cryptotomies with fistulectomy were performed in 10 patients (45.5%) who had involved crypt. There was one recurrence. These results suggest that fistula-in-ano in young children less than two years of age is different from those in older children or adults. Fistulotomy is suggested to be the recommended treatment of choice. A future study involving non-operative management would be required to explore all treatment options.
Abscess ; Adult ; Child ; Drainage ; Humans ; Infant ; Male ; Rectal Fistula ; Recurrence ; Retrospective Studies

PURPOSE: We performed this study to evaluate the clinical presentation of, as well as the surgical intervention for, ovarian metastasis from colorectal cancers identified during postoperative follow-up. METHODS: Twelve cases (2.4%) of ovarian metastasis were observed among retrospective chart review of 493 females patients who underwent a resection of colorectal cancer between 1981 and 2006. The covariates used for the survival analysis were patient age at the time of ovarian relapse, size of the tumor, initial TMN stage of the colon cancer, the interval to metastasis, and the presence of gross residual disease after treatment for a Krukenberg tumor. The cumulative survival curves for the patient groups were calculated with the Kaplan-Meier method and were compared by means of the Log-Rank test. RESULTS: The average age of the patients was 48.9 years, ranging from 24 to 71 years, and the average survival time of the 12 patients was 19.6 months (estimated 3-year survival rate was 16.7%), with a range of 3 to 59 months after the diagnosis of a Krukenberg tumor. The survival rate for patients without gross residual disease was longer than that of patients with gross residual disease (P=0.0003). In contrast, patient age, size of the ovarian tumor, initial stage of the colon adenocarcinoma, and interval to metastasis were not prognostic indicators for survival after the development of ovarian metastasis. CONCLUSIONS: Our results suggest that, in general, most cases with ovarian metastasis have poor prognosis and that the absence of residual disease after treatment is a favorable prognostic factor in cases of a Krukenberg tumor of colon origin.
Adenocarcinoma ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Krukenberg Tumor ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: We performed this study to evaluate the clinical presentation as well as the proper surgical intervention for ovarian metastasis from gastric cancers and these tumors were identified during postoperative follow-up. This will help establish the optimal strategy for improving the survival of patients with this entity. MATERIALS AND METHODS: 22 patients (3.2%) with ovarian metastasis were noted when performing a retrospective chart review of (693) females patients who had undergone a resection for gastric cancer between 1981 and 2008. The covariates used for the survival analysis were the patient age at the time of ovarian relapse, the size of the tumor, the initial TNM stage of the gastric cancer, the interval to metastasis and the presence of gross residual disease after treatment for Krukenberg tumor. The cumulative survival curves for the patient groups were calculated with the Kaplan-Meier method and they were compared by means of the Log-Rank test. RESULTS: The average age of the patients was 48.6 years (range: 24 to 78 years) and the average survival time of the 22 patients was 18.8 months (the estimated 3-year survival rate was 15.8%) with a range of 2 to 59 months after the diagnosis of Krukenberg tumor. The survival rate for patients without gross residual disease was longer than that of the patients with gross residual disease (P=0.0003). In contrast, patient age, the size of ovarian tumor, the initial stage of gastric adenocarcinoma, the interval to metastasis and adjuvant chemotherapy were not prognostic indicators for survival after the development of ovarian metastasis. CONCLUSIONS: Early diagnosis and complete resection are the only possible hope to improve survival. As the 3-year survival rate after resection of Krukenberg tumor is 15.8%, it seems worthwhile to consider performing tumorectomy as the second cytoreduction.
Adenocarcinoma ; Chemotherapy, Adjuvant ; Early Diagnosis ; Female ; Follow-Up Studies ; Humans ; Krukenberg Tumor ; Neoplasm Metastasis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate

Primary heterotopic ossification has been previously noted in abdominal laparotomy scars, but the presence of ectopic bone within the peritoneum is extremely rare and chracterized by new bone formation in a tissue which does not normally undergo ossification. Our patient in a 59-year-old man who underwent operation for acute cholecystitis had formation of heterotopic bone involving mesentery of intestine. The features of various types of ectopic calcification are discussed, and several theories concerning the pathogenesis and treatment of heterotopic ossification are examined.
Cholecystitis, Acute ; Cicatrix ; Humans ; Intestines* ; Laparotomy ; Mesentery* ; Middle Aged ; Ossification, Heterotopic* ; Osteogenesis ; Peritoneum