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Duodenal Obstruction due to Duodenal Web in Three-year-old Girl: A Case Report.

Journal of the Korean Association of Pediatric Surgeons.2014;20(2):65-68. doi:10.13029/jkaps.2014.20.2.65

Congenital duodenal obstruction is a one of the emergent surgical conditions in neonates. Almost of them were diagnosed with double-bubble sign in prenatal ultrasonography. However, partial obstruction caused from duodenal web could be overlooked. We reported a duodenal web in early childhood. A three-year-old girl visited at our pediatric clinic for constipation. She had been showed non-bilious vomiting after weaning meal since 6 months old of her age, but her weight was relevant for 50-75 percentile of growth curve. Barium enema was initially checked, but any abnormal finding was not found. We noticed the severely distended stomach and 1st portion of duodenum. Upper gastrointestinal series revealed partial obstruction in 2nd portion of duodenum. After laparotomy, we found the transitional zone of duodenum and identified a duodenal web via duodenotomy. We performed duodeno-duodenostomy without any injury of ampulla of Vater. She was recovered uneventfully. During 6 months after operation, she does well without any gastrointestinal symptoms or signs, such as vomiting or constipation.
Ampulla of Vater ; Barium ; Child ; Constipation ; Duodenal Obstruction* ; Duodenum ; Enema ; Female ; Humans ; Infant, Newborn ; Laparotomy ; Meals ; Stomach ; Ultrasonography, Prenatal ; Vomiting ; Weaning

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Biliary Pseudolithiasis in Children: To Avoid Unnecessary Surgical Procedure.

Shinn Young KIM ; Soo Ah LIM ; Myung Duk LEE

Journal of the Korean Association of Pediatric Surgeons.2014;20(2):62-64. doi:10.13029/jkaps.2014.20.2.62

Gallbladder stones in children are not common without underlying hemolytic diseases or other risk factors like obesity. Ceftriaxone, a third generation cephalosporin, is known to make biliary precipitations that can be mistaken for biliary stones. We here report two children with biliary pseudolithiasis with different treatment modalities. One child was mistaken for symptomatic gallbladder stones and underwent elective laparoscopic cholecystectomy, while the other child, after thorough history taking on the ceftriaxone medication, was suspected of biliary pseudolithiasis and was treated conservatively. Both children had the history of usage of ceftriaxone in previous hospitals for infectious diseases. The ceftriaxone history of the first child was missed before the surgery. When gallbladder stones are found in children without any underlying diseases, specific history taking of the usage of ceftriaxone seems to be absolutely required. In this case, immediate interruption of the antibiotic could resolve the episode and avoid unnecessary surgical procedure.
Ceftriaxone ; Child* ; Cholecystectomy, Laparoscopic ; Communicable Diseases ; Gallbladder ; Humans ; Obesity ; Risk Factors

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Inguinal Lipoblastoma Mimicking Recurrent Inguinal Hernia.

So Hyun NAM ; Yun Jung LIM ; Yeon Mee KIM

Journal of the Korean Association of Pediatric Surgeons.2014;20(2):58-61. doi:10.13029/jkaps.2014.20.2.58

Palpable inguinal mass in children should be differentiated from inguinal hernia, hydrocele, lymph node, and tumor. Though using ultrasonography, fatty tumor would be misdiagnosed as incarcerated inguinal hernia containing fatty component. We experienced the huge inguinal lipoblastoma in 5-year-old girl mimicking recurrent incarcerated hernia. Laparoscopic exploration revealed it was not incarcerated hernia but well demarcated bulging mass from abdominal wall. Mass was about 10x4x3 cm and extended from internal inguinal ring to saphenous opening. It was near total excised because of right external iliac vein injury. Pathologically, it was proven as lipoblastoma containing mature adipocyte with lipoblast and fibrous septa. Postoperatively, we noticed a segmental thrombotic occlusion of external iliac vein. After 1 year, she has no symptom related to occluded vessel. The remained lipoblastoma showed no interval change. Even lipoblastoma has a good prognosis with low recurrence rate, we need careful follow-up.
Abdominal Wall ; Adipocytes ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Humans ; Iliac Vein ; Inguinal Canal ; Lipoblastoma* ; Lipoma ; Lymph Nodes ; Prognosis ; Recurrence ; Ultrasonography

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Clinical Feature of Neonatal Neuroblastoma: Comparison of Outcome between Diagnosed Prenatally and at Postpartum Group.

Hwon Ham PARK ; Soo Hong KIM ; Sung Eun JUNG ; Seong Cheol LEE ; Kwi Won PARK ; Ji Won LEE ; Hyoung Jin KANG ; Hee Young SHIN ; Hae Woon BAEK ; Hyun Young KIM

Journal of the Korean Association of Pediatric Surgeons.2014;20(2):53-57. doi:10.13029/jkaps.2014.20.2.53

PURPOSE: Neonatal neuroblastoma (NBL) is the most common malignant tumor in neonates, but there have been few studies about it. The purpose of this study was to investigate the clinical features of NBL and to compare prenatal and postnatal diagnosed groups. METHODS: Nineteen patients who were diagnosed with NBL prenatally or within 28 days after birth from February 1986 to February 2013 in Seoul National University Hospital were enrolled in the study. The patients were categorized according to the International Neuroblastoma Staging System (INSS) and Children's Oncology Group (COG). Retrospective medical-record reviews were performed on these patients. The operative date, complication, pathological stage, and overall survival of the prenatally diagnosed group and the postpartum diagnosed group were compared. RESULTS: Tumor was detected via prenatal ultrasonography in 8 patients (42.1%), and 11 patients (57.9%) were diagnosed within 28 days after birth. Based on INSS, the patients were divided into the stage I (n=8), stage II (n=1), stage III (n=3), stage IV (n=4), and stage IVs (n=3) groups, respectively. Based on COG, on the other hand, the patients were divided into the low-risk (n=8), intermediate-risk (n=8), and high-risk (n=3) groups. The postoperative complication rate was 29%. One patient died from complications from chemotherapy. The other 18 patients' mean follow-up period was 77.7 months. The differences between the postoperative complication rate, proportion of early-stage tumor, and overall survival of the prenatal and postnatal groups were not statistically significant (p=0.446, p=0.607, p=0.414). CONCLUSION: NBL showed favorable outcomes but relatively higher postoperative complications. There seem to be no significant statistical differences in the postoperative complications, proportion of early-stage tumor, and overall survival between the prenatally diagnosed group and the postpartum diagnosed group.
Drug Therapy ; Follow-Up Studies ; Hand ; Humans ; Infant, Newborn ; Neuroblastoma* ; Parturition ; Postoperative Complications ; Postpartum Period* ; Prenatal Diagnosis ; Retrospective Studies ; Seoul ; Ultrasonography, Prenatal

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Surgical Outcomes of Single-port Laparoscopic Appendectomy versus Conventional Laparoscopic Appendectomy in Children: Preliminary Report of a Prospective Randomized Trial.

Jung Rae CHO ; Won Me KANG ; Soo Min AHN

Journal of the Korean Association of Pediatric Surgeons.2014;20(2):48-52. doi:10.13029/jkaps.2014.20.2.48

PURPOSE: Currently the substantial clinical benefits of single-port laparoscopic appendectomy (SLA) over conventional three-port laparoscopic appendectomy (CLA) are equivocal. The aim of this study was to compare surgical outcomes between SLA and CLA in children with acute appendicitis. METHODS: A single blind prospective randomized single center study was performed to compare the surgical outcomes of SLA and CLA. A total of 105 patients were randomized and various parameters were analyzed, 52 patients with SLA and 53 patients with CLA between July 2013 and March 2014. Patients with sonographically confirmed acute appendicitis were randomly assigned to receive either SLA or CLA. The outcome measurements were operating time, wound complication, and intraperitoneal morbidities, postoperative pain score and cosmetic result score. RESULTS: Operating time is significantly longer in SLA (70.4+/-26.7 minutes vs. 58.0+/-23.4 minutes; p=0.016). There were no significant differences in the postoperative wound complication rate and intraperitoneal morbidities between two groups. There were no significant differences in postoperative resting pain score (6.6+/-2.5 vs. 6.3+/-2.5; p=0.317) and activity pain score (6.9+/-2.4 vs. 6.3+/-2.5; p=0.189), and the cosmetic result score (9.2+/-1.1 vs. 9.1+/-1.4; p=0.853). CONCLUSION: Although SLA would be a safe and feasible procedure in children, SLA could not demonstrate the clear benefit over CLA.
Appendectomy* ; Appendicitis ; Child* ; Humans ; Pain, Postoperative ; Prospective Studies* ; Wounds and Injuries

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Comparison of Pyloromyotomy with Supraumbilical Incision and Laparoscopic Pyloromyotomy for Hypertrophic Pyloric Stenosis Performed by a Single Surgeon.

Jong Woo LEE ; Dae Yeon KIM ; Seong Chul KIM ; Jung Man NAMGOONG ; Ji Hee HWANG

Journal of the Korean Association of Pediatric Surgeons.2014;20(2):43-47. doi:10.13029/jkaps.2014.20.2.43

PURPOSE: Hypertrophic pyloric stenosis (HPS) is known to be one of the most common cause of surgery for infants and pyloromyotomy was considered to the standard treatment. There has been an ongoing debate about whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the best option for treating HPS. The aim of this study is to evaluate safety and effectiveness of LP by comparing the clinical results of both surgical strategies performed by single surgeon. METHODS: Between January 2000 and December 2013, 60 patients who underwent pyloromyotomy at Asan Medical Center performed by a surgeon were followed: open-supraumbilical incision (n=36) and LP (n=24). The parameters included sex, age and body weight at operation. Clinical outcomes included operation time, time to full feeding, postoperative hospital stay, and postoperative complications. RESULTS: There were no significant differences in characteristics, postoperative hospital stay between the two groups. Time to full feeding was shorter in LP (OP 24.5 hours vs. LP 19.8 hours; p=0.063). In contrast, the mean operation time was longer in LP (OP 37.5 minutes vs. LP 43.5 minutes; p=0.072). Complications such as perforation of mucosal layer (OP 1 vs. LP 0) and wound problems (OP 2 vs. LP 0) were found to be not worse in laparoscopic group as compared with open group. CONCLUSION: There has no difference both laparoscopic and open-supraumbilical incision in terms of postoperative hospital stay, time to full feeds and frequency of complications.
Body Weight ; Chungcheongnam-do ; Humans ; Infant ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Pyloric Stenosis, Hypertrophic* ; Wounds and Injuries

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The Prognosis of Gastroschisis and Omphalocele.

Eunkyoung JWA ; Seong Chul KIM ; Dae Yeon KIM ; Ji Hee HWANG ; Jung Man NAMGOONG ; In Koo KIM

Journal of the Korean Association of Pediatric Surgeons.2014;20(2):38-42. doi:10.13029/jkaps.2014.20.2.38

PURPOSE: Gastroschisis and omphalocele are major anterior abdominal wall defects. The purpose of this study was to analyze the clinical differences and mortalities of gastroschisis and omphalocele in Asan Medical Center. METHODS: A retrospective review of the medical records was conducted of 103 cases of gastroschisis and omphalocele from September 1989 to February 2013 in Asan Medical Center in Korea. RESULTS: There were 43 cases (41.7%) of gastroschisis and 60 cases (58.3%) of omphalocele. There was a female predominance in both gastroschisis (60.5%) and omphalocele (58.3%). The average gestational age at delivery was 36.7+/-0.4 weeks for both groups. The mean birth weights were 2,381.9+/-80.6 g for gastroschisis and 2,779.4+/-82.8 g for omphalocele (p=0.001). Mean maternal ages in the gastroschisis and omphalocele groups were 27.5+/-0.7 years and 30.5+/-0.7 years, respectively (p=0.002). Associated malformations were documented in 13 infants (30.2+/-) with gastroschisis and 46 infants (76.7+/-) with omphalocele (p<0.001). All of gastroschisis patients except one underwent surgery including 31 primary repairs and 11 staged repairs. Fifty-two infants with omphalocele underwent surgery-primary repair in 41 infants and staged repair in 11 infants. Among 103 cases, 19 cases (18.4%) expired. Mortality rates of gastroschisis and omphalocele were 23.3% (10/43 cases) and 15.0% (9/60 cases), respectively (p=0.287). The main causes of death were abdominal compartment syndrome (6/10 cases) in gastroschisis, respiratory failure (4/9 cases) and discharge against medical advice (4/9 cases) in omphalocele. CONCLUSION: Gastroschisisis was associated with younger maternal age and lower birth weight than omphalocele. Associated malformations were more common in omphalocele. The mortality rates did not make a statistical significance. This might be the improvement of treatment of cardiac anomalies, because no patient died from cardiac dysfunction in our study. Furthermore, abdominal compartment syndrome might be the main cause of death in gastroschisis.
Abdominal Wall ; Birth Weight ; Cause of Death ; Chungcheongnam-do ; Female ; Gastroschisis* ; Gestational Age ; Hernia, Umbilical* ; Humans ; Infant ; Intra-Abdominal Hypertension ; Korea ; Maternal Age ; Medical Records ; Mortality ; Prognosis* ; Respiratory Insufficiency ; Retrospective Studies

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Malignant Degeneration and Hepatic Metastasis Related to Choledochal Cyst with Internal Drainage Procedure: a Case Report.

Moonjong JI ; Hyukjin YOON ; Shinyong KANG ; Jinyoung PARK

Journal of the Korean Association of Pediatric Surgeons.2005;11(2):186-191.

A 10-year-old-girl who underwent Roux-en-Y cystojejunostomy under the diagnosis of choledochal cyst at another hospital at the age of 3 months was referred to our hospital due to abdominal pain. Abdominal ultrasonography (USG) and computed tomography (CT) showed the type I choledochal cyst and multiple gall bladder stones. Severe inflammation and adhesion made difficulty of radical resection and only partial resection of choledochal cyst with Roux-en-Y hepaticojejunostomy could be performed. She complained of intermittent abdominal pain, fever, nausea and vomiting 2 1/2 years after the second operation. Follow-up abdominal CT scan showed the polypoid nodular lesion in the remnant choledochal cyst and suspicious metastatic lesion in the segment 7 of the liver. The duodenum was obstructed by the mass arising from the remnant choledochal cyst. The USG-guided liver biopsy revealed the moderately differentiated adenocarcinoma. A secondary palliative gastrojejunostomy was performed to relieve the obstruction of duodenum. She died of hepatic insufficiency 4 months later of third operation.
Abdominal Pain ; Adenocarcinoma ; Biopsy ; Choledochal Cyst* ; Diagnosis ; Drainage* ; Duodenum ; Fever ; Follow-Up Studies ; Gastric Bypass ; Hepatic Insufficiency ; Inflammation ; Liver ; Nausea ; Neoplasm Metastasis* ; Tomography, X-Ray Computed ; Ultrasonography ; Urinary Bladder Calculi ; Vomiting

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Laparoscopic Operation for Superior Mesenteric Artery Syndrome and Follow-up with 3-Dimensional Reconstructive CT: 1 Case Report.

Seong Min KIM ; Sung Hoon KIM ; In Kyou KWON ; Myoung Joon KIM ; Woo Jin HYOUNG ; Seung Hoon CHOI

Journal of the Korean Association of Pediatric Surgeons.2005;11(2):180-185.

Superior mesenteric artery (SMA) syndrome is a rare disorder caused by extrinsic compression of the third portion of the duodenum by the SMA. The operative treatment of choice is bypassing the obstructed duodenal segment by duodenojejunostomy. We report one case of SMA syndrome treated by laparoscopic duodenojejunostomy and followed up by 3D-reconstructive CT scan. A fifteen-year-old boy with intermittent vomiting and weight loss was admitted. Ultrasonography showed narrowing of the distance between the SMA and aorta. Hypotonic duodenography showed dilatation of duodenal third portion and barium stasis. On 3D-reconstructive CT scan, the angle between SMA and aorta was 37 degrees. The postoperative course was uneventful. Three months later, he had gained 3 kg of weight and the angle between SMA and aorta increased to 38-39 degrees on 3D reconstructive CT scan. Laparoscopic duodenojejunostomy for bypassing the obstructive duodenum in SMA syndrome is a feasible and safe method.
Aorta ; Barium ; Dilatation ; Duodenum ; Humans ; Male ; Mesenteric Artery, Superior* ; Superior Mesenteric Artery Syndrome* ; Tomography, X-Ray Computed ; Ultrasonography ; Vomiting ; Weight Loss

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Recurrent Pancreatitis Caused by Intraluminal Duodenal Diverticulum in an 11-year-old Girl: a Case Report.

Moonjong JI ; Shinyong KANG ; Byungho CHOE ; Jinyoung PARK

Journal of the Korean Association of Pediatric Surgeons.2005;11(2):175-179.

An 11-year-old girl with history of two previous attacks of acute pancreatitis was admitted to another hospital. On physical examination, she had epigastric tenderness. Laboratory studies included amylase of 657IU/L and lipase of 3131IU/L. Abdominal computed tomography (CT) scan suggested necrosis in 30% of pancreas. To establish the cause of recurrent pancreatitis, endoscopic retrograde cholangiopancreatography (ERCP) was performed after acute pancreatitis subsided. Duodenoscopic view revealed a blind sac covered by normal duodenal mucosa at the second portion of the duodenum. Barium upper gastrointestinal series (UGI) showed a large sac separated from adjacent duodenal lumen by a radiolucent band. Diagnosis of intraluminal duodenal diverticulum (IDD) was made and endoscopic excision was considered. The apex of the diverticulum was incised endoscopically using a needle knife papillotome. At a follow-up endoscopy one day after procedure, bleeding from the incised edge of diverticulum was noted. Despite hemoclipping and injection of hypertonic saline-epinephrine solution by under the endoscopy, hemostasis was unsuccessful. She was transferred to the Kyungpook National University Hospital after resuscitation. Open duodenotomy and excision of the diverticulum were performed. She has recovered well from surgery and remains asymptomatic.
Amylases ; Barium ; Child* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diverticulum* ; Duodenum ; Endoscopy ; Female* ; Follow-Up Studies ; Gyeongsangbuk-do ; Hemorrhage ; Hemostasis ; Humans ; Lipase ; Mucous Membrane ; Necrosis ; Needles ; Pancreas ; Pancreatitis* ; Physical Examination ; Resuscitation

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