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Hemolytic Crisis Recovered by Exchange Transfusion in a Child with Fulminant Wilson's Disease.

Hee Joung CHOI ; Hae Ri LIM ; Byung Ho CHOE

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):108-113.

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

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A Case of Belsey Mark IV Fundoplication after Failed Nissen Antireflux Surgery.

Su Min SHON ; Hyun Jung SHIN ; Moon Ho PARK ; Dong Yoon KEUM ; Chang Kwon PARK ; Won Joung CHOI ; Ae Suk KIM ; Jin Bok HWANG

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):103-107.

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

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A Case of Epiploic Appendagitis Presented with Right Lower Quadrant Pain of Abdomen.

Hyo Cheol KANG ; Ji Hyung NAM ; Se Yun JEON ; Gyeong Hee YOO ; Young Tong KIM

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):98-102.

An inflammation of an epiploic appendage is a relatively rare cause of acute abdominal pain. It can be clinically misdiagnosed as either acute appendicitis or diverticulitis. Judicious interpretation of imaging with ultrasound or computed tomography may lead to an early diagnosis and prevent unnecessary surgical or medical treatment. Conservative treatment of symptoms is usually sufficient. We have experienced a case of epiploic appendagitis treated by conservative management and report this case with the review of the literature.
Abdomen* ; Abdominal Pain ; Appendicitis ; Diverticulitis ; Early Diagnosis ; Inflammation ; Ultrasonography

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Left Diaphragmatic Eventration Diagnosed as Congenital Diaphragmatic Hernia by Prenatal Sonography.

Jung Sook YEOM ; Ji Sook PARK ; Eun Sil PARK ; Ji Hyun SEO ; Jae Young LIM ; Chan Hoo PARK ; Hyang Ok WOO ; Eun Jung JUNG ; Jae Min JO ; Hee Shang YOUN

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):92-97.

Congenital diaphragmatic eventration is the abnormal elevation of the diaphragm into the thoracic cavity. Sometimes, it is not easy to differentiate congenital diaphragmatic eventration from diaphragmatic hernia by either prenatal sonography or postnatal chest radiography. However, differential diagnosis of both diseases is practical because of different prognosis and surgical approaches. Careful interpretation of postnatal serial chest X-rays is mandatory to differentiate between both diseases. We report two neonates with congenital diaphragmatic eventration of left diaphragm that initially misdiagnosed as diaphragmatic hernia by prenatal sonography and postnatal chest radiography.
Diagnosis, Differential ; Diaphragm ; Diaphragmatic Eventration* ; Hernia, Diaphragmatic* ; Humans ; Infant, Newborn ; Prognosis ; Radiography ; Thoracic Cavity ; Thorax

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A Case of PFAPA Syndrome Mimicking Cyclic Vomiting Syndrome.

Seok Pyo HONG ; Hyun Jung SHIN ; Yeo Hyang KIM ; Byung Kyu CHOE ; Won Jung CHOI ; Ae Suk KIM ; Jin Bok HWANG

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):85-91.

PFAPA syndrome is characterized by periodic fevers associated with aphthous stomatitis, pharyngitis, and cervical adenitis and is unusual in infants and children. We report on a case of PFAPA syndrome mimicking cyclic vomiting syndrome in a 42-month-old girl. She had experienced multiple episodes of cyclic vomiting with abdominal pain from age 20 to 30 months. When she was 30 months old, periodic fever with pharyngitis was combined with cyclic vomiting, and when 40 months old, aphthous stomatitis and cervical adenitis were added. These periodic symptoms and signs were not treated with prokinetics or antibiotics. Symptom duration of an episode was 3 days. After cimetidine therapy (150 mg three times daily for 6 months), her febrile and cyclic vomiting episodes ceased. At the time of writing she had not received therapy for 10 months and has remained well without periodic attack.
Abdominal Pain ; Anti-Bacterial Agents ; Child ; Child, Preschool ; Cimetidine ; Female ; Fever ; Humans ; Infant ; Lymphadenitis ; Pharyngitis ; Stomatitis, Aphthous ; Vomiting* ; Writing ; Yemen

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A Case of Isolated Rice Allergy.

Moon Ho PARK ; Su Min SHON ; Byung Kyu CHOE ; Yeo Hyang KIM ; Yu Na KANG ; Won Joung CHOI ; Ae Suk KIM ; Jin Bok HWANG

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):80-84.

Rice allergen has low antigenicity, and thus, anaphylactoid reactions to rice are exceedingly rare. We experienced a case of isolated rice allergy in a 5 month-old girl who had been fed a milk formula without incident. However, after feeding a powdered weaning milk formula containing rice, she developed symptoms of projectile vomiting and diarrhea, at this time rice specific antigen tests were all negative. One month later a challenge test was performed using a rice gruel, and her symptoms recurred. Endoscopic and microscopic findings showed hyperemic mucosa in the duodenum and subtotal villous atrophy. Thereafter, she showed no adverse reaction to almost all foods appropriate for her age, but after feeding rice gruel at 10 months, she developed symptoms of cyanosis and vomiting. However, none of the allergic symptoms were demonstrated at 13 months upon repeated challenge test. Currently, she is 28 months old and tolerates all foods including rice.
Atrophy ; Child, Preschool ; Cyanosis ; Diarrhea ; Duodenum ; Female ; Humans ; Hypersensitivity* ; Infant ; Milk ; Mucous Membrane ; Respiratory Sounds ; Vomiting ; Weaning

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A Case of Intussusception Caused by Meckel's Diverticulum with Heterotopic Pancreatic and Gastric Tissues.

Mi Jin KIM ; Jae Young KIM ; Ji Young SUL ; Dae Young KANG

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):75-79.

Intussusception is a frequent cause of intestinal obstruction in early childhood and most are idiopathic in origin. In a minority of cases a definite pathological lead point is identified by imaging studying or during surgery. As the pathologic lead point of intussusception, Meckel's diverticulum is the most common lesion. In symptomatic patients, 40~60% of Meckel's diverticulum contain ectopic tissue, with gastric mucosa being far the most common type. A few Meckel's diverticulum contain pancreatic tissue. Combined heterotopic pancreatic and gastric tissues in the Meckel's diverticulum especially causing intussusception is extremely rare. We report the case of 5-year-old girl with an intussusception caused by Meckel's diverticulum containing both heterotopic gastric and pancreatic tissues.
Child, Preschool ; Choristoma ; Female ; Gastric Mucosa ; Humans ; Intestinal Obstruction ; Intussusception* ; Meckel Diverticulum*

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A Case of Recurrent Transient Small Bowel Intussusception.

Yun Hee MUN ; Min Jung YUN ; Su Youn KIM ; Yeong Ho RHA

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):70-74.

Isolated small bowel intussusception accounts for 10% of all pediatric intussusception. It is more common in children older than 2 years of age. Presentation usually is with vomiting and abdominal pain. Currant jelly stool and palpable mass are less frequent than typical intussusception. There are few reported cases of children with transient small bowel intussusception. We describe 3-year-old boy presented with intermittent cyclic crampy abdominal pain for 6 months was diagnosed as having recurrent transient small bowel intussusception by abdominal ultrasonography and small bowel series.
Abdominal Pain ; Child ; Child, Preschool ; Humans ; Intussusception* ; Male ; Ultrasonography ; Vomiting

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A Case of Gastroparesis Followed after Rotavirus Gastroenteritis.

Jae Lee KIM ; Young Hwan KIM ; Ki Soo KANG

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):65-69.

We experienced a 15 month old child who had persistent gastroparesis after an acute viral illness tested positive for rotavirus. She was admitted because of persistent postprandial vomiting, abdominal distension and anorexia followed after acute rotavirus gastroenteritis. Other diagnostic tests did not demonstrate any evidence of some organic disease. But, we could find the delayed gastric emptying in gastric scintigraphy. The initial percentage gastric emptying in 60 minutes tested by scintigraphy was 13.4%. The second result of percentage gastric empting after clinical improvement was 49.9%.
Anorexia ; Child ; Diagnostic Tests, Routine ; Gastric Emptying ; Gastroenteritis* ; Gastroparesis* ; Humans ; Infant ; Radionuclide Imaging ; Rotavirus* ; Vomiting

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A Nutritional Study of Tube-fed Patients with Severe Neurodevelopmental Disability.

Sung Sook CHO ; Su Jung CHOI ; Seung Min SUL ; Sun Mi SHIN

Korean Journal of Pediatric Gastroenterology and Nutrition.2006;9(1):58-64.

PURPOSE: The purpose of this cross-sectional study was to assess the nutritional states and investigate the energy intake of tube-fed patients with severe neurodevelopmental disability. METHODS: Eighty six tube-fed patients with severe neurodevelopmental disability were studied. Heights were measured by flexible scale segmentally. Nutritional parameters of weight, triceps skin- fold thickness and mid-arm circumference were also measured. Total caloric intakes through the tube were calculated. RESULTS: The anthropometric results showed that nutritional states of tube-fed patients with severe neurodevelopmental disability were poor. The mean daily caloric intake was much less than daily energy requirement (mean=45.2% of requirement). The caloric intake was 7.2 kcal/height (cm), 57.0 kcal/weight (kg). Height was more related with caloric intake (r=0.476) than weight (r=0.263). CONCLUSION: These results provide that tube-fed patients with severe neurodevelopmental disability were growth retarded and their energy intakes were much less than daily energy requirements. The preliminary evidence was that they need adequate nutritional supply.
Anthropometry ; Cross-Sectional Studies ; Energy Intake ; Humans

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