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A Case of Late Presenting Congenital Diaphragmatic Hernia.

Ji Eun SONG ; Oh Kun KWON ; Young Ho KIM ; Hae Ran LEE

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):246-250.

Congenital diaphragmatic hernias (CDH) usually cause respiratory distress soon after birth and are associated with a high mortality rate in the early postnatal period. However, there is a milder form of CDH that does not manifest during the neonatal period. The late presenting CDH is characterized by a variable clinical picture. We present the case of an otherwise healthy 5-month-old girl, who was referred for evaluation of an 1-day history of vomiting and irritability. Chest simple X-ray and CT showed bowel loops in the left thoracic cavity, which was consistent with diaphragmatic hernia. At operation, she was found to have a small left posterolateral diaphagmatic defect with viable small bowel loops in the left thoracic cavity. After surgical reposition of the hernia, the symptoms such as vomiting and irritability subsided. The lack of typical manifestation of CDH such as respiratory distress may lead to delayed diagnosis. The possibility of late presenting CDH should not be overlooked even after the neonatal period.
Delayed Diagnosis ; Hernia ; Hernia, Diaphragmatic ; Humans ; Infant ; Parturition ; Thoracic Cavity ; Thorax ; Vomiting

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Pyoderma Gangrenosum in a Patient with Ulcerative Colitis: A Case Report.

Kyoung In KANG ; Sun Young YOU ; Sang Ha OH ; Jae Young KIM

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):240-245.

Pyoderma gangrenosum associated with ulcerative colitis is an unknown etiology of destructive skin disorder, characterized by progressive painful ulceration. It begins as a erythematous areola or pustule and rapidly progress into a deep ulceration with a discrete and violaceous edge. Early diagnosis followed with non-compressive moist dressing, topical application and systemic immunosuppressants are cornerstone in treating this disease. We report a case of pyoderma gangrenosum exacerbated with incision and drainage in a 15 year old girl with ulcerative colitis. This case emphasizes the importance of early consideration of pyoderma gangrenosum in patient with a background of related systemic disease and minimal traumatized wound care.
Bandages ; Colitis, Ulcerative ; Drainage ; Early Diagnosis ; Humans ; Immunosuppressive Agents ; Pyoderma ; Pyoderma Gangrenosum ; Skin ; Ulcer

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A Case of Hepatic Vein Thrombosis Associated with Ulcerative Colitis.

Joon Sung KIM ; Kyung Mo KIM

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):235-239.

Patients with inflammatory bowel disease are known to have hypercoagulability and an increased risk for venous thromboembolism. The deep veins of the lower extremities and the pulmonary veins are the most common sites of thrombosis in ulcerative colitis. However, hepatic vein thrombosis (Budd-Chiari syndrome) is a very rare extra-intestinal complication of ulcerative colitis in children. We describe a case of hepatic vein thrombosis in a 15-year-old girl with ulcerative colitis who presented with abdominal pain and hematochezia. Doppler ultrasonography and an abdominal CT scan revealed the characteristic filling defects caused by large thrombi in both hepatic veins. These lesions were successfully treated with conventional management for ulcerative colitis and anticoagulation therapy.
Abdominal Pain ; Adolescent ; Budd-Chiari Syndrome ; Child ; Colitis, Ulcerative ; Gastrointestinal Hemorrhage ; Hepatic Veins ; Humans ; Inflammatory Bowel Diseases ; Lower Extremity ; Pulmonary Veins ; Thrombophilia ; Thrombosis ; Ulcer ; Ultrasonography, Doppler ; Veins ; Venous Thromboembolism

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A Case of Trichobezoar with Small Bowel Obstruction.

Jin Sung PARK ; Hong Joo KIM ; Ju Young CHUNG

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):230-234.

Trichobezoars are commonly found within the stomach, but rarely induce small bowel obstruction. We report an 8-year-old girl who presented with bilious vomiting and colicky abdominal pain. She had a history of depression and trichophagia. A diagnosis of small bowel obstruction was made on computed tomography and a trichobezoar in the ileum was evacuated by exploratory laparatomy.
Abdominal Pain ; Bezoars ; Child ; Depression ; Humans ; Ileum ; Intestinal Obstruction ; Stomach ; Vomiting

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A Case of Henoch-Schonlein Purpura with Acute Pancreatitis and Hypovolemic Acute Renal Failure.

Ki Won OH ; Sang Kyu PARK ; Joon Sung KIM

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):226-229.

Gastrointestinal involvement in Henoch-Schonlein purpura (HSP) is common. However, both acute pancreatitis and acute renal failure appear to be very rare complications of HSP. We describe a case of HSP with acute pancreatitis and hypovolemic acute renal failure in a 7-year-old girl who presented with a vasculitic purpuric rash involving the lower extremities, abdominal pain, hematochezia, vomiting, and oliguria. Laboratory findings showed increased serum levels of amylase, lipase, and creatinine. An abdominal CT scan revealed diffuse enlargement of the head and body of the pancreas. The patient was successfully managed with conservative treatment, including corticosteroids, and then her pancreatic enzymes and renal function returned to normal. Acute pancreatitis should be differentiated from other causes of acute abdomen in HSP to avoid unnecessary surgery.
Abdomen, Acute ; Abdominal Pain ; Acute Kidney Injury ; Adrenal Cortex Hormones ; Amylases ; Child ; Creatinine ; Exanthema ; Gastrointestinal Hemorrhage ; Head ; Humans ; Hypovolemia ; Lipase ; Lower Extremity ; Oliguria ; Pancreas ; Pancreatitis ; Purpura, Schoenlein-Henoch ; Unnecessary Procedures ; Vomiting

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Isolated Splenic Vein Thrombosis Associated with Acute Pancreatitis.

Hyang Soon SONG ; Noo Ri YANG ; So Hee JIN ; Kyeong Dan CHOI ; Young Taek JANG

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):221-225.

Pancreatic disease is the most frequent cause of isolated splenic vein thrombosis. Splenic vein thrombosis causes a localized form of portal hypertension known as sinistral or left-sided portal hypertension. Splenic vein thrombosis may be complicated by the formation of gastric varices, with the potential of massive upper gastrointestinal bleeding. Whereas splenectomy is considered to be the treatment of choice for symptomatic splenic vein thrombosis, the role of splenectomy in the patient with asymptomatic splenic vein thrombosis remains controversial. We report a rare case of acute pancreatitis complicated by isolated asymptomatic splenic vein thrombosis. Recognition of this disease entity is important because the risk of secondary variceal bleeding, while uncommon, can be life-threatening.
Esophageal and Gastric Varices ; Hemorrhage ; Humans ; Hypertension, Portal ; Pancreatic Diseases ; Pancreatitis ; Splenectomy ; Splenic Vein ; Thrombosis

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Weaning Food Practice and Assessment in Children with Iron Deficiency Anemia.

Boo Young KIM ; Eun Hye CHOI ; Sung Kil KANG ; Yong Hoon JUN ; Young Jin HONG ; Soon Ki KIM

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):215-220.

PURPOSE: Recently, the favorable merits of breast feeding have received widespread attention and the number of breast feeding children is increasing. We investigated the weaning practices between breast feeding infants and non-breast feeding infants with respect to iron deficiency anemia (IDA). METHODS: Between March 2006 and January 2009, we surveyed 70 parents, the children of whom had been medically diagnosed with IDA, and 140 parents, the children of whom did not have IDA, about how they feed their children and how much they know about the weaning process. The infants and children were 6~36 months of age and attended the Inha University hospital. RESULTS: IDA patients started weaning later than non-IDA patients. Also, breast feeding in IDA patients was more frequent than in non-IDA patients (82% vs. 30%). The breast feeding group began weaning at approximately 6.4 months of age, which was statistically meaningfully compared to non-breast feeding infants. There were no differences in knowledge between the two groups of parents. CONCLUSION: According to our research, we assume that if weaning begins at 6 months, we cannot supply sufficient iron to meet the infant's needs, which increase sharply around 6 months of age because of depletion of stored iron. Thus, infants need to initiate weaning from breast feeding at 4 months of age to furnish an ample amount of iron or take iron-containing supplements. These methods would be expected to prevent IDA in breast feeding infants.
Anemia, Iron-Deficiency ; Breast Feeding ; Child ; Humans ; Infant ; Iron ; Parents ; Weaning

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The Prevalence of Obesity and Metabolic Abnormalities in Korean Pediatric Population.

Han Nae NHO ; Cu Rie KIM ; Ji Hyun UHM ; Jeong Tae KIM ; Sun Mi JIN ; Ji Young SEO ; Hye Won HAHN ; Hwa Young PARK ; Hye Sun YOON ; Young Min AHN ; Keun Chan SHON

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):207-214.

PURPOSE: Childhood obesity can be complicated by hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and diabetes mellitus. The aim of this study was to evaluate the prevalence of obesity and metabolic complications of children and adolescents based on the degree of obesity. METHODS: We analyzed the records of 8,880 students who received student health examinations between May 2006 and October 2008 at the Eulji General Hospital. The prevalence of obesity was evaluated by the body mass index and obesity index. A total of 1,076 obese students had blood tests. We analyzed aspartate aminotransferase (AST), alanine aminotransferase (ALT), fasting glucose, total cholesterol, and blood pressure according to the degree of obesity. RESULTS: According to the body mass index, the overall prevalence of obesity was 7.2% (7.8% of male and 6.5% of female students). Based on the obesity index, 12.3% of students (mild: 6.3%, moderate: 5.0%, and severe: 1.0%) were obese. The prevalence of hypercholesterolemia, ALT elevation, and hypertension were increased as a function of the degree of obesity (p<0.05), but hyperglycemia showed no significant differences (p=0.298). The overall prevalence of ALT elevation was 17.7% (mild obese group, 10.4%; moderate obese group, 20.5%; and severe obese group, 46.8%). The prevalence of hypercholesterolemia, hypertension, and hyperglycemia were significantly higher in the elevated ALT group (24.7%, 42.6%, and 5.2%, respectively) compared to the normal ALT group (11.1%, 29.8%, and 2.0%, respectively; p<0.05). CONCLUSION: Hypercholesterolemia, liver function test abnormalities, and hypertension were associated with the degree of obesity. We should focus our attention on managing obese children and adolescents to prevent metabolic complications.
Adolescent ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Pressure ; Body Mass Index ; Child ; Cholesterol ; Diabetes Mellitus ; Fasting ; Fatty Liver ; Female ; Glucose ; Hematologic Tests ; Hospitals, General ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Hyperlipidemias ; Hypertension ; Liver Function Tests ; Male ; Obesity ; Prevalence

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Posttransplantation Lymphoproliferative Disorder after Liver Transplantation in Pediatric Patients: Report from a Single-center Over 21 Years.

Jung Hwa LEE ; Jae Sung KO ; Jeong Kee SEO ; Nam Joon YI ; Kyung Suk SUH ; Kuhn Uk LEE ; Gyeong Hoon KANG

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):199-206.

PURPOSE: To analyze the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after liver transplantation in children. METHODS: From January 1988 to June 2009, we retrospectively reviewed the medical records of 8 PTLD cases among 148 pediatric patients underwent liver transplantation. The age at transplantation, time of presentation after transplantation, clinical manifestations, histologic diagnosis, results of EBV (Epstein-Barr virus) assessments, managements and outcomes of PTLD were investigated. RESULTS: The prevalence of PTLD in liver transplant pediatric recipients was 5.4% (8 of 148). The mean age of patients was 25.4+/-21.3 months (range 10 to 67 months). Seven of 8 patients (87.5%) underwent liver transplantation before 1 year of age. The common clinical presentations were persistent fever (8 of 8, 100%) and bloody diarrhea (6 of 8, 75%). PTLD was diagnosed with gastrointestinal endoscopic biopsies in five patients and surgical biopsies in three. Histologic findings showed early lesion in three patients, polymorphic in two, and monomorphic in three. Burkitt lymphoma and lymphoblastic lymphoma were found in two of 3 monomorphic patients. Seven of 8 patients were found with EBV-positive. Eight patients were treated with dose reduction of immunosuppressants and infusion of ganciclovir. Rituximab was added to four patients. PTLD were successfully managed in all patients except one who died of sepsis during chemotherapy. CONCLUSION: Major risk factor of PTLD was to undergo liver transplantation before 1 year of age. Continuous monitoring for EBV viral load and gastrointestinal endoscopic biopsy may be useful to early detection of PTLD.
Antibodies, Monoclonal, Murine-Derived ; Biopsy ; Burkitt Lymphoma ; Child ; Diarrhea ; Fever ; Ganciclovir ; Herpesvirus 4, Human ; Humans ; Immunosuppressive Agents ; Liver ; Liver Transplantation ; Lymphoproliferative Disorders ; Medical Records ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prevalence ; Retrospective Studies ; Risk Factors ; Sepsis ; Transplants ; Viral Load ; Rituximab

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Transient Intestinal Ileus in Neonate: A Study of Comparison with Hirschsprung's Disease.

Kwang Hae CHOI

Korean Journal of Pediatric Gastroenterology and Nutrition.2009;12(2):194-198.

PURPOSE: Severe abdominal distension is not uncommon symptom in the neonate. Two major causes of this symptom are benign transient intestinal ileus (BTII) and Hirschsprung`s disease (HD). But it is difficult to differentiate BTII from HD based on the symptoms and simple abdominal x-ray findings. The aim of this retrospective study was to assess the clinical aspects and diagnostic tests differencing two diseases. METHODS: From August 2004 to March 2009, nineteen patients with severe abdominal distension, who underwent barium enema, anorectal manometry, and rectal suction biopsy (triple tests) due to a suspicion of HD, were enrolled. A comparison of clinical data associated with BTII and HD based on the clinical features and results of triple tests. RESULTS: The age of onset of symptom was between 2 and 6 weeks in BTII and within 3 weeks in HD. On the barium enema, transitional zone revealed in 6 (50%) patients in BTII and 4 (57.1%) in HD. On anorectal manometry, the anorectal inhibitory reflex was present in 11 (91.7%) patients in BTII and 1 (14.3%) in HD. On rectal suction biopsy, ganglion cell was present in 9 (75%) patients in BTII and 0 (0%) in HD. Abdominal distension was improved within 3 months of life in all cases of BTII. CONCLUSION: We think that anorectal manometry may be more simple and useful diagnostic method than barium enema and rectal suction biopsy for differential diagnosis of transient intestinal ileus and Hirschsprung's disease.
Age of Onset ; Barium ; Biopsy ; Diagnosis, Differential ; Diagnostic Tests, Routine ; Enema ; Ganglion Cysts ; Hirschsprung Disease ; Humans ; Ileus ; Infant, Newborn ; Manometry ; Reflex ; Retrospective Studies ; Suction

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