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The Role of Massive Shaking Irrigation and Abdominal Drainage After Laparoscopic Appendectomy for Panperitonitis Secondary to Perforated Appendicitis in Children.

Woo Yeon KIM ; Jae Hee CHUNG

Journal of the Korean Association of Pediatric Surgeons.2011;17(1):51-57.

Use of laparoscopic appendectomy (LA) for perforated appendicitis (PA) in children remains controversial because of the development of postoperative intra-abdominal abscess formation. We developed the irrigation method for the prevention of abscess formation after LA performed for PA in children with severe panperitonitis. We called it 'the shaking irrigation'. The object of this study was to analyze the efficacy of this irrigation method. All cases of PA with severe panperitonitis in children that underwent LA with massive shaking irrigation and drainage between June 2003 and December 2007 were studied retrospectively. We included only PA with panperitonitis and large amounts of purulent ascites throughout the abdomen as well as an inflamed small bowel with ileus. Thirty-four children were involved in this study. The mean patient age was eight years. The mean amount of irrigation fluid was 8.2L (range: 4-15L). The mean operative time was 89.5 min. The mean length of the hospital stay was 5.1 days. There were no postoperative intra-abdominal abscesses. There was no conversion to open surgery. In conclusion, Use of LA in PA with severe panperitonitis in children is safe and effective. Massive shaking irrigation and abdominal drainage appears to prevent intra-abdominal abscesses after LA for PA with panperitonitis.
Abdomen ; Abdominal Abscess ; Abscess ; Appendectomy ; Appendicitis ; Ascites ; Child ; Conversion to Open Surgery ; Drainage ; Humans ; Ileus ; Length of Stay ; Operative Time ; Retrospective Studies

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Operative Management of Complicated Meckel's Diverticulum Laparotomy and versus Laparoscopic Assisted Surgery.

Yura LEE ; Min Jeng CHO ; Taehoon KIM ; Dae Yeon KIM ; Seong Chul KIM ; In Koo KIM

Journal of the Korean Association of Pediatric Surgeons.2011;17(1):45-50.

Meckel's diverticulum (MD) has various clinical presentations and due to the limitation of imaging studies, pre-operative diagnosis is a challenge in pediatric patients. Recently, laparoscopic exploration has been suggested as a favorable method for the diagnosis and treatment of complicated MD. We investigated the results of laparoscopic-assisted surgery compared with open technique. We retrospectively studied patients who underwent resection of complicated MD at our institute from 1997 to 2010 and compared 11 treated by laparoscopic-assisted diverticulectomy (LD) with 11 treated by open diverticulectomy (OD) for complicated MD. Operation time was not significantly different in the two groups. Hospital stay and time to diet were not significantly different. Two patients were re-admitted due to mechanical ileus in the LD group. None of patients in either group needed re-operation. Considering the possibility of false-positive results with imaging studies and the cosmetic benefit, laparoscopic-assisted surgery is a safe and effective treatment modality to diagnose and treat complicated Meckel's diverticulum.
Cosmetics ; Diet ; Humans ; Ileus ; Laparotomy ; Length of Stay ; Meckel Diverticulum ; Retrospective Studies

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Risk Factors Affecting Recurrence of Thyroglossal Duct Cyst in Children.

Heekyung JUNG ; Jinyoung PARK

Journal of the Korean Association of Pediatric Surgeons.2011;17(1):35-44.

Thyroglossal duct cysts (TGDC) are the most common type of congenital developmental anomaly encountered in the anterior midline of the neck in childhood. The aim of the study was to evaluate the clinical characteristics of TGDC and identify any factors that could be related to recurrence after surgery. This study consisted of a retrospective chart review of 45 patients treated at Kyungpook National University Hospital for TGDC between 1990 and 2008. All records were reviewed for age and sex, length of history, presentation, diagnostic methods, sizes and locations of cyst, surgical management, histopathology of the lesion and recurrences. The statistical analysis of risk factors for recurrence was made using the Fisher's exact test with a significance level of p < 0.05. The male to female ratio was 2.2:1 with a male preponderance. The mean age at operation was 5 years and 2 months (4 months - 17 years). The most common presenting symptom was a nontender cervical mass (78%). Most TGDC were found in the midline position. Twenty four were infrahyoid, 17 were hyoid, and 4 were suprahyoid level. Forty one (91%) patients received the Sistrunk operation, and 4(9%) patients received cyst excision. Postoperative a seroma developed in six patients in the early postoperative days. There were a total of 3(6.6%) recurrences, 2 in patients who had excision only and in one patient who had the Sistrunk operation. Univariate analysis for risk factors with recurrence showed that there was no statistical relationship between the presence of preoperative infection and the development of recurrence. The removal of hyoid bone along with TGDC was a statistically significant risk factor for recurrent disease. This study suggests that the Sistrunk operation is the treatment of choice for TGDC in order to reduce recurrence.
Child ; Female ; Humans ; Hyoid Bone ; Male ; Neck ; Recurrence ; Retrospective Studies ; Risk Factors ; Seroma ; Thyroglossal Cyst

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Clinical Manifestations of Childhood Intussusception with Ubiquitous Ultrasonography: Comparison with Small Bowel and Ileocecal Type.

Wan sung KIM ; Jin ho JEONG ; Jong Hoon LEE ; Jae Kun PARK ; Hyoun jong MOON ; Hyuk Jai SHIN ; Jong in LEE

Journal of the Korean Association of Pediatric Surgeons.2011;17(1):23-34.

We analyzed the clinical characteristics and outcome of ileocecal and small bowel intussusceptions (ICI and SBI) in the pediatric patients. From August 2003 to July 2010, 144 children with intussusception were included in this study. We retrospectively reviewed the clinical records and imaging study findings. A total of 86 children with ICI and 58 children with SBI were diagnosed. Children with SBI were older than ICI (36.6+/-24.6 months vs. 24.2+/-21.6 months, p=0.002). Typical symptoms such as irritability, abdominal mass, bloody stool were more frequent in ICI than SBI (p<0.05) patients. In the ICI group, intussusceptums were reduced with air reduction (84.5%), surgery (17.4%), and spontaneity (1.2%). All patients in the SBI group were reduced spontaneously. SBI occurred in older age and was reduced spontaneously more frequently than ICI. Conservative management with close observation with follow-up by ultrasonography is recommended for SBI.
Child ; Follow-Up Studies ; Humans ; Intussusception ; Retrospective Studies

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Meconium Obstruction in Neonates-Clinical Characteristics and Treatment.

Eun Young CHANG ; Mi Jung LEE ; Myung Joon KIM ; Jae Ho SHIN ; Hye Kyung CHANG ; Seok Joo HAN ; Jung Tak OH

Journal of the Korean Association of Pediatric Surgeons.2011;17(1):15-22.

Meconium obstruction (MO) in neonates arises from highly viscid meconium and the poor motility of the premature gut. Recently the incidence of the MO in neonates has been increasing, but, the diagnosis and treatment of this disease have not yet been clarified. Between March 2004 and April 2010, 24 neonates were treated for MO at Severance Children's Hospital. Their clinical characteristics and treatment were reviewed retrospectively. Twenty neonates were diagnosed with MO and 4 neonates were diagnosed with Hirschsprung's disease (HD). The mean birth weight and gestational age of the 20 neonates with MO were 1.45+/-0.90kg and 31.1+/-4.6 weeks, respectively. Thirteen neonates (65%) diagnosed with MO weighed less than 1.5kg and 10 neonates (50%) weighed less than 1kg. Half of the neonates with MO were treated by non-operative methods and the other half were treated by operative methods. Compared with the group that weighed over 1.5kg, the group that weighed less than 1.5kg were more frequently operated upon (61.5% vs. 28.5%), and contrast enemas were performed later and more frequently. Also the group that weighed less than 1.5kg had a higher mortality rate (15.4% vs. 0%). Three of the four neonates with HD were diagnosed with long-segment aganglionosis. In conclusion, MO occurred in very low birth weight neonates more often and must be differentiated from HD. Also, MO in very low birth weight neonates should be treated with special attention due to more a complicated clinical course.
Birth Weight ; Enema ; Gestational Age ; Hirschsprung Disease ; Humans ; Incidence ; Infant, Newborn ; Infant, Very Low Birth Weight ; Meconium ; Retrospective Studies

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Biliary Atresia.

Seok Joo HAN

Journal of the Korean Association of Pediatric Surgeons.2011;17(1):1-14.

Biliary atresia (BA) is an infantile cholestatic disease of progressive obliterative cholangiopathy with varying degrees of damage to both extra and intrahepatic bile ducts due to unknown causes. The diagnostic studies should be done to diagnose or exclude BA without unnecessary delay. Kasai portoenterostomy is the first choice of treatment for bile drainage from microscopic bile ductules present in the portal fibrous mass. The medical management after Kasai portoenterostomy should be done carefully to maintain bile excretion and prevent and treat complications including cholangitis, hepatic fibrosis, portal hypertension and nutritional problem. The reported five years-survival rates after Kasai portoenterostomy range from 30 to 60%. About 20% of all patients undergoing Kasai portoenterostomy during infancy survive into adulthood with their native liver. Even if Kasai portoenterostomy remains as the first line of treatment in BA, liver transplantation serves as a good salvage treatment when portoenterostomy fails or liver function gradually deteriorates after initially successful establishment of bile flow. Overall 5-year survival rate in BA is about 90% in recent series.
Bile ; Bile Ducts, Intrahepatic ; Biliary Atresia ; Cholangitis ; Drainage ; Fibrosis ; Humans ; Hypertension, Portal ; Liver ; Liver Transplantation ; Survival Rate

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Laparoscopic-Assisted Transanal Endorectal Pull-Through for Segmental Dilatation of Rectosigmoid Colon in a Child.

Ji Young PARK ; Jinyoung PARK

Journal of the Korean Association of Pediatric Surgeons.2013;19(2):156-161. doi:10.13029/jkaps.2013.19.2.156

Congenital segmental dilatation of the colon is a very rare entity of unknown etiology, characterized by a localized dilatation of a bowel segment of the colon of variable length and an abrupt transition between the normal and dilated intestine. It can affect any part of the colon, with the rectosigmoid colon being the most commonly affected site. The clinical and radiological features may resemble that of Hirschsprung disease, but differ in that the normal ganglion cells are found in the dilated and normal segment of the colon. We performed laparoscopic-assisted transanal endorectal pull-through for segmental dilatation of rectosigmoid colon in an 8-year-old boy with chronic constipation since the age of 5 months.
Child* ; Colon* ; Constipation ; Dilatation* ; Ganglion Cysts ; Hirschsprung Disease ; Humans ; Intestines ; Male

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Tuberculous Iliopsoas Muscle Abscess Associated with Multiple Intraabdominal and Thoracic Abscesses in 9-year-old Boy.

Eunyoung JUNG ; Woo Hyun PARK ; Soon Ok CHOI

Journal of the Korean Association of Pediatric Surgeons.2013;19(2):150-155. doi:10.13029/jkaps.2013.19.2.150

Tuberculous Iliopsoas muscle abscess is a rare manifestation in patient with extrapulmonary tuberculosis and hardly observed in developed country. Paradoxical response to anti-tuberculous medication could make difficult therapeutic decision to clinicians. The authors report a case of tuberculous iliopsoas muscle abscess with multiple intraabdominal and thoracic abscesses in 9 year-old-boy who presented paradoxical response to anti-tuberculous treatment.
Abscess* ; Child* ; Developed Countries ; Humans ; Male* ; Muscles* ; Psoas Abscess ; Tuberculosis

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Hemorrhagic Complication of Protruding Preperitoneal Fat Presenting as an Incarcerated Inguinal Hernia in a Patient with Clinically Occult Inguinal Hernia.

Eunyoung JUNG ; Woo Hyun PARK ; Soon Ok CHOI

Journal of the Korean Association of Pediatric Surgeons.2013;19(2):145-149. doi:10.13029/jkaps.2013.19.2.145

No abstract available.
Hemorrhage ; Hernia, Inguinal* ; Humans ; Lipoma

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A Case of An Incidentally Diagnosed Adrenal Venous Malformation in A Child.

Yoon Jung BOO ; Eun Hee LEE ; Kwang Chul LEE ; Nam Hee WON

Journal of the Korean Association of Pediatric Surgeons.2013;19(2):140-144. doi:10.13029/jkaps.2013.19.2.140

Adrenal venous malformation is an uncommon disease. We report a case of an incidentally diagnosed adrenal cystic mass during an evaluation for gastritis in a child. A 14-year-old girl admitted to our pediatric department for epigastric pain. After the gastroscopy, she was diagnosed with hemorrhagic gastritis. A 5.5 cm-sized cystic mass was incidentally found adjacent to her left adrenal gland during an ultrasound examination for evaluating her abdominal symptoms. She underwent laparoscopic surgery for the diagnosis and treatment of this cystic mass, which was confirmed to be venous malformation at pathologic diagnosis.
Adolescent ; Adrenal Glands ; Adrenalectomy ; Child* ; Diagnosis ; Female ; Gastritis ; Gastroscopy ; Humans ; Laparoscopy ; Ultrasonography

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