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A Case of Neonatal Hydrocolpos due to Vaginal Atresia.

Young Jung JO ; Jong Hoon PARK ; Sang Youn KIM

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):166-169.

A 37-week gestation female neonatal infant presented with lower abdominal distension. Ultrasonography showed a hydrocolpos, measuring 8.3 cm x 6.9 cm x 6.1 cm in size and on perineal examination, vaginal atresia was noticed. On a follow-up ultrasonography performed 41 days after aspiration, the hydrocolpos was enlarged to 10 cm x 8 cm x 7 cm in size, and compressed adjacent small bowel significantly with concomitant bilateral hydronephrosis. Temporary tubed vaginostomy was carried out with the provision of excellent drainage and easy access for contrast studies to outline the pathologic anatomy. We are planning to perform vaginal reconstructive surgery on her age around 2 years, when her vaginal structure might grow sufficiently for reconstructive surgery.
Drainage ; Female ; Follow-Up Studies ; Gynecological Examination ; Humans ; Hydrocolpos* ; Hydronephrosis ; Infant ; Pregnancy ; Ultrasonography

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Clear Cell Sarcoma of the Kidney: A case report.

Jae Hyun PARK ; Jae Hee JUNG ; Ah Won LEE ; Young Tack SONG

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):162-165.

Clear Cell Sarcoma of the Kidney (CCSK) is a rare malignant childhood tumor with frequent metastasis to the bone. We report a case of right sided in a 5 month-old girl. A radical nephrectomy was performed. It was clinical stage III with renal capsular invasion and lymph node metastasis by the classification of NWTS-5. Histologic examination revealed the classic pattern of CCSK. Postoperative adjuvant chemotherapy with doxorubicin and radiotheraphy were applied.
Chemotherapy, Adjuvant ; Classification ; Doxorubicin ; Female ; Humans ; Infant ; Kidney* ; Lymph Nodes ; Neoplasm Metastasis ; Nephrectomy ; Sarcoma, Clear Cell*

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Laparoscopic Meckel's Diverticulectomy in Children.

Seok Joo HAN ; Jun Young KIM ; Jeong Wook HUH ; Airi HAN ; Eui Ho HWANG

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):157-161.

Meckel's diverticulum is one of the common causes of gastrointestinal bleeding in the pediatric patient requiring laparotomy. Two children with Meckel's diverticulum have been successfully treated by laparoscopic excision. Both patients recovered without incident and were discharged at 3 and 5 days after surgery. The authors believe that laparoscopic diverticulectomy is a safe, effective, and minimal invasive treatment of Meckel's diverticulum in children.
Child* ; Hemorrhage ; Humans ; Laparotomy ; Meckel Diverticulum

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OK-432 Intralesional Injection Therapy for Lymphangioma in Children.

Kyung Hun KIM ; Hyun Hahk KIM ; Suk Koo LEE ; Jeong Meen SEO ; Weon Young CHANG ; Byung Boong LEE

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):142-146.

Lymphangioma is a congenital malformation of the lymphatic system, commonly seen in the neck. Operation was the treatment of choice but it is difficult to resect the lymphangiomas completely. The aim of this study is to evaluate the result of intralesional injection of OK-432 as a treatment strategy of lymphangioma in children. Medical records of 51 cases of lymphangioma from March 1996 to February 2001 were reviewed retrospectively. Intralesional injection of 0.1 mg OK-432 in 10ml normal saline was performed after the aspiration of as much fluid as possible. The location of the lesion was the face and neck in 26 patients, the chest wall in 14, the extremities in 9, and the abdominal wall in 2. The cystic type was present in 45 patients and the cavernous type in 6. Four postoperative recurrent cases were included. Fluid aspiration from the lesion was impossible in 5 patients. Development of fever after injection was observed in 27 patients and local inflammatory reaction was in 5 patients. There was no scar formation at injection sites. Complete shrinkage was observed in 20 patients, remarkable shrinkage in 23, slight shrinkage in 3, and no response in 5. Cystic type or aspiration-possible cases showed better outcome than cavernous type or aspiration-impossible cases. All of four recurrent cases after surgical excision showed at least remarkable shrinkage. These results indicate that intralesional injection of OK-432 is a safe and satisfactory treatment modality of lymphangiomas in children and might be considered as a treatment of choice, even in recurrent cases.
Abdominal Wall ; Child* ; Cicatrix ; Extremities ; Fever ; Humans ; Injections, Intralesional* ; Lymphangioma* ; Lymphatic System ; Medical Records ; Neck ; Picibanil* ; Retrospective Studies ; Thoracic Wall

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Results of Modified Sistrunk Operation in thyroglossal duct cyst: A review of 81 cases.

Kyeong Geun LEE ; Poong Man JUNG

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):137-141.

Thyroglossal duct cyst is ectodermal remnant, which may develop along the line of descent of the thyroid gland from the foramen cecum of the tongue to the pyramidal lobe of the thyroid gland. Meticulous dissection of the cyst and duct, along with the body of the hyoid bone is necessary to avoid recurrence. Eighty-one patients with thyroglossal duct cyst treated at Hanyang University Hospital between January 1980 and December 2000 were reviewed to determine the incidence and to analyze the result of management. The male-to-female ratio was 1.4:1 (47:34) with a male preponderance. They are most commonly present at 3-8years (54.2%) of age, but rarely present at infancy. The most common symptom was a painless midline neck mass (76.5%, 62cases). Eighty-one patients underwent modified Sistrunk operation without evidence of recurrence. Eight-nine percent (72 cases) of these lesions were located between thyroid substance and hyoid bone, and 11% (9 cases) were above the hyoid bone. There were 22 infected cysts (27.2%). The Sistrunk operation is a gold standard for treating the thyroglossal duct cysts. For best results in thyroglossal duct cyst surgery, one should make every effort to remove the cyst intact in continuity with the body of the hyoid bone. In our institute, Sistrunk operation modified by the authors showed a good result.
Cecum ; Ectoderm ; Humans ; Hyoid Bone ; Incidence ; Male ; Neck ; Recurrence ; Thyroglossal Cyst* ; Thyroid Gland ; Tongue

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Short-Term Outcomes of Transanal One-Stage Pull-Through for Hirschsprung's Disease.

Gyung Mo SON ; Young Eun PARK ; Sung Who PARK ; Hae Young KIM

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):130-136.

The aim of this study was to evaluate the short-term outcomes of the transanal one-stage pull-through procedure (TOP) in Hirschsprung's disease. Eight patients aged 3 weeks to 8 months with Hirschsprung's disease underwent this procedure. A rectal mucosectomy was performed from just proximal to dentate line to the level of peritoneal reflexion, where muscle layer was incised circumferentially. Rectosigmoid was mobilized out through the anus, and full-thickness frozen biopsy was taken for confirmation of ganglionic cells. After the rectal muscular cuff was divided longitudinally in the posterior aspect, aganglionic bowel was removed and ganglionic colon was anastomozed to the anus. The mean operating time was 161 minutes, and the mean hospital stay after operation was 3.8 days. Five patients had three to four bowel movement per day without other therapy at mean postoperative 39.2 days. Although long-term follow-up will be required, the TOP might be the new alternative surgical procedure for Hirschsprung's disease.
Anal Canal ; Biopsy ; Colon ; Follow-Up Studies ; Ganglion Cysts ; Hirschsprung Disease* ; Humans ; Length of Stay

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Leadpoints in Childhood Intussusception.

Kwan Ju LEE ; Jae Hee CHUNG ; Min Kwang HONG ; Won Yong SUNG ; Chang Hyeok AN ; Young Tack SONG

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):126-129.

Childhood intussusception is usually idiopathic, and pathological lesions as the leading point are found in limited cases. Sixteen operative cases with leadpoints among 2,889 cases of childhood intussusecption treated at the surgical departments of the affiliated hospitals of Catholic University over 19 years are reviewed. The approximate incidence of pathological lesions as the leading point was 0.6%. The male to female ratio was 2:1. The mean age was 3.5 years. There was not an age preponderance. The symptoms were vomiting (63%), abdominal pain (38%), irritability (38%), bloody stools (25%), fever (25%) and abdominal mass (6%). The average duration of the symptoms was 2.4 days (1-10days). The most common lesion was Meckel's diverticulum, followed by malignant lymphomas, polyps, ectopic pancreas, and cecal duplication. An ileocolic type was most frequent, followed by ileoileocolic and ileoileal. Segmental resection or wedge resection of the ileum was done in 10 cases, ileocecectomy in 3, and right hemicolectomy in 3. Surgical reduction was done only in an ectopic pancreas, with no later recurrence. The average hospital stay was 10 days. Postoperative adhesive ileus occurred in two cases, and in one of them adhesiolysis was performed. One case of malignant lymphoma died at 28 days after surgery due to chemotherapy related complication.
Abdominal Pain ; Adhesives ; Drug Therapy ; Female ; Fever ; Humans ; Ileum ; Ileus ; Incidence ; Intussusception* ; Length of Stay ; Lymphoma ; Male ; Meckel Diverticulum ; Pancreas ; Polyps ; Recurrence ; Vomiting

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Clinical analysis of adhesive ileus in children.

Jong Jae LEE ; Hyun Jo YOUN ; Yeoun Jun JEONG ; Jae chun KIM

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):118-125.

The effectiveness of operative and non-operative management for postoperative adhesive ileus in children has been discussed. This study reviews the clinical characteristics and the treatment consequences of adhesive ileus in our institution, Department of Surgery of Chunbuk National University Hospital, retrospectively. A total of 62 cases of post-operative small bowel obstruction treated between January 1975 and December 1998 under the 15 years of age are included in this study. The patients were divided into two groups, operative (n=26) and non-operative (n=36) groups. The prevalent age was between 11 and 15 years (28 cases; 45.2%), and the most common previous operation was appendectomy (28 cases; 45.2%). The most common operative procedures were adhesiolysis (17 cases; 65.4%). The interval between admission and operation was 1 day in 11 cases (42.3%). The most common site of adhesion was the ileum in 13 cases (50.0%) and band constriction was the most frequent pattern (8 cases; 30.8%). Intestinal resection was significantly high in delayed operations of more than four days, in the patients with three or more classical signs of strangulation (fever, tachycardia, leukocytosis, abdominal pain, rebound tenderness), and in the cases of complete obstruction on plain abdomen film (p < 0.05). In conclusion, operation should be considered in cases with three or more signs of strangulation, no clinical improvement for over four days of conservative treatment, and signs of complete obstruction on plain abdomen film during the observation periods.
Abdomen ; Abdominal Pain ; Adhesives* ; Appendectomy ; Child* ; Constriction ; Humans ; Ileum ; Ileus* ; Leukocytosis ; Retrospective Studies ; Surgical Procedures, Operative ; Tachycardia

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Intestinal Perforations in Very Low Birth Weight Infants.

Dae Yeon KIM ; Seong Chul KIM ; Ai Rhan KIM ; Ki Soo KIM ; Soo Young PI ; In Koo KIM

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):112-117.

With the advances in neonatal intensive care, pediatric surgeons experience very low birth weight infants, weighing <1,500 g, more frequently. We report our 14 cases of very low birth weight infants with intestinal perforations without congenital causes, at the Asan Medical Center during the 11-year period from 1989 to 2000. The average birth weight was 919 g (563-1,490), and average gestational age was 206 days (161-286). There were nine males and five females. Operation was performed at an average age of 14.0 days (3-38). Ten neonates with symptomatic PDA were given indomethacin in an attempt to close the ductus. Bowel perforation involved the jejunum in two and ileum in twelve. At laparotomy, there were seven focal intestinal perforations, five typical NEC, one intussusception, and an unknown cause. Four neonates underwent resection and anastomosis of the bowel, and nine underwent exteriorization. One underwent resection and anastomosis after peritoneal drainage. Four patients had postoperative complications; two leakage of anastomosis, one stoma necrosis, and one internal herniation. Seven of fourteen patients survived (50.0%). Seven patients died of septic complication. There was a significant difference in the birth weight and gestational age in survivors compared with those who died (p<0.05). There was an increased risk of bowel perforation in indomethacin treatment for PDA. Careful clinical observation and keen judgment are essential for this particular group of infants.
Birth Weight ; Chungcheongnam-do ; Drainage ; Female ; Gestational Age ; Humans ; Ileum ; Indomethacin ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Intestinal Perforation* ; Intussusception ; Jejunum ; Judgment ; Laparotomy ; Male ; Necrosis ; Postoperative Complications ; Survivors

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Diagnostic Strategy Using Barium Enema and Rectal Suction Biopsy with Acetylcholinesterase Histochemistry in Neonates Suspected of Having Hirschsprung's Disease.

Young Il CHOI ; Soon Ok CHOI ; Woo Hyun PARK

Journal of the Korean Association of Pediatric Surgeons.2001;7(2):105-111.

To investigate the diagnostic accuracy and applicability of barium enema (BE) and rectal suction biopsy with acetyl cholinesterase (AChE) histochemistry in the diagnosis of neonatal Hirschsprung's disease (HD), we retrospectively reviewed the findings of BE and AChE staining in 96 neonates with suspected HD during a 10-year period from January 1991 to December 2000. Sixty-nine cases of HD (58 males and 11 females) and 27 cases of non-HD are included in this study. In regard to BE, HD was based on definite transitional zone, suspicious HD on reversed rectosigmoid index (RSI <1), and non-HD on normal RSI (RSI>1). The histochemical criterion used for the diagnosis of HD was that of Chow et al (1977), i.e., the presence of many coarse discrete cholinergic nerve fibers in the muscularis mucosae and in the immediately subjacent submucosa regardless of infiltration of cholinergic nerve fibers in the lamina propria. Of 66 neonates with HD who underwent BE, transitional zone was identified in 33 cases (50%) and reversed RSI in 19 cases (21%), microcolon in 4 cases and normal finding in 10 cases (15%) while of 27 neonates with non-HD, there was normal finding in 16 cases and reversed RSI in 9 cases (41%). Thus diagnostic accuracy based on transitional zone was 64%. The positive predictive value of reversed RSI for the diagnosis of HD was 68%. Of 42 neonates with HD who underwent AChE histochemistry, there were 41 AChE-positive reactions and one AChE-negative reaction in a neonate with total colonic aganglionosis, while of 27 cases of non-HD, there were one equivocal AChE-positive reaction and 26 AChE-negative reactions. Thus AChE histochemical study showed a 97% diagnostic accuracy with a 98% sensitivity and a 96% specificity. In conclusion, we believe that BE is valuable as a first diagnostic step since about 80% of neonates with HD show significant radiologic findings such as a transitional zone or reversed RSI. AChE histochemical study was a more reliable diagnostic tool showing a 97% diagnostic accuracy, and is particularly valuable in neonates with HD who showed reversed RSI or normal RSI on BE. A diagnostic algorithm in neonates with suspicious HD was proposed.particularly valuable in neonates with HD who showed reversed RSI or normal RSI on BE. A diagnostic algorithm in neonates with suspicious HD was proposed.
Acetylcholinesterase* ; Barium* ; Biopsy* ; Cholinesterases ; Diagnosis ; Enema* ; Hirschsprung Disease* ; Humans ; Infant, Newborn* ; Male ; Mucous Membrane ; Nerve Fibers ; Retrospective Studies ; Sensitivity and Specificity ; Suction*

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