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Journal of the Korean Association of Pediatric Surgeons.2004;10(1):47-51.

Visceral lipoma originating from the mesentery is very rare in childhood. A 29-month-old male presented with painless abdominal distension. Abdominal ultrasonography and CT revealed a huge multilobulated hypodense mass in the peritoneal cavity. Exploratory laparotomy showed a 26 x 25 x 5 cm sized encapsulated, lobulated, homogenous mass, which originated from the transverse mesocolon. Histologic examination revealed a lipoma. The postoperative course was uneventful.
Child, Preschool ; Humans ; Laparotomy ; Lipoma* ; Male ; Mesentery ; Mesocolon ; Peritoneal Cavity ; Ultrasonography

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Trichobezoar: Two Cases of Unusual Presentation.

Doo Sun LEE

Journal of the Korean Association of Pediatric Surgeons.2004;10(1):43-46.

Two cases of trichobezoar with unusual presentation in female children are described. The first case is a 7-year-old female with a 3-day history of abdominal pain, obstipation, and emesis. She developed intestinal obstruction and showed double bezoars in the stomach and intestine respectively. She had been in a habit of biting or sucking hairs before sleeping from infancy until 5 years of age. The other patient is a 6-year-old girl referred for an epigastric mass, emotional disturbance and trichotillomania. In spite of the psychological treatment, 4 laparotomies were necessary due to repeated recurrences.
Abdominal Pain ; Affective Symptoms ; Bezoars* ; Child ; Female ; Hair ; Humans ; Intestinal Obstruction ; Intestines ; Laparotomy ; Recurrence ; Stomach ; Trichotillomania ; Vomiting

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A Case of Thymolipoma in a Child.

Suk Woo SON

Journal of the Korean Association of Pediatric Surgeons.2004;10(1):39-42.

Thymolipoma is a rare benign mediastinal tumor, composed of mature fatty and thymic tissues. A 9-year-old boy was referred with a one-month history of neck swelling. Preoperative computed tomography scan and fine needle aspiration biopsy suggested thymolipoma. Despite it being rare, thymolipoma should be considered in the differential diagnosis of mediastinal tumors. Characteristics of its clinical feature and radiological findings that can differentiated it from other mediastinal tumors are discussed with a review of the literatures.
Biopsy ; Biopsy, Fine-Needle ; Child* ; Diagnosis, Differential ; Humans ; Male ; Mediastinum ; Neck ; Thymus Gland

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Visceral Leishmaniasis in a Child.

Hyun Young KIM ; Seung Eun JUNG ; Kwi Won PARK ; Woo Ki KIM

Journal of the Korean Association of Pediatric Surgeons.2004;10(1):35-38.

Visceral leishmaniasis is a life-threatening systemic infection caused by a protozoa of the genus leishmania and transmitted by sandfly. We report the first case of visceral leishmanaisis in Korea. The patient was a one-year-old girl admitted with the symptoms of fever, abdominal distension, pancytopenia, and purpura. She traveled to Argentina 5 months ago, and has had symptoms such as fever and pale appearance. Laboratory findings were: WBC, 12,680/mm3; Hg, 3.7g/dL; platelet, 100K; total bilirubin, 1.2mg/dL; AST/ALT, 48/10 U/L. CT scan and MRI showed hepato-splenomegaly. On laparotomy, excision of an accessory spleen and splenic hilar lymph nodes were performed. Many amastigotes were microscopically identified in histiocytes from the biopsy tissues. Sodium stibogluconate was administrated for 2 weeks, which did not relieve the symptoms. After administration of the additional Amphotericin B for 3 weeks, symptoms were improved.
Amphotericin B ; Antimony Sodium Gluconate ; Argentina ; Bilirubin ; Biopsy ; Blood Platelets ; Child* ; Female ; Fever ; Histiocytes ; Humans ; Korea ; Laparotomy ; Leishmania ; Leishmaniasis, Visceral* ; Lymph Nodes ; Magnetic Resonance Imaging ; Pancytopenia ; Psychodidae ; Purpura ; Spleen ; Tomography, X-Ray Computed

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Laparoscopic Splenectomy in Children.

Eun Young JUNG ; Dae Yeon KIM ; Seong Chul KIM ; In Koo KIM

Journal of the Korean Association of Pediatric Surgeons.2004;10(1):31-34.

The laparoscopic splenectomy (LS) became popular over the last 10 years. The advantage of LS over open splenectomy (OS) includes short hospital stay, improved cosmesis, less development of postoperative intestinal ileus, and less analgesics required. The purpose of this study is to evaluate the outcome of LS at Asan Medical Center from January 1999 to January 2003. The records of 14 consequent children who underwent splenectomy were reviewed retrospectively. Patients characteristics, morbidity, mortality, operative time, blood loss, and hospital stay were analyzed., Seven patients age 5 to 15 years underwent LS under the indications: idiopathic thrombocytic purpura (ITP, n=3), hereditary spherocytosis (n=3), and myelodysplastic syndrome (n=1). Seven patients, age 7 to 16 years, underwent OS during the same period for ITP (n=7). Median operative time was 120 minutes (80 to 170 mins.) in OS, and 270 minutes (110 to 480 mins.) in LS (p<0.05). Median length of hospital stay was 6 days (3 to 8) in OS, and 4 days (3 to 6) in LS (p>0.05). Median splenic length was 12.0 cm (9.2 to 18.0) in OS, 14.0 cm (10.0 to 19.5) (p>0.05). Accessory spleens were identified in 3 of 7 LS and 1 of 7 OS cases. In the LS group, there was no conversion to open surgery. Two patients in LS required blood transfusion postoperatively. LS in children can be performed as effectively and safely as OS.
Analgesics ; Blood Transfusion ; Child* ; Chungcheongnam-do ; Conversion to Open Surgery ; Humans ; Ileus ; Laparoscopy ; Length of Stay ; Mortality ; Myelodysplastic Syndromes ; Operative Time ; Purpura ; Retrospective Studies ; Spleen ; Splenectomy*

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A Clinical Analysis of Complicated Gastroduodenal Ulcer in Children.

Kwang Yong JUNG ; Yeon Jun JEONG ; Chan Young KIM ; Doo Hyun YANG ; Jae Chun KIM

Journal of the Korean Association of Pediatric Surgeons.2004;10(1):22-30.

A total of 30 cases of the peptic ulcer in children, who underwent operations from January 1981 to December 1995 because of complications at Department of the Surgery, Chonbuk National University Medical School, is reviewed. Twenty-three were males (76.7%), 7 females (23.3%) and male was preponderant at 3.3:1. There were 25 cases (83.3%) age 10 to 15 years, 3 (10.0%) between 2 and 9 years, and 2 (6.7%) below 2. The ulcer was located at duodenum in 27 (90.0%), and at stomach in 3 cases (10.0%). Complications were perforation in 19 cases (63.3%), pyloric obstruction in 9 (30.0%) and bleeding in 2 (6.7%). For perforation, truncal vagotomy with pyloroplasty was done in 11 cases, truncal vagotomy with hemigastrectomy and gastrojejunostomy in 6, and simple closure in 2 cases. For obstruction, truncal vagotomy with hemigastrectomy and gastrojejunostomy was done in 5, and truncal vagotomy and pyloroplasty in 3 cases. For bleeding lesions, truncal vagotomy and pyloroplasty was performed in 2 cases. Ten postoperative complications developed in 9 patients; adhesive ileus in 5, recurrence in 2, pneumonia 2, and wound seroma 1 case. One patient developed a primary duodenal perforation and another a recurrent obstruction. Both of patients had symptoms for more than 3 years and were treated with truncal vagotomy and pyloroplasty for the primary operations. Hospital stay was 11.5 days for the patient with perforated ulcer, 11.0 days for the patient with pyloric obstruction, and 14.5 days for the child with bleeding. Average hospital period was 11.6 days. To reduce recurrences after operation, extensive procedure such as distal gastrectomy with vagotomy at the first operation should be considered in case with severe complication or with patients who have been symptomatic for long periods.
Adhesives ; Child* ; Duodenum ; Female ; Gastrectomy ; Gastric Bypass ; Hemorrhage ; Humans ; Ileus ; Jeollabuk-do ; Length of Stay ; Male ; Peptic Ulcer* ; Pneumonia ; Postoperative Complications ; Recurrence ; Schools, Medical ; Seroma ; Stomach ; Ulcer ; Vagotomy ; Vagotomy, Truncal ; Wounds and Injuries

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Operative Management of the Prenatally Diagnosed Choledochal Cyst.

Yun Mee CHOI ; Jae Hyuck CHOI ; Jeong Meen SEO ; Suk Koo LEE

Journal of the Korean Association of Pediatric Surgeons.2004;10(1):17-21.

Improvement in prenatal ultrasonography is leading to diagnose choledochal cyst before birth and before onset of classical symptom more frequently. But, there is a controversy about optimal timing for cyst excision of prenatally diagnosed asymptomatic choledochal cyst. To identify the most appropriate timing for surgery in prenatally diagnosed choledochal cysts, we analyzed 6 patients who had operation for choledochal cysts within 30days after birth at the division of Pediatric Surgery, Samsung Medical Center and Inha University School of Medicine, from June 1995 to June 2002. Males were four and females 2, the mean age at operation was 11.2 days, and the median age 8.0 days. The range of gestational ages of the antenatal diagnosis of bile duct dilatation was 24 weeks to 32 weeks, mean was 38.3 weeks, and mean birth weight was 3,298.3 g. After birth, abdominal ultrasonography, hepatobiliary scintigraphy, and magnetic resonance cholangiopancratography (MRCP) were performed. Mean age at operation was 11.2 days. All patients had the cyst excision and Roux- en-Y hepaticojejunostomy. Immediate postoperative complication was not found. During the median follow-up period of 41 months, one patient was admitted due to cholangitis, and the other due to variceal bleeding. Early operative treatment of asymptomatic newborn is safe and effective to prevent developing complications later in life.
Bile Ducts ; Birth Weight ; Cholangitis ; Choledochal Cyst* ; Dilatation ; Esophageal and Gastric Varices ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Infant, Newborn ; Male ; Parturition ; Postoperative Complications ; Prenatal Diagnosis ; Radionuclide Imaging ; Ultrasonography ; Ultrasonography, Prenatal

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A Clinical Study of Intestinal Duplication.

Tae Woo KIM ; Poong Man JUNG

Journal of the Korean Association of Pediatric Surgeons.2004;10(1):9-16.

Intestinal duplication is a rare congenital anomaly. The diagnostic approach is difficult because of the differences in its location and clinical presentation. To evaluate the diagnostic as well as the therapeutic approaches in children, the medical records of 20 patients with intestinal duplications which had been operated upon from July 1980 to October 2002 were analyzed, retrospectively. The range of age was from 1 day to 11 years. The variables, such as age, sex, clinical presentation, diagnostic method, localization, anatomic type, treatment, complication, and combined anomalies were analyzed. Most of the cases were presented as incidental finding. The majority of the duplications except hindgut were cystic type. Treatment included segmental intestinal resection, excision of the lesion without intestinal resection, and septotomy. Seventy-five percent of the patients were detected before 1 year of age. The anatomic type of the lesion was closely related with its location. The cases of hindgut were almost always tubular type except 1 case. Clinical presentation was related to age, location, and anatomic type. There were no specific diagnostic methods. Perfect localization and application of appropriate operation are the most important requirements for successful treatment.
Child ; Gastrointestinal Tract ; Humans ; Incidental Findings ; Intestines ; Medical Records ; Retrospective Studies

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Re-pull-through Operation in Hirschsprung's Disease.

Hyun Young KIM ; Kwi Won PARK ; Yong Soon CHUN ; Seung Eun JUNG ; Seong Cheol LEE ; Woo Ki KIM

Journal of the Korean Association of Pediatric Surgeons.2004;10(1):1-8.

A re-pull-through operation for Hirschsprung's disease is performed when the primary operation has failed because of the remnant or acquired aganglionosis, anastomotic stricture and/or fistula. The purpose of this study is to review our experience of the re-pull-through procedure for Hirschsprung's disease. From May 1978 to July 2003, 26 patients who underwent re-pull-through operations at the Department of Pediatric Surgery, Seoul National University Children's Hospital, were studied retrospectively by means of chart review as well as telephone interview. The mean age at primary operation and re-operation were 11months (2 months - 10 years) and 43 months (1 year - 23 years 3 months), respectively. Initial operation for Hirschsprung's disease was Duhamel's procedure in 17, Swenson's in 6 and Soave's 3. Causes of failure of primary operation were remains of secondary aganglionic segment (n=23), vascular arcade injury (n=1), rectoperineal fistula (n=2, due to mesenteric torsion and poor blood supply). Mean interval between the primary operation and the re-operation was 34 months (6 months-22 years). Reoperation methods were Soave's in 12, Duhamel's in 8, APSP (abdomino-posterosagittal pull-through procedure) in 5, and Swenson's in 1 case. In 2 cases of repeated rectoperineal fistula or rectourethral fistula, re-APSP were performed 3 times, respectively. A total of 29 re-pull-through operations were performed. Postoperative complications were wound infection (n=1), adhesive ileus (n=1), rectoperineal fistula (n=3), rectourethral fistula (n=2), and death due to pulmonary embolism (n=1). Mean follow up period of reoperation was 78 months (1 month-23years). In current state, 2 patients have an ileostomy because of repeated rectoperineal fistula and rectourethral fistula. Of the remaining 23 patients, 21(91 %) are totally continent with or without minimal soiling. Reoperation for Hirschsprung's disease was effective and safe for the patients complicated to the initial pull-through operation.
Adhesives ; Constriction, Pathologic ; Fistula ; Follow-Up Studies ; Hirschsprung Disease* ; Humans ; Ileostomy ; Ileus ; Interviews as Topic ; Postoperative Complications ; Pulmonary Embolism ; Reoperation ; Retrospective Studies ; Seoul ; Soil ; Wound Infection

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Prevalence and Significance of Immature Ganglion Cell in Hirschsprung's Disease.

Hee Beom YANG ; Hyun Young KIM ; Soo Hong KIM ; Sung Eun JUNG ; Kwi Won PARK

Journal of the Korean Association of Pediatric Surgeons.2013;19(2):122-129. doi:10.13029/jkaps.2013.19.2.122

Immature ganglion cell (IGC) is known for its relationship with intestinal motility and its impact on postoperative functional outcomes of Hirschsprung's disease (HD). There are few studies on the relationship between intestinal dysmotility and IGC in HD patients. 67 patients pathologically diagnosed with HD and who received definitive operation in Seoul National University Children's Hospital from 2010 to 2011 were included. 10 patients were excluded due to inadequate immunohistochemical staining results. The proximal end of resected ganglionic segment was evaluated with immunohistochemistry examination with MAP-2, a marker of ganglionic cells and bcl-2, a marker of IGCs The median age at operation was 155 (15-4678) day-old. 55 (96.5%) patients positive for bcl-2, were regarded as having IGC, and 2 (3.5%) patients positive for MAP-2 but negative for bcl-2, were regarded as having only mature ganglion cells. In the bcl-2 positive group, there were 7 patients (12.7%) with constipation, 15 patients (27.3%) with soiling, 3 patients (5.5%) with perianal excoriation and 6 patients (10.9%) with medication use. In bcl-2 negative group, intestinal dysmotility was not seen. There was no statistical significance in the two groups. Considering that HD is diagnosed at a young age, the rate of IGC present is very high and it might be inappropriate to relate IGC to functional outcome at young ages.
Constipation ; Ganglion Cysts* ; Gastrointestinal Motility ; Hirschsprung Disease* ; Humans ; Immunohistochemistry ; Prevalence* ; Seoul ; Soil

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