ABSTRACT
PURPOSE: The single stage transanal pull-through (SSPT) for Hirschsprung’s disease is becoming the most popular procedure. This single center study compared the result of single stage operation with two-stage operation for Hirschsprung’s disease in neonates. METHODS: We retrospectively reviewed medical records of all patients who were diagnosed as Hirschsprung’s disease and underwent SSPT or two-stage operation operation in Asan Medical Center between January 2003 and July 2014. RESULTS: There were 17 SSPT and 28 two-stage operation. The mean age of SSPT group was 14.2±7.1 days, and the mean age of two-stage operation group was 15.4±8.6 days for stomy formation, and 188.6±36.3 days for Duhamel operation. The operation time of SSPT was shorter than Duhamel operation (145.0±37.0 minutes vs. 193.0±36.0 minutes, p<0.001). The mean follow-up period of SSPT and two-stage operation was 35.5±34.9 months (range, 2-132 months) and 56.6±35.5 months (range, 1-121 months), respectively. Defecation problem rate such as fecal soiling or fecal impaction showed no significant difference between the two groups (p=0.719). Two SSPT patients required botulinum toxin injection due to rectal stenosis. Three patients of SSPT group underwent re-do endorectal pull-through due to remnant aganglionic or hypoganglionic bowel. CONCLUSION: The SSPT showed shorter hospital days. However, few patients experienced rectal stenosis, but were manageable with botulinum toxin injection. The SSPT requires experienced-pathologist, as well as surgeon, because intra-operation pathology reading is critical for appropriate SSPT. SSPT is a feasible and reasonable option to treat Hirschsprung’s disease.
Subject(s)
Humans , Infant, Newborn , Botulinum Toxins , Constriction, Pathologic , Defecation , Fecal Impaction , Follow-Up Studies , Hirschsprung Disease , Medical Records , Pathology , Retrospective Studies , SoilABSTRACT
Intestinal obstruction involves a partial or complete blockage of the bowel which results in the failure of intestinal contents to pass through. The mechanical causes of obstruction may include the followings: hernias, postoperative adhesions or scar tissue, impacted feces, gallstones, tumors, granulomatous processes, intussusception, volvulus, foreign bodies, and etc. Hernias are the third leading cause of intestinal obstruction by 10% approximately. However, most hernias are the cases with abdominal wall, inguinal or internal hernia. Femoral, obturator, lumbar, or sciatic hernia as the cause of obsturction is rare. Furthermore, the cases accompanying soft tissue necrosis are seldomly reported. Herein, we report a case of intestinal obstruction caused by strangulated femoral hernia accompanying soft tissue necrosis in a 78-years-old female patient.
Subject(s)
Aged , Female , Humans , Diagnosis, Differential , Hernia, Femoral/complications , Intestinal Obstruction/diagnosis , Necrosis , Skin/pathology , Tomography, X-Ray ComputedABSTRACT
Mucocele of the appendix is basically a cystic dilatation of the appendix distal to an obstruction of the appendiceal lumen. It develops in unusual situations in which the distal lumen does not contain enough bacteria to initiate appendicitis when obstruction develops. The continuing mucous secretion causes gradual distention of the appendix and thinning of the wall until mucous secretion stops. The changes after the sudden blocking of the lumen of the appendix depend on the amount and character of the content distal to the obstruction. If the lumen is empty, the appendix distends with mucus to form a mucocele. Here we report a case which we experienced a 68-years-old female patient whose vermiform appendix had mucoceles with appendiceal intussusception.
Subject(s)
Female , Humans , Appendicitis , Appendix , Bacteria , Dilatation , Intussusception , Mucocele , MucusABSTRACT
Most reported cases of intraductal papillary mucinous neoplasms (IPMNs) originate from Wirsung's duct or their branches. IPMNs arising from Santorini's duct and its branches have rarely been reported. Eight cases of IPMN arising from Santorini's duct have been published worldwide. However, these cases are associated with incomplete type of pancreas divisum. Recently, one report of IPMN with complete absence of Wirsung's duct has been reported. This patient was a 57-year-old woman who was admitted to the hospital due to progressive jaundice. On endoscopic retrograde cholangiopancreatography, there was a severely bulging ampulla of Vater and patulous minor papilla draining mucinous material and a cystic lesion communicating with the dilated Santorini's duct without any communication with Wirsung's duct. A pancreaticoduodenectomy was performed and the pathologic examination of resected specimen showed no evidence of Wirsung's duct, but an IPMN arising from Santorini's duct with peripancreatic lymph node metastasis. Herein, we report a case of invasive IPMN arising from pancreatic head without ventral pancreatic duct with a review of the relevant literatures.
Subject(s)
Female , Humans , Middle Aged , Carcinoma, Pancreatic Ductal , Pancreas/abnormalities , Pancreatic Ducts/abnormalities , Pancreatic NeoplasmsABSTRACT
A coffee enema which has been suggested as a part of a cancer treatment, has been misused as a treatment for obesity and constipation among the general population. Its proponents claim that caffeine is absorbed in the colon, which leads to vasodilatation in the liver and stimulation of the hepatocellular function to detoxify the products of the tumor cell metabolism. However, the clinical efficacy of the anti-cancer effect of coffee enemas has not been demonstrated. Many side effects of coffee enemas have been reported. These include severe electrolyte imbalance, polymicrobial enteric septicemia, and even death. We experienced a patient who presented with abdominal pain and a bloody stool after receiving a coffee enema to relieve constipation. We report this case of coffee enema-induced colitis with a review of the relevant.
Subject(s)
Humans , Abdominal Pain , Caffeine , Coffee , Colitis , Colon , Constipation , Enema , Liver , Metabolism , Obesity , Sepsis , VasodilationABSTRACT
PURPOSE: Symptomatic and/or malignant changes in hepatic cysts require surgical treatment, but there are few comparative studies with respect to the safety and long-term effectiveness. We compared the resection and non-resection of hepatic cysts from the view point of recurrence and complications. METHODS: We reviewed 24 patients who underwent surgery for hepatic cysts between 1990 and 2001 at a single institution. There included 15 resections and 9 non-resections. RESULTS: The median age was 59 years, with a male to female sex ratio of 9: 15. The median size of the dominant cyst was 12 cm, and 22 patients presented with symptoms. We treated 12 simple cysts, 3 polycystic liver diseases (PCLD), 3 cystadenomas, 1 cystadenocarcinoma, 2 hamartomas, 1 hydatid cyst, 1 traumatic cyst and 1 other. The causes requiring an operation were peritoneal irritation in 7, a mass effect such as early satiety or jaundice in 5, possible malignancy in 4, associated hepatobiliary diseases in 3, increase of cyst sizes in 2 and another disease in 2. We performed 5 right lobectomies, 2 left lobectomies, 1 left lateral segmentectomy, 3 non-anatomical resections, 3 cyst excisions, and 1 total hepatectomy for liver transplantation in the resection group. 6 unroofings and 3 fenestrations were performed in the non-resection group, in which a laparoscopic approach was applied in 3 cases. The incidence of postoperative complications were uncommon in both groups, whereas resection decreased the recurrence rate significantly (P=0.003). CONCLUSION: Resection is a safe and effective procedure to lower the recurrence of all cystic lesions in the liver.
Subject(s)
Female , Humans , Male , Cystadenocarcinoma , Cystadenoma , Echinococcosis , Hamartoma , Hepatectomy , Incidence , Jaundice , Liver , Liver Diseases , Liver Transplantation , Mastectomy, Segmental , Postoperative Complications , Recurrence , Sex RatioABSTRACT
BACKGROUND/AIMS: Pancreatoduodenectomy is a common procedure for benign or malignant periampulary diseases. But the morbidity and mortality of the procedure are usually high. Being related with morbidity and mortality, the most important procedure of pancreatoduodenectomy is how handle the remnant pancreas. We analysed retrospectively the efficiency of the new method for low morbidity and low mortality in handling of the remnant pancreas in the procedures of pancreatoduodenectomy. METHODS: 118 consecutive patients who had undergone a pancreatoduodenectomy and pancreaticojejunostomy performed by one surgeon, between September 1994 and June 1999, were evaluated retrospectively. The cases were analysed by age, sex, pathologic dianosis, operation time, the amount of transfusion during operation, the hospital stay, postoperative complications and state of survival. RESULTS: The average age of 118 patients was 57.6 years, and the male and female ratio was 1.19:1. The classification by patholoic diagnoses were distal common bile duct cancers (29%), the ampulla of Vater cancers (23%), the pancreas head cancers (14%), the duodenal cancers (1.7%) and the others (32%) including benign diseases. The average operation time was 8 hours 3 minutes, the average amount of transfusion was 0.84 unit and the average hospital stay was 26.1 days. There are 12 (10.2%) postoperative complications. The most were 6(5%) cases of delayed gastric emptying, and the others were 2 (1.7%) cases of leakage of pancreaticojejunostomy, 1 (0.8%) case of ARDS, 1 (0.8%) case of gastroduodenal artery bleeding, 1 (0.8%) case of remnant pancreas bleeding, and 1 (0.8%) case of pseudoaneurysmal bleeding of gastroduodenal artery. The 2 cases of leakage of pancreaticojejunostomy developed at the patients of duodenal cancer and ampulla of Vater cancer. The patient who diagnosed by ampulla of Vater cancer died for sepsis due to leakage of the pancreaticojejunostomy (1/118, 0.8%). CONCLUSION: We had good results in pancreatoduodenectomy and pancreaticojejunostomy by a new method that protect the anastomotic leakge from pancreaticojejunostomy site. This method include pancreas transection by elctrocoagulation, not doing sutures of remnant pancreas to prevent ischemic change of pancreatic cut surface and complete drainage of pancreatic juice using stent that was inserted at remnant pancreatic duct and externally ligated by vicryl with keeping the lumen.