Infantile Hypertrophic Pyloric Stenosis / 이화의대지

Infantile hypertrophic pyloric stenosis (IHPS) is common surgical disease in infants having vomiting. This disease is still not fully documented despite of various hypotheses. This article reviews the literature on the etiology, clinical course, diagnosis and management of IHPS including recent opinion.

A Case of Ruptured Acute Appendicitis Presenting as Pneumoperitoneum in Low Birth Weighted Premature Baby

Acute appendicitis is very rare in premature neonates. Preoperative diagnosis of this condition is difficult, and then it leads to high morbidity and mortality. We report 9-day-old premature male with ruptured acute appendicitis presented with pneumoperitoneum on plain films of the abdomen. Awareness of this rare condition and possible differential diagnosis in this age group is also discussed.

A Study on the Factors that Influence the Surgical Outcomes of Choledochal Cyst in Children

No abstract available.

In Pediatric Patients with Presumed Appendicitis, Is the Urgent Appendectomy the Best?: Appropriate Management for Pediatric Patients with Presumed Acute Appendicitis

PURPOSE: The emerging studies have suggested steadily negative appendectomy rates. The purpose of this study is to verify that short-term observation under conservative management helps surgeons avoid unnecessary surgery without poor progress in pediatric patients with presumed acute appendicitis. METHODS: We reviewed 650 medical records of pediatric patients aged 12 years and younger with presumed acute appendicitis at Ewha Womans University Medical Center between January 2005 and December 2009. We then compared 283 'appendectomy group (AG)' including 229 suppurative appendicitis (SA) and 54 normal appendix or mild appendicitis (MA), pathologically, with 96 'conservative treatment group (CG)' who were diagnosed with mesenteric lymphadenopathy associated with early appendicitis or normal appendix in radiologic study and effectively treated with conservative management. RESULTS: There was no significant difference in gender and age distribution between SA and MA groups, but the mean age of CG was younger than MA group (P=0.000). The main clinical findings between SA, MA and CG were similar but the mean duration of symptom was longest in CG. 'Delayed' and 'night-time' surgery was frequent in MA (P=0.006, P=0.027). Thirteen patients(4.6%) developed complications in AG without significant difference between SA and MA. The mean hospital stay was significantly shorter in CG than MA (P=0.000) without significant difference between SA and MA. The medical cost of CG was much cheaper than AG (P=0.000). No patient in CG needed appendectomy for the follow-up period. CONCLUSION: The authors suggested that short-term watchful waiting for presumed appendicitis in pediatric patients under conservative treatment could reduce unnecessary appendectomy, complications and cost.

The Clinical Features and Management of IHPS: A Comparison between 1980's and 2000's

PURPOSE: A precise and simple tool for diagnosis and the growing public interest in health caused infantile hypertrophic pyloric stenosis (IHPS) to be diagnosed in good time. The approach to pyloromyotomy as the standard treatment is undergoing changes. We compared 2000's IHPS patients with 1980's to identify the clinical features and management. METHODS: We analyzed, retrospectively, the clinical findings, diagnoses, and treatment of 68 patients with IHPS who underwent pyloromyotomy at Ewha Womans University Medical Center from January 2000 to December 2008 (2000's group), and compared the results with that of 42 patients in the 1980's (1980's group). RESULTS: There were no significant differences in age, gender, birth rank, seasonal distribution, and symptoms between both groups, but the number of patients with metabolic changes and palpable 'olive' was significantly lesser in the 2000's group. Upper gastrointestinal series (UGI) was the most common imaging tool in the 1980's (71.4%) but USG has become the standard diagnostic tool in the 2000's (88.2%). All patients received open pyloromyotomy using traditional incision in the 1980's, and supraumbilical semicircular incision in 36.8% of patients in the 2000's. The average length of hospital stay after operation was significantly shorter in the 2000's group. In the 2000's, the mean preoperative stay at hospital was 4.4+/-4.3 days. Twenty-nine (42.0%) patients did not vomit postoperatively and postoperative vomiting did not delay discharges of any patients. CONCLUSION: There were significant improvements in diagnosis and treatment in the 2000's. We suggest that the surgeon, without the need for a radiologist perform USG for IHPS in order to shorten the preoperative hospital stay.

Optimal Time for Appendectomy in Perforated Appendicitis of Children

PURPOSE: It is controversial to treat complicated appendicitis in pediatric patients on several points, especially optimal time for appendectomy. The purpose of this study is to determine optimal time for operation in perforated appendicitis in pediatric patients. METHODS: Children with perforated appendicitis under the age of 14 underwent appendectomy between January 2006 and December 2008 at Ewha Womans University Mokdong Hospital were analyzed retrospectively according to factors which may affect the postoperative hospital course such as complications, time of beginning of diet, and length of hospital stay. RESULTS: During the study period, 357 patients with acute appendicitis underwent appendectomy and 118 patients were diagnosed with perforated appendicitis. Comparing symptom durations between more than 48 hours and less, the former induced significantly higher postoperative complication rates. Body temperature above 37.5degrees C at admission affected significantly higher complication rates and delay of beginning of diet. Children with intraabdominal abscess at appendectomy showed higher complication rates than without abscess. Children who underwent operation in the daytime started diet significantly earlier and showed less complication than those operated on at night. The frequency of preoperative antibiotics administration did not alter the postoperative hospital course. CONCLUSION: For the children diagnosed with perforated appendicitis, non-urgent appendectomy in the daytime after initial conservative management including intravenous administration of antibiotics, hydration, and correction of serum electrolyte is safer and more efficient than performing emergency operation, and moreover there is no necessity for secondary admission for interval appendectomy.

Analysis of the Management of Children with Abdominal Solid Organ Injuries

PURPOSE: In pediatric solid organ injury, non-operative management is considered as a standard treatment when the patient is hemodynamically stable. However, treatment according to the injured organ and the depth of injury is controversial. The purpose of this study is to evaluate treatment results in the management of abdominal solid organ injuries in children. METHODS: This analysis was performed retrospectively with 57 consecutive children under 15 year of age who were diagnosed with abdominal solid organ injuries at Ewha Womans University Mokdong Hospital from January, 1999 to June, 2007. RESULTS: The major cause of pediatric solid organ injury was traffic accidents (59.6%) and the most frequently injured organ was the liver (66.7%). 54 patients (94.7%) were treated non-operatively and the success rate was 100%. There was no difference in type of management and success rate according to the depth of injury or the injured organs. The average ICU stay was 4.3 days, and the average hospital stay was 13.6 days and that was extended depending on the depth of injury. And according to the cause of injury, cases by traffic accident stayed significantly longer than cases by other causes. CONCLUSION: High grade of injury is not contraindication of nonoperative management in pediatric solid organ injury. Hemodynamic instability is the only absolute indication of operation. Therefore, if the patient is stable, non-operative management with intensive observation is the choice of treatment.

Prognostic Factors of Surgically Treated Pneumoperitoneum in Neonates

PURPOSE: This study aims to determine the prognostic factors of pneumoperitoneum in neonates. METHODS: We reviewed 35 neonates who underwent operations for pneumoperitoneum between 1999 and 2007. The prognostic factors on survival were evaluated. RESULTS: Twenty-eight patients were male and 7 were female. Mean gestational age was 35.9+/-4.6 weeks and birth weight was 2,703.1+/-999.2 gr. Mean apgar-score were 6.0+/-2.9 at 1 min, and 6.7+/-2.6 at 5 min. The most common clinical finding was abdominal distension. Most patients were diagnosed with a simple abdominal X-ray. Perforation sites were stomach (n=8), small bowel (n=20), colon (n=5), and small bowel and colon (n=2). Operative methods were bowel resection with enterostomy (n=15), resection with anastomosis (n=9), wedge resection (n=4), primary closure (n=3), primary closure with enterostomy (n=3), and penrose-drain insertion (n=1). Postoperative complications occurred in 16 patients, and 26 patients survived and 9 expired. Mortality rate was significantly higher in lesser gestational age, lower birth weight and apgar-score, need of preoperative ventilator, and abnormalities in ABGA or platelet count. CONCLUSION: The significant prognostic factors were gestational age, birth weight, Apgar-score, need of preoperative ventilator, and abnormal laboratory findings in ABGA and platelet count. The other variables including sex, symptom duration, underlying diseases, perforation sites, and operation methods were not correlated with survival.

Change of the Clinical Aspects and Management of Childhood Intussusception

PURPOSE & METHODS: Nonoperative reduction of childhood intussusception is the treatment of choice. However, few techniques of nonoperative reduction are available. When used, nonoperative reduction can be successfully completed by a radiologist. In this study, we analyzed 637 cases of childhood intussusception diagnosed and treated by ultrasound-guided saline enema reduction (UGSER) over nine years at Ewha Womans University Mokdong Hospital. We compared the results of 76 cases surgically treated after UGSER (US group) with 84 cases surgically treated after barium enema reduction in 1980s (BE group). RESULTS: The success rate of the saline reduction was 88.1%. The risk factors associated with surgery were the patient's age, symptom duration and the type of intussusception. The rate of bowel resection was 32.9%. Patients less than six months old and a pathologic lead point (PLP) on the US were risk factors for bowel resection. There were no significant differences in age, gender and the number of PLPs between the US and BE groups. The number of patients with a spontaneous reduction was greater in the BE group and bowel perforation occurred only in the US group. The bowel resection rate was significantly higher in the US group. However, the median hospital stay was significantly shorter in the US group. CONCLUSION: UGSER is reliable and safe in childhood intussusecption. Moreover, it has a high success rate and is easy to perform. The surgeon, without the need for a radiologist, performs this procedure from diagnosis to treatment. In addition, it might help avoid invasive surgery.

Toxicity of Concurrent Adjuvant CMF Chemotherapy and Radiotherapy in Patients with Early Breast Cancer / 한국유방암학회지

PURPOSE: Many patients with early stage breast cancer are currently being treated with both adjuvant chemotherapy (CT) and radiotherapy (RT). We performed this study to assess the toxicity of concurrent adjuvant cyclophosphamide, methotrexate, and 5-fluourouracil (CMF) CT and RT for treating early breast cancer patients. METHODS: Between January 2000 and December 2005, 97 patients with stage I or II invasive breast carcinoma were treated with breast-conserving surgery, and they received 6 monthly cycles of classic oral chemotherapy with CMF. Within day 7 of cycle 1, the patients started 3 dimensional conformal RT (3DCRT) with a stadard dose, followed by a boost. We used the Common Terminology Criteria for Adverse Events v 3.0 to score the level of acute toxicity for CT. The adverse effects of RT were graded according to the Radiation Therapy Oncology Group criteria. RESULTS: The mean age of the patients was 45.8 yr (range:30-64). The most common toxicity was nausea and leukopenia. The dose of chemotherapy was reduced to 80% of the planned dose for 6.2% of the patient. CT was disrupted for 4.1% of the patients. RT was not disrupted for any patient. Grade 3 and 4 neutropenia occurred in 41 (42.3%) patients, but only one patient needed hospitalization due to fever. Grade 3 skin lesions developed during or shortly after RT in 10.7% of the patients. Radiation penumonitis was noted in 15.5% of the patients. The median follow-up time was 38 months. There was no local recurrence and 2 (2.08%) distant metastases during follow-up. CONCLUSION: From the results of our study, we conclude that the concurrent administration of adjuvant CMF CT and RT is associated with a low risk of serious toxicity and this is an acceptable adjuvant regimen for patients with early stage breast cancer.

Mortality Analysis of Surgical Neonates : A 20-year Experience by A Single Surgeon

Pediatric surgery could establish a definitive position in the medical field on the basis of a stable patient population. Neonatal surgery, the core of pediatric surgery, requires highly skilled surgeons. However, recent advancement of prenatal diagnosis followed by intervention and decreased birth rate has resulted in a significant decrease in the neonatal surgical population and the number of surgical operations. The purpose of this study is to examine the outcome of neonatal surgeries and to propose a guide for the future surgeries. A total of 359 neonatal surgical patients operated upon at the Department of Surgery, Ewha Medical Center, during past 21 years were studied. The study period hasbeen divided into two time periods : from 1983 to 1993 and from 1994 to 2004. Analysis was based on the Clinical Classification System and mortality pattern, frequency of disorders, occurrence and cause of death, and other changes. Neonatal surgery was 6.4 % of all pediatric surgery during the total 21 year period, 9.9 % in the first period and 4.8 % in the second. Male to female ratio increased from 2.7 : 1 to 2.1 : 1. The overall mortality was 6.7 %, and there was significant decrease from 7.4 % in the first period to 6.0 % in the second. The clinical classification system (CCS) for death cases included class II 2, III 4, and IV 7 during the first period and class III 3, and IV 8 during the second, respectively. According to the mortality pattern by Hazebroek, there were 6 preventable death cases during the first period, and only one in the second, and 2 non-preventable death cases during the first period and 8 in second, respectively. Although the patients in the second period had more serious diseases, surgical mortality has been decreased in the second period, which may be the result of improved surgery methods for newborns and advanced patient care.

Trend (in 2005) of Repair of Inguinal Hernia in Children in Korea : A National Survey by the Korean Association of Pediatric Surgeons in 2005

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the "American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)". For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to 'wait and see' until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.

Histological evaluation of the resection margin for percutaneus excision of breast fibroadenoma with using ultrasound-guided Mammotome(R) / 한국유방암학회지

PURPOSE: The excision of breast lesion with using ultrasound-guided Mammotome(R) is currently used for both the treatment and diagnosis of benign lesions. However sonographic evidence for tumor removal by Mammotome(R) excision does not confirm histological clearance of the resection margin. The purpose of this study was to evaluate the efficacy of ultrasound-guided Mammotome(R) for the removal of fibroadenomas by performing histological examination of an additional margin biopsy. METHOD: From March 2003 to May 2005, percutaneous removals of fibroadenoma with using ultrasono-guided Mammotome(R) biopsy were performed for 167 fibroadenomas in 154 women. Margin biopsies were additionally done after complete excision was achieved via ultrasonography. Histological evaluation was performed for these specimens. The patients were scheduled for follow-up ultrasound examination at 6 months. RESULTS: The mean tumor diameter was 1.32+/-0.54 cm. 45 (26.9%) lesions of the 167 lesions showed histological remained fibroadenoma on margin biopsies. The risk factors for remnant lesions were the age of a patient and the size of a lesion. No further ultrasonographic evidence of tumors was noted for 96.9% of the lesions at 6 months CONCLUSION: Although the breast fibroadenoma is a common benign breast tumor, the treatment and follow-up for these lesions is still debatable. We suggest that excision of breast lesion using ultrasound-guided Mammotome(R) can be used as minimally invasive surgery for fibroadenoma. If a lesion is larger than 2cm in a young woman, the physician should be careful to achieve enough excision for a complete removal of tumor.

Histological evaluation of the resection margin for percutaneus excision of breast fibroadenoma with using ultrasound-guided Mammotome(R) / 한국유방암학회지

PURPOSE: The excision of breast lesion with using ultrasound-guided Mammotome(R) is currently used for both the treatment and diagnosis of benign lesions. However sonographic evidence for tumor removal by Mammotome(R) excision does not confirm histological clearance of the resection margin. The purpose of this study was to evaluate the efficacy of ultrasound-guided Mammotome(R) for the removal of fibroadenomas by performing histological examination of an additional margin biopsy. METHOD: From March 2003 to May 2005, percutaneous removals of fibroadenoma with using ultrasono-guided Mammotome(R) biopsy were performed for 167 fibroadenomas in 154 women. Margin biopsies were additionally done after complete excision was achieved via ultrasonography. Histological evaluation was performed for these specimens. The patients were scheduled for follow-up ultrasound examination at 6 months. RESULTS: The mean tumor diameter was 1.32+/-0.54 cm. 45 (26.9%) lesions of the 167 lesions showed histological remained fibroadenoma on margin biopsies. The risk factors for remnant lesions were the age of a patient and the size of a lesion. No further ultrasonographic evidence of tumors was noted for 96.9% of the lesions at 6 months CONCLUSION: Although the breast fibroadenoma is a common benign breast tumor, the treatment and follow-up for these lesions is still debatable. We suggest that excision of breast lesion using ultrasound-guided Mammotome(R) can be used as minimally invasive surgery for fibroadenoma. If a lesion is larger than 2cm in a young woman, the physician should be careful to achieve enough excision for a complete removal of tumor.

Plexiform Neurofibroma Involving the Ascending Colon and its Mesentery in a Child

The neurofibromatosis type 1 (NF-1) is a rare hereditary disease of autosomal dominant fashion with the overall incidence of one in 3,000. It is characterized by cafe-au-lait spots of skin, multiple cutaneous neurofibromas and a broad spectrum of clinical finding. Plexiform neurofibroma is a frequent complication of NF-1 but symptomatic involvement of the gastrointestinal tract in children with NF-1 is rare. It may present with complications such as obstruction, dysfunction, pain and hemorrhage. We report that a 13-year-old female diagnosed with NF-1 at the age of 10 years had abdominal pain and showed huge plexiform neurofibromas of right mesocolon in abdominal cavity. She also presented with multiple cafe-au-lait spots and axillary freckling. She was performed a right hemicolectomy with complete excision of the mass and had an uneventful course.

Abdominal Injury by Falls from a Height in Children

OBJECTIVE: Falls from a height are the leading cause of injury and death among urban children. In this study, objective was to describe the incidence, clinical characteristics, and treatment results of the children who fell from a certain height and admitted over abdominal injury. METHODS: The medical records of patients under 15 years old admitted over abdominal injury by a fall from one meter or more height between January 1997 and December 2003 at Ewha Womans University Mokdong Hospital were analyzed retrospectively. RESULTS: Of 585 consecutive patients who admitted to our hospital after a fall from a height of 1 to 31.2 meters, 28 patients (4.8%) suffered from blunt abdominal trauma. The male to female ratio was 2.1: 1. The children between 12 months and 13 years old were the patients with 5.5 years old of the median age, and the median height fallen was 3 meters. Fifteen patients (53.6%) were during the summer and seventy-nine percent of the falls occurred between noon and 9 pm. Eighteen (64.3%) of falls occurred in residential place and 19 (67.8%) of patients arrived at the emergency department in 30 minutes after the accidents. Only 16 patients (57.1%) complained of abdominal pain. Liver injuries were found in 12 (42.9%), spleen injuries in 5 (17.9%), kidney injuries 3 (10.7%), pancreatic injuries in 1 (3.6%) and nonspecific abdominal injuries in 9 (32.1%) of cases. The increased SGOT and SGPT were found in each 23 (82.2%) and 18 (64.3%) of cases. Eleven patients (39.3%) had been associated with head injuries and limb injuries in each 17.9% and thoracic injuries in 7.1%. Twenty-five patients (89.3%) were recovered under the conservative treatments and the median length of hospital stay was 6 days (range, 2 -20 days). CONCLUSIONS: Despite the absence of abdominal symptoms or shock, falls from a height in children may carry a significant intra-abdominal organ injuries. Moreover the height of free fall cannot reliably predict the degree of the abdominal injury. Accordingly after a fall from height, the abdomen should be evaluated by CT scan for potential injury.

Surveillance of Surgical Wound Infections among Patients from the Department of Surgery: Prospective Trial

PURPOSE: Despite advances in infection control practices, Surgical Site Infections (SSIs) remain a substantial cause of morbidity and mortality among hospitalized patients. This study was undertaken to determine prospectively the incidence of postoperative wound infections in surgical patients and to identify the risk factors associated with the development of wound infections. METHODS: Prospective data on 761 surgical operation patients in the department of surgery at Ewha Womans University Mokdong Hospital were collected over a 7 month-period from May 1, to December 31, 2001. The Centers for Disease Control and Prevention (CDC)'s definitions of surgical wound infections were used. RESULTS: A total of 761 patients were observed over 30 days. The overall incidence of wound infection was 2%. SSIs were significantly associated with the degree of wound contamination (P=0.0004). The infection rate increased as the degree of wound contamination increased from clean (1.4%) through clean-contaminated (1.8%) and contaminated (1.8%), to dirty- infected wound (12.7%). The infection rate was related with the American Society of Anesthesiologists (ASA) preoperative assessment score (P=0.00153). There were no SSIs from laparoscopic surgery. The duration of operation was not associated with an increase in wound infections. Enterococcus faecium and Staphylococcus aureus were the most frequently isolated organisms. Three out of the five (60%) cases of E. faecium were vancomycin-resistant enterococci (VRE) and all of three cases of S. aureus were methicillin- resistant Staphylococcus aureus (MRSA). CONCLUSION: This study confirms that the degree of wound contamination is a significant preoperative risk factor for SSI. Many antibiotic-resistant bacteria such as MRSA and VRE were isolated. Accordingly, infection control practitioners need to consider this risk factor in the design of effective infection control strategies. There should be another safe and feasible option available for the treatment of selective patients.

Clinical Features of the Midgut Volvulus in Children

Midgut volvulus secondary to intestinal malrotation usually presents within the first month of life. Diagnostic delay may result in midgut infarction and mortality. In this retrospective study, we review seventeen cases of midgut volvulus to assess the importance of early recognition for midgut volvulus in pediatric patients of any age.. These patients were diagnosed as having a midgut volvulus by operation at Ewha Womans University Hospital. Eleven patients (64.7 %) were less than 1 month of age, and fifteen were boys (88.2 %). The mean gestational age was 38.3 weeks and the birth weight was 3.1 kg. Eight patients (47.1 %) had one or more combined anomalies such as heart malformation, brain ischemia, Down's syndrome or duodenal atresia. Vomiting was the most common symptom. Only thirteen patients underwent preoperative diagnostic procedures; 13 abdominal sonography demonstrated the whirlpool sign in 8 patients, upper gastrointestinal tract roentgenography showed a cork-screw pattern in 7 patients, and barium enema or small bowel series demonstrated positive findings in 7 patients. A Ladd's procedure was was formed on all patients.. There was no mortality or severe morbidity such as short bowel syndrome. Midgut volvulus should be included in the differential diagnosis in any infant or child who presents with the symptoms of acute abdomen, especially with vomiting.

A Clinical Study of Pediatric Inguinal Hernia Before and After Using Ultrasonography for Diagnosis

The purpose of this retrospective study was to evaluate the effects of diagnostic sonography in pediatric patients with inguinal hernias. The patients were classified into two groups. Group A included the patients who had been operated upon for inguinal hernia in 1980's, when diagnostic sonography was not available. Group B included the patients, operated upon for inguinal hernia from 2001 to 2002, when inguinal sonography was employed to detect potential bilateral hernias. The age distribution, sex ratio, laterality, bilaterality, and concomitant symptoms were compared between group A and group B. There were 296 cases in group A and 377 cases in group B. The prevalent age group was from 1 to 5 years. There was no difference in age group distribution between both groups. The male to female ratio was 5.3:1 in group A and 3.5:1 in group B. The ratio of unilateral to bilateral hernia was 5:1 in group A and 3:1 in group B. In cases with a unilateral hernia, the ratio of right to left was 1.5:1 in group A and 1.8:1 in group B. In cases with bilateral hernia, the simultaneous bilateral hernia was 33 cases (67.4 %) in group A and 75 cases (80.6 %) in group B. The sequential bilateral hernia was 16 cases (32.7 %) in group A and 18 cases (19.4 %) in group B. Although the ratio of bilateral hernia was increased in group B, the portion of the sequential bilateral hernia was significantly decreased in group B. In conclusion, there were no differences in the age distribution and the laterality between group A and B. The ratio of female patients and the incidence of bilateral hernia were increased in group B even though the portion of the sequential bilateral hernia was decreased. This result shows that the preoperative inguinal sonography in unilateral hernia with potential bilateral hernia is useful in early detection of the sequential contralateral hernia.

Usefulness of Ultrasonography in Potential Bilateral Inguinal Hernia of Children

Inguinal hernia is the most frequent problem requiring surgery in children. Moreover, subsequent contralateral occurrence after repair of the symptomatic unilateral inguinal hernia(UIH) is not rare. This study is to evaluate the diagnostic value of inguinal ultrasonography (IUS) for potential bilateral inguinal hernia(BIH). A prospective study was performed for preschool children less than 6 years of age who were diagnosed as UIH from July 1999 to December 2000. We selected 58 cases with potential BIH, based on the past history, such as prematurity, ventriculo-peritoneal shunt, family history of BIH, hernia on the left side (LIH), age below 2, female, and contralateral positive silk glove sign on the physical examination. Screening with IUS and bilateral surgical exploration were applied on these cases. Forty-seven cases were males (81.0%) and 11 cases were females(19.0%). Thirty-four were infants. Symptomatic right inguinal hernia (RIH) were 28 (48.3%), and LIH were 30 cases (51.7%). Six cases had no evidence of contralateral patent process vaginalis (PPV) by IUS but showed contralateral PPV by operation, Two cases were suspicious to contralateral PPV under IUS, but operative findings were negative. Fifty cases showed contralateral PPV by IUS as well as operation. The detection rate of contralateral PPV under IUS was 86.2%. The preoperative IUS may reduce contralateral exploration.