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.

Perforation of Meckel's Diverticulum in Children

Meckel's diverticulum (MD) occurs in approximately 2 % of the population. The major complications of MD are bleeding, intestinal obstruction, infection and perforation. Perforation is the least common but most serious complication, the incidence od which is about 5-10 %. The causes of perforation are inflammatory diverticulitis and peptic ulceration. the purpose of study is to review the characteristics of perforated MD in children. Six patients with perforated MD who had been operated upon at the Department of Pediatric Surgery, Yeungnam University Hospital from April 1984 to July 2001 were included. Male predominated in a ratio of 5:1 and there were 2 neonates. The chief complaints were abdominal pain and distension. Half of the children showed a past history of bloody stools. The average age was 4 year and 9 months. The mean distance from the ileocecal valve to the diverticulum was 60 cm. Average length of the diverticulum was approximately 3 cm and width was 1.7 cm. The perforation site was the tip of the diverticulum in 3 cases, the base in 2 cases and along the lateral border in one. In two patients, ectopic gastric mucosa was found in the specimen. All of the patients were operated upon with a diagnosis of peritonitis of unknown etiology. In conclusion, when a child shows symptoms of acute abdomen or peritonitis, especially in boys, with the history of bloody stools and episodic abdominal pain, perforated MD should be suspected.

Diagnosis and Treatment of Bleeding Meckel's Diverticulum

The major complications of Meckel's diverticulum(MD) are bleeding, intestinal obstruction, infection, umbilical fistula and perforation. Although the relative incidences vary between authors, bleeding is the most common complication in children. The aim of our study is to show the symptomatic guideline for the diagnosis of the bleeding MD. Eight cases with bleeding MD which were operated upon at the department of Pediatric Surgery, Yeungnam University Hospital from April 1985 to April 2001 were reviewed. Half of the patients were under 2 years of age and all patients were male. All patients were preoperatively diagnosed by previous history of intestinal bleeding (melena, hematochezia) and 99mTc pertechnetate MD scan. Segmental resection and end-to-end anastomosis was performed in 6 patients and diverticulectomy in 2 patients. Heterotropic gastric mucosa was found in 6 patients. Postoperative complication was not observed in any cases. In conclusion, in any male children with obscure intestinal bleeding, especially less than 2 years of age, bleeding MD must be suspected. It seems to us that 99mTc pertechnetate MD scan is a useful tool to diagnose bleeding MD.

Two Cases of Pancreatoblastoma

Pancreatoblastoma is uncommon in children and is exceedingly rare in adults. Prognosis is known to be good if the tumor is discovered prior to metastasis. Complete tumor resection is the most important factor for long survival. We report two cases of pancreatoblastoma in a 4 year and 7 year- old females. Palpable abdominal mass was accidentally discovered by their parents. Abdominal CT scan showed huge retroperitoneal mass of unknown origin in one case and of the pancres in the other case. At laparotomy, well encapsulated tumor mass (10x10 cm in diameter) was noted in the body of pancreas in one case, and well encapsulated tumor mass ( 8x7 cm in diameter) in the tail of pancreas in the other case. We resected the tumor and saved spleen in both ases. Histologic examination revealed that the tumors were pancreatoblastoma. Patients received postoperative chemotherapy with 6 cycles of cisplatinum, adriamycin, ifosfamide and etoposide and are alive in good condition 19 months and 17 months after operation.

The pathologic lead points in childhood intussusception

Most childhood intussusceptions are occured by unknown cause, but a few of them have pathologic lead points. We have collected and analyzed cases with pathologic lead points, and compared them with cases without pathological lead points. A retrospective review was performed on 227 patients who were operated on for intussusception in Yeungnam University Hospital from Jan. 1986 to Apr. 1999. We divided them into 2 groups; idiopathic group (209 cases, 92.1%) and pathologic lead points group (18 cases, 7.9%), and compared the characteristics of each group. Intussusceptions were most commonly occurred in patients between 2 to 6 months of age in both groups. Enteroenteric type of intussusception was relatively more frequent in pathologic lead points group than in idiopathic group (p<0.05). The pathologic lead points were veil (10 cases, 52.6%), Meckel's diverticulum (3 cases, 15.8%), lymphoma (3 cases, 15.8%), ectopic pancreas (2 cases, 10.5%), and Henoch-Schonlein purpura (1 case, 5.3%). The rate of bowel resection was 44.4% in pathologic lead points group and 8.6% in idiopathic group (p<0.05). The present study suggests that the sex, age, type, and operation of intussusception behaved somewhat differently between idiopathic group and pathologic lead points group.

Effect of Interleukin-10 on Pulmonary Injury in the Murine Model of Acute Visceral Ischemia

BACKGROUND: Visceral ischemia-reperfusion produces injury both to the visceral organs that are made ischemic and to distant organs, such as the lung, that are not made ischemic. The pulmonary injury after visceral ischemia-reperfusion is, in part, a result of the production and release of a variety of humoral factors, such as proinflammatory cytokines, activated complements and lipid mediators. Two proinflammatory cytokines, tumor necrosis factoralpha (TNFalpha) and interleukin (IL)-1, have been implicated as early initiators of this response to visceral ischemia-reperfusion injury. Recently, additional concepts have been developed to block the synthesis and release of proinflammatory cytokines by using anti-inflammatory cytokine. Interleukin (IL)-10 inhibits proinflammatory cytokine which is produced by activated monocyte/ macrophages and prevents production of TNFalpha in acute inflammatory states. The purpose of this study is to determine the effect of exogenous administration of the anti-inflammatory cytokine, recombinant human IL-10, on proinflammatory cytokine production and pulmonary injury after visceral ischemia-reperfusion. METHODS: Two hours before 25 minutes of supraceliac aortic clamp, ICR mouse which weighed 30-40 g were injected with 0.2 microgram and 2.0 microgram of recombinant human IL-10 intraperitoneally and classified into A and B treatment groups, respectively. A control group underwent 25 minutes of supraceliac aortic clamp, and then reperfusion only. A sham group underwent laparatomy only. Two hours after reperfusion, all animals were sacrificed and submitted for a study of serology and histologic changes. To determine the pulmonary injury, wet/dry ratio, tissue myeloperoxidase (MPO) assay of the lung were measured and the microscopic findings for the lung tissue were analyzed. To evaluate the change in the cytokine during study, murine serum TNFalpha level was also measured. RESULTS: The wet/dry ratios of the lung tissue were significantly decreased in both IL-10 treatmentgroups (A and B treatment group) compared to the control group (p<0.05, p<0.05). The tissue MPO assays of the lung were significantly decreased in the IL-10 2.0 microgram treatment group (B treatment group) compared to the control group (p<0.05). The level of serum TNFalpha was also decreased in B treatment group compared to the control group (p<0.05). Microscopic findings revealed severe neutrophilic infiltration and microvascular congestion in the control group, but in both IL-10 treatment groups, neutrophilic infiltration and microvascular congestion were mild or moderate. CONCLUSIONS: The inhibitory effect of IL-10 on pulmonary neutrophil infiltration and on the level of TNFalpha during visceral ischemia-reperfusion injury was significant in the experiment. The use of exogenous IL-10 may offer a new therapeutic approach for decreasing the complications associated with visceral ischemia-reperfusion.

The Effect of Granulocyte Colony Stimulating Factor, Glutamine and Antibiotic on the Bacterial Translocation in the Endotoxemic Rats

BACKGROUND: Now, there is good evidence suggesting that the gastrointestinal tract is not simply a bystander organ in critically ill patients but also may serve as an initiator and stimulator of a generalized systemic inflammatory response, and may function as the "motor" of sepsis and the MOFS (multiple organ failure syndrom). The aim of this study was to investigate the pattern of bacterial translocation and the effects of the granulocyte colony stimulating factor, enteral glutamine and prophylactic antibiotic on the bacterial translocation in endotoxemic rats. METHODS: Thiry-Vella loops were made in 80 male Sprague-Dawley rats weighing between 250 and 300 g. After 7 days, they were arbitrarily divided into 4 groups (control, G-CSF, glutamine and antibiotic groups). After inducing endotoxemia, the same amount of radiolabelled E. coli (500,000 CPU/ml) was insufflated through the Thiry-Vella loop. Then, after 4 hours, radioactivities of the lung, the liver, the spleen, the kidney, and serum (CPM gm wet wt.) were measured with a Wallac 1410. To investigate the pattern of bacterial translocation, we divided the control group into 2 subgroups and harvested each organ at 1 hour and 4 hours after inducing endotoxemia. RESULTS: The organ distribution of radiolabelled E. coli differed with the lapse of time. Bacterial translocation was observed as early as 1 hour, and significantly higher levels of radioactivity were observed in the lung at 1 hour, and in the liver at 4 hours after endotoxemia than were observed in the other organs (P<0.01). G-CSF, glutamine and a prophylactic antibiotic could prevent the bacterial translocation in endotoxemic rats. Also, bacterial translocation was significantly reduced in the glutamine group compared with the G-CSF and the prophylactic antibiotic group (P<0.05). However, there was no difference in mucosa atrophy (villous height/mucosa thickness) among the group. CONCLUSIONS: The results suggested that bacterial translocation could be prevented with G-CSF, glutamine, and prophylactic antibiotics and it might be hopeful in treating the patients suffering from shock, sepsis, trauma, and surgical stress.

A Case of Retroperitoneal Lipoblastoma in a Child

Lipoblastoma, a rare benign tumor of adipose tissue, occurs in infants and young children. The prevalent sites are chiefly the upper and the lower extremities and less commonly the head, neck, trunk, mesentery, mediastinum, and retroperitoneum. Circumscribed forms (benign lipoblastoma) are more common and superficially located. Diffuse forms (diffuse lipoblastomatosis) are more deeply situated. Prognosis is excellent after excision. The recurrence rate after surgical excision is low and tumors recur mainly in the deep diffuse type because of incomplete removal of the tumor. Therefore, wide local excision appears to be the treatment of choice. We experienced a 4-year-old boy who presented with a palpable mass on the left upper abdomen and was suspected to be a benign lipoblastoma of the retroperitoneum on computerized axial tomography. The tumor was completely excised. Final histologic examination confirmed the diagnosis of a benign lipoblastoma.

Evaluation of Plasma and Urinary Tumor Necrosis Factor alpha Interleukin-2 Receptor and Interleukin-6 Levels in Renal Allograft Recepients / 대한이식학회지

This is the report of 98 cases in renal allograft, which were treated at Yeungnam University Hospital from January 1994 to July 1996 and compared the significance of changes of TNF alpha, IL-2R, IL-6 in blood and urine as an early diagnostic tool of acute rejection in renal allograft. The aim of this study was to investigate the value of plasma and urinary TNF alpha, IL-2R, IL-6 in patients with renal allografts. Renal allografts patients were divided into four groups (control, acute rejection, acute tubular necrosis, systemic infection) according to their postoperative diagnostic methods. Blood and urine samples in four groups were obtained: control group (2 days before transplantation, at the day of transplantation and every other day after transplantation), acute rejection group (everyday sampling from 2 days before therapy to the end of therapy), acute tubular necrosis and systemic infection group (everyday sampling from the day of diagnosis to the end of therapy). In acute rejection group, there were significant elevation of cytokines; plasma TNF alpha (68.4%, p<0.01), IL-2R (73.6%, p<0.01), and IL-6 (89.5%, p<0.01), urinary TNF-alpha (42.1%, p<0.01), IL-2R (89.5%, p<0.01) and IL-6 (94.7%, p<0.01). In systemic infection group, all cytokines except urinary TNF-alpha were significantly elevated. The results suggested that plasma and urinary TNF-alpha, IL-2R, and IL-6 may play a complementary early diagnostic tool of acute rejection in renal allograft patients although the differential diagnosis is difficult with systemic infection. Urinary TNF-alpha was not elevated in systemic infection group, so it may be used in differential diagnosis between acute rejection and systemic infection.

Evaluation of Plasma and Urinary Tumor Necrosis Factor alpha Interleukin-2 Receptor and Interleukin-6 Levels in Renal Allograft Recepients / 대한이식학회지

This is the report of 98 cases in renal allograft, which were treated at Yeungnam University Hospital from January 1994 to July 1996 and compared the significance of changes of TNF alpha, IL-2R, IL-6 in blood and urine as an early diagnostic tool of acute rejection in renal allograft. The aim of this study was to investigate the value of plasma and urinary TNF alpha, IL-2R, IL-6 in patients with renal allografts. Renal allografts patients were divided into four groups (control, acute rejection, acute tubular necrosis, systemic infection) according to their postoperative diagnostic methods. Blood and urine samples in four groups were obtained: control group (2 days before transplantation, at the day of transplantation and every other day after transplantation), acute rejection group (everyday sampling from 2 days before therapy to the end of therapy), acute tubular necrosis and systemic infection group (everyday sampling from the day of diagnosis to the end of therapy). In acute rejection group, there were significant elevation of cytokines; plasma TNF alpha (68.4%, p<0.01), IL-2R (73.6%, p<0.01), and IL-6 (89.5%, p<0.01), urinary TNF-alpha (42.1%, p<0.01), IL-2R (89.5%, p<0.01) and IL-6 (94.7%, p<0.01). In systemic infection group, all cytokines except urinary TNF-alpha were significantly elevated. The results suggested that plasma and urinary TNF-alpha, IL-2R, and IL-6 may play a complementary early diagnostic tool of acute rejection in renal allograft patients although the differential diagnosis is difficult with systemic infection. Urinary TNF-alpha was not elevated in systemic infection group, so it may be used in differential diagnosis between acute rejection and systemic infection.

Three Cases of True Splenic Cyst

Cysts of the spleen are uncommon disease entities and can be classified as either primary (true) or secondary (pseudo-) depending on the presence of a true epithelial lining. True nonparasitic cysts of spleen are very rare, and the majority of the cases are classified as epidermoid cysts. True splenic cysts were found in three children during the last eleven years (1989~1999) in Yeungnam University Hospital. Two of the children were girls and one was boy. The age at diagnosis ranged from 7 to 15 years. Abdominal ultrasonography was utilized to the initial diagnosis, and computerized tomography was done for the detailed studies. Radionuclide scanning was performed in a patient. Surgical resection (one partial splenectomy and two total splenectomies) was performed. The cysts were from 4cm to 9cm in maximum diameter. Pathologic finding was epidermoid cyst of the spleen.

A Case of Ileal Duplication with Intestinal Hemorrhage

Duplications of the alimentary tract are uncommon congenital anomalies that usually present in childhood. They are cystic or tubular in shape, and composed of muscular walls with gastrointestinal mucosal lining. These lesions are almost invariably adjacent to the alimentary tract, most often found in the ileum, may communicate with the lumen, and may be multiple. We experienced an unusual case of a 18-month-old male patient who presented with intermittent blood-tinged stool as an initial manifestation of ileal duplication. The lesion was revealed by bleeding scan and Meckel's scan and was suspected to be a bleeding Meckel's diverticulum due to peptic ulceration of the ileum adjacent to the ectopic gastric mucosa. At laparotomy, a 3-cm-sized cystic mass communicating with the adjacent bowel lumen and multiple conglomerated lymph nodes were identified at the mesenteric side of the distal ileum. Resection of the lesion and adjacent ileum containing enlarged lymph nodes was done. In microscopic findings, the unilocular cystic structure lying in the mesenteric border showed an intestinal wall lined in part by gastric fundic mucosa with a small ulcer, especially at the blind end, and in part by small intestinal mucosa. Muscularis propria and serosa were also present.

Clinical Analysis of Infantile Hypertrophic Pyloric Stenosis

Infantile hypertrophic pyloric stensosis (IHPS), which occurs three of 1,000 live births, is a major cause of nonbilious vomiting of early infancy, but its etiology and pathogenesis are still obscure. The operation of pyloromyotomy as described by Ramstedt in 1912 remains the standard of care for the treatment of IHPS. From January 1990 to July 1997, 64 infants with IHPS were reviewed at department of Pediatric Sursery, Yeungnam University Hospital. The ratio of male to female was 7:1, and the most prevalent age group was between 2 weeks and 8 weeks (81.2%). There were 37 (57.8%) first born babies among total 64 infants. The body weight percentile at admission was lower than 50 percentile in all 64 cases. Onset of symptoms was predominantly between 2week and 4weeks in 23 cases (35.9%). All had a history of nonbilious vomting, generally projectile in nature. In the measured serum electrolytes, hypokalemia was noted in 14 cases (21.9%), hypochloremia was observed in 26 cases (40.6%). In the preoperative ultrasonography, the average muscle thickness, diameter, and length of the pylorus were 6.3mm, 12.3mm, and 17.8mm, respectively. A total of thirteen associated anomalies were noted in twelve patients. All 64 cases were treated with Fredet-Ramstedt pyloromyotomy. There were postoperative complications of wound infection in 3 cases. Intermittent nonprojectile vomiting was presented in 13 cases (20.3%) after operation, but one of them was relieved in 13 days and the rest were relieved within one week by adjustment of oral intake.

Clinical Study of Congenital Duodenal Obstruction / 영남의대학술지

Successful management of duodenal obstruction in newborn infant implies not only satisfactory nutrition but also achivement of normal growth. To aid early diagnosis and management, we evaluated the diagnostic methods, operative interventions and clinical characteristics of thirty-nine infants with congenital duodenal obstructions. In the 11-year period from July 1986 through June 1997, thirty-nine patients with congenital duodenal obstruction (23 males and 16 females) were treated and reviewed at the Department of Pediatric Surgery, Yeungnam University Hospital. The ratio of male to female was 1.4:1, and 29 cases(74.1%) among total 39 patients were newborn. There were 5 premature patients and 16 patients of small for gestational age. The most common causes of the congenital duodenal obstruction was malrotation (26 cases, 66.7%) and followed by annular pancreas (9 cases, 23.1%), type 1 atresia (3 cases, 7.7%) and wind-sock anomaly (1 case, 2.6%). Common symptoms were vomiting, abdominal distention, jaundice. Plain abdominal X-ray study combined with upper gastrointestinal series was the most commonly used diagnostic method. The operative procedures were performed by same pediatric surgeon utilizing Ladd's procedure in 26, duodenoduodenostomy in 8, duodenojejunostomy in 4, excision of wind-sock membrane in 1. A total of 15 associated congenital anomalies were found in 9 patients. Postoperative complications occurred in 13 (33.3%). Overall mortality was 2.6%(1/39). Bilious vomiting and plain abdominal radiologic study were most useful for the diagnosis of congenital duodenal obstruction. Early diagnosis and operative intervention were important to prevent complications such as sepsis and peritonitis.

Significance of Changes of Tumor Necrosis Factor-alpha in Blood and Urine as a Early Diagnostic Tool of Acute Rejection in Renal Allograft / 대한이식학회지

This is a report of 51 cases in renal allograft, which were treated at the Yeungnam University Hospital from February 1994 to July 1996 and compared the significance of changes of TNF-alpha in blood and urine as a diagnostic tool of acute rejection in renal allograft. The aim of this study was to investigate the value of plasma and urinary TNF-alpha in patients with renal allografts. Renal allografts divided them into four groups (control, acute rejection, acute tubular necrosis and systemic infection) that obtained plasma and urinary TNF-alpha. The sampling day of blood and urine in each group were as follows: in control group at the day of transplantation and postoperative 1, 5, 7 days respectively, in acute rejection group at before the day of initiation of therapy and the 1, 3 days after therapy, in acute tubular necrosis group at the day of low urine output and the 4 subsequent days, and in systemic infection group at the day of diagnosis and the 3 subsequent days. The results were as follows: Plasma TNF-alpha levels were significantly elevated in 68.4% (p0.05). In contrast, urinary TNF-alpha were detected in acute rejection group (42.1%, p<0.01) and acute tubular necrosis group (20.0%, p<0.05). Control and systemic infection groups were not detectable in urinary TNF-alpha. The results suggested that plasma and urinary TNF-alpha may be used as the complementary diagnostic tool of acute rejection in renal allograft patients.

Two Cases of Segmantal Dilatation of the Intestine in Newborn Infants / 대한주산의학회잡지

Segmental dilatation of small intestine or colon can induce signs of intestinal obstruction, such as abdominal distension, vomiting and constipation. There are no anatomical gross obstructive lesions, and moreover, ganglion cells are observed in both dilated and undilated distal segments of the intestine. It often accompanied by other congenital anomalies. We reported two cases of segmental dilatation of the intestine in the newborn infants, one in small intestine and the other in colon, with brief review of the related literatures.

Infantile Hypertrophic Pyloric Stenosis / 영남의대학술지

Infantile hypertrophic pyloric stenosis(IHPS), which occurs three of 1,000 live births, is a major cause of 1 nonbilious vomiting of early infancy but its etiology and pathogenesis are still obscure. The operation of pyloromyotomy as described by Ramstedt in 1912 remains the standard of care for the treatment of IHPS. From January 1993 to October 1996, 35 infants with IHPS were surgically treated and the following results were obtained. 1. Thirty-five patients comprised 32 males and 3 females, and the ratio of male to female was 10.7:1. 2. The most prevalent age group was between 2 weeks and 8 weeks. 3. Of 35 infants, first born babies were 23 cases(65.7%). 4. Breast feeding was in 23 cases(65.7%). 5. The body weight percentile at admission was lower than 50 percentile in all 35 cases. 11. A total of seven associated anomalies were noted in six patients. 12. All 35 cases were treated with Fredet-Ramstedt pyloromyotomy. 13. There were postoperative complications of wound infection in 2 cases. Intermittent nonprojectile vomiting was presented in 8 cases(22.9%) after operation, but one of them was relieved in 13 days and the rest were relieved within one week by adjustment of oral intake.

Double Tracheoesophageal Fistula

Esophageal atresia(EA) with a double tracheoesophageal fistula(TEF) is rare. It accounts for only 0.7% of all cases of EA and TEF. A male newborn weighing 2860g was born by normal vaginal delivery at 41weeks' gestation to a 27-year-old mother who had a normal pregnancy. But immediately developed recurrent choking and respiratory distress. Feeding tube was inserted and chest X ray showed the feeding tube coiled in the proximal pouch(T-2 level). With a preoperative diagnosis of EA and distal TEF, the thoracotomy was performed on the third day of life. At thoracotomy, TEF was proved to be a double fistula. Both fistulas were divided and an esophageal anastomosis was performed. The postoperative course was uncomplicated until the eighth postoperative day when a minor anastomotic leak. The patient was discharged at 103 days of age.

A Case of Surgical Treatment of Nesidioblastosis in Infancy

Nesidioblastosis in one of the causes of hyperinsulinemic hypoglysemia in infancy. The most important goal of treatment for persistent hypoglycemia is the prevention of permanent brain damage. The early surgical management is satisfactory to this goal in nesidioblastosis and maintains normal blood sugar level without administration of drugs or supplement of sugar postperatively in many cases. We experienced a female infant of 3 months old who has suffered from persistent hypoglysemia due to hyperinsulinism and was suspected nesidioblastosis for ' its cause clinically. She underwent 95% distal pancreatectomy. The histologic findings of nesidioblastosis was confirmed postoperatively. No postoperative complication was occured and her blood sugar levels were maintained within normal range without medical treatment.

Bilateral Adrenal Neuroblastoma

Neuroblastoma is the most common solid malignancy in childhood. However, a neuroblastoma presenting as bilateral and multifocal is very rare. A male newborn weighing 2.7 kg was born by normal vaginal delivery at 39 weeks' gestation to a 27-year-old mother who had a normal pregnancy. He was in good condition at birth but presented palpable masses in the both upper abdomen and both side of the neck. Ultrasound examination showed the lesions to be 3 × 3cm sized calcified mass in right suprarenal area and 5 × 3cm sized homogenous mass in left suprarenal area. The abdominal mass was also examined by computed tomography with similar findings. With the impression of bilateral neuroblastoma or metastatic spread, the laparotomy was performed on the 13th day of life. Frozen section of biopsy of the left neck mass was obtained, which showed neuroblastoma. Intraoperative findings revealed bilateral adrenal masses which were distinct and anatomically separate. Bilateral adrenalectomy was accomplished and the initial postoperative course was unevenful. The patient was discharged for hopeless and expired at age 45 days. We present bilateral adrenal neuroblastoma considered to be simultaneous occurrence rather than metastases from one site to another.