Postnatal Management of Antenatally Diagnosed Patent Urachus with Bladder Prolapse

A case of bladder prolapse through a patent urachus is reported in a female infant born with a large, red, tubular mass inferior to the umbilical cord. A cystic mass communicating with fetal bladder was detected by prenatal ultrasound performed at 20(+2) weeks of gestation. A fetal MRI was also performed to confirm the diagnosis and to exclude associated fetal anomalies. At 40(+4) weeks, the cystic mass was no longer present and a new small solid mass was noted at the fetal abdominal wall. After birth, a protruded mucosal mass inferior to the umbilical cord was noted, and catheterization confirmed communication between the protruded mass and the urinary bladder. On the second day of life, reduction of the bladder and partial resection of the urachus was performed. A voiding cystourethrogram showed good bladder capacity and no vesicoureteral reflux. The patient voided well and was discharged after 10 days. Here, we present a case of urinary bladder prolapse through a patent urachus, diagnosed by fetal sonography and this is the first case reported that was treated by simple excision without complication.

Postnatal Management of Antenatally Diagnosed Patent Urachus with Bladder Prolapse

A case of bladder prolapse through a patent urachus is reported in a female infant born with a large, red, tubular mass inferior to the umbilical cord. A cystic mass communicating with fetal bladder was detected by prenatal ultrasound performed at 20(+2) weeks of gestation. A fetal MRI was also performed to confirm the diagnosis and to exclude associated fetal anomalies. At 40(+4) weeks, the cystic mass was no longer present and a new small solid mass was noted at the fetal abdominal wall. After birth, a protruded mucosal mass inferior to the umbilical cord was noted, and catheterization confirmed communication between the protruded mass and the urinary bladder. On the second day of life, reduction of the bladder and partial resection of the urachus was performed. A voiding cystourethrogram showed good bladder capacity and no vesicoureteral reflux. The patient voided well and was discharged after 10 days. Here, we present a case of urinary bladder prolapse through a patent urachus, diagnosed by fetal sonography and this is the first case reported that was treated by simple excision without complication.

Cystic Lymphangioma of the Spleen: Report of a Case

Splenic cystic lesion is uncommon in children, and cystic lymphangioma of the spleen has not been reported in Korean pediatric patients. Here we report a case of cystic lymphangioma arising from the spleen in a 16 year-old male. The patient presented with left flank pain for 5 days after blunt trauma to the same site. On physical examination, left abdominal tenderness and a palpable spleen were noted. Abdominal ultrasound and MRI revealed multiple septated macro-cystic mass abutting to the spleen medially, suggestive of cystic lymphangioma of the spleen. Laparotomy revealed a 20 cm sized cyst in the spleen, and 2,000mL of dark-brownish fluid was aspirated from the cyst. Splenectomy was performed. Pathological examination revealed the cystic lymphangioma. Post-operative recovery was uneventful, and the patient was discharged at 7 days after surgery.

Ganglioneuroblastoma Associated with Malignant Hypertension and Cardiac Failure

Neuroblastoma is the most common extracranial solid tumor in children, and accompanies various clinical symptoms including hypertension. Hypertension is associated with catecholamines secreted from the tumor, and is usually not severe. We report one case of malignant hypertension with cardiac failure in a patient with adrenal neuroblastoma, successfully treated with adrenalectomy. A 3 year-old boy complained of protrusion of the chest wall. Physical examination revealed severe hypertension with cardiac failure. The levels of metabolites of catecholamine were increased in blood (norepinephrine >2000 pg/mL) and urine (norepinephrine 1350.5 ug/day). Abdominal CT showed a 7 cm-sized solid mass arising from the right adrenal gland. After stabilizing the hemodynamics with oral phenoxybenzamine, right adrenalectomy was performed. Pathological diagnosis was a ganglioneuroblastoma. The hypertension and cardiac failure were resolved after tumor removal.

A Comparative Study of the Clinical Features between Negative Appendectomy and Conservative Treatment Groups in Suspected Appendicitis

This study is a clinical review of two groups of patients. Group I was composed of 97 patients who were submitted to negative appendectomy under the impression of acute appendicitis and, group II was 45 patients who received conservative treatment with the same impression at the department of surgery, Dae Rim Saint Mary's Hospital, from January 1, 1994 to August 31, 1996.The purpose of this study is to identify possible factors for the decision of operation or conservative treatment in the patients with suspected appendicitis and so to decrease unnecessary operation. Clinical characteristics of the patients were compared between two groups by the method of comparison of means(X test). The following results were obtained; 1) The incidences of group I and group II among the patients in the state of suspicious appendicitis were 97 of 1,004 cases(9.7%) and 45 of 1,004 cases(4.5%) respectively. 2) The number of female patients was 1.5 times more than male in both groups(p0.05) 8) Leukocytosis above 10,000/mm3 appeared in 44% of patients in group I and 53.3% in group II(p>0.05). 9) In admission route, the patients via ER was 2 times more than those of OPD in group I and in group II that was 5 times more than this.