Small bowel obstruction by water beads in a 12-month-old girl presenting with acute hyponatremia with seizure

Although foreign body ingestion is relatively common in children aged 6 months-3 years, small bowel obstruction rarely develops, and few cases require surgical interventions. We report a case of 12-month-old girl who presented to the emergency department with new-onset seizure after projectile bilious vomiting. The initial diagnosis was seizure caused by hyponatremia based on laboratory findings, plain abdominal radiograph, brain magnetic resonance imaging, and electroencephalography. Despite fluid resuscitation, clinical manifestations did not improve, and severe ileal obstruction was found on computed tomography. Emergency laparoscopy showed a foreign body (a water bead [superabsorbent polymer], 3 cm in diameter) that was subsequently removed by enterotomy. After the surgery, bilious vomiting continued, and gastrografin did not pass on fluoroscopy. The second laparoscopy showed a residual foreign body that was crushed and then removed by minimal enterotomy. She was discharged in good condition 5 days after the second surgery. This case suggests a particular danger of water beads as foreign bodies and the need for differential diagnosis of multiple foreign bodies in children with poor communication skills.

A Case of Cap Polyposis with Epidermal Nevus in an Infant

Cap polyposis is extremely rare in children. We report a case of an 11-month-old male infant who visited our hospital because of rectal prolapse and small amount of hematochezia lasting several days. He also had an epidermal nevus in the sacral area. Colonoscopy showed erythematous, multilobulated, circumferential, polypoid lesions with mucoid discharge from the rectum. He was diagnosed with cap polyposis by endoscopy and histologic examination. He was treated with surgical resection, and was closely followed up. In the relevant literature, there is no report of cap polyposis in an infant. We report the first case of cap polyposis in the youngest infant.

Clinical Features of Varicose Vein in Pediatric Population / 소아외과

PURPOSE: Varicose veins requiring operative treatment have been more common recently, but there are not enough studies among children dermographics because most patients belong to the adult population. We concentrated on varicose vein of under 18 years old, and here intend to report cases of our clinical experiences. METHODS: From January 2003 until December 2014, there were 6 children under 18 years old who required varicose vein management. Data was collected by the investigation of medical records retrospectively, including preoperative symptoms, diagnostic tools, treatment methods, results of treatment, and complications. RESULTS: The mean age was 11 years (range, 3-17 years), and gender ratio was 1:2 (2 male, 4 female). The involved legs were on the right in 3 cases, on the left in 2 cases, and on both in 1 case. The most common symptoms were venous bulging and tortuosity in 6 cases, and other symptoms were Klippel-Trenaunay-Weber syndrome in 2 cases, pain and fatigue in 1 case, port-wine stain in 1 case, and telangiectasia in 1 case. Duplex sonography was performed to confirm venous reflux in all cases. The additional venography was performed to check for anatomical variation in 1 case, and three-dimensional CT in 2 cases. Treatments were high ligation and stripping in 3 cases, and endovenous laser therapy in 3 cases. Additionally, remnant varicosities after first operations were treated by endovenous laser therapy in all cases. During the mean postoperative follow-up period of 60 months, complications included edema of the foot and petechia in 2 cases each, and were not severe. CONCLUSION: Operative treatments including high ligation and stripping, and endovenous laser therapy are very effective for the management of varicose vein in the pediatric population, with improvements in quality of life including relief of symptoms and management of the cosmetic aspect.

Congenital Thoracic Ectopic Kidney associated with Diaphragmatic Hernia in a 15-month-old Boy

Congenital thoracic ectopic kidney is a very rare developmental disorder and the rarest type of ectopic kidney. This condition is usually asymptomatic and detected incidentally on routine chest radiography. Most cases of thoracic ectopic kidney develop in adulthood and during the neonatal period, and congenital thoracic ectopic kidney rarely develops in children. Most patients are asymptomatic, and the treatment depends on the diagnosis. Herein, we report a rare case of ectopic thoracic kidney associated with a diaphragmatic hernia in a 15-month-old male infant, who presented with periodic severe irritability. The thoracic ectopic kidney was detected as a mass in the right base of the chest on routine chest radiography.

Abdominal Fibromatosis in a Young Child: A Case Study and Review of the Literature

Fibromatoses comprise many different entities of well-differentiated fibroblastic proliferation with variable collagen production and form a firm nodular mass. Abdominal fibromatosis is distinguishable from other forms of fibromatosis because of its location and its tendency to occur in women of childbearing age during or following pregnancy. Abdominal fibromatosis in children is an extremely rare condition. A 15-month-old boy presented with an abdominal wall mass that had recently increased in size. Mass excision was perfomed. The tumor was 4.3x4.1 cm and partly circumscribed. Histologically, the tumor was composed of parallel long fascicles of spindle-cells with a uniform appearance. The edges of the resected mass were infiltrative, and the surgical margins were positive. Mitotic figures were <1/10 high power fields. No cellular atypia or necrosis was present. The tumor cells were positive for vimentin and nuclear beta-catenin staining.

Extradigit Glomus Tumor Causing Abdominal Pain: A Case Report

Glomus tumors are small vascular tumors that are usually benign and rarely occur. They originate from glomus bodies and present in the reticular dermis. They are clinically distinguished by their small size and their ability to cause extreme pain. Most of these tumors are subungually located. However, atypical locations of the tumors sometimes cause misdiagnosis, particularly when the lesion is rarely reported. Therefore, we report a case of glomus tumor which presented with chronic abdominal pain, found in the abdominal wall that has never been reported before.

Torsion of a mucocele of the vermiform appendix: a case report and review of the literature / 대한외과학회지

Torsion of a mucocele of the vermiform appendix is an extremely rare condition and also a rare cause of an acute abdomen with a clinical presentation that is indistinguishable from acute appendicitis, and thus, the condition is diagnosed during operation. Here, the authors describe the case of a 78-year-old female, who presented with intermittent abdominal pain. The appendix had a pelvic position and the torsion was counterclockwise. In addition, the torsion was associated with mucocele of the appendix, which was considered a secondary factor of torsion. Appendectomy and drainage were performed.

Choledochal cyst with ectopic distal location of the papilla of Vater / 대한외과학회지

In cholangiographic techniques, the close relationship between choledochal cyst and anomalous union of pancreaticobiliary duct has attracted medical attention. There have been rare cases in which the papilla of Vater was found in a position other than its normal position, and such cases have been reported sporadically. However, such cases are interesting in the anatomical context. In this review, we present our experience of choledochal cyst in a 30-month-old boy in whom the papilla of Vater was positioned in the third portion of the duodenum.

Clinical Analysis of Blunt Abdominal Trauma in Childhood

Traumatic injury is one of the leading causes of morbidity and mortality in children. This is a clinical review of pediatric blunt abdominal trauma. A retrospective analysis of the 112 children with blunt abdominal trauma aged 15 years or less treated at the Department of Pediatric Surgery, Chonbuk National University Hospital was performed. The analysis included age, sex, injury mechanism, number and site of the injured organ, management and outcomes. The average age of occurrence was 7.6 years, and the peak age was between 6 and 8 years. There was a male preponderance with a male to female ratio of 2.3:1. The most common cause of blunt abdominal trauma was traffic accidents (61.6%), principally involving pedestrians (79.7%). The accident prone times were between 8:00 AM and 8:00 PM, the weekends (40.2%), and the winter respectively. Thirthy-five patients (31.2%) had multiple intra-abdominal organ injuries and the most common injured organ was the liver. Seventy-four cases (66.1%) were managed non-operatively and eleven cases (9.8%) expired. Of the patients who were treated surgically or were to be operated on one patient died before surgery, the remainder died during or after surgery. Risk factors such as number of injured organ, systolic and diastolic blood pressure, and trauma scores by Glasgow coma scale (GCS), Pediatric trauma score (PTS), revised trauma score (RTS), injury severe score (ISS), TRISS were significantly correlated with mortality rate.

Changes of the Clinicopathological Characteristics and Survival Rates of Gastric Cancer with Gastrectomy: 1990s vs early 2000s

PURPOSE: The incidence of upper gastric cancer and especially the diffuse type have increased in western countries. The aim this study was to investigate the chronologic changes of the clinicopathological features and survival rates of Korean upper gastric cancer patients. MATERIALS AND METHODS: 1,638 gastric cancer patients who underwent gastrectomy were included in this study and they were divided into two groups; the 1990's (1991~1999, n=987) and the early 2000's (2000~2003, n=651). We evaluated the differences of the clinicopathologic features and the factors that affected the survival rates by univariative and multivariative analysis. RESULTS: The older age (>60) patients increased from 42.7% to 50.7% respectively. Being overweight (body mass index> or =23) also increased from 31.5% to 43.2%. For the pathology, the incidence of stage Ia gastric cancer increased (29.8% to 44.5%) and the incidence of stage IV gastric cancer decreased (23.5% to 11.8%). Yet there was no difference according to the WHO classification, Lauren's classification and the location of tumor between the groups. The 5 year survival rates increased 67.7% to 83.7%, according to the group. Multivariative analysis showed that the odd ratios of the early 2000s was 0.715 (95% CI; 0.555~0.921) as compared to that of the 1990s. CONCLUSION: There were no changes of the clinicopathologic features, like the pattern in western countries, although the incidence early gastric cancer, old age patients and overweight patients increased. The survival rate of early 2000s was better that that of the 1990s.

Effectiveness of Silk-glove Test in the Contralateral Exploration of Inguinal Hernia in Children

Inguinal hernia is one of the most common surgical diseases in pediatric patients. But the management of the side opposite the clinically apparent inguinal hernia, the "silent side" is controversial. Four hundred fifty-eight cases of pediatric inguinal hernias, operated by one pediatric surgeon at the Divisionof Pediatric Surgery, Department of Surgery, Chonbuk National University Hospital from January 1998 to December 2002, were reviewed retrospectively to determine the characteristics and significances of the silk-glove test on the side opposite the clinically apparent inguinal hernia. Males were preponderant as 2.8:1. Allhernias were of the indirect type and were repaired by high ligation of the sac. There were 238 (52.0%) right sided hernias, 160 (35.0%) were on the left and 60 (13.0%) were bilateral. The number of patients with a positive silk-glove sign on the contralateral side was 158(39.7%), and 133 of these had a contralateral patent processus vaginalis. Positive predictive value of Silk-glove test was 84.2% (133/158). The silk-glove test is a simple, safe, and relatively accurate method for contralateral exploration in the unilateral inguinal hernias in children.

Effectiveness of Silk-glove Test in the Contralateral Exploration of Inguinal Hernia in Children

Inguinal hernia is one of the most common surgical diseases in pediatric patients. But the management of the side opposite the clinically apparent inguinal hernia, the "silent side" is controversial. Four hundred fifty-eight cases of pediatric inguinal hernias, operated by one pediatric surgeon at the Divisionof Pediatric Surgery, Department of Surgery, Chonbuk National University Hospital from January 1998 to December 2002, were reviewed retrospectively to determine the characteristics and significances of the silk-glove test on the side opposite the clinically apparent inguinal hernia. Males were preponderant as 2.8:1. Allhernias were of the indirect type and were repaired by high ligation of the sac. There were 238 (52.0%) right sided hernias, 160 (35.0%) were on the left and 60 (13.0%) were bilateral. The number of patients with a positive silk-glove sign on the contralateral side was 158(39.7%), and 133 of these had a contralateral patent processus vaginalis. Positive predictive value of Silk-glove test was 84.2% (133/158). The silk-glove test is a simple, safe, and relatively accurate method for contralateral exploration in the unilateral inguinal hernias in children.

Extrapelvic Endometriosis

PURPOSE: Endometriosis is a condition where uterine mucosal tissue is located outside the uterus, and may be pelvic or extrapelvic. Extrapelvic endometriosis is a diagnostic challenge due to its very low incidence. The aim of this study was to analyze the clinical features of extrapelvic endometriosis in order to help diagnosis and treat this condition. METHODS: Between January 1998 and May 2005, 6 patients diagnosed with extrapelvic endometriosis after surgery at our hospital were retrospectively reviewed by a telephone interview. RESULTS: All cases were women in their reproductive years, with a median age of 37.5 years (range 34~50 years). Five of the six cases had a prior medical history of a caesarean section and 1 case had episiotomy during a normal vaginal delivery. Five cases were located in the lower abdomen and 1 case was located in the perineum. All patients presented with a surgical scar mass associated with pain and size that increased during menstruation. The median mass size was 2.5 cm (range 1~3.4 cm). The mass was found after a median interval of 13 months (range 1~45 months) from pelvic surgery. All cases were suspected of having extrapelvic endometriosis due to their specific clinical features, and 2 of them were confirmed by fine needle aspiration cytology (FNAC). All the patients were treated with a surgical excision. There was no recurrence after a median follow up of 27 months (range 4~86 months). CONCLUSION: Patients with a surgical scar mass associated with pain that increases in size during menstruation should be suspected of having extrapelvic endometriosis and be treated by a complete surgical excision to prevent a recurrence.

Iliopsoas Bursitis with Compression of the Common Femoral Vein Resulting in Acute Lower Leg Edema

The clinical manifestations related to iliopsoas bursitis can vary due to compression of the adjacent structure such as the common femoral vein, nerve and bladder. We report here on a rare case of iliopsoas bursitis with compression of the common femoral vein that resulted in acute lower leg edema.

A case of phyllodes tumor in a 10-year-old girl / 한국유방암학회지

A premenarcheal 10-year-old girl visited our clinic due to a rapidly growing and painless mass of the right breast of three months duration. The breast mass was removed using a wide local excision. The pathological findings revealed the tumor was made up of a phyllodes tumor. A phyllodes tumor, also known as cystosarcoma phyllodes, is a rare fibroepithelial tumor of the breast, which accounts for 0.3 to 1.0 % of all breast neoplasms. They have a greater degree of stromal cellularity than fibroadenomas, with a characteristic leaf-like projection. These tumors can occur between the ages of 9 to 88 years, but are most common in the third and fourth decades of life; therefore, are uncommon in children. A phyllodes tumor in an adolescent patient was first studied by Amerson, in 1970, at which time he reviewed 355 cases from the American literature, and found a five percent incidence in subjects below 20 years old. Because only a few cases have been reported in the literature; here we report a case of a phyllodes tumor in a 10-year-old girl.

Abdominal Endometriosis Diagnosed by Fine Needle Aspiration Cytology: A Report of Two Cases / 대한세포병리학회지

The incidence of endometriosis in post-operative abdominal scars is rare. We describe two cases of abdominal endometriosis diagnosed by fine needle aspiration (FNA). Both patients presented with subcutaneous masses at previous cesarean section scars with cyclic symptoms of pain. The cytologic smears were cellular and comprised two distinct cell populations consisting of epithelial and stromal components. An epithelial component consisted of flat sheets of polygonal cells and the second stromal component showed crowded clusters of spindle cells or isolated single cells. Hemosiderin-laden macrophages were found in the background. FNA offers a safe and effective tool for diagnosis of abdominal wall endometriosis.

Torsion of Ovarian Cyst in the Fetal Period: a Case Report

Ovarian cyst is found in 32% of necropsies in neonates, and can be visualized during gestation by ultrasonography. The clinical evolution of these cysts is variable, but in most cases the prognosis is favorable. Ovarian torsion, bleeding, rupture, and peritonitis have been described as complications. We report a newborn girl with torsion of ovarian cyst. A cystic mass measuring 41.9x31.9 mm on left side of abdomen was identified at 32 weeks of gestation by fetal ultrasonography. Surgery was performed after birth.

A Clinical Analysis of Complicated Gastroduodenal Ulcer in Children

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.

Adnexal Torsion Misdiagnosed as Periappendiceal Abscess in a Child

A 4-year-old female with acute lower abdominal pain was admitted with the diagnosis of periappendiceal abscess made by ultrasonography. At laparotomy, the appendix was normal, but the left ovary was twisted and necrotic. Appendectomy and left salpingo-oophorectomy were performed. The pathology of the appendix was normal, and the left tube and ovary were ischemic and had hemorrhagic necrosis. Pediatric adnexal torsion may be difficult to diagnosis clinically. Sonography is the preferred imaging study. It usually confirms a pelvic mass but may not establish the diagnosis. The correct diagnosis of adnexal torsion is often made at exploration. The most common erroneous diagnosis is acute appendicitis or periappendiceal abscess. Therapy for adnexal torsion remains controversial. While extirpation has been the standard of treatment in the past, there are current proponents of conservative therapy with adnexal sparing. Early diagnosis may lead to more frequent salvage of affected adnexa.

A Case of Thyroid Hemiagenesis / 대한내분비외과학회지

Thyroid hemiagenesis is considered to be a rare congenital anomaly, but its incidence is propabley underestimated because the diagnosis is usually incidental. The left lobe is absent four times as often as the right and women are about three times more likely to have this developmental defect. Many of these patients are hyperthyroid or medical attention. We present the case of a 14-year-old women with right thyroid hemiagenesis associated without other thyroid disorders. The diagnosis of hemiagenesis was established by isotope imaging and thyroid ultrasound. In most of the clinical reports on thyroid hemiagenesis, an association with other thyroid disorders was found such as hyperthyroidism, multinodular goitre, hypothyroidism, benign adenama, Graves' disease, acute and subacute thyroiditis, and carcinoma. Even if morphology and function of thyroid gland is normal on diagnosis, a follow-up survey should be recommended.