Torsion of an Accessory Spleen; Diagnosed Preoperatively and Excised Laparoscopically

We report on a case of torsion of an accessory spleen occurring in a 19-year-old female. She was admitted with a three-day history of left-upper quadrant pain that became slowly aggravated. On physical examination, left-side abdominal tenderness was observed, most markedly in the left upper quadrant, but no rebound tenderness was noted. Contrast-enhanced computed tomography (CT) scan showed a non-enhancing mass with a tubular vascular pedicle and normal enhancing spleen in the left upper abdomen. Doppler ultrasound showed no vascular flow within the hypoechoic mass in the left upper abdomen. Torsion of an accessory spleen was suspected, and emergent laparoscopic exploration was performed. Laparoscopic exploration showed a large rounded violet mass with a tw isted vascular pedicle, located anterior to the normal spleen. The mass was excised laparoscopically and then removed through a 2.5 cm extended incision of the left-sided trocar incision. Postoperative recovery was normal and she was discharged on the fifth postoperative day.

Torsion of an Accessory Spleen; Diagnosed Preoperatively and Excised Laparoscopically

We report on a case of torsion of an accessory spleen occurring in a 19-year-old female. She was admitted with a three-day history of left-upper quadrant pain that became slowly aggravated. On physical examination, left-side abdominal tenderness was observed, most markedly in the left upper quadrant, but no rebound tenderness was noted. Contrast-enhanced computed tomography (CT) scan showed a non-enhancing mass with a tubular vascular pedicle and normal enhancing spleen in the left upper abdomen. Doppler ultrasound showed no vascular flow within the hypoechoic mass in the left upper abdomen. Torsion of an accessory spleen was suspected, and emergent laparoscopic exploration was performed. Laparoscopic exploration showed a large rounded violet mass with a tw isted vascular pedicle, located anterior to the normal spleen. The mass was excised laparoscopically and then removed through a 2.5 cm extended incision of the left-sided trocar incision. Postoperative recovery was normal and she was discharged on the fifth postoperative day.

Laparoscopic transabdominal extraperitoneal mesh repair of lumbar hernia / 대한외과학회지

Lumbar hernias are rare posterolateral abdominal wall defects that may be congenital or acquired. There are two types of lumbar hernia, the superior lumbar hernia through Grynfeltt triangle, and the inferior lumbar hernia through Petit triangle. Many techniques have been described for the surgical repair of lumbar hernias including primary repair, local tissue flaps, and conventional mesh repair. But these open techniques require a large skin incision. We report a case of superior lumbar hernia, which was successfully repaired using a laparoscopic approach.

Iatrogenic Gallbladder Perforation during Gastric Endoscopic Mucosal Resection

With the exception of accidental perforation during a laparoscopic Cholecystectomy, An Iatrogenic Gallbladder Perforation Is Quite Rare. Several Cases Have Been Reported As A Complication Of Interventional Or Endoscopic Procedures. Although A Case Of Gallbladder And Stomach Perforation During Gastric Endoscopic Mucosal Resection (Emr) Has Been Reported, We Encountered A Case Of Gallbladder Perforation During Gastric Emr Without Evidence Of A Perforation Of The Stomach, Which Has Not Been Reported In The Literature.

A Rare Ileal Intussusception Caused by a Lipoma of the Ileum

Adult intussusception is a rare disease and it differs from childhood intussusception in its presentation, cause and treatment. Most of the cases have an underlying lesion within the intussusception that requires surgical resection. Making the diagnosis can be delayed because of the nonspecific and chronic symptoms, and many cases are diagnosed during performance of emergency laparotomy for treating the obstructive symptoms. A computed tomography (CT) scan is most useful for making the diagnosis of adult intussusception and is helpful in revealing the underlying lesion, although a barium enema can help to diagnose colonic intussusceptions. Surgical resection remains the recommended treatment for nearly all cases, but there is controversy about whether or not the intussusception should be initially reduced before resection. Gastrointestinal lipomas are rare benign tumors that can occur anywhere along the gut, and the small bowel is the second most common site for gastrointestinal lipomas after the colon. Intussusception of the ileum by a lipoma is very rare. We report here on a case of ileo-ileal intussusception that was caused by a lipoma of the ileum in a 35-year-old man who complained of abdominal pain of one week duration. The diagnosis of an ileo-ileal intussusception caused by a lipoma of the ileum was suspected preoperatively according to the typical CT findings, so we tried to initially reduce the intussusception during laparotomy. But manual reduction was impossible due to the edema of the lesion, and an ileum of some length had to be resected.

Gallbladder Torsion with Accompanying Acute Appendicitis

Gallbladder torsion is a rare clinical entity and it is a difficult condition to diagnose preoperatively. About 500 cases of gallbladder torsion have been reported since 1898, when Wendel first described gallbladder volvulus. This condition most commonly occurs in elderly women and the symptoms of this disease are largely non-specific and they mimic those of acute cholecystitis. Even with the recent advances of radiologic imaging modalities, making a preoperative diagnosis of gallbladder torsion is difficult and most cases are diagnosed at the time of surgery. An early diagnosis and prompt cholecystectomy for this disease are important in order to avoid the complications of gangrene and perforation, and to reduce mortality. A high index of suspicion of gallbladder torsion on the basis of the clinical situation and the specific findings on the radiologic images, usually ultrasonography and computed tomography (CT) scanning, can make the correct preoperative diagnosis possible. Gallbladder torsion is a rare disease, and gallbladder torsion with accompanying acute appendicitis is extremely rare. We report here on a case of gallbladder torsion with accompanying acute appendicitis in an 89-year-old woman and we review the clinical aspects of gallbladder torsion. Unfortunately, the diagnosis of gallbladder torsion was missed in this case, so we retrospectively reviewed and correlated the CT findings with the surgical findings.

Operative Treatments in Syringomyelia Caused by Trauma or Arachnoiditis

OBJECTIVE: Most cases of syringomyelia with arachnoid scarring were related to spinal trauma or inflammatory reaction. The aim of this study is to analyze the influence of arachnoid scarring on the altered dynamics of cerebrospinal fluid(CSF) and determine the proper treatment. METHODS: Between Jan 1991 and Dec 2001, We have operated on 15 patients with progressive neurological deficits associated with syringomyelia. We analyze the clinical presentations, radiographic and magnetic resonance images. RESULTS: As to cause of syringomyelia, 11 patients were related with trauma and 4 patients were tuberculous meningitis. Shunting procedures underwent in 11 patients and 5 showed clinical improvement. Subarachnoid adhesiolysis and expansile duraplasty were performed in 4 patients and 3 experienced clinical improvement. The 6 patients with shunting procedures were neurologically deteriorated and 4 were reoperated. CONCLUSION: The arachnoid scarring interferes with CSF flow and causes syringomyelia. Successful long-term outcome in the surgical treatment of syringomyelia caused by focal arachnoid scar appeared to require microsurgical dissection of scar and expansile duroplasty. For extensive arachnoid scarring over multiple spinal levels or after previous surgery, shunting procedure may be indicated only.

A study of the calcification of the second and the third molars in skeletal Class II and III malocclusions / 대한치과교정학회지

The work was undertaken to evaluate the calcification of the second and the third molars in skeletal Class II and III malocclusions. The differences in the calcification stages between skeletal Class II and III malocclusion were evaluated and statistically analysed from panoramic radiographs of 202 males and females ranging in age from 11 to 15 years old. The results were as follows, 1. The calcification stages of the second and the third molars were not different between the skeletal Class II and III malocclusions in each age groups of both sexes. 2. The calcification stages of lower second and third molars of the skeletal Class III malocclusion are more advanced than those of the skeletal Class II malocclusion in male. 3. The clacification stages of upper second and third molars are more advanced than those of lower second and third molars in skeletal Class II malocclusion. 4. The calcification stages of lower second and third molars are more advanced than those of upper second and third molars in skeletal Class III malocclusion.

Transoral Fusion of the Odontoid Process Fracture

The Odontoid process fracture has been treated by prolonged external immobilization of by internal fixation and fusion. We reported congential and traumatic odontoid process fracture which were successfully treated by transoral fusion. Operative preparation, technique and postoperative management are described by in detail.

A Clinical Analysis of Treatment of Cervical Fracture and Dislocation

Recently, the authors experienced the thirty-one cases of cervical fracture and dislocation. Among them, nineteen cases underwent surgical treatment and remained conservative treatment. There are three ways in operation ; 1) anterior approach(Cloward, Smith-Robinson method). 2) posterior approach. 3) combined approach(modified Smith-Robinson and posterior fusion). We did a combined approach and the results were excellent.

Two Cases of Spontaneously Absorbed Chronic Subdural Hematoma

The authors managed forty cases of chronic subdural hematoma which were diagnosed by carotid angiography and computerized tomographic scanning. Within fortieth-day after onset, only two cases are absorbed without any specific treatment and clearly.

A Clinical Study of Recurrent Intussusception

No abstract available.

A Clinical Study of 15 Cases of Pneumocystis Carinii Pneumonia

No abstract available.

A Clinicostatistical Study on Surgical Abdomen in Children

A clinicostatistical study was made in 405 cases who were admitted to department of pediatrics, general surgery, urology, gynocology of N.M.C. for abdominal surgery from 1973 to 1978 and following results were obtained. 1. Distribution and incidece of surgical abdomen diseases showed acute appendicitis 107 cases(26.4%), inguinal hernia 82 cases(20.2%), intussusception 73 casese(18.0%) and intestinal obstructuction due to congenital origin 47 cases(11.6%). 2. Male was more predominant than female in proportion of 2.32:1. Age distribution revealed highest frequency in 10-15 years with 125 cases(30.8%) followed by 1 month to 1 year with 105 cases(25.9%). 3. In 47 casess of intestinal obstruction due to congenital origin, 3 common diseases were imperforated anus 14 cases, congenital megacolon 12 cases and congenitalpyloric stenosis 12 cases. 4. In 19 cases of acquired intestinal obstruction except intussusception and inguinal hernia, the most common cause was adhesion 10 sease(52.6%). 5. In 30 cases of abdominal mass, wilm's tumor was the commonest with 8 cases(26.7%). 6. In 19 cases of intestinal bleeding and perforation, accidental injury was the commonest cause with 12 cases(63.2%). 7. Highest incidence of diseases in relation to age group were as follows: newborn infant: intestinal obstruction due to congenital origin(96.7%), 1 month-1 year: intussusception (55.7%), 1-2year and 2-6year; inguinal hernia(46.3% and 50.0%), 6-10years and 10-15years; acute appendicitis(52.1% and 61.2%). 8. Overall mortality rate was 6.2%(25 out of 405 cases) and the highest mortality rate was noted in congenital anomaly with 23.1%(12 out of 52 cases).