Clinical and Experimental Pediatrics
- 제46권1호
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- Pages.37-41
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- 2003
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- 2713-4148(eISSN)
소아 장중첩증에서 공기 주입 정복술 시행 도중 발생한 장천공
Colon Perforation during Air Enema Reduction of Intussusception
- 김용국 (가천의과대학 소아과학교실) ;
- 임혜라 (가천의과대학 소아과학교실) ;
- 이광훈 (가천의과대학 소아과학교실) ;
- 한수진 (가천의과대학 소아과학교실) ;
- 선용한 (가천의과대학 소아과학교실) ;
- 류일 (가천의과대학 소아과학교실) ;
- 조강호 (가천의과대학 소아과학교실) ;
- 차한 (가천의과대학 소아과학교실) ;
- 이학수 (가천의과대학 소아과학교실)
- Kim, Yong Kuk (Department of Pediatrics, Gachon Medical School) ;
- Im, Hae Ra (Department of Pediatrics, Gachon Medical School) ;
- Lee, Gwang Hoon (Department of Pediatrics, Gachon Medical School) ;
- Han, Soo Jin (Department of Pediatrics, Gachon Medical School) ;
- Sun, Yong Han (Department of Pediatrics, Gachon Medical School) ;
- Ryoo, Eell (Department of Pediatrics, Gachon Medical School) ;
- Cho, Kang Ho (Department of Pediatrics, Gachon Medical School) ;
- Tchah, Hann (Department of Pediatrics, Gachon Medical School) ;
- Lee, Hak Soo (Department of Pediatrics, Gachon Medical School)
- 투고 : 2002.09.07
- 심사 : 2002.10.08
- 발행 : 2003.01.15
초록
목 적 : 장중첩증의 진단 및 치료에 효과적인 방법인 공기 주입 정복술을 시행하는 도중 발생한 장천공에 대한 국내의 연구는 미미한 실정이다. 따라서 저자들은 이에 대한 위험인자 및 수술 합병증, 예후 등에 대하여 분석하고자 하였다. 방 법 : 1990년 1월부터 2001년 12월까지 가천의대 길병원 소아과에 장중첩증으로 입원하였던 환아 중 공기 주입 정복술을 시행하는 도중 장천공이 발생하였던 12명의 환아를 대상으로 병록지를 통하여 성별 및 연령 분포, 주요 임상 증상, 증상 발현후 내원까지의 경과 시간, 장중첩증의 유형, 장중첩증의 천공 부위와 수술소견, 병리소견 등을 후향적으로 조사하여 분석하였다. 결 과 : 1) 공기 주입 정복술을 시행하였던 657명의 환아 중에서 596명이 성공적으로 치료되어 정복율은 90.7%였고, 장천공은 모두 12례에서 발생하여 천공율은 1.83%였다. 공기 주입 정복술 도중 천공된 환아들 중 남아는 11명(91.7%), 여아는 1명(8.3%)이었으며, 평균연령은
Purpose : Although air enema reduction has been known as a good method of diagnosis and treatment of intussusception, it could develop colon perforation. However, there have been few studies about this complication. So we analyzed the risk factors of colon perforation during air enema reduction in patients with intussusception. Methods : We reviewed the charts of 12 colon perforation patients during air enema reduction of intussusception, who were admitted to Gil Medical Center from Jan. 1990 to Dec. 2001. Their age, sex, major symptoms, length of time till hospital visit, types of intussusception, operative findings and pathologic reports were reviewed. Results : Among 657 cases, 596 patients(90.7%) were successfully treated, but 12 patients(1.83%) failed in air enema reduction and had colon perforation. In patients with colon perforation the male to female ratio was 11 : 1, and average age was 5.3 months. The most common symptom at the time of hospital visit was vomiting(91.7%). Cyclic irritability(75.0%), bloody stool(75.0%) and abdominal mass(41.7%) were also noted. The average length of time between symptom onset and hospital visit was 44.7 hours. Types of intussusception were predominantly ileocolic, ileocecal, and ileoileocolic. The site of perforation was most commonly found at the proximal part of intussusception including ascending colon(50%) and transverse colon(50%). Most cases were uncomplicated, and had a single perforation. Pathologic reports showed hemorrhagic necrosis and mesenteric laceration at the site of colon perforation. Complications of colon perforation were tension pneumoperitonium(58.3%), requiring immediate decompression. Conclusion : The chance of colon perforation during air enema reduction increases in cases with small bowel obstruction on simple abdominal x-ray of a patient younger than 6 months, delay in time till hospital visit and higher air pressure during reduction. Therefore more careful investigation is needed in these cases.