• 제목/요약/키워드: 소장협착

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Endoscopic Diagnosis and Treatment of Benign Small Bowel Stricture (양성 소장협착의 내시경적 진단과 치료)

  • Jinsu Kim
    • The Korean Journal of Medicine
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    • v.99 no.4
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    • pp.199-205
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    • 2024
  • Benign small bowel strictures can occur in association with various conditions, including small bowel Crohn's disease, nonsteroidal anti-inflammatory drug-induced enteritis, ischemic enteritis, intestinal tuberculosis, radiation enteritis, postoperative adhesions, and anastomotic strictures. Benign small bowel strictures are classified into two categories, low-grade and high-grade. Low-grade small bowel strictures involve a partial reduction of the internal diameter of the small intestine, causing slight obstruction of the passage of food and digestive fluids without significant bowel obstruction symptoms. By contrast, high-grade small bowel strictures involve a severe narrowing of the intestinal lumen, leading to marked obstruction of the passage of food and digestive fluids and pronounced bowel obstruction symptoms. Small bowel strictures can be diagnosed using various methods, including abdominal plain radiography, abdominal computed tomography, computed tomography enterography, magnetic resonance enterography, balloon-assisted enteroscopy, and abdominal ultrasound. Each diagnostic method has unique advantages and disadvantages as well as differences in diagnostic specificity and sensitivity. Therefore, even if small bowel strictures are not observed using a single imaging technique, their presence cannot be completely excluded. A comprehensive diagnosis that combines clinical information from multiple diagnostic modalities is necessary. Therapeutic approaches for managing small bowel strictures include medical therapy, endoscopic balloon dilation using balloon-assisted enteroscopy, and surgical methods such as strictureplasty and segmental resection. Endoscopic balloon dilation, in particular, can help reduce complications associated with repeated surgeries for strictures.

Mucosal Resection in the Corrosive Esophageal Stricture -A new technique- (부식성 식도 협착에서 식도 점막 절제술)

  • 김공수;구자홍;박상철
    • Journal of Chest Surgery
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    • v.34 no.2
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    • pp.194-197
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    • 2001
  • 부식성 물질에 의한 양성 식도 협착 환자에서 식도 확장술이 일반적으로 사용되는 술식이나 협착부위가 잔존하여 연하곤란이 발생하므로 식도 재건술이 이용된다. 식도재건술은 대용 식도로 위관, 대장관, 소장관이 이용하여 광범위한 박리, 여러 부위의 절개, 문합부 대용 식도 위치에 따른 문제점 및 협착된 식도를 잔존시킴으로 식도암 발생가능성이 있으며 식도 재건술후 식도 기능의 문제점이 많다. 이에 시고 기능에 이상을 초래하지 않으면서 합병증이 적고 수술하기 쉬운 방법이 요구된다. 저자는 식도 근층만을 절개하고 점막하층을 박리한 후 협착부 점막만 절제하고 점막 단단 문합함으로 좋은 결과를 얻었기에 증례와 더불어 수술 방법을 소개하고자 한다.

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A Case of Mesodiverticular Band Causing Small Intestinal Obstruction (소장 폐쇄의 원인이 된 게실 간막 띠(Mesodiverticular band) 1례)

  • Na, Hyun Jung;Lee, Gyeong Hoon
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.7 no.2
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    • pp.278-283
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    • 2004
  • Meckel's diverticulum is found in about 3% of the population, often incidentally during laparotomy or at autopsy. Over 50% of patients who develop symptoms from this anomaly are younger than 2 years of age. The most common symptom of this lesion is intestinal obstruction. Rarely Meckel's diverticulum is complicated by a mesodiverticular band, which is believed to be a remnant of a vitelline artery. We report a 11-year-old girl with small bowel obstruction because of an intestinal hernia beneath the mesodiverticular band. The causative factor was a stenotic area in the terminal ileum caused by a ringlike lipovascular mesenteric band encroaching externally on the lumen. Although the incidence of mesodiverticular bands complicating Meckel's diverticulum is quite low, the rapid clinical course and the associated high mortality rate make this an important disease.

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The Usefulness of Capsule Endoscopy in Diagnosis of Small Bowel Diseases (소장질환의 진단에 캡슐내시경 검사의 유용성)

  • Eun, Jong-Ryul;Jang, Byung-Ik
    • Journal of Yeungnam Medical Science
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    • v.23 no.1
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    • pp.45-51
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    • 2006
  • Background: This study was conducted to evaluate the usefulness of capsule endoscopy (CE) for the diagnosis of small bowel diseases. Materials and Methods: We reviewed the medical records of 66 patients (mean age: 52.1 years, male/female: 39/27), who underwent CE at Yeungnam University Hospital from August 2003 to March 2006. Results: Suspicious gastrointestinal (GI) bleeding presenting as anemia or history of gross bleeding was the most common reason to perform CE (71.2%). Other indications included GI symptoms (21.2%) such as abdominal pain/discomfort, nausea, diarrhea, and others (7.6%). In studies performed for GI bleeding (n=47), ulcer/erosion was the most common finding (n=22, 46.8%) followed by tumor (n=5, 10.6%), angiodysplasia (n=3, 6.4%), polyp (n=3, 6.4%), active bleeding (n=1, 2.1 %), ulcer with stenosis (n=1, 2.1%), and normal findings (n=12, 25.5%). Of these, a bleeding focus was detected in 32 cases (68.1%) undergoing CE studies. Among 14 patients with GI symptoms, only two patients had typical findings related with symptoms. Surgical resection was performed in five cases with tumor. Of these, four were diagnosed as gastrointestinal stromal tumor and the other one was a lymphangioma. There were no complications associated with the CE procedure. Conclusion: Capsule endoscopy is a safe, noninvasive diagnostic tool for small bowel diseases and may be useful for the diagnosis of small bowel hemorrhage including obscure bleeding. However, further studies are needed to confirm its utility for abdominal symptoms other than hemorrhage because of the low diagnostic yield.

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Migrated Pancreaticojejunal Stent Forming a Stent-Stone Complex in the Jejunum with Resultant Small Bowel Obstruction: A Case Report (췌공장 스텐트의 공장으로의 이동으로 발생한 스텐트-돌 복합체 형성과 이로 인한 소장폐색: 증례 보고)

  • Jiwon Kim;Young Han Kim;Byung-Hee Lee
    • Journal of the Korean Society of Radiology
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    • v.84 no.2
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    • pp.512-517
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    • 2023
  • Transanastomotic pancreatic duct stent placement during reconstruction following pancreaticoduodenectomy is widely performed to prevent postoperative pancreatic fistulas and duct stenosis. However, stent-related complications, such as stent occlusion and migration, may occur. Here, we report a rare case of a migrated pancreatic duct plastic stent. After pylorus-preserving pancreaticoduodenectomy, the stent migrated to the jejunum and served as a nidus of the stent-stone complex, which developed jejunal obstruction. The stent-stone complex was removed by explorative laparotomy.

Ischemic Enterocolitis in Children (소아에서 발생한 허혈성 소장결장염)

  • Lee, Byung-Ky;Park, Jae-Hong
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.10 no.2
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    • pp.138-146
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    • 2007
  • Purpose: Ischemic enterocolitis (IEC) is the total or partial infarction of the intestine in the absence of occlusion of a major mesenteric blood vessel. The purpose of this study was to evaluate the clinical features of IEC in children. Methods: A clinical analysis of 6 patients with IEC who were admitted to the Department of Pediatrics at Pusan National University Hospital, between 1996 and 2005 was conducted retrospectively. Patients were diagnosed with IEC based on clinical characteristics, including radiologic, endoscopic, histopathologic, and intraoperative findings. Results: Four boys and 2 girls between the age of 6 weeks and 6 years were included in this study. Most of the patients were born at term and had a birth weight that was appropriate for their gestational age. The major symptoms of IEC observed included hematochezia or hematemesis (5 cases), vomiting, diarrhea, abdominal pain or irritability (4 cases), as well as abdominal distension and fever (3 cases). IEC occurred in thecolon in 5 cases (2 descending colon, 1 descending and sigmoid colon, 1 sigmoid colon, 1 whole colon) and the duodenal bulb and gastric antrum in 1 case each. The type of the lesions observed includedulcera, which were found in 3 cases, perforation, which was pbserved in 2 cases, necrotic patches, which were observed in 2 cases, stricture, which was observedin 1 cases, and massive membranous desquamation of the epithelium, which was observed in 1 case. Two of the patients received surgical treatment and the remaining four were treated conservatively. None of the patients died. Conclusion: The presentation of IEC varies, and the findings of this study will be helpful in managing patients with IEC.

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Surgical Correction of Chronic Hypertropic Pyloric Gastropathy in a Dog (개에서의 만성 비후성 유문 위장애에 대한 수술적 치료)

  • Kim Joon-young;Jeong Soon-wuk;Park Sang-heuk;Yoon Hun-young;Han Hyun-jung;Jang Ha-young;Lee Bo-ra;Kim Gu-yuong
    • Journal of Veterinary Clinics
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    • v.21 no.4
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    • pp.398-401
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    • 2004
  • A ten-year-old, female Yorkshire terrier dog with intermittent vomiting, weight loss, polydipsia and depression was referred to the Veterinary Medical Teaching Hospital of Konkuk University. On the radiological survey, gas and fluid-filled gastric distention was detected. No contrast medium entraneed to the small bowel, in 60 minutes after contrast medium administration. And marked fluid accumulation in gastric body and thickening of the pyloric mucosa were found with ultrasonograph. So gastric obstruction by reason of pyloric stenosis was strongly suspected. At the surgery, hypertrophied mucosa was resected adequately, and Heineke-Mikulicz pyloroplasty was applied. Microscopically the symptom was characterized by gastric mucosa hyperplasia and mild diffuse Iymphoplasmocytic gastritis. So this condition was diagnosed as chronic hypertrophic pyloric gastropathy. Intermittent vomiting and mild depression were shown for 9 days after the operation. After that, the patient was recovered gradually. One month later, the patient had normal appetite and activity without complications.

Imaging Techniques and Differential Diagnosis for Inflammatory Bowel Disease (염증성 장질환의 영상기법 및 감별진단)

  • Kyoung Doo Song
    • Journal of the Korean Society of Radiology
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    • v.84 no.3
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    • pp.536-549
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    • 2023
  • The two main types of inflammatory bowel disease (IBD) are Crohn's disease and ulcerative colitis. Currently, when IBD is suspected, CT enterography is widely used as an initial imaging test because it can evaluate both the bowel wall and the outside of the bowel, helping to differentiate IBD from other diseases. When IBD is suspected, it is necessary to distinguish between Crohn's disease and ulcerative colitis. In most cases this is not difficult; however, in some cases, it is difficult and such cases are called IBD-unclassified. CT findings are often non-specific for ulcerative colitis, making it difficult to differentiate it from other diseases using imaging alone. In contrast, characteristic CT findings for Crohn's disease are often helpful in diagnosis, although diseases, such as tuberculous enteritis can mimic Crohn's disease. Recently, mutations in the gene encoding a prostaglandin transporter called SLCO2A1 have been discovered as the cause of the disease in some patients with multiple ulcers and strictures, similar to Crohn's disease. Therefore, genetic testing is being used to make a differential diagnosis.

Postoperative Complications after Preoperative Chemoradiotherapy Combined with Hyperthermia in Locally Advanced Rectal Cancer (국소 진행성 직장암의 수술전 동시 화학방사선치료와 온열치료병합시 수술후 부작용)

  • Yea, Ji Woon
    • Progress in Medical Physics
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    • v.25 no.2
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    • pp.89-94
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    • 2014
  • We investigated whether regional hyperthermia (HT) increased post-surgical complications in patients with locally advanced rectal cancer treated with preoperative concurrent chemoradiotherapy (CCRT). Between 1996 and 2007, 205 patients treated with preoperative CCRT and curative surgery were evaluable for the analysis of acute and late toxicities. A total dose of 39.6 Gy or 45 Gy was delivered concurrently with one or two cycles of chemotherapy (5-fluorouracil, leucovorin). Eighty-eight patients received regional HT twice a week using an 8-MHz radiofrequency capacitive heating device. Surgery was performed 4~6 weeks after the completion of preoperative CCRT. The median age was 59 years (range, 18~83) and the median follow-up period was 61months (range, 2~191). The 5-year overall survival and complication-free survival rate of all patients was 77.4% and 73.7%, respectively. Early leakage, delayed leakage, anastomotic stricture, fistula, and small bowel obstruction occurred in 1.0%, 2.9%, 1.5%, 5.9%, and 17.1%, respectively. HT did not increase all kinds of complications. The 5-year complication-free survival rate was 71.8% in the non-HT group and 76.3% in the HT group (p=0.293). Regional HT did not increase postoperative complications in patients with locally advanced rectal cancer treated with preoperative CCRT followed by curative surgery.

Formation of an Intestine-Cartilage Composite Graft for Tracheal Reconstruction (기관 재건을 위한 장과 연골의 복합 이식판 개발)

  • Jheon, Sang-Hoon;Lee, Sub;Jung, Jin-Yong;Kong, Jun-Hyuk;Lim, Jeong-Ok;Kim, Yu-Mi;Jin, Chun-Jin;Park, Tae-In;Lee, jae-Ik;Sung, Seok-Whan;Choh, Joong-Haeng
    • Journal of Chest Surgery
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    • v.37 no.6
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    • pp.474-481
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    • 2004
  • Background: Tracheal transplantation is necessary in patients with extensive tracheal stenosis, congenital lesions and other oncologic conditions but bears. many critical problems compared to other organ transplantations. The purpose of this study was to develop intestine-cartilage composite grafts for potential application in tracheal reconstruction by free intestinal graft. Material and Method: Hyaline cartilage was harvested from trachea of 2 weeks old New Zealand White Rabbits. Chondrocytes were isolated and cultured for 8 weeks. Cultured chondrocytes were seeded in the PLGA scaffolds and mixed in pluronic gel Chondrocyte bearing scaffolds and gel mixture were embedded in submucosal area of stomach and colon of 3 kg weighted New Zealand White Rabbits under general anesthesia. 10 weeks after implantation, bowels were harvested for evaluation. Result: We identified implantation site by gross examination and palpation. Developed cartilage made a good frame for shape memory. Microscopic examinations included special stain s howed absorption of scaffold and cartilage formation even though it was not fully matured. Conclusion: Intestine-cartilage composite graft could be applicable in the future as tracheal substitute and should be further investigated.