• Advances in pediatric surgery
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• 제20권2호
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• pp.33-37
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• 2014

Purpose: The purpose of this study was to compare the diagnostic accuracy of the non-invasive diagnostic methods and rectal suction biopsy for the detection of Hirschsprung disease (HD). Methods: We reviewed diagnostic methods and results retrospectively in patients who underwent anorectal manometry, barium enema and rectal suction biopsy for the diagnosis of HD at Asan Medical Center from January 2000 to December 2012. Results: There were 97 patients (59 neonates and 38 infants) in the study period. The overall accuracy of anorectal manometry for the diagnosis of HD was 71.1% and its sensitivity was 51.4% (48.1% in neonate and 62.5% in infant, respectively) and its overall specificity was 82.3% (81.3% in neonate and 83.3% in infant, respectively). The Overall accuracy of barium enema was 66.0% (72.8% in neonate and 55.3% in infant, respectively) and specificity of barium enema was 53.2% (56.3% in neonate and 50.0% in infant, respectively). These results were lower than those of anorectal manometry. The overall sensitivity of barium enema was 88.6% (92.6% in neonate and 75.0% in infant, respectively) and it was higher than the sensitivity of anorectal manometry. Histological studies confirmed HD in 35 patients, in one of whom the suction biopsy showed negative finding. Conclusion: Accuracy of non-invasive methods for diagnosis of HD in our study is lower than those in previous study, so we need to improve the quality of diagnostic tools in our hospital. We conclude that the rectal suction biopsy is the most accurate test for diagnosing HD, so the biopsy to confirm the diagnosis of the HD is very important.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제6권1호
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• pp.24-31
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• 2003

목 적: Hirschsprung병의 진단 시 일차적 선별검사로서 항문직장 내압검사의 유용성을 평가하고 한국 영아에서 이 검사에 대한 자료를 제공하고자 본 연구를 시행하였다. 방 법: 1995년 7월부터 2002년 5월까지 서울아산병원에 복부팽만이나 구토, 배변장애, 만성설사 등으로 내원하여 항문직장 내압검사를 시행한 61례를 대상으로 그들의 의무기록 정보를 후향적으로 분석하였다. 그 중 33례에서 대장조영술을 시행하였고 두 가지 검사에서 Hirschsprung병이 의심되었을 때 교정 수술 시 얻은 전근육 조직생검상 신경절 세포의 결여를 확인하여 진단하였다. Hirschsprung병의 진단에 대한 항문직장 내압검사와 대장조영술의 예민도, 특이도, 양성 예측치, 음성 예측치를 비교분석 하였고 정상 대조군의 항문괄약근의 길이와 직장항문 억제반사를 일으키는데 필요한 풍선의 공기량을 측정하였다. 결 과: Hirschsprung병으로 확진돤 18례를 환자군으로, 나머지 43례를 대조군으로 하여 측정한 항문직장 내압검사의 민감도, 특이도, 양성 예측도, 음성 예측도는 각각 1.00, 0.91, 0.82, 1.00이었고 대장조영술은 각각 0.93, 0.67, 0.70, 0.92이었다. 정상 대조군에 서 측정한 항문괄약근의 평균길이는 $1.68{\pm}0.67$ cm로 신장, 연령, 체중과 모두 상관 관계를 보였으며 그중 신장과 가장 유의한 상관 관계를 보였다. 또한 정상 대조군에서 직장항문 억제반사를 일으키기 위해 직장내 위치한 풍선에 주입한 공기량의 중위수는 10 mL (5~20 mL)이었고 이는 신장이나 연령, 체중과의 상관관계를 보이지 않았다. 결 론: Hirschsprung병의 진단 시 항문직장 내압검사는 일차 선별검사 방법으로 매우 유용함을 확인 할 수 있었다. 또한 정상 대조군에서 측정한 항문괄약근의 길이에 대한 자료는 향후 국내에서 영아를 대상으로 한 항문직장 내압검사에 도움이 될 것으로 생각된다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권1호
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• pp.23-30
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• 2014

Manometry is a noninvasive diagnostic tool for identifying motility dysfunction of the gastrointestinal tract. Despite the great technical advances in monitoring motility, performance of the study in pediatric patients has several limitations that should be considered during the procedure and interpretation of the test results. This article reviews the clinical applications of conventional esophageal and anorectal manometries in children by describing a technique for performing the test. This review will develop the uniformity required for the methods of performance, the parameters for measurement, and interpretation of test results that could be applied in pediatric clinical practice.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권2호
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• pp.194-198
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• 2009

목 적: 본 연구는 후향적으로 신생아기의 일시적 장폐쇄와 허쉬스프룽병에서 임상 양상과 검사법에 따른 결과의 비교를 통하여 양 질환의 감별 진단을 위한 검사법의 유용성을 알아보고자 하였다. 방 법: 2004년 8월부터 2009년 3월까지 심한 복부팽만으로 방문한 신생아 중 단순복부촬영을 하여 전체 장관의 심한 확장을 보이면서 직장에 공기 음영이 보이지 않아 바륨조영술, 항문직장압력 검사, 직장흡인 생검을 모두 시행한 19예를 대상으로 하였으며 이들을 일시적 장폐쇄군과 허쉬스프룽병군으로 분류하였다. 결 과: 총 19예 중, 일시적 장폐쇄군의 경우 남아 8명(66.7%), 여아 4명(33.3%)이었다. 발생 시기는 일시적 장폐쇄군은 출생 후 2주에서 6주, 허쉬스프룽병군은 출생 후 3주 이내였다. 바륨조영술에서 이행부위는 일시적 장폐쇄군 6예(50%), 허쉬스프룽병군 4예(57.1%)에서 관찰되었다. 항문직장압력 검사에서 항문직장억제 반사가 관찰된 경우는 일시적 장폐쇄군 11예(91.7%), 허쉬스프룽병군 1예(14.3%)였다. 직장 흡인 생검에서 신경절세포가 관찰된 경우는 일시적 장폐쇄군 9예(75%), 허쉬스프룽병군 0예(0%)였다. 복부팽만의 호전 시기는 생후 1개월 이전 1예(8.3%), 1~2개월 8예(66.7%), 2~3개월 3예(25.0%)였으며, 전례가 3개월까지는 복부팽만이 호전되었다. 결 론: 생후 2주 이후에 심한 복부팽만이 나타나는 경우, 허쉬스프룽병과의 감별을 위해 바륨조영술보다 먼저 항문직장압력 검사를 시행하고 항문직장억제 반사가 없거나 불확실한 경우에 선별적으로 직장 흡인 생검을 하는 것이 불필요한 검사를 줄이는데 도움이 될 것으로 생각된다.

• Advances in pediatric surgery
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• 제8권1호
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• pp.1-5
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• 2002

Diagnosing Hirschsprung's disease is a clinical challenge. Hirschsprung's disease should be considered in any child who has a history of constipation dating back to the newborn period. We examined diagnostic methods and their results retrospectively in 37 neonates and infants who underwent both barium enema and anorectal manometry for the diagnosis of Hirschsprungs disease at Asan Medical Center between January 1999 and April 2001. Two radiologists and a surgeon repeatedly reviewed both of the diagnostic results. In anorectal manometry, thirty-four studies were in agreement with the definitive diagnosis, giving an overall diagnostic accuracy of 91.9 % (neonate; 100 %, infant; 85.7 %). The accuracy and specificity of barium enema was lower than those of anorectal manometry, but sensitivity was higher. There was no significant difference between the two methods. Both studies showed findings consistent with the final diagnosis. However, discordant results needed further evaluation or close observation to diagnose accurately. We conclude that Hirschsprungs disease should not be diagnosed by only one diagnostic method.

• Advances in pediatric surgery
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• 제5권2호
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• pp.103-110
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• 1999

To estimate the normal anal canal pressure in neonates, anal manometry was performed in 46 normal babies less than 6 days of age. Twenty-eight of the subjects were boys and 18 girls. All the subjects passed meconium within 24 hours after birth. Birth weights were above 2.4 kg. There were no sexual differences in birth weight, birth height, gestational age, postnatal age, or Apgar score (p<0.05). The mean manometry values were; anal sphincter length $18.6{\pm}3.9$ mm, high pressure zone (HPZ) $9.2{\pm}3.6$ mm, vector volume $2027.2{\pm}2440.7$ mmHg2cm, maximum pressure $42.3{\pm}17.4$ mmHg, and position of the maximum pressure $6.0{\pm}22.4$ mm. Only the HPZ of boys was longer than those of girls (p=0.005). In squeezing state, HPZ and the position of maximun pressure were not changed from resting state. HPZ, vector volume, and maximum pressure in boys were higher than those in girls. As the birth weight increased, the anal sphincter length (p=0.001) and the HPZ increased (p=0.047). The resting pressures of the anal canal were evaluated in three portions; /23 upper portion, $12.8{\pm}8.6$ mmHg, middle portion, $20.3{\pm}10.8$ mmHg, and lower portion, $26.1{\pm}12.9$ mmHg. These normal values may serve as guidelines for the evaluation, diagnosis and treatment of neonatal anal diseases.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제2권1호
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• pp.30-39
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• 1999

목적: 정상어린이, 변비 및 유분증이 있는 환아에서 직장항문압검사를 시행하여 이의 유용성을 알아보고자 하였다. 방법: 정상대조군 어린이 11명과 36명의 환아(특발성변비환아 20명, 유분증환아16명)에서 항문직장압검사를 시행하였다. 결과: 외괄약근압은 대조군에서($21.0{\pm}8.00$ mmHg) 단순 변비군($34.4{\pm}15.3$; p=0.028)이나 유분증군($33.8{\pm}15.2$ mmHg; p=0.028)과 비교하여 유의하게 낮았다. 내괄약근압도 대조군에서($30.0{\pm}14.57$ mmHg) 단순변비군($41.0{\pm}15.3$ mmHg, p=0.016)과 유분증군($49.3{\pm}13.6$, p=0.016)과 비교하여 의미있게 낮았다. 최소감각용적은 단순 변비군($54.2{\pm}35.9$ ml, p=0.002) 유분증군($73.6{\pm}33.5$ ml, p=0.002) 모두 대조군($11.4{\pm}4.52$ ml)보다 높은 수치를 나타내었다. 직장-항문 반사 역치는 단순변비군($17.1{\pm}8.75$ ml), 유분증군($13.2{\pm}11.1$ ml) 및 대조군($8.91{\pm}$ ml)에서 유의한 차이가 없었다(p=0.212). 또한 최소감각용적에서 직장항문반사역치를 뺀 값은 대조군($-1.00{\pm}6.99$ ml)에 비해 환아군($44.0{\pm}39.5$ ml)에서 의미있게(p=0.005) 높았다. PRRAIR는 세 군 간의 차이가 없었다(p=0.307). 결론: 위의 결과는 유분증환아 및 변비 환아에서 항문생리를 객관적인 수치로 표시하였을 때 정상 어린이와 차이가 있음을 보여주었고 환아의 치료 방침을 정하거나 변비의 객관적인 평가에 직장항문압검사가 유용하게 이용될수 있음을 보여주었다. 또한 유분증과 단순변비간에 여러수치의 차이가 없는 것은 일부를 제외하고는 변비와 유분증은 같은 병태생리를 갖고 있는 것을 나타내는 것이라 할 수 있다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권sup1호
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• pp.44-54
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• 2008

Chronic functional constipation is a common problem in childhood, with soiling a significant issue. It presents a management problem for pediatrician, and parental concern is high. About 5% of pediatric patients is known to have constipation and/or encopresis which is the second most referred disease in pediatric gastroenterology clinic, accounting for up to 25% of all visits. The etiology of constipation was based on initiation factors including vicious cycle concept, genetic factors, psychological factors, dietary influences and histologic abnormalities of colon. Emphasis is placed on the evaluation and management options that are available to the treating pediatrician. Careful history taking is most important to diagnose functional constipation. In addition, diagnostic tests such as plain abdominal radiograph, colonic transit study, anorectal manometry, barium enema were helpful to diagnose the constipation. Childhood constipation can be very delicate to treat. It often requires prolonged supports by physicians and parents, demystification, medical treatment and especially with the child and parent's cooperation.

• Advances in pediatric surgery
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• 제8권1호
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• pp.48-53
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• 2002

Diagnosing Hirschprungs disease (HD) is a clinical challenge to pediatric surgeons. The cardinal symptoms are failure of passage of meconium within first 24 hours of life, abdominal distension, and vomiting. The severity of these symptoms and the degree of consitpation vary considerably between patients. HD is suspected on the basis of history and clinical findings and the diagnosis is established by radiological examination, anorectal manometry, and histochemical analysis of biopsy specimens. In this review, the advantages and pitfalls of each diagnostic modality are discussed. And a diagnostic approach utilizing these diagnostic modalities in children with suspicious HD is presented.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.215-218
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• 2022

The rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was working. He was hemodynamically unstable, and the Focused Assessment with Sonography for Trauma showed hemoperitoneum and hemoretroperitoneum; therefore, damage control surgery with pelvic packing was performed. A subsequent whole-body computed tomography scan showed a displaced pelvic bone and sacrum fracture. There was evidence of an anorectal full-thickness laceration and urethral laceration. In second-look surgery performed 48 hours later, the pelvis was stabilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A tractioned rectal probe with an internal balloon was positioned in order to approach the flaps of the rectal wall laceration. On postoperative day 13, a radiological examination with endoluminal contrast injected from the stoma after removal of the balloon was performed and showed no evidence of extraluminal leak. Rectosigmoidoscopy, rectal manometry, anal sphincter electromyography, and trans-stomic transit examinations showed normal findings, indicating that it was appropriate to proceed with the closure of the colostomy. The postoperative course was uneventful. The optimal management for extraperitoneal penetrating rectal injuries continues to evolve. Primary repair with fecal diversion is the mainstay of treatment, and a conservative approach to rectal lacerations with an internal balloon in a rectal probe could provide a possibility for healing with a lower risk of complications.