• 한국산학기술학회논문지
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• 제20권1호
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• pp.371-375
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• 2019

혈역학적으로 불안정한 췌장손상의 치료에서 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)의 역할은 아직 불명확하다. 저자들은 출혈을 동반한 췌장손상에서 REBOA와 경도관 동맥색전술을 시행하여 출혈을 먼저 제어한 후 수술을 시행한 증례를 보고하고자 한다. 65세 남자가 20 m 높이에서 추락하면서 발생한 복통과 흉통을 호소하며 본원 응급실을 통하여 내원하였다. 전산화단층촬영에서 췌장 미부에 grade III 손상이 의심되고 비장동맥으로부터 조영제 누출이 관찰되었다. 전산화단층촬영 시행 후 수축기혈압이 60 mmHg까지 하강하여 혈역학적 안정을 위해 REBOA를 시행하였다. REBOA 시행 후 수축기혈압이 130 mmHg로 상승하였으며, 비장동맥에 대해 색전술을 시행하였다. 혈관조영술에서 더 이상 출혈이 없는 것을 확인하고, REBOA 제거 후 응급 개복 및 췌장미부절제술을 시행하였다. 수술 소견에서 췌장미부의 주췌관 손상을 동반한 열상이 관찰되었으며, 수술 중 큰 출혈은 관찰되지 않았고 주 췌관의 손상이 확인되었다. 술 후 환자는 합병증 없이 회복하였다. 본 증례에서 저자들은 혈역학적으로 불안정한 출혈을 동반한 췌장손상 환자에서 REBOA와 동맥색전술 시행 후 췌장미부절제술을 안전하고 효과적으로 진행할 수 있었다.

• Advances in pediatric surgery
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• 제15권2호
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• pp.180-185
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• 2009

We report a case of nonfunctioning neuroendocrine tumor of the pancreas in a 15-year-old girl who presented with back pain. On physical examination, there was mild tenderness in the left upper quadrant of the abdomen. The patient had no pancreatic hormone-associated symptoms. An abdominal ultrasonography showed a well-demarcated hypervascular solid mass with calcification in the tail of the pancreas. An abdominal computed tomography scan showed a $6{\times}5cm$ sized well-encapsulated enhancing solid mass with cystic component in the tail of the pancreas. Distal pancreatectomy was performed. Pathology revealed awelldifferentiated nonfunctioning low grade malignant neuroendocrine tumor of the pancreas. The postoperative course was uneventful.

• Advances in pediatric surgery
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• 제19권2호
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• pp.98-107
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• 2013

Debates exist about the appropriate treatment for pancreatic trauma in children. We intended to examine the safety of the operation of pancreatic trauma in children. This is a retrospective study of 13 patients, younger than 15, who underwent surgery for pancreatic trauma, between 1993 and 2011 in Seoul National University Children's Hospital. Medical records were reviewed for mechanism of trauma, clinical characteristics, radiological findings, operation and outcomes. Organ injury scaling from the AAST (American Association for Surgery of Trauma) was used. All injuries were caused by blunt trauma. Patients with grade III, IV, and those who were difficult to distinguish grade II from IV, underwent surgery due to severe peritonitis. Three patients with grade II were operated for reasons of mesenteric bleeding, tumor rupture of the pancreas, and progression of peritonitis. Distal pancreatectomy was performed in 10 patients and subtotal pancreatectomy and pylorus preserving pancreaticoduodenectomy in 1 patient each. The remaining one underwent surgical debridement because of severe adhesions. The location of injury, before and after operation, coincided in 83.3%. The degree of injury, before and after the operation, was identical in all the patients except for those who were difficult to tell apart grade II from grade IV, and those cannot be graded due to severe adhesion. Postoperative complications occurred in 23.1%, which improved with conservative treatment. Patients were discharged at mean postoperative 12(range 8~42) days. Even though patients with complications took longer in time from diagnosis to operation, time of trauma to operation and hospital stay, this difference was not significant. In conclusion, When pancreatic duct injury is present, or patient shows deterioration of clinical manifestation without evidence of definite duct injury, or trauma is accompanied by other organ injury or tumor rupture, operative management is advisable, and we believe it is a safe and feasible method of treatment.

• Advances in pediatric surgery
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• 제13권2호
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• pp.155-161
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• 2007

Pancreatic tumors in children are very rare but have a better prognosis compared with that in adult. Pediatric pancreatic tumors are more often benign and easier to resect. To evaluate the characteristics and prognosis, the records of 13 patients who underwent pancreatic resection, from June 1997 to May 2005, at Samsung Medical Center were reviewed. The mean follow up period was 48 months. The male to female ratio was 1: 1.6. Mean age was 10.3 years. Signs and symptoms included abdominal pain (7), abdominal palpable mass (5), jaundice (1), hypoglycemic (1), and non-specific GI symptoms (4). The commonly used diagnostic tools were CT and abdominal sonography. In addition, MRI, ERCP, EEG, and hormone test were also done when indicated. Surgical procedures included distal pancreatectomy (5), pylorus preserving pancreaticoduodenectomy (4), tumor excision (3), and subtotal pancreatectomy (1). Locations of lesions in pancreas were head (4), tail (5), and body and tail (4). Postoperative complications developed in 3 cases; postoperative ileus (1), wound problem (1), and pancreatitis (1). The pathologic diagnosis included solid-pseudopapillary tumor (6), congenital simple cyst (1), pancreatic duplication cyst (1), serous oligocystic adenoma (1), mucinous cystadenocarcinoma (1), rhabdomyosarcoma (1), insulinoma (1), and pancreatoblastoma (1). Three cases received adjuvant chemotherapy and radiotherapy. Overall survival rate was 81 %. One patient with a mucinous cystadenocarcinoma died. In this study, pancreatic tumors in children were resectable in all patients and had good survival. Surgery of pancreatic tumors should be regarded as the gold standard of treatment and a good prognosis can be anticipated in most cases of benign and malignant tumors.

• Advances in pediatric surgery
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• 제4권1호
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• pp.55-60
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• 1998

Six children with solid and papillary epithelial neoplasm of the pancreas were studied retrospectively. There were 2 boys and 4 girls. The mean age at operation was 11 years(range; 8-13years). Three patients had incidental abdominal mass, in two patients the mass was non-tender, in one patient the mass was tender. The minimum size of tumor was $6.5{\times}6.0$ cm and the maximum was $10.5{\times}8.0$ cm. Five tumors were located in the head of the pancreas, and the other one in the tail. Local invasion or metastasis was not noticed. Tumors were removed completely by performing the following operations: 3 pylorous preserving pancreaticoduodenectomy, 2 Whipple's operation and 1 distal pancreatectomy. There was no mortality. The histologic findings were characteristic. There were no recurrences during a follow-up of 0.5 to 12 years (mean; 5.0 years).

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4363-4365
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• 2016

Background: The complex anatomy of the pancreaticobiliary duct was crucial in management of pancreatic and biliary tract disease. Materials and Methods: Fresh specimens of pancreas, common bile duct (CBD), and duodenum were obtained en bloc from autopsies of 160 patients. Results: Ninety-three male and 67 female patients were included. The length of the pancreas ranged from 9.8-20 cm (mean, 16.20 +/- 1.70 cm). The intrapancreatic portion of the CBD showed patterns of three types: most common (85.30%) was type A, in which the anterior surface of the common bile duct was totally covered, while its posterior surface was partially covered, by the pancreatic parenchyma. On dissection of the accessory duct of Santorini, the accessory duct was traceable to the duodenal wall in 67.6%. The anatomy of the Wirsung-choledochus confluence was grouped into five different types. The common channel was found in 75.60% and its length varied from just a common junction (so-called "V-type" anatomy) to 15 mm (Y-type-b). Separate papillae (so-called "II-type") were found in 15.3% of specimens. Conclusions: Several important points regarding the anatomy of the pancreaticobiliary junction and pancreatic ductal system were illustrated in this study.

• Journal of Trauma and Injury
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• 제26권1호
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• pp.18-21
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• 2013

Pancreatic injury following blunt abdominal trauma is rare, but it has high morbidity and mortality. Various treatments have been attempted, but none has yet been clearly established. The pancreatic neck transection is usually managed by using a distal pancreatectomy with or without a splenectomy. However, pancreatic insufficiency and the risk of post-splenectomy infection remain significant problems. To avoid these problems in patients with a pancreatic neck transection, one may use a pancreaticoenteric anastomosis as a treatment option, but a pancreatic fistula from the pancreaticoenteric anastomosis remains a significant cause of morbidity and mortality. Recently, several reports proposed the binding pancreaticogastrostomy to minimize the possibility of a postoperative pancreatic fistula developing after pancreatic surgery. Thus, we report a case of a traumatic pancreatic neck transection successfully treated with a binding pancreaticogastrostomy.

• 한국간담췌외과학회지
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• 제27권4호
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• pp.428-432
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• 2023

Minimally invasive pancreatoduodenectomy (MIS PD) is a well reported technique with several advantages over conventional open pancreatoduodenectomy. In comparison to distal pancreatectomy, the adoption of MIS PD has been slow due to the technical challenges involved, particularly in the reconstruction phase of the pancreatojejunostomy (PJ) anastomosis. Hence, we introduce a lowcost model for PJ anastomosis simulation in MIS PD. We fashioned a model of a cut pancreas and limb of jejunum using economical and easily accessible materials comprising felt fabric and the modelling compound, Play-Doh. Surgeons can practice MIS PJ suturing using this model to help mount their individual learning curve for PJ creation. Our video demonstrates that this model can be utilized in simulation practice mimicking steps during live surgery. Our model is a cost-effective and easily replicable tool for surgeons looking to simulate MIS PJ creation in preparation for MIS PD.

• Journal of Chest Surgery
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• 제42권2호
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• pp.263-267
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• 2009

혈성 흉수를 동반한 췌흉강루는 췌가성낭포 파열 혹은 췌관 폐쇄에 의해 생기는 드문 질환이다. 만성 음주력이 있는 48세 남자가 다량의 우측 총수로 내원하였다. 흉수 내 아밀라제와 리파제가 상승되어 있었고, 전산화 단층촬영에서 췌가성낭포 파열에 의한 췌흉강루로 진단되었다. 최초 치료로 흉관 배액, 금식, 총정맥영양 및 췌장액 분비억제제 등의 보존적 치료를 시행하여 증상이 호전되었으나, 이후 출혈성 췌가성낭포가 커지고 혈성 흉수가 재발하여 수술적 치료를 하였다. 환자는 특별한 합병증 없이 수술 후 27일째 퇴원하였다.

• Clinical and Experimental Pediatrics
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• 제58권2호
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• pp.69-72
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• 2015

Insulinoma, which arises from insulin-producing pancreatic beta cells, is a rare tumor in children. Only 5%-10% of insulinomas are malignant and undergo metastasis. We report a case of an 11-year-old girl who experienced hypoglycemia-related seizures induced by an insulinoma; after resection of the primary tumor, she developed hepatic focal nodular hyperplasia (FNH). Laboratory test results indicated marked hypoglycemia with hyperinsulinemia. Abdominal ultrasonography (US) and computed tomography results were normal; however, magnetic resonance imaging (MRI) showed a solid mass in the pancreatic tail. Therefore, laparoscopic distal pancreatectomy was performed. Two months after the surgery, an abdominal MRI revealed multiple nodular lesions in the liver. An US-guided liver biopsy was then performed, and histological examination revealed FNH without necrosis or mitotic activity. The patient has been free of hypoglycemia for 2 years, and recent MRI studies showed a decrease in the size of FNH lesions, without any evidence of metastasis. Even though no metastatic lesions are noted on imaging, close observation and follow-up imaging studies are required in a child with insulinoma that has malignant potential on histopathologic findings.