• Journal of Gastric Cancer
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• 제13권3호
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• pp.188-191
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• 2013

As the incidence of early gastric cancer increases, laparoscopic surgery has become one of the treatments of choice for gastric cancer. With the increase of laparoscopic surgery, the chance of discovering aberrant anatomy during the operation also increases. We present a case of laparoscopic total gastrectomy in gastric cancer patients with intestinal malrotation. Intestinal malrotation occurs in one in every 500 births. We found that laparoscopic total gastrectomy in such patients can be performed successfully when it is performed with a proper Roux limb orientation through an alternative minilaparotomy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권5호
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• pp.447-452
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• 2019

Purpose: Few studies have reported non-acute long-term morbidity rates in children with intestinal malrotation. The aim of this study was to investigate the rate of constipation in children undergoing Ladd's procedure for isolated intestinal malrotation. Methods: This retrospective study included children aged <15 years who underwent Ladd's procedure for intestinal malrotation between 2001 and 2016. Demographics, presence of volvulus perioperatively, need for bowel resection, short term (<30 days) and long-term complications, including mortality were recorded. Constipation was defined as treatment with laxatives at 1-year follow-up. Results: Of the 43 children included in the study, 49% were boys. The median age at surgery was 28 days (0-5, 293 days). Volvulus occurred in 26 children (60.5%), and bowel resection was required in 4 children (9.3%). Short-term complications categorized as grades II-V according to the Clavien-Dindo classification occurred in 13 children (30.2%). Of these, 5 children (11.6%) required re-operation. Constipation was observed in 9 children (23.7%) at the 1-year follow-up. No difference was observed in the rate of perioperative volvulus between children with and without constipation (44% vs. 65%, p=0.45). Excluding re-operations performed within 30 days after surgery, 3 children (6%) underwent surgery for intestinal obstruction during the study period. Conclusion: Many children undergoing Ladd's procedure require bowel management even at long-term follow-up, probably secondary to constipation. It is important to thoroughly evaluate bowel function at the time of follow-up to verify or exclude constipation, and if treatment of constipation is unsuccessful, these children require evaluation for dysmotility disorders and/or intestinal neuronal dysplasia.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제2권1호
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• pp.99-103
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• 1999

저자들은 출생 후부터 1년에 수 회 반복되는 담즙이 포함된 사출성 구토가 있었던 9세 여아에서 발견된 십이지장 격막과 동반된 장이상회전 1례를 경험하였기에 보고하는 바이며, 장의 완전 폐쇄가 아닌 경우에는 년장아에서도 선천성 장폐쇄의 소견이 나타날 수 있으므로 구토가 심하게 반복되는 경우에는 항상 주의깊게 감별진단해야 한다.

• Advances in pediatric surgery
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• 제15권2호
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• pp.121-131
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• 2009

Intestinal malrotation presents with different clinical characteristics, depending upon the age of the patient. The medical records of 44 patients treated for intestinal malrotation with/without midgut volvuls between January 2002 and August 2009 at Seoul National University Children's Hospital were reviewed retrospectively. Patients were grouped by the age criteria of 1 and 12 months. Fourteen patients were under 1 month of age (31.8 %), 9 patients between 1 month and 12 months (20.5 %) and 21 patients over 12 months (47.7 %). Twenty patients (45.5 %) presented with volvulus. Vomiting (66 %) and abdominal pain (20 %) were the most common symptoms. UGIS (68.2 %) was the most frequent diagnostic tool. Mean postoperative hospital stay was 13.7 days. There were 7 mild postoperative complications. Volvulus was more frequent in patients under 1 month (p=0.025) than over 1 month. The interval between diagnosis and operation was shorter in patients under 1 month (p=0.003) than in patients over one month of age. In the age between under and over 12 months, volvulus was more common in those under 12 months of age, but the difference was not significant. The interval from diagnosis to operation was shorter in patients under 12 months than over 12 months of age (p=0.001). Vomiting was the most frequent symptom in patients under 12 months. On the other hand, abdominal pain was the most frequent symptom in patients over 12 months. In conclusion, patients with intestinal malrotation had age-related differences in the presence of midgut volvulus, the interval between diagnosis and operation, and clinical symptoms. The age of the patient should be considered in order to determine adequate treatment of malrotation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제5권1호
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• pp.79-82
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• 2002

저자들은 간헐적인 구토와 복통을 주소로 내원한 6세 된 남아에서 상부 위장관 조영술과 복부단층촬영으로 진단된 중장염전을 동반한 장 이상회전 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Advances in pediatric surgery
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• 제13권1호
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• pp.30-36
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• 2007

Intestinal malrotation is usually asymptomatic and most often is found during abdominal exploration for other surgical diseases. However, a serious complication of intestinal malrotation, midgut volvulus is a true surgical emergency of childhood. The clinical findings, diagnostic procedures, treatment, and prognosis of midgut volvulus were reviewed by a retrospective study. Between 1980 and 2005, 29 patients with midgut volvulus ranging in age from 1 day and 15 years were treated at HanYang University Hospital. Seventy-nine percent of the patients presented before 1 month of age. Midgut volvulus occurred 2 times more frequently in male. The clinical findings were bilious vomiting (96.6 %), irritability (34.5 %), abdominal distention (13.8 %), abdominal pain (10.3 %), and palpable abdominal mass (6.9 %). The diagnosis was made by abdominal simple x-ray (17.2 %), upper gastro-intestinal contrast study (37.9 %), abdominal sonogram (20.7 %), abdominal CT (3.4 %), and abdominal exploration (20.7 %). Among the 29 patients, 5 patients developed gangrene of small intestine due to strangulation and underwent resection of bowel. Two patients died due to sepsis.

• Advances in pediatric surgery
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• 제12권2호
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• pp.257-261
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• 2006

Appendicitis is a common disease in children. But left lower abdominal pain in acute appendicitis is a rare clinical feature. A 6 year-old-girl complained of left sided abdominal pain for 2 days. Past medical history was not contributory. Abdominal tenderness and guarding in left lower quadrant were noticed. Abdominal sonography and abdominal computed tomography scan demonstrated reversed position between superior mesenteric artery and vein, and a mass in the left lower quadrant abdomen suggesting appendicitis. Acute appendicitis in left lower quadrant, associated with intestinal malrotation, was found at laparatomy.

• Journal of Yeungnam Medical Science
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• 제14권2호
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• pp.393-398
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• 1997

1987년 5월에서 1997년 10월까지의 영남대학교 의과대학 부속병원에서 임상적으로 선천성 중장 회전 이상을 의심하여 방사선학적으로 진단되고 수술을 시행한 17명의 환아를 대상으로 임상소견과 수술 기록 및 방사선학적 소견을 후향적으로 분석한 결과는 임상적인 주된 증상은 구토나 구토를 동반한 복통이었으며, 수술 소견상 16명의 환아에서 선천성 중장 회전 이상이 확진되었고, 1명의 환아에서 중장 회전 이상 없이 윤상 췌장으로 진단되었다. 모든 환아에서 상부 위장관 조영술과 바륨 관장술을 시행한 결과, type I인 경우가 3명, type IIA가 2명, type IIC가 1명, type IIIA가 5명, type IIIc가 4명이었으며 이중에서 type IA로 진단된 1명은 수술 소견상 윤상 췌장으로 확인되었다. 수술로 확진된 16명의 환아중 13명은 상부 위장관 조영 소견에서 선천성 중장 회전 이상이 진단되었고 3명의 환아에서는 상부 위장관 조영 소견은 확실하지 않았으나 바륨 관장 소견상 선천성 중장 회전 이상이 증명되었다. 결론적으로 선천성 중장 회전 이상은 중장 염전과 장 괴사와 같은 치명적인 합병증으로 출생 첫 주에 높은 사망률을 보이기 때문에 조기 진단이 매우 중요하며, 임상적으로 선천성 중장 회전 이상이 의심되면 상부 위장관 조영술을 먼저 실시해야 하고 십이지장 공장 접합부가 정상적으로 위장 유문부와 같은 축상에 있는지 우측 측사위 촬영에서 확인해야된다. 비록 정상 소견을 보일지라도 위음성이 있을 수 있으므로 반드시 바륨 관장술을 실시해서 압박, 사위, 좌측와위 촬영에서 맹장과 회장 말단부의 위치를 확인해야 될 것으로 생각된다.

• Clinical and Experimental Pediatrics
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• 제51권4호
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• pp.431-434
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• 2008

13세 남자 환아가 반복적이고, 발작적으로 발생하는 복통과 설사를 주소로 내원하였다. 복부 초음파검사, 복부 전산화 단층촬영검사와 상부 위장관 검사를 통하여 창자 회전이상은 동반되지 않은 작은 창자 꼬임을 진단하였다. 수술을 통해서 치료를 하였으며 병리, 조직 검사를 통하여 낭성 림프관종에 의한 작은 창자 꼬임으로 밝혀졌기에 보고하는 바이다.

• Neonatal Medicine
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• 제28권1호
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• pp.53-58
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• 2021

Intestinal malrotation with midgut volvulus (MV) is a life-threatening surgical emergency. Most events of MV occur in the neonatal period with bilious vomiting, abdominal distension, feeding intolerance, and bloody stools. Neonatal gastric perforation (GP) is a rare and life-threatening condition associated with high mortality. It occurs either in an idiopathic form or in association with gastrointestinal anomalies such as duodenal atresia and MV. The pathogenesis of both MV and GP is related to ischemic change and inflammatory response. MV and GP can lead to morbidities such as sepsis, intestinal ischemia, and organ failure, but not neurologic problems. We herein report the case of a term infant at 5 days after birth, with MV accompanied by GP, who developed periventricular leukomalacia.