• Advances in pediatric surgery
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• 제4권1호
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• pp.79-84
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• 1998

We have treated a case of pseudocyst of transverse mesocolon in 3-year-old male child. Operative findings demonstrated that the pseudocyst originated in the transverse mesocolon, and was not connected to the pancreas. A colonic duplication was found incidentally near the pseudocyst. On microscopic examination, ectopic pancreatic tissue was noted in the transverse mesocolon. This pseudocyst was thought to have originated from the ectopic pancreas of the transverse mesocolon. This is the first reported case of pseudocyst originated from ectopic pancreas of the transverse mesocolon, combined with a colonic duplication. The pathogenesis is discussed.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제8권1호
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• pp.81-86
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• 2005

저자들은 내원 6개월 전부터 간헐적인 복통이 있어오다가 1개월 전부터는 복통이 심해지고, 3일 전부터는 기침과 흉통이 발생되어 내원한 9세 여아에서 다량의 늑막 삼출을 동반한 만성 췌장염 1례를 진단하고 금식, 흉관 삽입, 항생제 및 octreotide의 투여 등의 보존적 방법으로 치료 한 증례를 경험하였기에 문헌 고찰과 함께 보고한다.

• Advances in pediatric surgery
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• 제6권2호
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• pp.143-148
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• 2000

Pseudoaneurysm of the splenic artery may arise from a vascular erosion by a surrounding inflammatory processes in acute and chronic pancreatitis. Rupture of the pseudoaneurysm may threaten the patient's life. Conservative management for massive hemorrhage may cause 100 percent mortality and even with prompt therapy there is a high mortality. Preoperative detection of bleeding source is desirable because of the difficult identification of the bleeding site at laparotomy. Angiographic identification and embolization of the hemorrhagic vessels in selected cases may obviate the risk of urgent surgery. The authors have recently managed a case of ruptured splenic artery pseudoaneurysm combined with a pancreatic pseudocyst in a 6 years old boy. A bolus enhanced CT scan and angiography confirmed the diagnosis. We managed this child successfully with the urgent transcatheter arterial embolization followed by elective surgery.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.136-142
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• 2011

Purpose: Blunt pancreatic injury has a high mortality rate, especially if adequate management is delayed. Although many guidelines exist for diagnosis and treatment, there is no consensus to date. Therefore, we analyzed the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool for the treatment of traumatic pancreatic injury. Methods: We retrospectively reviewed the electronic medical records (EMR) database at Asan Medical Center (Seoul, South Korea) to identify all patients diagnosed with trauma to the pancreas between June 2003 and December 2010. Clinical and operative findings, CT (computed tomography) images, and ERCP findings were assessed. Results: A total of 40 patients were evaluated in this study. Of these, 14 patients underwent diagnostic ERCP, and 26 did not. Of the 14 patients who underwent diagnostic ERCP, 5 were found to have normal pancreatic ducts, thereby preventing a needless laparotomy in these patients. Of the patients diagnosed with ductal injury, four were treated with endoscopic intervention, and four underwent an exploratory laparotomy. The remaining patient was treated with radiologic intervention (percutaneous drainage) to manage pancreatic pseudocyst formation. Conclusion: Our findings suggest that ERCP is a beneficial diagnostic and therapeutic modality for the treatment of traumatic pancreatic injury.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권3호
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• pp.251-262
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• 2022

Purpose: Endoscopic drainage is an established treatment modality for adult patients with pancreatic fluid collections (PFCs). Available data regarding the efficacy and safety of endoscopic drainage in pediatric patients are limited. In this systematic review and meta-analysis, we aimed to analyze the outcomes of endoscopic drainage in children with PFCs. Methods: A literature search was performed in Embase, PubMed, and Google Scholar for studies on the outcomes of endoscopic drainage with or without endoscopic ultrasonography (EUS) guidance in pediatric patients with PFCs from inception to May 2021. The study's primary objective was clinical success, defined as resolution of PFCs. The secondary outcomes included technical success, adverse events, and recurrence rates. Results: Fourteen studies (187 children, 70.3% male) were included in this review. The subtypes of fluid collection included pseudocysts (60.3%) and walled-off necrosis (39.7%). The pooled technical success rates in studies where drainage of PFCs were performed with and without EUS guidance were 95.3% (95% confidence interval [CI], 89.6-98%; I²=0) and 93.9% (95% CI, 82.6-98%; I²=0), respectively. The pooled clinical success after one and two endoscopic interventions were 88.7% (95% CI, 82.7-92.9%; I²=0) and 92.3% (95% CI, 87.4-95.4%; I²=0), respectively. The pooled rate of major adverse events was 6.3% (95% CI, 3.3-11.4%; I²=0). The pooled rate of recurrent PFCs after endoscopic drainage was 10.4% (95% CI, 6.1-17.1%; I²=0). Conclusion: Endoscopic drainage is safe and effective in children with PFCs. However, future studies are required to compare endoscopic and EUS-guided drainage of PFCs in children.

• Investigative Magnetic Resonance Imaging
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• 제6권2호
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• pp.129-136
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• 2002

목적 : 총담관 확장을 유발하는 원인 중 결석과 종양을 제외한 여러 원인을 평가하는데 있어서 MRCP의 진단적 유용성을 알아보고자 하였다. 대상 및 방법 : ERCP와 MRCP를 모두 시행받은 환자 26명 (남:여=15:11, 평균연령 62세)을 대상으로 하였으며, 이들 중 12명은 역동적 MRCP를, 10명은 조영증강 MRI를 추가로 시행하였다. 총담관, 간내 담도, 췌관 등의 확장 정도, 간내 담도 결석, 췌장 가성낭종, 유두부의 부종이나 결절성 종대 등을 관찰하였다. 총담관은 T2-강조 관상영상에서 담낭절제술을 받지 않은 경우 7 mm 이상, 절제술을 받은 경우 10 mm 이상을 비정상적인 확장으로 판정하였다. 결과 : 담낭절제술을 받지 않은 환자의 총담관 평균 직경은 12.7mm(n=21, 9-19 mm)였고, 절제술을 받은 환자의 평균 직경은 13.0 mm(n=5, 10-15mm)였다(p〉0.05). MRCP에서 담관염 11명(42.3%), 만성 췌장염 8명(30.8%), 원위부 총담관 협착 6명(23.1%), 팽대부 주위 게실 3명(11.5%), Vater 팽대부 협착, 오디 괄약근 기능장애, 췌장 두부의 국소적 췌장염이 각각 2명 (7.7%), 유두염, 췌장 두부 가성낭종에 의한 총담관 확장, 총담관 내 회충이 각각 1명(3.8%) 있었다. 췌관의 확장은 10명(38.5%)에서 보였고, 십이지장 게실은 3명(11.5%)에서 관찰되었다. 역동적 MRCP(n=12)에서 2명(16.7%)은 일반 MRCP에서 보이지 않던 원위부 총담관이 관찰되었고, 조영증강 MRI를 시행한 10명 중 1명 (10.0%)만이 유두염의 소견을 보였다. 결론 : 비결석, 비종양성 총담관 확장의 원인을 찾는데 있어서 MRCP는 총담관 원위부 협착 및 만성 췌장염, 역동적 MRCP를 이용한 생리적 총담관의 확장, 조영증강 MRI 를 통한 담관염 및 담관 외 병소의 발견 등에 있어서 도움이 되는 것으로 생각된다.

• Advances in pediatric surgery
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• 제16권1호
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• pp.18-24
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• 2010

Pancreaticoduodenectomy is the treatment of choice for adult periampullary lesions. However there has been no studies on the clinical outcomes of pancreaticoduodenectomy in children. To evaluate the clinical outcomes, records of 13 patients who underwent pancreaticoduodenectomy, from 1989 to 2009, at Seoul National University Children's Hospital were reviewed. Mean follow up period was 83 (2-204) months, the male to female ratio was 1:3.3, and the mean age was 11 (2-14) years. Ten patients underwent PPPD and 3 patients had Whipple's operation. The postoperative diagnosis included solid pseudopapillary tumor (9), cavernous hemangioma (1), pseudocyst (1), benign cyst (1), pancreatic disruption (1). Two patients developed postoperative adhesive ileus and among them one patient required operative intervention. Four patients required pancreatin supplementation due to steatorrhea and other gastrointestinal symptoms. There were no postoperative mortality during the follow up period and no evidence of recurrence in SPT patients. This study demonstrates that the pancreaticoduodenectomy procedure in children is not only feasible but also safe, with no mortality and an acceptable complication rate.

• 대한한방내과학회지
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• 제41권3호
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• pp.306-325
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• 2020

Objectives: The aim of this study is to investigate the effect of a Dachaihu decoction for hyperlipidemic acute pancreatitis (HLAP) by systematic review and meta-analysis of Chinese clinical studies. Methods: China National Knowledge Infrastructure (CNKI) was utilized as the major search engine. The date of the literature search was March 7, 2020. Randomized controlled trials (RCTs) about using a Dachaihu decoction for HLAP were included in this study. Meta-analysis was performed by synthesizing outcome data, including total effective rate, abdomen pain relief time, first bowel movement time, blood amylase recovery time, and triglyceride (TG) levels (mmol/L). The selected literature was assessed using Cochrane's risk of bias (RoB). Results: Twelve of 44 RCTs met the inclusion criteria. Most studies were evaluated with RoB as having unclear risk. The total effective rate of herbal medicine treatment based on the Dachaihu decoction was significantly higher than that of symptomatic supportive treatment in 10 articles (risk ratio=1.15, 95% CI: 1.08 to 1.21, p<0.00001, I²=0%). Herbal medicine treatment based on a Dachaihu decoction was significantly more effective than symptomatic supportive treatment in terms of reducing abdomen pain relief time (in all articles; mean difference=-1.70, 95% CI: -1.91 to -1.41, p<0.00001, I²=45%), first bowel movement time (in 7 articles; mean difference=-1.46, 95% CI: -1.86 to -1.05, p<0.00001, I²=73%), blood amylase recovery time (in 8 articles; mean difference=-1.48, 95% CI: -2.04 to -0.92, p<0.00001, I²=90%), and TG levels (in 8 articles; mean difference=-1.59, 95% CI: -2.28to -0.91, p<0.00001, I²=90%). Only one article reported side effects of treatment among the intervention group and control group, citing pancreatic ulcer and pancreatic pseudocyst formation. Conclusions: This study suggests that herbal medicine treatment based on a Dachaihu decoction could yield higher efficacy for HLAP than symptomatic supportive treatment alone. However, the results might be somewhat biased because of the poor quality and small sample size of the included RCTs. Well-qualified clinical studies are needed to prove the effectiveness of Dachaihu decoction therapy for HLAP.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.68-74
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• 2011

Purpose: Although pancreas injury is rare in abdominal trauma, it poses a challenge to the surgeon because its clinical features are not prominent and the presence of main duct injury cannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosed as having pancreas injury by using an explo-laparotomy. Patients successfully treated by non-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases).Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due to massive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively, three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverse outcomes.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제13권1호
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• pp.58-65
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• 2010

목 적: 소아에서 급성 췌장염은 췌장을 침범하는 가장 흔한 질환으로 최근 발생 빈도가 증가하고 있다. 이 질환에 대한 보고가 많지 않아 임상적 특징을 알아보고자 본 연구를 시행하였다. 방 법: 1996년 1월부터 2007년 6월까지 부산대학교병원 소아청소년과에서급성 췌장염을 진단받았던 41명을 대상으로 의무 기록을 후향적으로 분석하였다. 급성 췌장염의 진단은 임상 소견, 혈청 amylase 및 lipase치의 상승 및 방사선 소견이 합당한 경우로 하였으며, 이 질환의 원인, 임상 소견 및 경과, 중증도 판정, 치료등을 분석하였다. 결 과: 남자가 20명, 여자가 21명이었고, 진단 시 평균 나이는 8.7${\pm}$4.5세였다. 증상 발현에서 진단까지의 기간은 7.0${\pm}$7.4일이었고, 내원 당시 주증상은 복통 37예(90.2%), 구토 24예(58.5%), 발열과 경구 섭취 불량이 각각 6예(14.6%)였다. 췌장염의 원인으로는 원인불명 22예(53.7%), 총담관낭 9예(22.0%), 췌담관 합류 이상 3예(7.3%), Henoch-schonlein 자반병과 유행성 이하선염이 각각 2예(4.9%)였고 그 외 분할췌장, 용혈 요독 증후군, 외상, 바이러스성 간염, 약물(L-asparaginase)이 각각 1예였다. 간질성 췌장염이 36예(87.8%), 괴사성 췌장염이 5예(12.2%)였고 재발성 췌장염이 4예(9.8%)였다. 방사선학적 소견은 췌종대 18예(43.9%), 췌장 주위 액체저류 12예(29.3%), 복수 10예(24.4%), 췌장 주위 지방괴사 5예(12.2%)였다. 진단 당시 혈청 amylase치는 535.3${\pm}$553.2 U/L, lipase치는 766.2${\pm}$723.6 U/L였고, 혈청 amylase 및 lipase치가 1주 내에 정상으로 회복한 경우가 각각 22예(59.5%), 14예(42.4%)였고, lipase치가 4주 이후에 정상화된 경우가 11예(26.8%)였다. 중증도 판정기준인 APACHE II, Ranson 기준, Balthazar 점수에서 대부분 경증에 해당하였다. 금식과 총정맥 영양이 전례에서 시행되었고, 금식 기간은 평균 13.1${\pm}$17.0일, 총정맥 영양 기간은 평균 8.2${\pm}$13.7일이었다. Octreotide는 8명(19.5%), Gabexate mesilate는 4명(9.8%)에서 투여되었고, 4명에서 조임근절개술이 시행되었다. 합병증으로는 복수(32.3%), 패혈증(16.1%), 거짓낭(12.9%), 신장장애(12.9%), 흉수, 십이지장 궤양, 혈성복막(6.5%) 등이 있었다. 34명이 완전 회복되었고, 2명(4.9%)이 췌장염의 합병증으로 사망하였다. 결 론: 소아 급성 췌장염은 드문 질환이 아니며 성인과는 다른 원인, 증상 및 경과를 보였다. 대부분 환자들이 수 일 이내 완전 회복되지만 아직 사망률이 높으므로 조기 진단과 발병 초기에 중증도를 평가하여 적절한 치료 및 합병증 관리가 중요하다.