• Advances in pediatric surgery
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• 제9권1호
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• pp.52-56
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• 2003

A 10 year old boy was admitted with blunt abdominal trauma by bike handle injury. The patient was operated upon for a generalized peritonitis due to pancreaticoduodenal injury. On opening the peritoneal cavity. complete transection of distal end of common bile duct and. partial separation between pancreas head and second portion of duodenum were found. Ligation of the transected end of the common bile duct. T-tube choledochostomy, and external drainage were performed. A pseudocyst was found around the head portion of the pancreas on the 7th postoperative day with CT. An internal fistula had developed between the pseudocyst and ligated common bile duct. The pseudocyst was subsided after percutaneous drainage. In the case of the undetermined pancreatic injury, percutaneous external drainage can be effective in treating the traumatic pancreatic pseudocyst in a pediatric patient.

• 대한방사선기술학회지:방사선기술과학
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• 제31권2호
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• pp.149-159
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• 2008

목 적: 지금까지의 경복부 초음파를 이용한 간외담관에 대한 검사는 주로 담낭과 간외 담도, 즉 총수담관(CBD)만을 확인하는 수준의 검사가 전부인 것처럼 여겨져 왔다. 그러나 저자들은 임상에서의 다양한 경험을 바탕으로 간외담도의 비정상 확장에 대해 분석할 수 있고, 담도질환 유무 및 관련성을 평가하는데 필요한 기술적 접근 방법에 대한 새로운 이론적 토대를 마련하였다. 이 새로운 이론을 기본으로 신뢰성 있는 검사 성적을 얻기 위하여 일정기간 교육 후 scanning 훈련을 시켜 그 효과를 평가함으로서 담관질환 검사의 새로운 기준을 정립코자 한다. 대상 및 방법: 초음파 교육생 30명을 대상으로 간외담관에 대한 새로운 이론에 근거하여 기술적 접근 방법에 대한 교육을 전수한 후 학생 1인당 3시간(30분${\times}$6회)을 배당하여 scanning 훈련을 집중였다. 교육 방법은 강사와 학생 1:1 방식으로 하였다. Scanning 훈련 후 평가 기준으로 모든 학생에게 5분 내에 간외담관 중에서 좌우 담관으로부터 (1) 담낭관 합류부(간외담관 및 담낭관), (2) 췌장 상부담관, (3) 췌두부내 담관, (4) 유두부내 공통관 등 네 분절을 명확하게 구분된 개념으로 scan하게 한 후 정확도를 평가하였다. 결 과: 기존의 교육과 훈련 방식은 간외담관에 대한 경복부 초음파검사의 신뢰도가 매우 낮고, 췌장 상부 담관에만 국한적으로 영상화할 수 있었다. 그러나 새로운 이론에 근거한 교육과 훈련을 마친 후 성적의 평가는 모든 학생(30명)이 (1) 담낭관 합류부(간외담관 및 담낭관), (2) 췌장 상부담관까지 객관성 있게 접근하였다. 24명의 학생이 (3) 췌두부내 담관 말단까지 접근하였으며, 1명의 학생만이 (4) 유두부내 공통관까지 영상화할 수 있었다. 결 론: 간내외 담관의 평가는 간내인성, 담관성 그리고 병태생리학적 다면 평가가 이뤄져야 하지만, 경복부초음파검사에 의해 간외담관을 유두부내 공통관까지 객관적이고 신뢰성 있게 영상화시킬 수 있다면 단순 감별진단 목적으로 시행하는 ERCP같은 환자에게 고통이 수반된 침습적인 검사를 대폭 줄일 수 있을 것이다. 따라서 저자들이 제시한 새로운 검사방법으로 간외 담관에 대한 기술적 접근 방법을 scanning 훈련하여 임상에 적용하게 된다면 초음파의 객관적인 신뢰도를 높일 수 있을 것으로 생각된다.

• Advances in pediatric surgery
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• 제2권2호
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• pp.143-147
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• 1996

Spontaneous perforation of the bile duct in children is a very rare disorder. We experienced a 6 year-old girl with spontaneous perforation of the right hepatic duct. The patient was initially misdiagnosed as hepatitis because of elevation of liver enzyme and then as appendicitis because of fluid collection in the pelvic cavity demonstrated by ultrasonogram. A laparoscopic exploration was done and no abnormal findings were detected except bile-stained ascites. Peritoneal drainage was performed and the patients seemed to improve clinically. Abdominal pain, distention and high fever developed after removal of the drains. DISIDA scan showed a possible of bile leak into the peritoneal cavity. ERCP demonstrated free spill of dye from the right hepatic duct. At laparotomy, the leak was seen in the anterior wall of the right hepatic duct 2cm above the junction of the cystic duct and common hepatic duct. The perforation was linear in shape and 0.8cm in size. The patient underwent cholecystectomy, primary closure of the perforation and T-tube choedochostomy. We could not identify the cause of the perforation; however, the T-tube cholangiography taken on the 42nd postoperative day showed a little more dilatation of the proximal common bile duct compared with the cholangiography taken on the 14th day. Long-term follow-up of the patient will be necessary because of the possibility for further change of the duct.

• Journal of Digestive Cancer Research
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• 제2권1호
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• pp.32-36
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• 2014

We report a patient with combined hepatocellular-cholangiocarcinoma confined in the common hepatic duct and scirrhous type of hepatocellular carcinoma in the caudate lobe of liver simultaneously. The patient was a 55-yearsold Korean man with hepatitis B virus (HBV) carrier who was referred from a local hospital due to detected liver mass on abdominal computed tomography (CT). He has presented jaundice and weight loss for the previous 3 weeks. Laboratory examination showed AST/ALT elevation and hyperbilirubinemia. HBsAg was positive. The tumor marker study showed elevated AFP and DCP, not CEA and CA 19-9. Abdominal CT disclosed an about 2.1×0.9 cm sized soft tissue density in hilum with both intrahepatic duct (IHD) dilatations and an about 3×2.1 cm sized arterial enhancing lesion at segment 8 of the liver. Patient received 15 cycles of Gemcitabine/Cisplantin chemotherapy from February 27, 2013 to December 31, 2013. Caudate lobectomy of liver, segmental resection of bile duct and Roux-en-Y hepaticojejunostomy was performed on February 10, 2014. The final pathologic report showed double primary liver cancer, combined hepatocellular-cholangiocarcinoma in common hepatic bile duct and scirrhous type of hepatocellular carcinoma in segment 1 of the liver. This is a very unusual case in which combined hepatocellular-cholangiocarcinoma confined in the large bile duct and two rare hepatic cancers coexisted.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권3호
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• pp.180-186
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• 2015

Purpose: Bile duct dilatation is a relatively common sonographic finding; nevertheless, its clinical significance in children is controversial because little research has been done in the area. Therefore, we investigated the natural course and clinical significance of biliary duct dilatation in children. Methods: We performed a retrospective study of 181 children (range, 1-day-old to 17-year-old) in whom dilatation of the intrahepatic duct and/or common hepatic duct and/or common bile duct was detected by abdominal ultrasonography at the Severance Children's Hospital between November 2005 and March 2014. We reviewed and analyzed laboratory test results, clinical manifestations, and clinical course in these patients. Results: Pediatric patients (n=181) were enrolled in the study and divided into two groups. The first group included 59 subjects, without definitive cause of bile duct dilatation, who did not require treatment; the second group included 122 subjects, with definitive cause of bile duct dilatation or underlying biliary disease, who did require treatment. In the first group, 24 patients (40.7%) showed spontaneous resolution of bile duct dilatation, 20 patients (33.9%) showed no change, and 15 patients (25.4%) were lost to follow-up. In the second group, 31 patients were diagnosed with choledochal cysts, and 91 patients presented with biliary tract dilatations due to secondary causes, such as gallbladder or liver disease, post-operative complications, or malignancy. Conclusion: Biliary dilatation in pediatric patients without symptoms, and without laboratory and other sonographic abnormalities, showed a benign clinical course. No pathologic conditions were noted on follow-up ultrasonography.

• Clinical and Experimental Pediatrics
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• 제45권9호
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• pp.1146-1149
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• 2002

저자들은 전신에 홍반성 반구진성발진과 발열을 주소로 내원한 ibuprofen을 복용한 14세 여자 환아에서 SJS, VBDS가 동반된 1례를 경험하였기에 문헌 고찰과 함께 보고한다.

• Advances in pediatric surgery
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• 제4권2호
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• pp.100-109
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• 1998

The anomalous pancreaticobiliary duct union (APBDU) might cause the formation of choledochal cyst and malignancies of hepatopancreaticobiliary system. The purpose of this study is to make an experimental animal model of APBDU similar to that of human. One to two-month-old Mongrel dogs (n=12) were divided into two groups; the control group (n=2) had a sham operation performed, and in the experimental group (n=10) the end of distal ' common bile duct (CBD) was anastomosed to the side of the dorsal pancreatic duct making APBDD. Serum was obtained for chemical analysis on the 10th postoperative day. The dogs were sacrificed at the 5th week (n=3), the 6th week (n=3), the 7th week (n=2), the 8th week (n=2) and the 6th month (n=2) after the experimental surgery. With sacrifice, operative cholangiogram was taken, and bile juice was obtained for chemistry and bacterial culture. The en-bloc specimens of the hepatopancreaticobiliary system were removed for microscopic examination. Serum and bile juice amylase levels were elevated in the experimental group(n=10), but not in the control group(n=2). Operative cholangiograms of control group revealed no evidence of bile duct dilatation.. On the other hand, the bile duct in the experimental group was markedly dilated without any evidence of stenosis at the anastomosis site (n=10). Histologic examination of the hepatopancreaticobiliary system in the experimental group resembled the findings of choledochal cyst in human. The APBDU of this animal model can produce bile duct dilatation by pancreaticobiliary reflux. We think that this animal model can be potentially promising for the research about the APBDU associated hepatopancreaticobiliary diseases.

• Applied Microscopy
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• 제20권1호
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• pp.36-50
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• 1990

This experiment was performed to study the morphological responses of the enterochromaffin cells in the duodenal mucosa of rabbit following bile duct ligation. Adult male rabbits were divided into normal, sham operation and experimental groups. Bile duct ligation was performed under ether anesthesia and animals were sacrificed on the 1st, 3rd, 5th, 7th and 14th day after operation. Mucosal specimens from the duodenum were prefixed with 2.5% glutaraldehyde-1.5% paraformaldehyde(0.1M Millonig's phosphate buffer, pH 7.3), followed by postfixation with 1% osmium tetroxide(0.1M Millonig's phosphate buffer, pH 7.3), and embedded within araldite mixture. The sections were cut on a LKB-V ultratome, and observed under a JEM 100CX II electron miroscope. The results were as follow; 1. Irregularities of the nuclei of the enterochromaffin cells were noticed from the 1st day after bile duct ligation, and concentration of the chromatin in the nucleus was more frequently observed on the 7th and the 14th day. 2. The granular endoplasmic reticulum and Golgi complex of the enterochromaffin cell were more developed than those of the normal on the 1st day after bile duct ligation, but they showed poor organization from the 3rd day. 3. Amount of the microfilaments in the enterochromaffin cell was significantly increased from the 5th day after bile duct ligation and they were more frequently observed in the vicinity of the nucleus. 4. Vacuoles with various electron densities in the enterochromaffin cell were increased in number from the 3rd day after bile duct ligation. 5. Glycogen-like particles in the enterochromaffin cell were frequently observed on the 3rd and the 5th day after bile duct ligation. 6. In the early stage of the ligation of bile duct, in the enterochromaffin cells, well developed intracellular organelles, such as granular endoplasmic reticulum and Golgi apparatus were pronounced. But, in the later stage, the cells contained poor organelles, with the some structural sign of necrotic change.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제2권1호
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• pp.59-64
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• 1999

목 적: 저자들은 백서에서 수술적으로 담도 결찰전과 결찰 4주 후에 지용성 비타민(vitamin A와 D)의 혈중 농도 변화 및 담도 결찰 후 담즙산을 투여했을 때 장관내 지용성 비타민의 흡수 변화에 대하여 알아보고자 하였다. 대상 및 방법: 생후 4주된 Sprague-Dawley rats을 대상으로 하여 수술적으로 담도를 결찰하였다. 담도 결찰 전과 결찰 4주후의 혈중 ALT, total bilirubin, vitamin A, vitamin D의 농도를 측정하였다. 백서들은 담도 결찰 후 4주간 사육하였으며, 사육기간 중 비타민만을 투요한 군, 담즙산을 투여한 군 및 UDCA를 투여한 3군으로 나누었다. 결 과: 1) 수술전 혈중 농도(평균): ALT 74.2 IU, total bilirubin 0.26 mg/dL; vitamin D 13.01 ng/mL vitamin A $0.87\;{\mu}g/mL$, total bile acids $25.16\;{\mu}mol/L$. 2) 수술 4주후 농도(평균): ALT 100.7 IU, total bilirubin 2.58 mg/dL; vitamin D 7.89 ng/mL vitamin A $1.37\;{\mu}g/mL$, total bile acids $278.22\;{\mu}mol/L$. 3) 수술후 각 군간의 혈중 vitamin A와 vitamin D의 농도 차이는 없었다. 결 론: 담도 결찰 후 vitmain A 혈중 농도는 상승 하였으며, vitamin D 농도는 감소하였다. 경구로 담즙산을 투였을 때 혈중 지용성 vitamin 농도는 투여하지 않은 경우와 차이가 없었다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권2호
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• pp.284-288
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• 2004

영아에서 담관의 자연 천공은 매우 드물며 조기에 발견하여 치료하지 않으면 사망할 수 있는 질환이다. 출생 후 건강하던 영아가 복부팽만, 복수, 황달이 나타나면 의심하게 되며 대부분 수술적 담도 조영술을 시행하는 과정에서 진단된다. 저자들은 복부팽만, 황달, 무담즙변 증상이 있는 생후 4개월 된 소아에서 총담관의 자연천공 1례를 경험하여 문헌 고찰과 함께 보고하는 바이다.