• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제16권1호
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• pp.1-9
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• 2013

Variceal bleeding results in significant morbidity and mortality in both children and adults. The guidelines for the management of variceal bleeding are well established in adults but not in children as there have been insufficient pediatric studies of this disorder. In addition, the adult guidelines for treatment of variceal bleeding cannot be applied directly to children as the etiology and natural course of this disease differs between children and adults. Examples of recommended treatments in children include endoscopic variceal ligation as secondary prophylaxis for biliary atresia whereas a meso-Rex shunt operation for extrahepatic portal vein obstruction. In this review, we discuss prophylaxis options and some technical aspects of endoscopic management for variceal bleeding in children.

• Journal of Chest Surgery
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• 제23권4호
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• pp.785-790
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• 1990

A 30-year-old male with a symptomatic aberrant right subclavian artery underwent surgical intervention on January 17, 1990. An aberrant right subclavian artery is a rare congenital anomaly, but it is the most common one of the aortic arch anomalies. This anomalous vessel usually does not produce symptoms, but occasionally symptomatic patients require surgical intervention. Although ligation and division of the aberrant right subclavian artery through left thoracotomy has been advocated by many surgeons, the ischemic symptoms of the upper extremity or the brain can occur. In the procedure described here, ligation and division of the aberrant artery and its anastomosis to the ascending aorta with Gore \ulcornerTex vascular graft was performed simultaneously through midsternotomy. With this procedure, we relieved the esophageal obstruction and established normal blood flow to the right arm. Hoarseness developed postoperatively. We consider that above symptom has been attributed to the injury of the left recurrent laryngeal nerve during dissection.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1436-1439
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• 1992

Esophageal hiatal hernia is common disorder in western sociey, and mainly affects mid-aged women, There are two types of hiatal gernia; common and more benign type is sliding [type I], and more severe type is paraesophageal [type II], and Skinner subdivided type II as true II, IIA, III, and paraesophageal group, As Skinner`s nomination, this case could be belong to IIA, which imply the state that natural hiatus is occupied with gastric antrum or duodenum instead of normal esophago-gastric junction, Main problem of paraesophageal hernia comes from its complication; intestinal obstruction, volvulus, strangulation, and incarceration, as well as pulmonary aspiration. So, as soon as confirm diagnosis, it should be corrected surgically to prevent above complications, and sometimes it could result in serious condition. We have experienced paraesophageal hiatal hernia in 3-day newborn infant and have repaired it successfully. We used transabdominal approach to repair and to prevent reflux Nissen`s fundoplication was performed. We would report that with reference study.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1977년도 제11차 학술대회연제 순서 및 초록
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• pp.9.3-9
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• 1977

Achalasia는 식도의 확장을 동반하는 탐도분문부의 비기질적폐색을 이르키는 질환으로 그 원인은 불명하나 식도하부괄약근의 이완장애와 식도체부에서의 정상연동운동의 결여로 나타나는데 원래 근육신경계의 기능장애의 하나로 중추신경계통의 병변으로 신경 신경절 및 근육의 변성을 이르켜 생긴다는 설이 유력시되고 있다. 주요증상은 연하장애 음식물토출 및 심와부 동통등이다. 저자들은 43세 여자에서의 achalasia 1례를 치험하였기에 문헌적고찰과 함께 보고하는 바이다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제17권3호
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• pp.296-301
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• 1995

Acute mediastinitis is almost always secondary to some other condition, and most cases are due to esophageal perforation. Although acute mediastinitis from odontogenic infection is extremely rare in the era of antibiotic drugs, some more fulminant odontogenic infections can produce complications including airway obstruction, necrotizing fascitis and extension of the infection to thorax. Irrespective of the changing incidence of etiologic factors, unless the pathophysiology of acute mediastinitis and its causes are understood and the conditions promptly recognized and properly treated, the result may be prolonged illness and even death. We experienced a case of odontogenic infection followed by acute mediastinitis and present review of literature.

• Journal of Chest Surgery
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• 제16권4호
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• pp.584-593
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• 1983

Esophageal reconstruction was performed in 344 patients with irreversible stricture of the esophagus resulting from caustic burns at National Medical Center from 1959 to 1982.There were 113 males and 231 females, and ranging from 2.5 to 58 years of age, and mean age was 26.5 years, and 25 cases were less than 10 years old. Caustic materials were 286 [83.2%] alkali and 50[14.5%] acid. The most frequent stricture site was upper thoracic esophagus as 56.7%, and the next was cervical as 31.4%, and lower, 11.9%. The stomach was involved in 10.8% totally, and hypopharyngeal stricture was also noticed in 3.2%, and in 3 cases, hypopharyngeal reconstruction was needed due to extensive scar change. In 329 of total 344 cases, colon interposition was performed without resection of the strictured esophagus except 4 cases which were complicated T-E fistula or perforation, and most of them, about 10-15 cm of terminal ileum with right half of the colon was used as the graft. The left colon with anti-peristalsis was used as graft only in 30 cases. The most common postoperative complication was anastomotic leak as 16.7% of total cases, and it was 12.5% from neck, 3.3% from ileocolostoma and 0.9% from cologastrostoma. Next common complication was neck stenosis [8.8%], aspiration pneumonia [6.4%], and graft necrosis [3.9%] in order. Overall operative mortality was 5.5% [14/329], and main causes of death were graft necrosis, sepsis due to anastomotic leak, gastric bleeding, and intestinal obstruction. Besides of colon interposition, according to shape or level of the stricture, plastic repair or segmental resection and direct anastomosis was done in 9, and 1 of them were complicated stenosis at the anastomotic site. In lower stricture, esophagogastrostomy was done in 10 cases, and 1 case expired due to hepatitis, and anastomotic stenosis was occurred in 2 cases at 1.5 months and 2.4 years later. During follow-up of 298 cases colon interposition from 6 months to 22 years, 82.6% was excellent, and 2.9% was complained of mild discomfort, and 4 cases were dead laterly, but 3 of them were not related to reconstruction.

• Journal of Nutrition and Health
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• 제25권7호
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• pp.668-683
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• 1992

To evaluate the current practices of the tube feeding and the status of tube feeding patient 76 adult in-patients at 6 hospitals located in Seoul and Chung-buk province were examined through reviewing patient charts observing patients and interviewing patients nurses dietitians patients' family or care-givers. The results were as follows : 1) An average age of the patients was 54.5 years with 41% over 60 years old. Patients with decreased mental status dysphagia esophageal obstruction and respiratory problem were fed by tubes. 2) The range of duration of tube feeding is between 4 days and 6 years. Most patients were received formula through nasogastric tube(89.5%) while 7.9% of gastrostomy and 2.6% of jejunostomy. Administration method for formula were bolus feeding regardless of the route of formula delivery. 3) Mean total calories received for men were 1590 kcal and 1450 kcal for female. Mean volume per meal was 282m, l and mean frequency of feeding was 5.68 while mean feeding interval 3$\frac{1}{4}$ hours and mean rate of infusion 68.4ml/min. All patients received hospital-blenderi-zed formula as the major source of nutrition. Home-blenderized formula and commercial formula as a supplement were used 35%, 13.2% respectively. 4) Thirty-eight percent of patients was hypoalbuminemia and 61% was at the moderate level of deficiency in hemoglobin. 5) Complications associated with tube feeding were diarrhea (22.4%) constipation(21.1%) vomiting(11.8%) and so on. 6) Serum albumin levels of patients who have complications associated with tube feeding were significantly lower than those of patients without complications In planning a tube feeding regimen the type of a formula must be integrated with both a delivery system and a protocol for administering the tube feeding. the multidisciplinary effort required to deliver enteral therapy is essential to improve current practices used at hospitals.

• Journal of Trauma and Injury
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• 제26권4호
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• pp.304-307
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• 2013

Food bolus impaction is the most common cause of esophageal foreign body obstruction in adults. Other causes include intentional ingestion in psychiatric patients or prison inmates. We experienced successful treatment of a patient with intentional ingestion of multiple sharp foreign bodies(25 cutter and razor fragments). A 47-year-old male patient who was suffering from chronic alcoholism was admitted, via the emergency room, with dysphagia and neck pain. He was suffering from alcoholic liver cirrhosis and psychiatric problems, such as chronic alcoholism, anxiety disorder and insomnia. The patient had intended to leave the hospital after having swallowed the sharp objects. Plain radiographs and computed tomography (CT) scan showed multiple, scattered metal fragments in the esophagus, stomach, and small bowel. We performed emergent endoscopy and successfully removed one impacted blade in the upper esophagus using by a snare with an overtube. The rest of the fragments had already passed through the pylorus, so we could not find them with endoscopy. We checked the patient with simple abdominal radiographs and careful physical examinations every day. All remaining fragments were uneventfully excreted through stool during the patient's 6 day hospital stay. Finally, we were able to confirm the presence of the objects in the stool, and radiographs were negative. The patient was discharged without complications after 14 days hospital stay and then was followed by the Department of Psychiatry.

• 대한임상독성학회지
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• 제7권2호
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• pp.113-120
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• 2009

Purpose: Though caustic injury of the upper digestive tract can lead to severe sequelae, there are few clinical studies on this subject. This study was undertaken to evaluate the clinical characteristics, the endoscopic findings and the risk factors of the upper digestive lesions in patient with caustic ingestion injury. Methods: We retrospectively reviewed the medical records of 137 patients who ingested caustic materials and who visited to our emergency room from January, 2000 to June, 2009. Results: The most common ingested agent was sodium hypochlorite (44.5%), followed by acetic acid (19.7%), hydrochloric acid (11.7%) and lye (8.0%). Ingestion for suicidal attempt (62.0%) was more frequent than accidental ingestion (30.7%). Grade IIa injury was the most frequent finding on endoscopy of the esophagus and Grade 1 injury was the most frequent finding on endoscopy of the stomach. For the late sequelae, there were 9 cases (6.6%) of esophageal stricture and 2 cases (1.5%) of gastric outlet obstruction. The initial signs and symptoms did not correlate with the development of stricture, but leukocytosis, and grade III injury were related to the risk of developing stricture. Conclusion: Caustic injury of the upper gastrointestinal tract is frequently observed on early endoscopy and it can cause significant late sequelae such as stricture. Therefore, it is necessary to evaluate these patients with regular follow up endoscopic examinations for the management of late sequelae.

• 대한영상의학회지
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• 제84권1호
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• pp.291-297
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• 2023

좌측 단독 문맥고혈압은 비장 정맥이 폐쇄되어 생기는 드문 임상 질환이다. 비장 정맥의 혈전증 혹은 외부 압박으로 인해 근위부 비장정맥의 고혈압이 발생하게 되며, 비장의 혈류는 짧은 위 정맥, 관상정맥, 위대망정맥 같은 측부혈관을 통하여 상장간막 정맥 혹은 문맥으로 흘러가게 된다. 위장관 출혈을 유발하는 좌측 단독 문맥고혈압에는 개복 비장절제술이 첫 번째 치료방법으로 추천된다. 하지만 중재시술을 통한 치료가 수술적 교정을 원치 않는 환자들에게는 임상적으로 유용한 치료 선택지가 될 수 있다. 본문에서는 위정맥류 출혈을 가진 좌측 문맥 고혈압에 대한 두 개의 증례를 다루고자 한다.