• Journal of Chest Surgery
• /
• 제5권1호
• /
• pp.57-60
• /
• 1972

Esopkageal rupture is one of the rarest disease. Mackler described that esophageal rupture was differentiated from esophageal perforation, the perforation is produced by esophagoscopy, and continuous erosion, such as esophagitis,gastric reflux, hiatal hernia and malignant neoplasm of the esophagus, the rupture is occurred by severe vomiting, cough and strong positive pressure into the esophageal lumen. Since,at first Boerhaave reported the esophageal rupture due to severe vomiting in 1742, several case reports of esophageal rupture have been in the literatures. Authors reported a case of the esophageal rupture due to explosion of gasoline in 50 year old female. The rupture occurred a longitudinal rent on the left posterolateral aspect of lower one third of esophagus and accompanied wlth second degree burn on the entire face and neck. The treatment consists of immediate thoracotomy in order to drainage of pyothorax and gastrostomy for nutritional problem, but patient expired because of septicemia probably due to uncontrollable empyema of thorax on 45th admitted day.

• 대한기관식도과학회:학술대회논문집
• /
• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
• /
• pp.13.1-13
• /
• 1983

음식물괴에 의한 갑작스런 식도폐쇄는 아주 드문 현상은 아니다. 주로 고령자나 치아의 결손이 있어 불충분한 저작후 큰 덩어리를 무리하게 삼켜 잘 일어난다. 대개는 해부학적 이상이 있는 사람에게서 일어나며 정상적인 식도를 가진 사람에서도 드물게 일어난다. 그러나 가장 흔한 원인중의 하나는 식도부식 등의 기왕력이 있은 후 이차적으로 생긴 식도협착증 이라고 할 수 있으므로 음식물괴에 의한 식도이물의 경우 기왕력을 확인하는 것이 무엇보다도 중요하다고 하겠다. 저자들은 최근 식도협착이 있는 58세 된 남자 환자에게서 10일 동안에 연거퍼 2회의 음식물괴에 의한 식도이물례를 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제17권1호
• /
• pp.150-156
• /
• 1984

Paraesophageal hiatus hernia represents a rare hiatal hernia that are treated surgically. The completely asymptomatic paraesophageal hernia often does not reach the clinician or surgeon. But the presence of a symptomatic paraesophageal hernia is sufficient indication for surgery. The paraesophageal hernia may be approached either transthoracically or transabdominally. The general technique is essentially the same, whichever route is used. From either transthoracic or transabdominal approach, following reduction of the viscus and elimination of the sac, the diaphragmatic opening is then closed with interrupted heavy dacron or silk sutures in paraesophageal hiatus hernia. But if the phrenoesophageal membrane often is destroyed when the esophagogastric junction and the distal esophagus have been mobilized, it becomes important to fix the esophagogastric junction below the diaphragm, so that it does not slide through the hiatus and produce a sliding-type hiatus hernia in future. We have experienced one case of paraesophageal hiatus hernia which was accompanied with severe anemia in child. We preferred to approach through left thoracotomy incision and then pushed down the stomach into the abdominal cavity with complete excision of the hernial sac. We employed Belsey Mark V procedure using of Teflon felt pledgets with the mattress sutures against development of sliding-type hiatus hernia in postoperative period. postoperative course has been uneventful and good for about 3 months to this time.

• Advances in pediatric surgery
• /
• 제6권2호
• /
• pp.100-105
• /
• 2000

Eleven children with gastroesophageal reflux disease underwent fundoplication. Eight had neurological impairment, two had hiatal hernias and one had a history of esophageal repair for esophageal atresia. The most common and significant symptom was vomiting(81.8 %), followed by recurrent respiratory infections(72.7 %) and failure to thrive(72.7 %). The most common diagnostic tool was 24 hour esophageal pH study, which showed pH less than 4 for more than 10 % of the total recorded time in 6 of 9 patients. Nissen fundoplication was performed in 10 patients. Thal fundoplication was carried out in one patient with esophageal atresia. Stamm gastrostomy was added for nutritional and/or swallowing problem in all 8 patients with neurological impairment. The median follow up period was 13 months. There was one late death of unrelated cause and one recurrence. The quality of life after antireflux surgery was greatly improved. Antireflux surgery should be done if indicated, and a simultaneous gastrostomy considered in a patient with neurological impairment.

• Journal of Gastric Cancer
• /
• 제18권4호
• /
• pp.313-327
• /
• 2018

The prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea, and physicians, including surgeons, have been focusing on its treatment. Indeed, in Korea, medical treatment using a proton pump inhibitor is the mainstream treatment for GERD, while awareness of surgical treatment is limited. Accordingly, to promote the understanding of surgical treatment for GERD, the Korean Anti-Reflux Surgery Study Group published the Evidence-Based Practice Guideline for the Surgical Treatment of GERD. The guideline consists of 2 sections: fundamental information such as the definition, symptoms, and diagnostic tools of GERD and a recommendation statement about its surgical treatment. The recommendations presented 5 debates regarding fundoplication: 1) comparison of the effectiveness of medical and surgical treatments, 2) effectiveness of surgical treatment in cases of refractory GERD, 3) effectiveness of surgical treatment of extraesophageal symptoms, 4) comparison of effectiveness between total and partial fundoplication, and 5) effectiveness of fundoplication in cases of hiatal hernia. The present guideline is the first to demonstrate the efficacy of the surgical treatment GERD in Korea.

• Neonatal Medicine
• /
• 제25권1호
• /
• pp.49-52
• /
• 2018

Arterial tortuosity syndrome (ATS) is a very rare autosomal recessive connective tissue disease characterized by generalized elongation and tortuosity of the medium- to large-sized arteries, and other systemic connective tissue manifestations. To date, this disease entity has not been reported in Korea. We report a case of ATS diagnosed in a neonate who presented with severe elongation and tortuosity of the aorta and its major branches, as well as the intracranial arteries. Additionally, the patient presented with a tortuous dilatation of the inferior vena cava, an aneurysmal dilatation of the extra-hepatic bile ducts, and an inguinal and sliding hiatal hernia. The diagnosis was confirmed using DNA sequencing analysis, and the patient demonstrated a compound heterozygosity for two novel mutations (c.738delG [p.Gln247Serfs*33] and c.362T>C [p.Ile121Thr]) in exon 2 of the SLC2A10 gene. Genetic analysis also confirmed that both parents were heterozygous carriers of the responsible mutations. Owing to such clinical manifestations, ATS is often misdiagnosed as other connective tissue diseases including Loeys-Dietz syndrome, Marfan syndrome, and Ehlers-Danlos syndrome. In patients presenting with a high index of suspicion, thorough clinical evaluation and screening for ATS including computed tomography or magnetic resonance angiography and target gene analysis are necessary for early diagnosis and management.

• Journal of Chest Surgery
• /
• 제42권1호
• /
• pp.115-118
• /
• 2009

중부 식도암에서 개흉적 식도절제술을 시행 받은 65세 남자가 식도열공 직상부의 좌측 종격 흉막이 찢어진 곳을 통해 횡행결장의 흉강내 탈장이 발생하였다. 단순흉부촬영상 좌측 하폐야에 공기음영의 누적이 발견되었고 이는 점차 진행하여 좌측 폐를 완전히 허탈시키고 혈역학적 불안정을 야기하였다. 식도절제술 후 생명을 위협하는 흉강내로의 탈장은 응급 개복술을 통하여 교정되었다. 식도절제술 후 식도열공을 통한 흉강내 탈장은 장의 폐색이나 꼬임의 위험 때문에 생명을 위협할 가능성이 있어 증상이 있는 환자에서 응급으로 복부절개를 통한 탈장의 수술적 복원을 시행하여야 한다. 하지만 식도절제술시 이러한 합병증의 예방을 위한 신중이 최우선일 것이다.

• Journal of Gastric Cancer
• /
• 제12권1호
• /
• pp.36-42
• /
• 2012

Purpose: The aim of this study was to evaluate the surgical outcomes of abdominal total gastrectomy, without mediastinal lymph node dissection for type II and III gastroesophageal junction (GEJ) cancers. Materials and Methods: We retrospectively reviewed surgical outcomes in 67 consecutive patients with type II and III GEJ cancers that were treated by the surgical resection between 2004 and 2008. Results: Thirty (45%) patients had type II and 37 (55%) had type III tumor. Among the 65 (97%) patients with curative surgery, 21 (31%) patients underwent the extended total gastrectomy with trans-hiatal distal esophageal resection, and in 44 (66%) patients, abdominal total gastrectomy alone was done. Palliative gastrectomy was performed in two patients due to the accompanying peritoneal metastasis. The postoperative morbidity and mortality rates were 21.4% and 1.5%, respectively. After a median follow up of 36 months, the overall 3-years was 68%, without any differences between the Siewert types or the operative approaches (transhiatal approach vs. abdominal approach alone). On the univariate analysis, the T stage, N stage and R0 resection were found to be associated with the survival, and multivariate analysis revealed that the N stage was a poor independent prognostic factor for survival. Conclusions: Type II and III GEJ cancers may successfully be treated with the abdominal total gastrectomy, without mediastinal lymph node dissection in the Korean population.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제20권1호
• /
• pp.34-40
• /
• 2017

Purpose: This study was performed to review the outcomes of gastrostomy insertion in children at our institute during 10 years. Methods: A retrospective chart review was performed on 236 patients who underwent gastrostomy insertion from October 2005 to March 2015. We used our algorithm to select the least invasive method for gastrostomy insertion for each patient. Long-term follow-up was performed to analyze complications related to the method of gastrostomy insertion. Results: Out of 236 patients, 120 underwent endoscopic gastrostomy, 79 had laparoscopic gastrostomy, and 37 had open gastrostomy procedures. The total major complication rates for endoscopic gastrostomy insertion, laparoscopic gastrostomy insertion, and open gastrostomy were 9.2%, 8.9%, and 8.1%, respectively. The most common major complication was gastroesophageal reflux requiring Nissen fundoplication (3.8%), and other complications included peritonitis (1.3%), hiatal hernia (1.3%), and bowel perforation (0.8%). Gastrostomy removal was successful in 8.6% and 5.0% of patients in the endoscopic and surgical gastrostomy groups, respectively. Gastrocutaneous fistula occurred in 60% of surgically inserted cases, requiring a second operation. Conclusion: This retrospective study was performed to review the outcome of gastrostomy insertion, as well as to introduce an algorithm that can be used for future cases. Further studies should be conducted to make a consensus on choosing the most appropriate method for gastrostomy insertion.

• Journal of Chest Surgery
• /
• 제56권3호
• /
• pp.171-176
• /
• 2023

Background: This study analyzed and described the clinical characteristics and surgical outcomes of diaphragmatic hernia (DH) repair according to the operative approach. Methods: After excluding cases with a combined approach and hiatal hernias, we analyzed 26 patients who underwent DH repair between 1994 and 2018. The baseline and perioperative characteristics of the thoracic approach group and the abdominal approach group were described and analyzed. Results: Fifteen of the 26 patients were treated through the thoracic approach, including 5 patients who underwent video-assisted thoracic surgery (VATS). Eleven patients underwent the abdominal approach. The thoracic approach was associated with a longer duration of DH than the abdominal approach (2 vs. 0.1 months), herniation of the right-sided abdominal organs, and herniation of the retroperitoneal organs. During the median follow-up of 23 months, there was no recurrence of DH. Conclusion: The surgical approach should be chosen considering the duration of DH and the location of herniated organs. VATS might be a safe and feasible option for repairing DH.