• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제13권2호
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• pp.128-133
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• 2010

목 적: 장중첩증은 영아기 급성 복통의 흔한 원인 중 하나로 대부분 특발성의 소장-대장형이다. 반면 소장형 장중첩증은 드물며 시작점을 보이는 경우가 있고 수술적 정복을 필요로하는 경우가 흔하다. 본 연구의 목적은 소아에서 소장형 장중첩증의 임상 양상과 경과에 대해 알아보고자 한다. 방 법: 2005년에서 2010년까지 서울대병원에서 소장형 장중첩증으로 진단받은 21명의 환아들의 임상 양상 및 영상 소견을 후향적으로 분석하였다. 결 과: 임상 양상은 복통 및 보챔(85%), 구토(23%), 발열(14%), 혈변(14%) 및 복부 종괴(4%) 등이었다. 여섯 명(28%)의 환아에서 수술적 치료가 필요하였다. 초음파에서 병변의 직경은 1.6${\pm}$0.7 cm였고 가장자리의 두께는 1.7${\pm}$1.8 mm였다. 열한 명에서 병변이 왼쪽 복부 혹은 배꼽 주위였다. 수술적 치료가 필요했던 환아들은 자연 정복된 환아들에 비해 평균 연령이 높았다(109${\pm}$17개월: 51${\pm}$20개월). 병변의 평균 직경 및 가장 자리의 두께는 수술적 치료가 필요했던 환아들에서 더 큰 소견을 보였고 위치는 두 그룹 간에 차이를 보이지 않았다. 결 론: 소장형 장중첩증은 많은 소아에서 자연 정복된다. 그러나 초음파에서 크기가 크고, 나이가 많을수록 또한 병변의 시작점이 있으면 수술적 치료를 고려할 수 있다.

• Advances in pediatric surgery
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• 제15권2호
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• pp.132-140
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• 2009

The purpose of this study was to determine the success rate of air reduction as the primary treatment of intussusception and whether the success of air reduction could be predicted by plain x-ray. The authors reviewed the medical records of 54 consecutive patients diagnosed with intussusception from Jan 2005 to Dec 2007 at the Department of Surgery, Masan Samsung Hospital. The natures of symptoms and findings of plain abdominal radiography performed in the emergency department (ED) were reviewed. Air reduction failed more frequently (26.3 %) in patients who visited ED more than 24 hours after symptom onset (p=0.009). The mean duration of symptom for operated patients was longer than air reduction group (p=0.01). Also, 3/4 of patients having localized distension of small bowel in the left upper quadrant abdomen had unsuccessful air reduction (p=0.002). In conclusion, the time interval from symptom onset to arrival at ED and localized distension of small bowel in the left upper quadrant abdomen significantly increased the failure rate of air reduction.

• Childhood Kidney Diseases
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• 제20권2호
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• pp.92-96
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• 2016

Henoch-$Sch{\ddot{o}}nlein$ purpura (HSP) is the most common vasculitis in children, mainly affecting the small vessels of the skin, joints, gastrointestinal tract, and kidneys. Although most cases of HSP resolve spontaneously without sequelae, serious nephrological and intestinal problems may occur in some cases. We experienced a case of HSP complicated by simultaneous intussusception and nephritis in a 14-year-old boy who developed a sudden abdominal pain and gross hematuria on the 11th day after onset of the disease. Imaging studies revealed intussusception that required emergency laparotomy. Despite treatment with steroid and angiotensin-converting enzyme inhibitors, nephritis and nephrosis progressed for 4 weeks, and renal biopsy was performed to confirm the diagnosis. Cyclosporin A therapy was started, and remission of proteinuria was achieved after 5 months. However, the nephritis recurred and worsened to end-stage renal failure during 15 years of follow-up.

• Clinical and Experimental Pediatrics
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• 제48권8호
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• pp.907-910
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• 2005

신생아에서 멕켈게실에 의한 장중첩증으로 장폐쇄를 유발한 경우는 매우 드물다. 신생아기에 장폐쇄의 원인으로 장중첩증은 장폐쇄의 원인 중 단지 3%, 멕켈게실은 0.3% 정도만이 보고되었다. 저자들은 출생 수시간 후부터 담즙성 구토를 보인 신생아에서 복부 초음파, 대장소영술 및 복부 전산화단층촬영상에서도 확진하지 못하고 시험적 개복술을 시행하여 비로소 확인된 태생기에 발생한 멕켈게실에 의한 장중첩증 1례를 경험하였기에 보고하는 바이다.

• 대한영상의학회지
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• 제82권3호
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• pp.708-714
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• 2021

소아 환자에서 장중첩증과 급성 충수돌기염은 흔한 응급 질환이다. 의심되는 증상이 있을 때 두 질환을 감별하는 것은 중요하다. 하지만, 드물게 두 질환이 한꺼번에 발생하는 경우도 있다. 이에, 우리는 병적인 충수돌기를 동반한 장중첩증을 보였던 두 증례를 소개한다.

• 대한영상의학회지
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• 제83권6호
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• pp.1380-1384
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• 2022

자궁내막암은 흔한 부인과암으로 소장으로의 전이는 드물며, 원격 전이보다 주변 장기로의 국소 침윤으로 발생한다. 자궁내막암이 다른 곳에 전이 소견 없이 단독으로 소장에 전이한 경우는 매우 드물다. 또한 성인에서 장중첩증은 드문 질환으로 이로 인해 장폐색이 발생하는 비율은 매우 낮다. 저자들은 자궁내막암 병기 IB로 수술 및 방사선 치료 후 경과관찰 중이던 환자에서 공장공장 장중첩증으로 인해 장폐색이 발생하였음을 소장 조영술 및 복부 전산화 단층촬영으로 진단하였고, 공장 국소절제술 후 자궁내막암의 단독 소장 전이로 확인하였던 증례를 문헌고찰과 함께 보고한다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제8권2호
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• pp.247-251
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• 2005

미숙아에서 드물기는 하나 심한 복부 팽만과 담즙이 섞인 구토, 혈변 등의 증상이 비교적 일찍 초래되는 경우 장중첩증을 감별 진단으로 고려하여야 한다. 저자들은 극소 저출생 체중 미숙아에서 괴사성 장염과 유사한 증상을 보였으나 생후 11일경에 수술로 진단된 회장 폐쇄를 동반한 태생기 회장-회장형 장중첩증 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권4호
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• pp.329-345
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• 2020

Purpose: This was a nationwide population-based study conducted to investigate the epidemiology, treatment, disease outcomes, and associated factors of childhood intussusception in South Korea. Methods: Data from the Korean National Health Insurance Service database on all patients <18 years old diagnosed with intussusception from 2007 to 2017 were analyzed. Results: A total of 34,688 cases were identified among 30,444 patients. The overall incidence was 28.3/100,000 person-years with a male predominance. Most cases (83.1%) occurred in children <3 years old, with an annual incidence of 195.2, 200.1, and 118.6 cases per 100,000 children in their first, second, and third year of life, respectively. The median age at the first occurrence was 18.7 months, and it was higher in boys than in girls. The post-discharge recurrence rate was 10.6% (3,226/30,444) and the in-hospital recurrence rate was 6.1% (1,842/30,444). The total recurrence rate (post-discharge recurrence and/or in-hospital recurrence) was 15.0% (4,580/30,444). Enema reduction was successful in 90.0% of cases. Enema reduction was more successful in girls than in boys. A total of 3,296 (10.8%) patients underwent 3,481 surgeries, including 735 (21.1%) laparoscopic surgeries. Post-discharge recurrence and surgery were significantly affected by age, sex, and hospital type. Mortality was noted in nine cases (0.03%). Conclusion: Our study provides accurate epidemiologic data on the treatment and outcomes of intussusception through complete enumeration during an 11-year-period.

• Journal of Minimally Invasive Surgery
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• 제21권4호
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• pp.154-159
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• 2018

Purpose: Intussusception is a common cause of intestinal obstruction in children. While most patients can be treated by enema reduction, about 20% require surgery. We investigated the usefulness and feasibility of laparoscopic surgery and the intraoperative risk of bowel resection. Methods: We retrospectively reviewed pediatric patients who underwent surgery for intussusception from 2010 to 2017. We collected data for age, gender, body weight, associated symptoms, duration of symptoms, white blood cell count, operating time, and postoperative complications. Results: Of 155 patients, 37 (23.8%) underwent surgery due to enema reduction failure in 29 (78.3%), recurrence in 6 (16.3%), a suspicious lead point in 1, and suspicious ischemic change observed on ultrasonography in 1. The mean age was $26.8{\pm}18.9$ months (range, 3.5~76.7 months), and the mean body weight was $12.9{\pm}3.9kg$ (range, 5.4~22.2 kg). Laparoscopic surgery was successful in 29 patients (78.4%), and 7 (18.9%) needed bowel resection and anastomosis. The mean operating time was $56.7{\pm}32.8min$. A lead point was found in 3 patients in the bowel resection group (p=0.005); in addition, the operating time and hospital stay were longer in this group. There were no intra- or postoperative complications. Conclusion: Laparoscopic surgery was successful in 78.4% of the patients with a short hospital stay and early oral intake. The only predictive factor for bowel resection was the presence of a lead point. Laparoscopic surgery may be an optimal treatment intervention for children with intussusception, except for those who show initial peritonitis.

• Advances in pediatric surgery
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• 제9권1호
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• pp.24-29
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• 2003

To evaluate the clinical findings of the recurrent intussusception, 351 patients with 445 intussusceptions were reviewed. Recurrence rate, pattern of recurrence, reducibility, pathologic lead points (PLP), and operative findings and long term follow up of the multiple recurrences were analyzed. Of 351 patients, 303 had no recurrence, 26 had one recurrence, and 22 had multiple recurrences. Over all recurrence rate was 16.4% ; 18.5% were managed by air reduction, 16.2% by barium reduction and 5.9% by operation. Eleven PLPs were proved operatively and an additional 6 suspected PLPs were depicted radiologically. The most frequent PLP was ileal lymphoid hyperplasia. Intervals between reduction and recurrence were less than 2 weeks in 31 cases, between 2 weeks and 1 year in 55, and more than 1 year in 8. The longest interval was 2 years and 4 months.