• Advances in pediatric surgery
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• v.2 no.2
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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 Chest Surgery
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• v.39 no.3 s.260
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• pp.214-219
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• 2006

Background: Perforation of esophagus is relatively uncommon. but it is associated with high morbidity and mortality. Treatment and outcome are largely determined by the time of presentation. We performed a retrospective review of patients with esophageal perforation to assess the outcome of current management techniques. Material and Method: A retrospective chart review was performed on all patients treated for perforation of esophagus from March 1990 to March 2005. There were 28 patients (22 men and 6 women: mean age 51 years, range 17 to 82 years) The causes of the perforations were as follows: foreign body retention (9 patients), trauma (7 patients), spontaneous rupture (7 patients), and iatrogenic (5 pati-ients). 18 patients were presented within 24 hours and 10 patients were presented after 24 hours., Esophageal repair was performed in 21 ($75\%$) of them, 4 patients were treated with esophagectomy, 3 patients were treated with feeding gastrostomy and drainage. Result: Hospital mortality was $18\%$ and iatrogenic was increase the mortality rate (p < 0.05). Site of perforation, time from perforation, and treatment method had no influence on mortality. Postoprative leaks occurred in 4 patients after primary repair and were treated conservatively. Conclusion: Esophageal perforation remains a devastating event which is difficult to diagnose and manage. Primary repair can be performed in most patients with esophageal perforation regardless of time to presentation with a low mortality. Accurate diagnosis and early treatment are essential to the successful management of patients.

• Clinical and Experimental Pediatrics
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• v.45 no.3
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• pp.406-412
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• 2002

Henoch-$Sch{\ddot{o}}nlein$ purpura(HSP) is one of the most common vasculitic diseases of childhood, referred to as a leukocytoclastic vasculitis affecting small vessels. Although HSP related gastrointestinal symptoms are seen in up to 80% of patients during acute illness, these symptoms are usually transient. However, some patients with HSP have gastrointestinal major surgical complications such as intussusception, bowel infarction, necrosis, stricture, and perforation. We experienced a rare case of HSP-related ileal perforation developed after corticosteroid treatment. We report a case with HSP-related intestinal perforation and assess the effect of corticosteroid on the outcome of abdominal pain in children with HSP.

• Advances in pediatric surgery
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• v.1 no.1
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• pp.59-62
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• 1995

Meconium peritonitis is defined as an aseptic, chemical or foreign-body peritonitis caused by spill of meconium in the abdominal cavity related to the prenatal perforation of the intestine. Perforation is usually caused by obstruction from meconium ileus, intestinal atresia, stenosis, volvulus, internal hernia, congenital peritoneal bands, intussusception, or gastroschisis. Less commonly, no evidence of distal obstruction exists. Here, we present two cases of generalized meconium peritonitis of antenatal diagnosis. The first case, detected at 8 months of gestational age, had a perforation of the proximal blind pouch of jejunal atresia, associated with respiratory distress due to severe abdominal distension. This case was successfully treated with resection and anastomosis and brief period of postoperative ventilatory support. The second case had a distal ileal perforation with thick meconium in the terminal ileum. In this case, there was no dilatation of ileum proximal to the perforation site. Resection and anastomosis was performed and postoperative course was uneventful.

• Steel and Composite Structures
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• v.22 no.4
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• pp.777-796
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• 2016

In this paper, the behavior of woven E-glass fabric composite laminate was experimentally investigated under quasi-static indentation and high velocity impact by flat-ended, hemispherical, conical (cone angle of $37^{\circ}$ and $90^{\circ}$) and ogival (CRH of 1.5 and 2.5) cylindrical perforators. Moreover, the results are compared in order to explore the possibility of extending quasi-static indentation test results to high velocity impact test results in different characteristics such as perforation mechanisms, performance of perforators, energy absorption, friction force, etc. The effects of perforator nose shape, nose length and nose-shank connection shapes were investigated. The results showed that the quasi-static indentation test has a great ability to predict the high velocity impact behavior of the composite laminates especially in several characteristics such as perforation mechanisms, perforator performance. In both experiments, the highest performance occurs for 2.5 CRH projectile and the lowest is related to blunt projectiles. The results show that sharp perforators indicate lower values of dynamic enhancement factor and the flat-ended perforator represents the maximum dynamic enhancement factor among other perforators. Moreover, damage propagation far more occurred in high velocity impact tests then quasi-static tests. The highest damage area is mostly observed in ballistic limit of each projectile which projectile deviation strongly increases this area.

• Korean Journal of Bronchoesophagology
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• v.10 no.2
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• pp.55-57
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• 2004

We report a case of successful transesophageal drainge of thoracic esophageal perforation with mediastinal cavities using two 5Fr angiographic pigtail catheters with portable suction bag(Hemovac)

• Journal of Chest Surgery
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• v.16 no.1
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• pp.121-126
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• 1983

8 cases of the esophageal perforations were treated at the department of thoracic surgery, Chungnam National University Hospital during the period from July, 1980 to Dec., 1982. The causes of the perforation were various; swallowed a piece of glass, stocking pin, coiled wire, compressed air blow, strenuous vomiting, dog bite, tiller accident, and endoscopic procedure. The perforation sites were cervical esophagus in 3 cases, upper thoracic in 2 cases and lower thoracic in remains. We have performed following surgical procedure; Incision and drainage for cervical abscess, closed thoracostomy, thoracotomy and debridement, esophagoscopy and gastrostomy. Two cases were died. The causes of death were massive bleeding and sepsis.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.1040-1046
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• 1990

Despite the improved diagnostic and treatment modalities recently introduced for a variety of esophageal disorders, a perforation or leak from the esophagus remains a sources of morbidity and mortality regardless of the cause of leak. After the perforation of esophagus, the contamination of mediastinum and pleural cavity with food, bacteria and corrosive gastric juice leads to sepsis and cardiopulmonary dysfunction. The early diagnosis and early treatment are very important, and the delayed treatment leads to high risk of morbidity and mortality. We experienced one case of esophageal perforation, after forced vomiting in 48 years old male patient. We used omentum on the treatment of ruptured esophagus, and it was successfully managed.

• Journal of Chest Surgery
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• v.23 no.6
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• pp.1233-1237
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• 1990

When the perforation of intrathoracic esophagus occurs in the presence of preexisting esophageal stricture, aggressive and definitive therapy often provides the only chance for patient salvage. Two adults suffering from intrathoracic esophageal perforation with underlying stricture underwent transhiatal esophagectomy. The perforations were due to esophageal instrumentation. Restoration of alimentary continuity with a primary cervical pharyngogastric anastomosis was carried out in one patient. Another patient underwent a cervical esophagostomy and had a subsequent colonic interposition 3 months later.

• Journal of Chest Surgery
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• v.22 no.2
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• pp.342-347
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• 1989

A 4-year-old male developed the esophageal perforation after air-gun shut injury in the thorax. The esophageal perforation was found on esophagogram at the next day after the accident. Because of delayed diagnosis, mediastinitis and pyopneumothorax were developed. The general conditions of the patient were very critical with sepsis on admission. Therefore, two staged operation was planned. At the first stage, exclusion and diversion of the esophagus was carried out to treat chemical pneumonitis due to gastric contents through the esophago-bronchial fistula by gastroesophageal reflux. Clinical conditions of the patient were improved after the first stage operation. At the second stage, the esophageal reconstruction with right colon was performed.