• Journal of Veterinary Clinics
• /
• v.37 no.2
• /
• pp.100-105
• /
• 2020

A 9-month-old, 11.3 kg, intact, male, mixed-breed dog was referred for treatment of cor triatriatum dexter (CTD); a 5-month-old, 1.9 kg, intact, male Maltese for pulmonic stenosis (PS); and a 3-year-old, 6.62 kg, intact, female West Highland white terrier for esophageal stricture with regurgitation. A balloon catheter intervention was performed in the dog with CTD, and subsequent color Doppler ultrasound and abdominal ultrasound showed normal blood flow across the perforated membrane dividing the right atrium and the disappearance of the severe ascites present before treatment. Balloon catheter intervention in the dog with PS reduced the blood flow through the stenosis from 5.82 m/s to 3.97 m/s. In the dog with esophageal stricture, balloon catheter intervention widened the esophagus and no subsequent regurgitation was observed. Balloon catheter intervention is an interventional radiology procedure that represents a definitive treatment option for various stenotic lesions in dogs, including CTD, PS, and esophageal stricture. Although interventional radiology procedures for these diseases have already been reported, details of procedures and successful outcome have not been reported in Korea.

• Advances in pediatric surgery
• /
• v.3 no.1
• /
• pp.47-53
• /
• 1997

Accidental ingestion of caustic substance is one of the common problems among children around the world. Acid intake accounts for a mere 5% of all reported cases of corrosive ingestion in the West. Because of the esophageal sparing effect of acid, clinically significant esophageal involvement after acid ingestion occurs in only 6 to 20 percent of the instances. Despite effort of prevention, 7% to 15% of children sustaining caustic esophageal burns develop esophageal strictures. If balloon dilatation or bougie dilatation fails to resolve the esophageal strictures, successful outcome following replacement by colon or stomach has been reported in children. But the complications and morbidity following these operations are still relatively high. Seven patients with corrosive-acid induced esophageal strictures who were operated upon at the Department of Pediatric Surgery, Seoul National University Children's Hospital from 1991 to 1995 were reviewed. Primary resection and anastomosis was performed in all of 7 patients. The stricture involved short segments of the esophagus at the level of the lower cervical and the upper thoracic vertebra. The operations were approached through a left cervical incision or a left thoracotomy. In one patient, operative repair of anastomotic leakage was done, and three patients required re-resection of anastomotic strictures postoperatively, and one patient required a third operation(reversed gastric tube) due to an anastomotic stricture. The other anastomotic leaks, strictures or pulmonary complications were resolved with conservative treatment. In conclusion, primary resection and anastomosis of the esophagus was performed successfully on the 6 of 7 children with acid induced corrosive esophageal strictures. This approach is physiologic, especially in children who should have a long life expectancy, and recommended for the treatment of short-segment acid induced corrosive esophageal strictures.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.7 no.2
• /
• pp.113-120
• /
• 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.

• Korean Journal of Bronchoesophagology
• /
• v.6 no.1
• /
• pp.62-71
• /
• 2000

Background: For the purpose of reducing operating time and rate of anastomotic leakage, we have performed esophagovisceral anastomosis with an EEA stapler using the largest size possible. If any difficulty in the approach of the EEA stapler was encountered one-layer interrupted hand-sewn anastomosis. Because the rate of postoperative benign anastomotic stricture was higher than expected, a retrospective study was done on all patients who underwent esophageal reconstruction. Material and Method: Over a period of 3 years from January 1996 to December 1998, we performed esophageal reconstructions on 30 patients. Patients were divided into two groups ; EEA stapler group(Group Ⅰ) comprised of 21 patients and hand-sewn group(Group Ⅱ) comprised of 9 patients.Result:The hospital mortality was 6.67 %(2/30) and the anastomotic leakage rate was 3.33 %(1/30). Among the discharged patients, the rate of recurrent anastomotic tumor was 3.57 %(1/28) and the rate of benign anastomotic stricture stricture rate was 35 %(7/20) in Group Ⅰ and 12.5 %(1/8) in Group Ⅱ, which was not significant. Conclusion: Although nontumor benign stricture was significantly higher in Group Ⅱ than in Group Ⅰ(p=0.0492), the incidence of anastomotic complications did not differ between the two groups. The one-layer interrupted hand-sewn esophagovisceral anastomosis by maintaining a wide lumen and close approximation of mucosa to mucosal layers with evenly spaced sutures could be one of the preferred surgical method to reduce benign anastomotic strictures.

• Journal of Chest Surgery
• /
• v.31 no.5
• /
• pp.549-551
• /
• 1998

Although dysphagia in patients with acute leukemia is usually related to reflux esophagitis, infectious esophagitis, chemotherapy1) and leukemic infiltration2), acute esophageal stricture resulting from chemotherapy in the patient with leukemia is very rare. A 40-year-old man with acute myelogenous leukemia was admitted for operation of esophageal stricture which was developed within 1 month of chemotherapy. An esophagectomy and esophagogastrostomy with pyloroplasty was carried out. Histology showed mucosal infiltration of mononuclear cells and transmural fibrosis involving submucosa and the muscle layer.

• Journal of the Korean Society of Radiology
• /
• v.15 no.5
• /
• pp.643-647
• /
• 2021

The purpose of this study was to access the possibility and ideal model for corrosive-induced tissue hyperplasia in the rat esophagus. Twenty rat were divided into two group: a healthy group, corrosive group. corrosive burn in esophagus were produced using 30% NaOH on the distal esophagus. After surgical procedure, behavioral and weight changes were monitored on a weekly. At 3 weeks after surgical procedure, fluoroscopic esophagogram was performed and then all rats sacrificed for histological analysis by administering inhalable pure carbon dioxide. Technical surgery for corrosive stricture were 100%. A total of 2 rats died in corrosive group from a corrosive burn related to dysphagia within 14 days. The esophageal stenosis ratio was significantly higher in the corrosive group than in the healthy group (40.1 ± 9.2 % and 1.4 ± 7.2%, respectively; p = 0.001). The tissue hyperplasia ratio was also significantly higher in the Corrosive group (62.5 ± 9% and 22.08 ± 6%, respectively; p = 0.001). Infusion of 30% NaOH may suggest alternative option to evaluation tool for preclinical study in a rat corrosive model.

• Journal of Gastric Cancer
• /
• v.5 no.4 s.20
• /
• pp.246-251
• /
• 2005

Purpose: Benign anastomotic stricture after an esophagojejunostomy using EEA stapler following a radical total gastrectomy is one of the most serious complications. The purpose of this study is to evaluate the incidence risk factors, and treatment associated with benign stricture. Materials and Methods: From March 1998 to February 2001, 436 patients underwent an esophagojejunostomy with Roux-en-Y anastomosis using an EEA stapler followed by an endoscopy. Thirty three of the 436 patients(5.5%) developed an anastomotic stricture; included 24 of the 33 patients had a benign stricture. Nine patients with a malignant stricture were excluded. Results: The median age of the 436 patients was 57 years $(23{\sim}85\;years)$. Two hundred ninety two patients were male, and 144 patients were female. The median time to diagnosing the stricture was 1.5 months $(0.5{\sim}6months)$. There was no statistical significance in any of the risk factors, including the diameter of the stapling device, the status of adjuvant treatment, the status of reflux esophagitis, and a clinical history of diabetes and hypertension. The strictured patients were treated with balloon dilatation, one to three times, with symptom relief. Conclusion: There were no statistically significant risk factors. However, further study of the vascularity of anastomoses and benign strictures needs to be considered. In the anastomotic strictured patients endoscopic balloon dilatation appeared to be the first line of treatment.

• Archives of Reconstructive Microsurgery
• /
• v.10 no.2
• /
• pp.81-85
• /
• 2001

In the treatment of urethral stricture, many problems still remain with the current methods making it a field of further exploration for reconstructive surgeon. Furthermore, when total or multiple strictures of the penile urethra exist, the methods of surgery become difficult due to a necessity for a long neourethra. Introduction of vascularized free flap has broadened the choice and improved the results of reconstruction for the urethra. The authors used a sensate ulnar forearm free flap in a patient with multiple penile urethral strictures for reconstruction. Uroflowmetry, 30 months after surgery, revealed that maximal flow rate was 15.5 ml/sec, average flow rate was 9.5 ml/sec, and voided volume was 157 ml. A urethrogram was performed 30 months postoperatively and a good result was achieved. The ulnar forearm free flap used by the authors are thin and pliable and is good for providing sufficient length to reconstruct the neourethra for a long urethral defect.

• The Korean Journal of Cytopathology
• /
• v.11 no.1
• /
• pp.11-18
• /
• 2000

Pancreaticobiliary tract strictures are frequent Indications for endoscopic retrograde cholangiopancreatography(ERCP). We have investigated the brushing cytology in order to determine its efficacy for diagnosis of pancreaticobiliary malisnancies. Brushing cytology during ERCP was evaluated in 56 patients with biliary tract stricture presenting to the Catholic Hospital of Taegu-Hyosung from April 1997 to August 1999. A comparison was made between the cytologic and histologic diagnoses on 32 cases from 30 patients. A diagnosis of malignancy was establishied in 78.1%, benign in 15.6%, and inadequate in 6.3% of the cases. Statistical data on cytologic diagnoses in strictures of the bile duct were as follows; specificity and sensitivity of blushing procedure was 100% & 83.3%, respectively: sensitivity of interpretation was 89.3%: with no false positive cases and 3 false negative cases: predictive value for malignancy was 100% & 100%, respectively: predictive value for benign was 28.6% & 40%,, respectively: overall diagnostic efficiency was 84.4%. It is concluded that brush cytology is a diagnostically reliable, highly specific technique for malignant lesions encounted at ERCP, although a negative result does not rule out the diagnosis of malignancy.

• Journal of Chest Surgery
• /
• v.15 no.2
• /
• pp.188-193
• /
• 1982

Between 1967 and 1980, a total of 99 patients with a benign stricture of esophagus, resulting from a chemical burn, underwent a reconstructive procedure in which various segments of colon were used to bridge the gap between the cervical esophagus and the stomach. There were 42 males and 57 females and most were in their twenties and thirties. The most frequent site of the stricture was upper 1/3 of the thoracic esophagus [48.5%] and the next most common site was the low cervical esophagus [23.2%]. In 89 cases, the right colon with or without the terminal ileum was used as the conduit in an isoperistaltic manner and in 10, the left colon was used in an antiperistaltic position, because the right colon was not suitable as the conduit. There was a higher incidence of regurgitation [90% vs 0%], leakage at cervical anastomosis [80% vs 27%] and stenosis at anastomotic site [70% vs 15%] in an antiperistaltic left colon anastomosis, as compared to isoperistaltic right colon anastomosis. This was felt to be due to the orad peristaltic motion of the transplanted colon which acted as a functional obstruction distal to the esophagocolic suture line, resulting in breakdown of the anastomosis, leakage and eventual stenosis at the site of anastomosis. In conclusion, colon is useful and effective conduit as an esophageal substitute. Either the right or the left colon can be used for this purpose, provided that it is placed in an isoperistaltic position to minimize some of the complications listed above.