• Clinical Endoscopy
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• 제56권3호
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• pp.340-352
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• 2023

Background/Aims: Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. Methods: We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. Results: From 2007 to 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p<0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Conclusions: Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.

• Journal of Chest Surgery
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• 제15권2호
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• pp.188-193
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• 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.

• Journal of Digestive Cancer Research
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• 제2권2호
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• pp.68-71
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• 2014

한 달 동안의 점점 커지는 복부의 종괴를 주소로 방문한 57세 남자 환자에서 대장-십이지장루를 동반한 대장암을 진단하였으며, 이에 대해 수술 전 동시 항암방사선 치료를 시행하여 수술 범위를 줄일 수 있었던 좋은 예였다. 국소적으로 진행된 대장암 환자에서 본 증례와 같은 합병증으로 수술의 범위가 커질 가능성이 있다면, 보존적 치료 및 수술 전 동시 항암방사선 치료를 시행하여 수술 범위를 좁히는 것이 환자의 치료 경과에 도움이 될 것으로 생각된다.

• Advances in pediatric surgery
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• 제18권2호
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• pp.68-74
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• 2012

Colonic atresia (CA) is the rare cause of intestinal obstruction, and diagnosis of CA is difficult. But only few research has been performed, so little information has been available. The purposes of this study was to analyze the clinical findings of CA so that help physicians make decision properly. Children with CA who were treated at the division of pediatric surgery at Asan Medical Center in the period from January 1989 to December 2011 were evaluated retrospectively. A total of 6 children were treated with CA. These accounted for 2.7% of all gastrointestinal atresias managed in Asan Medical Center. Only one child was premature and low birth weight, the others were fullterm neonates and showed normal birth weight. Vomiting and abdominal distension were common symptoms and simple X-ray and barium study were used for diagnose of CA. But only 66.7% of the babies were diagnosed as CA pre-operatively. And 2 children out of 6 underwent re-operation due to missed CA at the time of the first operation. In aspect of types of atresia, the type IIIa were two, type IV were two, type I was one case, and one child showed rectal stenosis due to rectal web. Various operations were done according to individual findings and associated diseases. The 50% (n=3) of children underwent the primary anastomosis and the others (n=3) underwent colostomy first and staged operation later for missed CA or associated disease. All of them were recovered any significant complications. Therefore, the prognosis of CA is satisfactory if diagnosis and surgical management could be made properly. But because of the low incidence of CA, delay of diagnosis and treatment may occur. To prevent delay of diagnosis, we suggest prompt evaluation of doubtful infant and careful inspection of distal patency of bowel including whole colon and rectum when operating patients with intestinal atresia at any level.

• 한국방사선학회논문지
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• 제14권4호
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• pp.439-445
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• 2020

본 연구는 쥐 대장 모델에서 자가팽창형 금속형 스텐트 삽입을 통한 삽입술의 유용성과 조직 과증식을 평가하고자 한다. 먼저 C57BL/6 쥐 대장의 직경을 확인하기 위해 1마리의 대장 투시조영 사전 실험을 실행하였다. 평균 직경은 4.05 mm였다. C57BL/6 쥐들은 두 군으로 나누어 각각 다른 스텐트의 직경을 비교 평가하였다. A 군은 직경이 5 mm, B군은 4mm 였다. 추적관찰 검사는 매주 투시를 통해 스텐트 삽입의 이상 유무를 평가하였다. 4주 후 내시경적 검사를 시행하고 희생하여 육안적 관찰 및 H&E 염색을 통해 조직 과증식을 평가하였다. 스텐트 삽입술은 시술 중 천공이 일어난 1마리를 제외하고 모든 쥐에서는 성공적으로 삽입되었다. 해당 데이터는 본 실험에서 제외하였다. 추적관찰 실험 기간에 A군에 속한 5마리의 쥐는 스텐트 삽입 후 7일 이내에 천공에 의해 사망하였다. B군의 1마리의 쥐는 곧창자로 스텐트의 이동이 발생하였다. A, B 군에서의 합병증은 각각 60%, 10%로 나타났다. 육안적 내시경적 결과에서는 모든 군에서 스텐트 와이어사이로 전체적인 조직 과증식이 일어남을 확인하였다. 조직병리에서의 결과 또한 두 군 사이의 통계적 차이는 유의하지 않게 조직 과증식이 일어났음을 확인할 수 있었다. 대장 스텐트의 삽입술은 기술적으로 유용하게 삽입이 가능했으며, 스텐트에 의한 조직 과증식이 쥐 모델에서 나타남을 확인하였다. 또한 스텐트 사이즈의 증가에 따라 쥐 대장내 천공이 많이 발생함을 확인할 수 있었다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권1호
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• pp.211-216
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• 2012

Background: Patients' demographics, presenting clinical and histopathological features for colo-rectal cancer (CRC) are important factors for patients' outcome and disease prognosis. This study aimed to describe the pattern of CRC in terms of patients' demographics, main presenting symptoms and histopathological features in Al Hassa region of Saudi Arabia. Subjects and Methods: A retrospective hospital records-based study which included reviewing of patients' records diagnosed with CRC at three general hospitals in Al Hassa region, Saudi Arabia. A compilation form was designed to collect information regarding socio-demographics, age at diagnosis; referral sites and the main presentations at CRC diagnosis. sites and the main presentations at CRC diagnosis. Histopathological reports were reviewed to delineate the main cytopathologic features, prominent cytological characteristics, the presence of predisposing pathology, and disease stage. Results: Of the 142 cases with CRC, 15.5% and 33.1% were affected before 40 and 50 years of age respectively. Emergency rooms were main referral sites for CRC cases (31.0%). Right colon was affected in 16.9% while left colonic lesions accounted for 62.7%. Intestinal obstruction was the main presentations (41.5%), and 26.1% presented with symptoms indicating distant metastastic lesions. Adenocarcinoma was the predominant pathological lesions (86.6%). Metastastic CRC was diagnosed in 62.7%. Duke's staging showed that 22.5% and 40.1% of lesions were classified into C and D categories respectively. Conclusion: Saudi patients with CRC present late with distant metastasis, and advanced disease stage. A sizeable proportion of patients developed the lesions at relatively young age. Screening recommendations should be enacted and revised in response to current change with younger age of affection.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제13권2호
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• pp.199-203
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• 2010

본 증례는 1년 전부터 갑작스럽게 복부팽만과 복통이 반복하다 내원 10일 전부터 심한 복통과 복부팽만, 구토가 발생하여 내원한 9세 남자 환자이다. 복부 X-선 촬영과 바륨 관장 등의 검사로 S상 결장 염전증을 진단하고 내시경적 염전 정복과 감압술 시도하였으나 실패하였다. 수술 시야에서 심하게 확장되고 비정상적으로 긴 S상 결장과 굵은 혈관이 포함된 결장간막이 관찰되었고 S상 결장의 원위부 및 근위부에서 좁아진 부위를 확인하여 이 부분을 포함한 S상 결장 절제술을 시행하였다. 이후 환자는 5년 동안의 추적관찰에서 증상의 재발이 없었다.

• Advances in pediatric surgery
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• 제1권1호
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• pp.68-72
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• 1995

Segmental dilatation of the colon is a very rare disease entity of unknown etiology and may mimic Hirschsprung's disease. It is characterized by dilatation of a segment of the colon of variable length with obstruction due to lack of peristalsis in a normally innervated intestine. Recently authors experienced a case of segmental dilatation of the sigmoid colon in a 6 month-old male, who presented with severe constipation, abdominal distention, and abdominal mass since 2 months of age. Down's syndrome and congenital nystagmus were associated. Barium enema demonstrated focal dilatation of the sigmoid colon, but the rectum and descending colon proximal t o the affected colon were of normal caliber. Rectal suction biopsy with acetylcholinesterase staining was normal and anorectal manometry showed normal rectosphincteric reflex. At operation, there was a massively dilated and hypertrophied sigmoid colon with increased tortuous serosal vessels, measuring 15 cm in length and 10 cm in width. Teniae coli were identifiable in the affected segment. Frozen section biopsies at the proximal, affected, and distal colon showed ganglion cells. Descending loop colostomy was constructed initially and segmental resection and end to end colocolostomy were carried out 3 months later. Final histologic examination showed 1) normal colonic mucosa with ganglion cells, 2) prominent submucosal fibrosis and marked muscular hypertrophy, 3) unremarkable acetylcholinesterase activity and immunohistochemical findings against S-100 protein. On 8 months follow-up, he has been doing well and moves bowels 1-2 times daily.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제6권2호
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• pp.202-207
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• 2003

장신경 이형성증은 만성 가성 폐색 증후군의 드문 원인질환으로 임상 증상이 선천성 거대결장증과 유사하여 진단이 늦어지는 경우가 많기 때문에 임상적인 의심이 필요하다. 저자들은 쌍생아에서 신생아기에 태변이 배출되지 않고 복부 팽만을 보여 선천성 거대결장증이 의심되었으나 임상경과와 조직검사로 진단된 장신경 이형성증을 보고하는 바이다.

• Advances in pediatric surgery
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• 제16권1호
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• pp.1-10
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• 2010

본 조사는 2007년부터 2009년까지 3년간 본 학회 정회원들에 의하여 수술받은 장폐쇄증 환아를 대상으로 한 후향적 조사이다. 또한 본 학회에서는 1994년부터 1996년까지 3년간의 증례를 대상으로 같은 조사(1 차조사)를 진행한 바 있다. 1 차 조사와 비교하여 본 조사에서 보이는 특징은 아래와 같이 요약할 수 있다. - 총 증례 수는 비슷하였으나 출생률을 감안하여야 할 것이다. - 각 기형별 비율은 비슷하였다. - 미숙아 및 저출생체중아의 비율은 증가 하였다. - 산전진단율은 증가하였다. - 복부단순촬영만 한 경우는 감소하였다. - 다른 기형이 동반된 예가 증가하였다. - 사망률이 13.8 %에서 3.6 %로 감소하였다. 장운동의 회복은 공장폐쇄증에서 십이지장이나 회장폐쇄증에서 보다 더뎠다. 하지만 십이지장-공장 이행부에서 문합부까지의 거리가 기술되지 않은 예가 많아 소위 "High Jejunal obstruction"에서의 장운동 회복기간을 알아 보지 못 하는 아쉬움이 있었다. 또한 주름형성술(plication) 또는 장의 직경을 줄이는 수술(tapering)의 효과도 시행한 예수가 작고, 문합부 위치의 기술 부족으로 알아 보지 못 하였다. 십이지장폐쇄증의 화타씨유두부와 위치 역시 향후 보다 정확한 수술기록을 토대로 조사되어야 할 것으로 생각된다. 치료 성적의 눈부신 향상은 여러 회원들의 각고의 노력과 의학의 발달에 기인한 것으로, 사망률 0 %를 향한 노력이 지속되어야 할 것이다.