• Journal of Chest Surgery
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• 제16권2호
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• pp.221-225
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• 1983

Morgagni, in 1760, 1st. described the findings of substernal herniation of abdominal contents into the thoracic cavity, based upon 25 postmortem dissections. Herniation through the foramen of Morgagni is the rarest occurrence of the congenital diaphragmatic hernias and is usually a few symptoms. With the increasing use of routine chest roentgenogram & the need to exclude the possibility of a mediastinal neoplasm, most such cases are brought to the attention of a surgeon. We had experienced 2 cases of Morgagni hernia, which one caused a simple mechanical intestinal obstruction & diagnosed as acute appendicitis with perforation & another one was diagnosed as mediastinal lipoma on routine chest X-ray film at arrival due to traffic accident. We had performed left paramedian abdominal incision as misdiagnosis of acute appendicitis with perforation and repair of the defect and returned transverse colon & stomach into abdominal cavity in one patient. And in another patient, we preferred to approach through right thoracotomy incision and then left upper paramedian abdominal incision and returned the omentum into the abdominal cavity. The post-operative courses were in uneventful and we report these cases and review and discuss the literatures.

• 대한간호학회지
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• 제15권2호
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• pp.25-33
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• 1985

This study intended to investigate the volume of respiration according to the postoperative time and positions among the upper abdominal surgery patients. Tidal volume and vital capacity were measured in three positions-supine, left lateral and sitting position-at preoperatively, 12 hours postoperatively and 36 hours postoperatively. Thirteen male and seven female patients who were admitted for elective abdominal surgery under general anesthesia were the subjects of the study. Those patients with cardiopulmonary problems, obesity and smoking habit were excluded from the study. The study was conducted from March 15 to June 30, 1985 in Seoul National University Hospital. Tidal volume and vital capacity were measured by Wright spirometer in various positions at preoperatively, 12 hours postoperatively and 36 hours postoperatively. The results were as following: 1) Vital capacity was significantly decreased at 12 hours preperatively and 36 hours postoperatively than preoperatively. Vital capacity was not significantly different in Various positions, but sitting position revealed better than left lateral and supine position. Tidal volume was not significantly different in each position. 2) Male patients showed significantly higher than female patients in tidal volume and vital capacity. Vital Capacity was not significantly different by sex in each position, but vital capacity was higher in sitting position than in lateral and supire position. 3) There was not significantly different in tidal volume and vital capacity according to the type of incision and positions, vital capacity was higher in sitting positionthan in left lateral and supine position.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1141-1145
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• 1992

A rare syphilitic abdominal aortic aneurysm associated with pulmonary embolism and deep vein throbosis is reported. We have experienced a huge infrarenal syphilitic abdominal aortic aneurysm which caused venous compression at left common iliac vein. A 29 year-old female was admitted via emergency room due to several episodes of hemoptysis. Clinical evaluation for this patient revealed a couple of small ill-defined masss densities on the both lung field and abominal aortic anuerysm. Emergency wedge resections of left upper and lower lobes were performed because of a massive hemoptysis. Pathologic diagnosis showed pulmonary infarction. 20 days after thoracotomy an elective operation on abdominal aortic anuerysm was successfully carried out and post operative pathology finding showed syphilitic aortitis.

• Journal of Chest Surgery
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• 제12권4호
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• pp.429-433
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• 1979

Morgagni hernia is a rare condition of the congenital diaphragmatic hernia which Is located at the anteromedial portion of the diaphragm, and is located immediately posterior to the sternum. Its cause is considered by embryologic defect and the abdominal organs are passed through a defect. The incidence is predirected women over 50 years old. Its synonym is hernia of subcostosternal, retrosternal, parasternal, rectocostoxiphoid, anterior diaphragmatic or Larrey`s. This report presents a symptomatic Morgagni hernia of ten months old male child on whom the diagnosis was established and was operated at the Busan Gospel Hospital. This patient was admitted with the chief complaints of mild cyanosis, frequent upper respiratory infections and protrusion of the right lower anterior chest. Herniorrhaphy was performed through the upper abdominal midline incision, hernial contents of the omentum and the colon, and sac as noticed from the Larrey`s space measuring 4 x 2 cm. in diameter and oval in shape. Interrupted sutures without difficulty repaired the defect. The cyanosis was disappeared and the patient had uneventful course of post-operative period. The patient was discharged at 7th. postoperative day. This case presentation with a brief review of literatures is given.

• Journal of Gastric Cancer
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• 제10권2호
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• pp.84-86
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• 2010

Bezoars are retained concretions of undigested animal or vegetable material that can produce gastrointestinal obstruction, ulceration, and bleeding. Therapeutic options for gastric bezoars include enzyme therapy (papain, cellulase, or acetylcysteine), endoscopic disruption and removal, and surgical removal. Multiple large gastric bezoars generally require conventional surgical management through an upper abdominal incision. With the recent improvement of laparoscopy, a lot of portions of abdominal operations have been performed laparoscopically. We successfully removed multiple large gastric phytobezoars in a 52-year-old female completely through laparoscopy. This supported the feasibility of laparoscopic surgery for patients with gastric bezoars.

• The Korean Journal of Pain
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• 제3권2호
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• pp.119-124
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• 1990

Reiestad and Stromskag recently introduced the interpleural installation of local anesthetic solutions as a technique for the management of postoperative pain in patients undergoing cholecystectomy, renal surgery, and breast surgery. This study was done to manage postoperative pain in the patients undergoing unilateral upper-abdominal surgery and thoracotomy. Twenty patients received 0.5% bupivacaine 20 ml with epinephrine (Children, received 10 ml). Results were as follows: 1) Analgesic effects appeared in 15.56 minutes; mean analgesic duration from the initial intrapleural injection was 10.5 hours. 2) Blood pressure increased more after the operation than before the operation. Blood pressure before injection of bupivacaine was highest (p<0.01). Heart rate was increased before injection and 10 minutes after injection of 0.5% bupivacaine (p<0.05). 3) The values of $PaCO_2$, were improved from $41.7{\pm}2.02\;mmHg$ ($PaCO_2$), $85.2{\pm}2.41\;mmHg$ ($PaO_2$) to $37.8{\pm}2.41\;mmHg$ ($PaCO_2$), $107.0{\pm}7.86\;mmHg$ ($PaO_2$) respectively (p<0.01). 4) Complication such as pneumothorax, atelectasis and CNS toxicity did not appear. 5) Intrapleural administration of local anesthetics after unilateral upper-abdominal and thoracic surgery provided a satisfactory pain control.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.49-52
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• 2010

A hemothorax usually occur, due to injuries to the intercostal and great vessels, pulmonary damage, and sometimes fractured ribs. We report a case in which the hemothorax that occurred, neither intrathoracic injury nor injury to internal thoracic vessels and organs, via lacerated diaphragmatic and liver laceration due to a right upper part of anterior chest stab injury caused by a sharp object. The patient's general conditions gradually worsened, so chest and abdominal computed tomogram were taken. The abdominal computed tomogram revealed diaphragmatic injuries and bleeding from the lacerated liver. We performed an exploratory laparotomy to control the bleeding from the lacerated liver with simple primary sutures. In addition exploration was performed in the right pleural space through the lacerated diaphragm with a thoracoscopic instrument. There were no bleeding foci in the right pleural space, the vessels, or the lung on the thoracoscopic video. Closure of the lacerated diaphragm was achieved with simple, primary sutures. The postoperative course of the patient was uneventful, and the patient was discharged.

• The Korean Journal of Pain
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• 제9권1호
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• pp.159-165
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• 1996

Background: Epidural analgesia has been widely used for postoperative pain relief. However, it is not known which regimen provides the best result due to many variety. The aim of this study is to evaluate the analgesia and side effects of epidural mixute of fentanyl, bupivacaine and clonidine, as one kind of regimen. Methods: One hundred adult patients scheduled for upper abdominal surgery under general anesthesia were evaluated. Epidural catheterization was done after operation. A bolus, 0.1% bupivacaine 10 ml containing fentanlyl 100 ${\mu}g$, was administered and followed up with continuous infusion of mixture of fntanyl 600 ${\mu}g$, 0.5% bupivacaine 20ml and clonidine 150 ${\mu}g$ at a rate of 2ml/hr for 50 hours. Analgesia was assessed using VAS, PHS and PRS. Side effects and number of patients who took additional analgesics were evalutated. Plasma samples were obtained to determine fentanyl concentration. Results: After the administrations of drugs, patients pain scores decreased notably, and pain relief scores increased significantly. Minimum side effects were noted. Twenty-one patients required additional analgesics. Plasma concentration of fentanyl was 0.07~0.14 ng/ml. Conclusion: Epidural infusion of mixture of fentanyl, bupivacaine and clonidine is an effective regimen for postoperative pain relief after upper abdominal surgery.

• Journal of Trauma and Injury
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• 제28권4호
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• pp.262-265
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• 2015

An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.

• Journal of Trauma and Injury
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• 제26권1호
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• pp.22-25
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• 2013

Severe blunt abdominal trauma frequently involves the liver. The development of nonsurgical treatment of liver trauma has led to more frequent appearance of unusual complications. A hepatic arterioportal fistula (APF) is a rare complication of liver trauma. We present a case of traumatic APF in a patient with liver trauma. A 31-year-old male visited our emergency department with pain in the right upper abdomen following a traffic accident. Initial physical exam and abdominal computed tomography (CT) revealed liver laceration with hemoperitoneum. An abdominal CT obtained on day 11 revealed early opacification of the right portal vein on the arterial phase. After we had come to suspect an APF of the liver, its presence was confirmed on angiography. It was subsequently managed by using transcatheter coil embolization. In patients with portal hypertension and no evidence or history of cirrhosis, one should consider an APF as a potential etiology if history of liver biopsy or penetrating trauma exists. In a patient with liver trauma, serial abdominal CT is important for early detection and treatment of an APF.