• Journal of Chest Surgery
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• 제20권4호
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• pp.839-846
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• 1987

The records of 10 patients with traumatic diaphragmatic hernia seen from November 1977 through July 1987 were reviewed. All the patients had a transdiaphragmatic evisceration of abdominal contents into the thorax. We treated 7 male and 3 female patients ranging in age from 3 to 62 years. In 8 patients, diaphragmatic hernia followed blunt trauma and in 2 patients, stab wounds to the chest. The herniation occurred on the right side in 3 patients and on the left side in 7. All the patients sustained additional injuries: rib fractures [7 patients], additional limb, pelvic and vertebral fractures [6], closed head injury [2], lung laceration [1], liver laceration [1], renal contusion [1], ureteral rupture [1], and splenic rupture [1]. Organs herniated through the diaphragmatic rent included the omentum [6 patients], stomach [4], liver [4], colon [3], small intestine [1], and spleen [1]. For right-sided injuries, the liver was herniated in all 3 patients and the colon, in 1. in the initial or latent phase, dyspnea, diminished breath sounds, bowel sounds in the chest were noted in 4 patients, and in the obstructive phase, nausea, vomiting, and abdominal pain were found in all 3 patients. Two patients had a diagnostic chest radiograph with findings of bowel gas patterns, and an additional 8 had abnormal but nondiagnostic studies. Hemothorax, pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Three patients were operated on during the initial or acute phase [immediately after injury], 4 patients were operated on during the latent or intermediate phase [3 to 210 days], and 3 patients were operated on during the obstructive phase [10 to 290 days]. Six patients underwent thoracotomy, 2 required thoracoabdominal incision, and 2 had combined thoracotomy and laparotomy. Primary suture was used to repair the diaphragmatic hernia in 9 cases. One patient required plastic repair by a Teflon felt. Empyema was the main complication in 2 patients. In 1 patient, the empyema was treated by closed thoracostomy and in 1, by decortication and open drainage. There were no deaths.

• Journal of Chest Surgery
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• 제41권5호
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• pp.651-654
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• 2008

외상에 의해 발생하는 쇄골하동맥의 가성동맥류는 매우 드물다. 10년전 교통사고를 당한 49세 여자환자는 외부병원에서 직장검진시 우연히 발견한 종격동 종양을 진단받고 본원에서 진단 및 치료 목적으로 개흉술을 시행 받았다. 개흉술하에 종괴의 일부분을 박리하던 중 대량 출혈 소견 보여 출혈 부위를 봉합한 후 혈관촬영을 추가로 시행하였다. 좌측 쇄골하동맥 가성동맥류 진단하에 재수술을 시행하여 동맥류를 절제하고 단단문합하였다. 환자는 술 후 특별한 문제없이 술 후 11일째 퇴원하였다.

• Journal of Chest Surgery
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• 제31권12호
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• pp.1243-1246
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• 1998

외상에 의한 기관-기관지 손상은 비교적 드물고 경부 부위를 제외하곤 국내에서는 대부분 둔상에 기인한다. 기관-기관지는 흉부 내에 깊이 있어 비교적 자상에 의한 손상은 적다. 저자들은 제5흉추 우측 옆부위의 자상으로 인한 기정맥과 좌측 주 기관지의 파열 1례를 치험하였다. 환자는 24세 남자로 응급실에서 촬영한 단순 흉부엑스선 사진상 흉부내에 칼이 보였다. 칼은 응급실에서 제거하지 않았다. 환자는 기관지 내시경 검사나 전산화 단층촬영 없이 내원 30분내 수술실로 옮겨 개흉하여 과도을 제거하였다. 사선으로 파열된 기정맥과 좌측 주 기관지를 봉합하였다. 환자는 술 후 14일째 특별한 문제없이 퇴원하였다.

• 대한두개안면성형외과학회지
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• 제19권2호
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• pp.102-107
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• 2018

Background: Nasal fracture and orbital blowout fracture often occur concurrently in cases of midface blunt trauma. Generally, these multiple fractures treatment is surgery, and typically, the nasal bone and orbit are operated on separately. However, we have found that utilizing a transconjunctival approach in patients with concurrent nasal bone fracture and orbital blowout fracture is a useful method. Methods: The participants in the present study included 33 patients who visited the Plastic Surgery outpatient department between March 2014 and March 2017 and underwent surgery for nasal fracture and orbital blowout fracture. We assessed patients' and doctors' satisfaction with surgical outcomes after indirect open reduction via a transconjunctival approach for the treatment of nasal bone fracture with associated orbital blowout fracture. Results: According to the satisfaction scores, both patients and doctors were satisfied with transconjunctival approach. Conclusion: We presented here that our method enables simultaneous operation of nasal fracture accompanied by orbital blowout fracture, rather than treating the two fractures separately, and it allows precise reduction of the nasal fracture by direct visualization of the fracture site without any additional incisions or difficult surgical techniques. Also, by preventing the use of excessive force during reduction, this method can minimize damage to the nasal mucosa, thereby reducing the incidence of nasal bleeding.

• Journal of Yeungnam Medical Science
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• 제32권1호
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• pp.31-34
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• 2015

In Korea, cases of direct insertion of foreign bodies into the rectum are rare in the literature. Most cases of rectal insertion of foreign bodies are associated with sexual acts and psychiatric disorder such as schizophrenia. Objects inserted into the anus are usually blunt and shaped like the male genitalia. The removal method can be varied depending on the size and shape of the foreign object, its anatomical location, and the accompanying complications. In cases wherein attempts to remove the object fail or there are rectal perforation and peritonitis complications, immediate laparotomy may be required in order to prevent serious complications such as sepsis. Here, we report on a case of rectal perforation and peritonitis due to insertion of a foreign body in a middle-aged patient, with a literature review. He inserted a sharp pig backbone in his rectum and he only had depression. The patient underwent a Hartmann's operation as well as psychiatric counseling and treatment. Thus, after removal of foreign bodies, psychiatric counseling and treatment should be carried out in order to prevent similar accidents and to minimize the need for trauma medicine.

• Archives of Plastic Surgery
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• 제35권2호
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• pp.205-207
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• 2008

Purpose: Although muscle hernia has been well described in the lower-extremity, muscle hernias in the upper extremity are extremely rare. As with lower extremity muscle hernias, the forearm muscle hernia may result from forced exertion of strenuous activity or following blunt trauma. The objective of this paper is to report an extraordinary case of forearm muscle hernia after radial forearm sensory tendocutaneous free flap with references. Methods: A 58-year-old male patient received wide excision and radical neck dissection and lower lip reconstruction with radial forearm sensory tendocutaneous free flap for squamous cell cancer on the lower lip. 16 weeks after the operation, he complained of protruding mass on the forearm and the size was increasing. In postoperative 18 weeks, MRI showed herniation of flexor digitorum superficialis. For unaesthetic cause and preventing progress, the authors performed direct fascial closure and Mesh graft. Results: In 12 months after the surgery there was no recurrence and the patient remained symptom-free. Conclusion: Pain on extremity exertion and unaesthetic buldge of forearm due to forearm muscle hernia were the primary indications for surgery which consist of direct closure, fasciotomy, fascia lata onlay graft, fascia lata inlay graft, etc. The authors experienced uncommon forearm muscle hernia after radial forearm free flap and satisfying result of treatment.

• Journal of Chest Surgery
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• 제39권2호
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• pp.162-165
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• 2006

무명동맥에 단독으로 발생하는 동맥류는 드문 질환으로 외상, 감염 또는 동맥경화증에 의해 발생하는 것으로 알려져 있다. 증례는 36세 남자 환자로 16년 전 교통사고의 병력 이외에는 특이한 과거력이 없었으며 신체검사에서 우연히 우상종격동 종양이 발견되어 본원으로 전원되었다. 컴퓨터단층촬영에서 흉골과 경계가 불분명한 5 cm크기의 진성 무명동맥류를 볼 수 있었으며 동맥류의 내부에는 혈전이 관찰되었다 수술은 중등도 이상의 저체온법을 이용하여 체외순환 하에서 Dacron Y-이식편을 사용하여 상행대동맥과 우측 경동맥 및 쇄골하동맥 사이에 우회도관을 연결하였으며 동맥류는 절제하였다. 환자는 수술 후 특별한 합병증 없이 회복되어 퇴원하였고 현재 추적 관찰 중이다.

• Advances in pediatric surgery
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• 제11권2호
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• pp.115-122
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• 2005

Falls from a height are the leading cause of injury and death among urban children. This study describes the incidence, clinical characteristics, and treatment results of children under 15 year of age who fell from a height of more than one meter and were admitted for abdominal injury. The medical records of 585 consecutive patients treated between January 1997 and December 2003 at Ewha Womans University Mokdong Hospital were analyzed retrospectively. The falling heights were 1 to 31.2 meters, and 28 patients(4.8 %) suffered from blunt abdominal trauma. The male to female ratio was 2.1: 1. The median age of the victims was 5.5 years, and the median height fallen was 3 meters. Fifteen patients (53.6 %) were injured during the summer and seventy-nine percent of the falls occurred between noon and 9 pm. Eighteen (64.3 %) of falls occurred in residential place and 19(67.8 %) of patients arrived at the emergency department within 30 minutes of the accident. Only 16 patients (57.1 %) complained of abdominal pain. Liver injuries were found in 12(42.9 %), spleen injuries in 5(17.9 %), kidney injuries 3(10.7 %), pancreatic injuries in 1(3.6 %) and nonspecific abdominal injuries in 9(32.1 %) cases. Increased SGOT and SGPT were found in 23(82.2 %) and 18(64.3 %) cases. Eleven patients (39.3 %) had associated head injuries. Limb injuries were present in 17.9% and thoracic injuries in 7.1%. Twenty-five patients (89.3 %) recovered without operation. The median length of hospital stay was 6 days (2 -20 days). Despite the absence of abdominal symptoms or shock, falls from a height in children may carry significant intra-abdominal organ injuries. The height falling could not predict the degree of the abdominal injury. For the evaluation of potential abdominal injuries, CT scan should be utilized.

• 대한기관식도과학회지
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• 제11권1호
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• pp.15-20
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• 2005

Background : It is well-known that esophageal perforation (EP) is difficult in diagnosis and has high mortality rate despite proper management. There are disputes in regarding the reatment in cases of delayed diagnosis although in the early diagnosed cases, operation is recommended without arguments. Methods: From April, 2001 to December, 2004, nine patients who were diagnosed as EP in our hospital were analyzed retrospectively about the causes, the interval between the cause and the treatment, and operation methods. Results: There were 8 male and one female with men age of 49.3 years (range: 25-67 years). The causes of EP included perforations following operations of corvical spine in three cases, spontaneous perforation(Boehaave syndrome) in two cases, foreign bodies in two cases, operation of esophageal diverticulum in one case and blunt trauma bytraffic accident in one case. Mean interval between the first treatments and the causes was 11.6 days (range: 2-30 days). The sites of perforation were upper third of esophagus in three cases, middle third in three cases and lower third in three cases. All except two cervical cases presented as mediastinitis or empyema at the time of diagnosis. Primary repair and irrigation had been performed in 7 cases but five cases out of them required more than two procedures. Conclusions : More than one procedure wasrequired in the treatment of EP because of contaminations and infections which had been spread at the time of initial manifestatios, howeverprimary closure and massive irrigation is the best method in order to preserve esophagus unless the remaining esophagus is extensively damaged.

• Journal of Chest Surgery
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• 제39권4호
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• pp.340-342
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• 2006

원발성 흉골 골수염은 드문 질환이다. 특히 소아에서 발생한 경우는 매우 드물어 영어로 보고된 문헌에 11예가 보고되었다. 원발성 흉골 골수염은 영양실조, 면역 저하, 흉부 둔상, 정맥을 통한 약물 주사, 낫 세포빈혈증 등의 환자에서 주로 발생하며, 배농 및 항생제 투여로 치료한다. 저자들은 기저질환이 없는 16세 남아에서 발생한 원발성 흉골 골수염 1예를 문헌 고찰과 함께 보고하는 바이다.