• 대한기관식도과학회지
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• 제9권2호
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• pp.69-73
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• 2003

Various flaps are using for reconstruction of esophageal defect. The choice of reconstruction is depended to the oncologic needs of the situation. If the entire esophagus or significant part of the thoracic esophagus is involved by tumor, then total esophagectomy and gastric pull-up or colon transposition is indicated. But for most hypopharyngeal tumors, laryngopharyngeal tumors, and cervical esophageal tumors, segmental resection of these area and replacement with a jejunal fee or forearm free flap has become the standard technique. The authors have experienced a case of total pharyngo-laryngo-esophago-gastrectomy and colon transposition in a patient of esophageal cancer following partial esophagectomy and gastic pull-up due to corrosive esophageal stricture. We report this case with brief review of the literatures.

• Journal of Chest Surgery
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• 제28권11호
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• pp.1032-1037
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• 1995

Between September 1988 and December 1993, 32 cases of benign esophageal stricture, of which 12 males and 20 females, were managed in Seoul National University Hospital hospital. Their age ranged from 2 to 61 years, and the mean age was 33.9 years. The ingestion of caustic agent was the most common cause, and the caustic material was acid in 16 patients [58% and alkali in 11patients [39% . Nearly all of the patients complained of dysphagia, and some of chest pain, epigastric pain, weight loss, vomiting, general malaise, and dyspnea. The most frequent site of stricture was found in the upper thoracic esophagus with 34% incidence followed by the lower thoracic esophagus[28% , whole esophagus[19% , and the mid esophagus[16% . The operations performed were 17[53% ECG[esophagocologastrostomy , 5[16% PCG[pharyngocologastrostomy , 5[16% EG[esophagogastrostomy , 2 EJG [esophagojejunogastrostormy by free jejunal graft , and 1 case each of EJ [esophagojejunostomy , esophageal end to end anastomosis, jejunostomy only, and gastrostomy only. In 23 patients [72% , diseased esophaguses were resected, using transhiatal total esophagectomy in 15 [47% and transthoracic partial esophagectomy in 8 [25% . Of those 23 patients, 3 patients [9.4% were diagnosed as esophageal carsinoma on microscopic examination. The postoperative most common complications were unilateral vocal cord palsy in 6 patients [19% , followed by cervical anastomosis leakage in 4 patients [12.5% , wound infection in 2 patients [6% , and pneumothorax in 2 patients [6% . Late death occurred 8 months after the operation in one patient, which was associated with infection due to anastomotic leakage. Our experience shows that the rate of mortality and the morbidity were low in patients receiving surgical management for esophageal stricture and that the cancer transformation rate was high. We recommend esophageal reconstruction surgery with esophagectomy [transhiatal or transthoracic for the esophageal stricture because it can avoid a chance of prevent cancer transformation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제19권1호
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• pp.71-75
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• 2016

Esophageal candidiasis is commonly seen in immunocompromised patients; however, candida esophagitis induced stricture is a very rare complication. We report the first case of esophageal stricture secondary to candidiasis in a glycogen storage disease (GSD) 1b child. The patient was diagnosed with GSD type 1b by liver biopsy. No mutation was found in the G6PC gene, but SLC37A4 gene sequencing revealed a compound heterozygous mutation (p.R28H and p.W107X, which was a novel mutation). The patient's absolute neutrophil count was continuously under $1,000/{\mu}L$ when he was over 6 years of age. He was admitted frequently for recurrent fever and infection, and frequently received intravenous antibiotics, antifungal agents. He complained of persistent dysphagia beginning at age 7 years. Esophageal stricture and multiple whitish patches were observed by endoscopy and endoscopic biopsy revealed numerous fungal hyphae consistent with candida esophagitis. He received esophageal balloon dilatation four times, and his symptoms improved.

• Journal of Chest Surgery
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• 제28권1호
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• pp.85-89
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• 1995

The early esophgeal carcinoma is limited to the mucosa or submucosa without lymph node metastsis which shows good 5-years survival rate. It is nearly 85-90% nowadays,if we just find and manage it.It is really helpful to use the endoscope in management and diagnosis, in addition the biopsy under the endoscopic finding.We experienced one case of early esophageal carcinoma. The patient was 57years old female,who ingested lye 27years ago for suicidal attempt, after 10years, the dysphagia was aggravated slowly. Before admission dysphagia was severely aggravated during 2months. Confirmation of diagnosis was made by endoscopic biopsy.Operation method was substernal colon bypass and total esophagectomy through right thoracotomy. Postoperative course was smooth.We report early esophgeal carcinoma related to lye stricture that was detected by the method of endoscopic examination and biopsy. It is important to screen the patients with longstanding history of benign esophageal stricture by the endoscopic biopsy.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
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• pp.13.1-13
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• 1983

음식물괴에 의한 갑작스런 식도폐쇄는 아주 드문 현상은 아니다. 주로 고령자나 치아의 결손이 있어 불충분한 저작후 큰 덩어리를 무리하게 삼켜 잘 일어난다. 대개는 해부학적 이상이 있는 사람에게서 일어나며 정상적인 식도를 가진 사람에서도 드물게 일어난다. 그러나 가장 흔한 원인중의 하나는 식도부식 등의 기왕력이 있은 후 이차적으로 생긴 식도협착증 이라고 할 수 있으므로 음식물괴에 의한 식도이물의 경우 기왕력을 확인하는 것이 무엇보다도 중요하다고 하겠다. 저자들은 최근 식도협착이 있는 58세 된 남자 환자에게서 10일 동안에 연거퍼 2회의 음식물괴에 의한 식도이물례를 경험하였기에 보고하는 바이다.

• Advances in pediatric surgery
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• 제3권1호
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• pp.47-53
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• 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.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1982년도 제16차 학술대회연제순서 및 초록
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• pp.5.2-5
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• 1982

생활수준 및 사회환경의 개선에 힘입어 부식성 약물인 식초, 염산, 쥐약및 농약으로 인한 식도 부식증은 현저히 감소되었다. 식도부식증으로 초래된 합병증인 식도 협착은 즉각적인 응급처치 및 입원치료로 그 발생빈도가 현저히 감소되었으나, 아직도 의사의 부적절한 치료 및 부주의, 환자 및 보호자의 비협조로 가끔 식도 협착을 만나게 된다. 고도의 식도 협착증 환자 7례중 18∼51 French Sippy esophaglal dilating bougie로 식도확장이 가능했던 6 례와 전식도부 협착으로 흉부외과로 전과된 1 례을 경험하였기에 보고하는 바이다. 증례 1 : 23세된 가정주부로 자살목적으로 염산을 섭취후 2개월후, 연하곤란으로 위루술 시행후 즉시 내원하여 제 1 생리적 협착부 확장이 가능했던 예. 증례 2 : 51세 남자로 가성소다를 오연하여, 2개월후 제 2 및 제 3 생리적 협착부 협착증을 일으켰는데, 성공적으로 확장이 가능했던 예. 증례 3 : 43세 남자로 빙초산을 술로 오연하여 부적절한 치료로 제 3 생리적 협착부에 협착을 일으켜 내원하여, 부지술로 식도 확장을 시도하고 있는 1예. 증례 4 : 58세된 여자로 염산쥐약을 섭취후 제 1 생리적 협착부 및 유문부 협착으로 위십이지장 문합술을 시행하여 2개월후에 내원하여 식도 확장이 성공한 예. 증례 5 : 47세 여자로 내원 4개월전 자살목적으로 염산을 섭취후 Tube 삽관을 1달 가량 하였으나, 제 1 및 3 생리적 협착부에 식도 협착이 와서 치료중인 예. 증례 6 : 21세 남자 운동선수로 14 개월간 3일에 2숟갈씩 뼈를 부드럽게 하기위해 빙초산을 섭취하여 연하곤란으로 일반 외과적 수술을 시행후 내원하여, 식도 엑스선촬영상 전식도부 폐색을 보여 흉부외과로 전과 시킨 예. 증례 7 : 3살된 여하로 가성소다를 오연해 전식도 부협착으로 전신마취하에 16개월간식도 부지법으로 확장중 식도 하부 천공이 생겨 치유시킨 예.l(20mg/kg)을 정맥마취 시킨후 수술현미경하에서 고막천공을 시켜 중이강점막에서 도말표본과 세균배양을 시행하였으며 실험군은 마취후 앙와위로 하고 연구개 정중선 부위에 약1 cm 정도로 종절개하여 이관의 인두측 개구부를 노출시킨 다음 2 $\times$ 3 $\times$ 2 mm의 silastic piece 2개와 이어서 2 $\times$ 3 $\times$ 2 mm의 Gel_foam (absorbable gelatine sponge) piece 2개를 이관내로 보충삽입시키고 전기소작하여 완전폐쇄시킨 후에 연구개를 봉합하여 삼출성중이염 유발을 시도하였다. 또한 술후 창상감염을 방지하기 위하여 앰피실린(100mg/kg)을 2일간 근육 주사 하였으며 술후 12시간, 18시간, 1 일, 3 일, 5 일, 7 일, 10일, 30 일 및 60 일에 각각 3마리 (6이)씩 수술현미경 하에서 고막을 절개하여 삼출액의 형성 시기를 관찰하고, 삼출액이 형성된 경우에는 도말표본을 통한 세포학적 분석과 세균배양을 하였으며 시기별로 중이강 점막의 수술현미경 및 광학현미경적 변화를 관찰하여 다음과 같은 결과를 얻었기에 문헌고찰과 함께 보고하는 바이다. 1) 이관폐쇄술후 18시간에 최초로 삼출액이 확인되었으며 그 이후는 전실험군에서 삼출성중이염이 유발되다. 2) 도말표본의 세포학적 검사에서 호산구는 전혀 발견되지 않았으며 초기에는 호중구가 주종을 이루었으나 제14 일이후에는 단핵구가 증가하는 경향을 보였다. 3) 삼출액의 세균배양검사에서는 전예에서 세균이 배양되지 않았다. 4) 수술현미경적 소견은 이관폐쇄 후 제 14 일에 점막비후가 가장 심하였으며 삼출액의 양도 가장 많았다. 5) 중이강점막의 병리학적 소견에서는 상피세포, 배세포 및 혈관의 증식과 염증세포의 침윤이 관찰되었으며 특히 염증세포는 도말표본에서와 같이 제 14 일 이

• Journal of Chest Surgery
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• 제25권2호
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• pp.183-187
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• 1992

Reconstructive surgery for corrosive esophageal stricture was performed in 392 patients at National Medical Center from 1959 to 1990 Between Jan. 1971 and Dec. 1990, 23 cases were experienced stenotic anastoma of neck after reconstructive surgery for corrosive esophageal stricture. The major procedure of esophageal reconstruction was colon interposition without resection of the strictured esophagus except jejunal interposition in 1 case. There were 12 males % 11 females, and mean age was forty years. The caustic materials were 16[70%] alkali and 7[30%] acid. Half of the cases had hypopharyngeal injury. After reconstructed surgery, dysphagia was developed immediate in 65%, from 2 months to 5 months in 31%, and from years in 4%[1 case]. The complications were anastomatic leakage in 13 cases, anastomatic stenosis in 8 cases, graft gangrene in 1 case, and cancer development in 1 case. The therapeutic procedures were end-to-end anstomolis & partial resection of stenotic anastoma in 18 cases, bourgination in 2 cases, and coin interposition with graft removal in 3 cases. The therapeutic results were excellent in 16 cases, mild discomfort in 3 cases, poor in 3 cases, and death in 1 cases.

• 대한임상독성학회지
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• 제7권1호
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• pp.32-37
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• 2009

Formic acid or formate is a common industrial compound used in the production of ensilage, disinfectants, decalcifying agents and mainly as a precursor in industrial chemical synthesis. It is also a well-known toxic metabolite produced in methanol poisoning. Thus, formate is a potential source of both accidental and deliberate poisoning. Very few reports have been published thus far, on the toxicology of direct formic acid poisoning. Here, we report a case of a 74-year-old man without a history of depression, who ingested about 30 gm of formic acid. The patient presented with profound high anion gap metabolic acidosis, acute renal failure and esophageal stricture. The patient was successfully treated with hemodialysis and supportive measures. But permanent esophageal stricture was complicated by formic acid burns in the gastrointestinal tract. We discuss the pathophysiology and treatment of this case.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1976년도 제10차 학술대회연제 순서 및 초록
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• pp.90.2-90
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• 1976

부식제에 의한 식도부식증은 한기의 적절한 치료로써 식도협착증의 발생을 방지할 수 있다. 그러나 부적절한 치료등으로 부득이 기되는 식도협착증의 치료방법으로는 경구적 카테테르법, 인도사법, 무단소식자법, 역행소식자법 등과 같이 각종 boogie를 사용하는 법과 수술적인 요법 등이 사용되고 있다. 저자들은 부식제에 의해 발생한 심한 협착증을 경구적 카테테르법으로 치료에 실패한 환자를 영양섭취를 위한 위루경형성술과 함께 무단소식자법에 의하여 치료에 성공한 2예를 보고하는 바이다.