• Advances in pediatric surgery
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• v.7 no.2
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• pp.126-129
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• 2001

Childhood intussusception is usually idiopathic, and pathological lesions as the leading point are found in limited cases. Sixteen operative cases with leadpoints among 2,889 cases of childhood intussusecption treated at the surgical departments of the affiliated hospitals of Catholic University over 19 years are reviewed. The approximate incidence of pathological lesions as the leading point was 0.6%. The male to female ratio was 2:1. The mean age was 3.5 years. There was not an age preponderance. The symptoms were vomiting(63%), abdominal pain(38%), irritability(38%), bloody stools(25%), fever(25%) and abdominal mass(6%). The average duration of the symptoms was 2.4 days(1-10days). The most common lesion was Meckel's diverticulum, followed by malignant lymphomas, polyps, ectopic pancreas, and cecal duplication. An ileocolic type was most frequent, followed by ileoileocolic and ileoileal. Segmental resection or wedge resection of the ileum was done in 10 cases, ileocecectomy in 3, and right hemicolectomy in 3. Surgical reduction was done only in an ectopic pancreas, with no later recurrence. The average hospital stay was 10 days. Postoperative adhesive ileus occurred in two cases, and in one of them adhesiolysis was performed. One case of malignant lymphoma died at 28 days after surgery due to chemotherapy related complication.

• Advances in pediatric surgery
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• v.17 no.1
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• pp.23-34
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• 2011

We analyzed the clinical characteristics and outcome of ileocecal and small bowel intussusceptions (ICI and SBI) in the pediatric patients. From August 2003 to July 2010, 144 children with intussusception were included in this study. We retrospectively reviewed the clinical records and Imaging study findings. A total of 86 children with ICI and 58 children with SBI were diagnosed. Children with SBI were older than ICI ($36.6{\pm}24.6$ months vs. $24.2{\pm}21.6$ months, p=0.002). Typical symptoms such as irritability, abdominal mass, bloody stool were more frequent in ICI than SBI (p<0.05) patients. In the ICI group, intussusceptums were reduced with air reduction (84.5%), surgery (17.4%), and spontaneity (1.2%). All patients in the SBI group were reduced spontaneously. SBI occurred in older age and was reduced spontaneously more frequently than ICI. Conservative management with close observation with follow-up by ultrasonography is recommended for SBI.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.1
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• pp.75-80
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• 2010

Intestinal duplication cysts are characterized by the attachment to some part of the gastrointestinal tract with which a blood supply is shared, and have an epithelial lining resembling some part of the alimentary tract. A 15-month-old female was admitted to our hospital with cyclic irritability, vomiting, and blood-tinged stool. The results of an ultrasound showed an ileocolic intussusception and a 1.3 cm cystic mass had double-wall sign and a Y-configuration with an adjacent ileal loop. She had a past history of two ileocolic intussusceptions. The cystic mass was considered to be a pathologic lead point, so resection and end-to-end anastomosis was performed. The gross and histologic evaluation of the specimen demonstrated a $2.4{\times}2.4$ cm cystic mass containing yellow mucoid fluid and the cyst wall was lined with intestinal and gastric mucosa and enclosed by a layer of muscle, which was shared with the adjacent ileum.

• Advances in pediatric surgery
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• v.16 no.2
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• pp.108-116
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• 2010

Air reduction is a safe, effective, and fast initial treatment for pediatric intussusception. There is low dose radiation exposure. Factors affecting outcomes of air reduction were analyzed by reviewing the clinical features and results of treatment. A total of 399 out of 485 patients with pediatric intussusceptions were treated at the Seoul National University Children's Hospital from 1996 to 2009. All of the patients received air reduction as the first line of treatment. Clinical features such as gender, age, seasonal variation, symptoms, signs, types, pathologic leading point, and treatment results including success rate, complication, recurrence, NPO time, and duration of hospitalization were reviewed. The Pearson chi-square, student T-, and logistic regression tests were used for statistical analysis. P-value less than 0.05 was considered to be statistically significant. The prevalent clinical features were: male (65.4 %), under one-year of age (40.3 %), ileocolic type (71.9 %), abdominal pain (85.4 %), and accompanying mesentery lymph node enlargement (2.2 %). The overall success rate for air reduction was 78.4 % (313 of 399 patients), and the perforation rate during reduction was 1.5 %. There were 23 recurrent cases over 21.6 months. All were successfully treated with re-do air reduction. Reduction failures had longer overall NPO times (27.067hrs vs. 43.0588hrs; p=0.000) and hospitalization durations (1.738d vs. 6.975d; p=0.000) compared to the successful cases. The factors affecting success rates were fever (p=0.002), abdominal distension (p=0.000), lethargy (p=0.000) and symptom duration (p=0.000) on univariate analysis. Failure rates were higher in patients with symptom durations greater than 24 hours (p=0.023), and lethargy (p=0.003) on multivariate analysis. Air reduction showed high success rates and excellent treatment outcomes as the initial treatment for pediatric intussusception in this study. Symptom duration and lethargy were significantly associated with reduced success rates.

• Advances in pediatric surgery
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• v.14 no.2
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• pp.125-133
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• 2008

To evaluate the long-term prognosis of biliary atresia after Kasai operation, a total of 14 patients (of the 41 patients operated upon from 1982 to 1997), who had been followed up for more than 10 years, were included in this retrospective study. Eleven out of 14 patients survived with their native livers, and their data analyzed for age at operation, clearing time of jaundice, histological outcome, postoperative complications, effectiveness after the application of an intussusception anti-reflex valve, and quality of life. Average age at surgery was 62.8 days. Serum bilirubin was normalized within three months in all patients. Six among the eleven long-term survivors had ascending cholangitis as one of the postoperative complications. The application of an intussusception anti-reflux valve did not show any statistical significance in long-term survival. Most of long-term survivors appeared to enjoy good quality of life. Kasai operation might not be the definitive treatment for biliary atresia; however, Kasai operation made it possible to achieve long-term survival for patients with biliary atresia when the patients were detected and treated as early as possible.

• Journal of Veterinary Clinics
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• v.39 no.5
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• pp.253-257
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• 2022

A 5-year-old castrated male Golden Retriever dog weighing 15 kg presented with evidence of intestinal intussusception. The patient had cachexia and severe dehydration before being referred to our department. Ultrasound imaging revealed a target sign indicative of intestinal intussusception. Emergency surgery was performed shortly after diagnosis. After a successful surgery, the patient was hospitalised for postoperative care. Initial treatment was aimed at the reversion of dehydration and the provision of adequate nutrition. Fluid therapy and central parenteral nutrition were administered via the peripheral and central venous catheters, respectively. Ten days postoperatively, swelling and edema were observed in the head and neck. Ultrasound and computed tomography confirmed complete blockage of the cranial vena cava due to thrombosis, which consequently obstructed both the left and right jugular veins. For treatment, dalteparin and tissue plasminogen activator were administered. However, the patient lost all of its vital function on the daybreak of postoperative day 11. Venous thrombus formation secondary to central parenteral nutrition application via the central line is a rare but possible complication. Veterinarians who are concerned about taking care of patients receiving CPN through the central line should keep the possibility of venous thrombus formation in mind.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.163-170
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• 2009

Purpose: Intussusception is the most common cause of intestinal obstruction in young children. Although intussusceptions are easily treated, some intussusceptions with or without a pathologic lead point (PLP) often recur. In this study, we analyzed the clinical characteristics and prognosis of recurrent intussusceptions (RI), the frequency of the PLP, and correlation between RI with PLP. Methods: The medical records of 144 patients, among 590 patients with intussusceptions who had been admitted to the Department of Pediatrics and Pediatric Surgery of Dankook University Hospital between May 1994 and June 2009 were reviewed retrospectively. Results: The overall recurrence rate of intussusceptions in this study was 9.2%. The mean interval between the initial occurrence and the first recurrent attack was 130${\pm}$175 days (range, 12 hours to 3 years). There was no statistically significant difference in the recurrence rate among patients who underwent air, barium, and manual reduction (p=0.131). Eighty-seven cases (92.6%) of RI had a successful reduction by the use of non-operative techniques. A PLP was present in 18 patients (3.0%). The most common PLP was intestinal lymphoid hyperplasia, followed by Meckel's diverticulum, duplication cyst, intestinal polyp, and adenomyoma. The mean number of intussusceptions was 4.7${\pm}$1.9 in 7 patients with PLP, which was significantly higher than (2.4${\pm}$0.9) patients without a PLP (p=0.023). The mean duration of recurrences was 17.4${\pm}$19.8 months (range, 2 days to 72 months). Conclusion: A careful search for a PLP should be performed to prevent recurrence of intussusception, especially when intussusception has recurred more than three times.

• Advances in pediatric surgery
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• v.16 no.2
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• pp.117-125
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• 2010

Unreduced small bowel intussusception requires operative treatment although the rate of spontaneous reduction is 60 to 70 %. The aim of this study is to compare clinical characteristics and outcome between spontaneous reduction and operation group and to analyze factors related to decisions to treat small bowel intussusceptions. The records of 25 patients with small bowel intussusceptions treated in Seoul National University Children's Hospital from January 1999 to August 2009 were reviewed respectively. Spontaneous reduction group (n=12, 48 %) had signs and symptoms of vomiting, abdominal pain, currant jelly stool, abdominal distension, fever, increased CRP but no rebound tenderness. One of them had been diagnosed with Henoch-Schonlein purpura and no one displayed pathologic leading point by image study. Operation group (n=13, 52 %) consisted of patients who had primary surgery. Their signs and symptoms were similar to spontaneous reduction group. Seven of them had underlying diseases such as Crohn' disease, ALL, Lymphoma, Peutz-Jeghers syndrome (n=3), post-transplanted state of liver and 2 of them displayed Peutz-Jeghers polyp and Meckel's diverticulum as pathologic leading point by preoperative ultrasonography. Mean relieve interval (interval between onset of symptoms and reduction/operation) was 1.78 days in spontaneous reduction group and 2.25 days in operation group (p=0.341). Seven of operation group had manual reduction and 6 out of 7 received segmental resection of the small bowel. No one of them underwent manual reduction and all of them underwent segmental resection were found to have pathologic leading points [Peutz-Jeghers polyp (n=3), Meckel's diverticulum (n=2), lymphoma (n=1)] during operation. In conclusion, 48% of small bowel intussusceptions resolved spontaneously. Patients' symptoms and relieve intervals were not related to the operative decisions. We therefore recommend significant factors for determining treatment plan such as change of clinical symptoms, underlying disease or pathologic leading point by imaging.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.1
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• pp.76-80
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• 2005

Peutz-Jeghers syndrome is an autosomal dominant inherited syndrome characterized by mucocutaneous pigmentation and gastrointestinal hamartomatous polyps. The most important complications that increase morbidity are intussusception, bleeding and obstruction. Most patients with Peutz-Jeghers syndrome may undergo multiple laparotomies for complications such as intussusception or bleeding every 2 to 3 years during adolescence and early adulthood. To decrease the relaparotomy rate, intraoperative endoscopy may be useful in the treatment of complications that are related to Peutz-Jeghers syndrome. Use of intraoperative endoscopy can lead to a healthier life and to a longer life expectancy for the patient. We describe a case of Peutz-Jeghers syndrome, who underwent polypectomy by total gut endoscopy in an 11-year-old girl presented with intestinal obstruction and anemia. During the course of the operation, the endoscope was inserted per the enterostomy and colostomy sites, and 16 polyps in the small and large intestine were removed endoscopically using a snare.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.2
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• pp.110-115
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• 2008

Purpose: Intussusceptions are one of the most common causes of intestinal obstruction in infants and young children. Although it is easily treated by non-operative reduction using barium, water or air, this treatment is very stressful for young patients and may cause bowel perforation, peritonitis and shock. In this study, we identified the risk factors associated with the failure of non-operative reduction, to identify a group of children that would benefit from the procedure and those who would not. Methods: We reviewed the medical records of patients with intussusception who were treated at the Korea University Medical Center Ansan hospital from March 1998 to July 2006. Three hundred fourteen children with intussusception were identified. Among them, non-operative reductions were performed in three hundred. Clinical and radiological variables were compared according to the failure or success of the non-operative reduction. Results: Non-operative reductions were successful in 243 (81%) and failed in 57 (19%). The group that had failed procedures had a younger age (12.3${\pm}$17.2 months vs. 18.0${\pm}$15.8 months, p=0.03), longer symptom duration before reduction (33.6${\pm}$29.0 hr vs. 21.5${\pm}$20.3 hr, p<0.01), more vomiting and lethargy (p<0.01), but less abdominal pain and irritability (p<0.01), compared with the group that had a successful procedure. Logistic regression analysis showed that the factors associated with the failure of non-operative reductions were a younger age, less than 6 months of age (odds ratio: 2.5, 95% confidence interval: 1.2~5.2, p=0.01), duration of symptoms, longer than 24 hrs before reduction (odds ratio: 2.1, 95% confidence interval: 1.2~4.2, p=0.03), bloody stool (odds ratio: 4.8, 95% confidence interval: 1.9~12.2, p<0.01), lethargy (odds ratio: 3.4, 95% confidence interval: 1.1~10.4, p=0.04), and abdominal pain or irritability (odds ratio: 0.2, 95% confidence interval: 0.1~0.4, p<0.01). Conclusion: For children with intussusception, an age younger than 6 months, and duration of symptoms more than 24 hrs before reduction, as well as the presence of bloody stools, lethargy and abdominal pain or irritability were variables associated with failure of a non-operative reduction. Knowledge of these variables should be considered in making clinical decisions for therapeutic interventions.