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장정진(Jung Jin Jang),홍성일(Sung Il Hong),김해성(Hae Sung Kim),이정훈(Jung Hoon Lee),김한준(Han Joon Kim),전장용(Jang Yeong Jeon),류병윤(Byoung Yoon Ryu),김홍기(Hong Ki Kim),최영희(Young Hee Choi) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.6
Purpose: Traumatic duodenal injury is rare. There is no consensus on what type of repair should be performed for duodenal perforations with respect to their varying severity. As a result, surgeons are confronted with the dilemma of choosing between several diagnostic tests and many surgical procedures. In this study, we report our experience with treating traumatic duodenal injury and also offer a review of the literature. Methods: Seventeen patients with duodenal injury following abdominal trauma were treated by several methods between January 1992 and October 2006. Based on review of the medical records, we classified the patients as having grade I through V duodenal injury using the scale constructed by the American Association for the Surgery of Trauma (AAST). We also noted clinical features, operative management, and outcome. Results: Among 17 patients, one patient who had a duodenal intramural hematoma was treated by conservative management. Seven patients were treated by duodenojejunostomy, with only one complication. The remaining 9 patients underwent various operations, including primary closure alone (n=3), primary closure with jejunal patch (n=1), primary closure with duodenostomy (n=3), and pancreaticoduodenectomy (n=2). The complication rate among patients who underwent surgery within 24 hours after injury was 1 case among 13. However, complications occurred in all 4 surgical cases undertaken more than 24 hours after injury. Conclusion: Early diagnosis (within 24 hours) and thorough inspection during exploration provide the best means toward reducing complications associated with traumatic duodenal injury.
장정진(Jung Jin Jang),김해성(Hae Sung Kim),김태화(Tae Hwa Kim),이정훈(Jung Hun Lee),김한준(Han Joon Kim),전장용(Jang Yeong Jeon),류병윤(Byoung Yoon Ryu),김홍기(Hong Ki Kim),남궁숙(Sook Kung Nam),이경화(Kyung Hwa Lee),최경찬(Kyung Cha 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.3
Gastrointestinal duplication is a rare congenital anomaly which can occur anywhere along the digestive tract. The most common site is the mesenteric border of the terminal ileum. Intestinal duplication usually becomes symptomatic early in life with the severity of symptoms depending on the location and type of mucosal lining. Ectopic gastric mucosa is an associated possibility. Gastrointestinal hemorrhage is the most serious complication, which can cause severe anemia and shock. Another complication, although rare, is carcinoma in a duplicate cyst. We experienced an unusual case of a 12-years-old girl who presented with intermittent abdominal pain and hematochezia. There was no abnormality on Meckel’s scan. Abdominal CT revealed a cystic mass in the pelvic cavity and subsequent transabdominal ultrasound showed the double-layered wall of the duplication. We performed laparoscopy-assisted, segmental resection of the ileum. The patient was discharged without any complication on the 7th postoperative day.
김병섭(Byung Seup Kim),임영아(Yong-Ah Lim),장경미(Kyung Mi Jang),김인규(In-Gyu Kim),전장용(Jang Yeong Jeon) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.5
Internal abdominal hernia is an unusual cause of intestinal obstruction. Paraduodenal hernia is relatively rare congenital malformations resulting from incomplete rotation of the midgut with entrapment of the small intestine beneath the developing colon. We report a case of paraduodenal hernia treated by laparoscopic approach. The patient was a 45-year-old man presenting with severe abdominal pain for 5 hours. Left paraduodenal hernia with jejunum hernia containing jejunal loops showed in abdominal CT. At operation, herniation of the small intestine into a retroperitoneal space through a defect on the left mesocolon was noted. After the herniated bowel was fully reduced, the hernia orifice was closed intra-corporeally in the manner of interrupted sutures with absorbable suture materials. The patient was discharged home without any serious complications on postoperative day 9. Conclusively, we think laparoscopic surgery in left paraduodenal hernia is feasible.
내장 역위증(Situs Inversus)을 동반한 말기 간경변 환자에게 시행된 뇌사자 전간이식
주선형(Sun Hyung Joo),박상훈(Sang Hoon Park),장명국(Myung Kook Jang),김한준(Han Jun Kim),김인규(In Kyu Kim),전장용(Jang Yeong Jeon),전성은(Sung Eun Jeon),이삼열(Samuel Lee),김주섭(Joo Seop Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.5
Situs inversus refers to a mirror image of the viscera, while situs solitus is defined as the normal anatomical situation. Several cases of successful liver transplantation for situs inversus recipients have been reported, and modifications of the standard surgical techniques were used. We report here on a case of cadaveric liver transplantation in an end-stage liver disease patient with situs inversus. The donor liver was rotated clockwise 90 degrees to the left with the right lobe lying in the left upper quadrant and the left lobe pointing down into the left iliac fossa. The donor’s suprahepatic vena cava was oversewn and the infrahepatic vena cava anastomosed end to side to the recipient’s inferior vena cava. The postoperative course was good until the postoperative 26th day, when rupture of a hepatic artery pseudoaneurysm occurred. An emergency laparotomy was done and the hepatic artery was ligated. Despite the hepatic artery ligation, the liver function recovered quite well. But sudden intracranial hemorrhage developed on the postoperative 28th day and sadly, the patient expired on the postoperative 30th day. Complete preoperative evaluation of the recipient is essential for the operative planning, and careful donor selection should be attempted to obtain a smaller graft to allow maximum flexibility for placing the donor liver. The use of a reduced-sized graft should be considered in the case for which a smaller graft is not available. In conclusion, adult situs inversus is no longer a contraindication for a liver transplant, although technical difficulties do exist for this procedure.