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Rectal Perforation Caused by Anal Stricture After Hemorrhoid Treatment
서용준,하헌균,오흥권,신루미,정승용,박규주 대한대장항문학회 2013 Annals of Coloproctolgy Vol.29 No.1
Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5°C. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation.
Omental Torsion and Infarction Secondary to Omental Hernia in the Right Inguinal Canal
이유현,임재훈,하헌균 대한영상의학회 2020 대한영상의학회지 Vol.81 No.4
Omental torsion secondary to inguinal hernia has rarely been reported as a cause of acute abdominal pain. However, in our case, omental infarction due to prolonged inguinal hernia-associated omental torsion led to the formation of a large omental mass with marginal fibrosis, and the patient presented with chronic abdominal pain. A 74-year-old man presented with complaints of lower abdominal pain for 1 month; subsequently, bilateral inguinal hernias were identified through inguinal ultrasonography. CT scans revealed that the greater omentum was trapped within the right inguinal canal, leading to omental torsion. The greater omentum, distal to the pedicle, appeared as a 30 cm-sized oblong fibrofatty mass in the right lower abdomen and pelvic cavity. Laparoscopic omentectomy with hernia repair was successfully performed.
만성 편측 장골동맥 폐색 환자에서 대퇴동맥-대퇴동맥 우회로조성술 시 혈관성형술의 의의
강석형,천영덕,민연기,하헌균,전재영,김남렬,송태진,이재복,정석인,김윤환,최상용,황정웅 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1
Purpose: The purpose of this article is to analysis the results of combined agioplasity and femorofemoral bypass in patients with unilateral iliac arterial occlusive disease. Method: During the 11-year period from 1990 to 2000, 44 patients with iliac artery occlusion and a hemodynamically significant contralateral iliac artery stenosis were treated by using a combination of percutaneous transluminal femoral bypass (n=14) at Korea university medical center. PTA was performed if the lesions in the donor iliac artery were less than 3 ??㎝ in length with in more than one well-localized lesion in either the common or external iliac artery, or both. Stent was deployed for suboptimal PTAs. The femorofermoral bypass was done within 3 to 5 days after PTA or stenting. Result: The mean age was 61.2 years. The Indications of fermorofermoral bypass were hypertension, ischemic heart disease, chronic obstructive lung disease, old age (>75), cancer, and previous abdominal operation, The complication rate of the combination treatment was lower than that of the others. Primary patency rate at 1 and 3 years were 89%, 78% for aortobifemoral bypass, 83%, 66% for iliofemoral bypass, and 77%, 65% for femorofemoral bypass, respectively. Conclusion: The combination of PTA with or without stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis in patients with severe comorbid illness, advanced age, and intra-abdominal pathology. Angioplasity can allow more widespread use of femorofemoral pypass in these patients.
Rectourethral Fistula: Systemic Review of and Experiences With Various Surgical Treatment Methods
최지혜,전병건,최상지,한언철,하헌균,오흥권,최은경,문상희,유승범,박규주 대한대장항문학회 2014 Annals of Coloproctolgy Vol.30 No.1
Purpose: A rectourethral fistula (RUF) is an uncommon complication resulting from surgery, radiation or trauma. Although various surgical procedures for the treatment of an RUF have been described, none has gained acceptance as the procedure of choice. The aim of this study was to review our experience with surgical management of RUF. Methods: The outcomes of 6 male patients (mean age, 51 years) with an RUF who were operated on by a single surgeon between May 2005 and July 2012 were assessed. Results: The causes of the RUF were iatrogenic in four cases (two after radiation therapy for rectal cancer, one after brachytherapy for prostate cancer, and one after surgery for a bladder stone) and traumatic in two cases. Fecal diversion was the initial treatment in five patients. In one patient, fecal diversion was performed simultaneously with definitive repair. Four patients underwent staged repair after a mean of 12 months. Rectal advancement flaps were done for simple, small fistula (n = 2), and flap interpositions (gracilis muscle flap, n = 2; omental flap, n = 1) were done for complex or recurrent fistulae. Urinary strictures and incontinence were observed in patients after gracilis muscle flap interposition, but they were resolved with simple treatments. The mean follow-up period was 28 months, and closure of the fistula was achieved in all five patients (100%) who underwent definitive repairs. The fistula persisted in one patient who refused further definitive surgery after receiving only a fecal diversion. Conclusion: Depending on the severity and the recurrence status of RUF, a relatively simple rectal advancement flap repair or a more complex gracilis muscle or omental flap interposition can be used to achieve closure of the fistula.