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윤기호,양현웅,박세영,유영욱,나승연,이영우,차상우 대한소화기내시경학회 2011 Clinical Endoscopy Vol.43 No.1
바륨충수염은 바륨을 사용한 장 조영술 후 바륨이 충수에 정체되어 발생하는 드문 합병증이다. 발병기전이 분명치는 않으나 배출이 지연된 바륨이 충수에서 대변과 함께 바륨대변돌을 형성하여 이것이 충수의 폐색을 유발해 염증을 일으키는 것으로 알려져 있다. 19세 남자환자가 발열과 우하복부 통증을 주소로 내원하였다. 2주 전 그는 흑색변을 주소로 내원했었고 위내시경과 대장내시경을 시행했으나 출혈 병변이 관찰되지 않아 소장출혈 병변을 확인하기 위해 바륨을 사용한 소장조영술을 시행하였다. 환자는 소장조영술 2주 후에 발열과 우하복부 통증을 호소하였고, 복부 단순 촬영에서는 바륨이 정체되 밝게 조영되는 충수를 확인할 수 있었다. 다음으로 복부 전산화 단층촬영을 시행했고 바륨으로 채워져 늘어난 충수를 확인할 수 있었다. 그는 바륨 정체에 의해 유발된 급성충수염이 진단되어 충수절제술을 시행했으며 합병증 없이 호전되어 수술 12일 후 퇴원하였다. Barium appendicitis is a rare complication that occurs due to barium retention in the appendix after a barium study. It is believed that retained barium in the appendix forms a barium-coated fecalith and causes barium appendicitis. A 19-year-old man visited the hospital due to melena. He underwent an endoscopy and a colonoscopy but no bleeding focus was discovered. Next, a small bowel series was performed to confirm the absence of small bowel bleeding. Two weeks later, he felt right lower quadrant pain in his abdomen and developed a fever. A blood test revealed an elevated white blood cell count. A plain abdominal radiograph indicated retained barium in the appendix. A computed tomography scan revealed a dilated barium filled appendix. Thus, the pain was thought to caused by barium retention in the appendix that precipitated acute appendicitis. He underwent an appendectomy and healed well without complications.
급성충수염 환아에서 복강경 충수절제술과 Needlescope을 이용한 충수절제술의 비교
김용석,곽금희,양근호,배병노,김기환,한세환,김홍주,김영덕,김홍용 대한내시경복강경외과학회 2010 Journal of Minimally Invasive Surgery Vol.13 No.2
Purpose: This clinical study evaluated the feasibility of needlescopic appendectomy (NA) in young patients with acute appendicitis, and we compare the outcome of this new technique with that of conventional laparoscopic appendectomy (LA). Methods: Two groups of young patients who underwent laparoscopic appendectomy at Sanggye Paik Hospital between January 2009 and December 2009 were studied. In the first group, a 2-mm instrument appendectomy was performed in 13 patients. These patients were compared with the second group, which were 21 patients who underwent conventional laparoscopic appendectomy. Statistical significance was set at p values<0.05. Results: The patient demographics and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. Postoperative ileus was occurred in 3 patients who underwent LA, but there was no statistical difference between the both groups (p=0.154). The needlescopic group had a shorter mean operative time (p=0.65), but there was no statistically significance. The mean hospital stay was significantly shorter (p=0.026) in the needlescopic group than that in the conventional laparoscopic group. Conclusion: According to our experience, needlescopic laparoscopic appendectomy is a safe and feasible procedure as compared with that of conventional laparoscopic appendectomy in young patients.
배현아(Hyuna Bae),노현(Hyun Noh),장혜영(Hye Young Jang),정구영(Koo Young Jung) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.3
Purpose: We wanted to describe the characteristics of the malpractice claims related to acute appendicitis and to identify medico-legal problems and potential preventability of such claims. Methods: A retrospective study was performed by reviewing the records at websites that furnishes judicial precedents. The records on closed malpractice claims involving acute appendicitis were abstracted from the files that were available for analysis. The records were reviewed and analyzed to determine the causes of the lawsuits, the preand post-operative diagnoses, the comorbid conditions of the patient, the causes of death or post-operative complications, the results of the lawsuits and the factors associated with a successful defense. Results: Twelve closed claims involving acute appendicitis were founded in the malpractice data. Two claims were Supreme Court decisions and ten were district court decisions. The causes of lawsuit were categorized as follows: delay in diagnosis or operation, mistakes during operation, inappropriate management of postoperative complications and problems related to general anesthesia. 3 claims were assigned to each of the 4 particular causes of lawsuits. The most common causes of death were abscess with peritonitis and sepsis, and ten of which resulted in indemnity payments. Conclusion: Appropriate explanation and attention in the diagnosis/progress of appendicitis, getting an informed consent from the patient, the patients’ comorbid conditions, early decision making in diagnosis/operation and proper care in the operation were critical for preventing lawsuits related to acute appendicitis.
조항주(Hang Joo Cho),황인용(In Yong Whang),김지일(Ji Il Kim),안창혁(Chang Hyuck Ahn),김정수(Jeong Soo Kim),유승진(Seung Jin Yoo),임근우(Keun Woo Lim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.2
Purpose: We wanted to evaluate the value of intravenous contrast enhanced abdomen-pelvis computed tomography (CT) for diagnosing acute appendicitis and we wanted to determine which patients groups will benefit from preoperative CT. Methods: Between January and June 2006, the medical records of 354 patients who had clinically suspected acute appendicitis were retrospectively reviewed. Appendectomy was performed in 260 patients and CT was conducted in 108 patients of the 260 patients. The 5㎜ slice CT scans were evaluated for the presence of appendicitis. The sensitivity, specificity and accuracy of CT were calculated. The negative appendectomy rate (NAR) was compared between the patients with CT scans and those without CT scans. Furthermore, the patients were classified into the children and adults groups and the male and female groups and the differences of the NARs were analyzed for each group. Results: The sensitivity, specificity and accuracy were 95%, 93% and 94%, respectively. The NAR was lower for the patients with a CT scan (12%) compared to 27% for those patients without CT scans (P=0.002). The difference of the NAR between the preoperative CT group and the without CT group was statistically significant for the female (P=0.004) and adult groups (P=0.012) (14% vs 36%, 11% vs 26%, respectively). Conclusion: Preoperative intravenous contrast enhanced abdomen-pelvis CT was effective in reducing the negative appendectomy rate in patients who were suspected of having acute appendicitis. Especially, the adults and women benefit more from CT scanning and they had a significantly lower negative appendectomy rate than the children and men, respectively.