Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?

우리나,계봉현,김건,김형진,조현민 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.4

Purpose: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. Methods: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. Results: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. Conclusion: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.

Mortality risk factor analysis in colonic perforation

Ri Na Yoo,Bong-Hyeon Kye,Gun Kim,Hyung Jin Kim,Hyeon-Min Cho 대한외과학회 2017 Annals of Surgical Treatment and Research Vol.93 No.4

Purpose: Colonic perforation is a lethal condition presenting high morbidity and mortality in spite of urgent surgical treatment. This study investigated the surgical outcome of patients with colonic perforation associated with retroperitoneal contamination. Methods: Retrospective analysis was performed for 30 patients diagnosed with colonic perforation caused by either inflammation or ischemia who underwent urgent surgical treatment in our facility from January 2005 to December 2014. Patient characteristics were analyzed to find risk factors correlated with increased postoperative mortality. Using the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) audit system, the mortality and morbidity rates were estimated to verify the surgical outcomes. Patients with retroperitoneal contamination, defined by the presence of retroperitoneal air in the preoperative abdominopelvic CT, were compared to those without retroperitoneal contamination. Results: Eight out of 30 patients (26.7%) with colonic perforation had died after urgent surgical treatment. Factors associated with mortality included age, American Society of Anesthesiologists (ASA) physical status classification, and the ischemic cause of colonic perforation. Three out of 6 patients (50%) who presented retroperitoneal contamination were deceased. Although the patients with retroperitoneal contamination did not show significant increase in the mortality rate, they showed significantly higher ASA physical status classification than those without retroperitoneal contamination. The mortality rate predicted from Portsmouth POSSUM was higher in the patients with retroperitoneal contamination. Conclusion: Patients presenting colonic perforation along with retroperitoneal contamination demonstrated severe comorbidity. However, retroperitoneal contamination was not found to be correlated with the mortality rate.

Retroperitoneal Mucinous Cystadenoma

Gyu Yeol Kim(김규열),Dae Hwa Choi(최대화),Young Chul Lim(임영철),Byung Kyun Ko(고병균),Sang June Park(박상준),Yang Won Nah(나양원),Hong Rae Cho(조홍래),Chang Woo Nam(남창우) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.1

일차성 후복막 점액성 낭선종은 흔치 않은 종양으로 여성에게만 발생하며, 수술 전에 정확한 진단을 하기 매우 어렵다. 하지만, 이러한 낭성 종양의 낭액에서의 증가된 암태아성항원의 수치가 일차성 후복막 점액성 낭선종의 유용한 진단 지표가 될 수 도 있다. 완전 절제가 이 종양의 적절한 치료이다. 또한, 수술 중 복강 내 타 장기들을 누르거나 할 필요가 없으며, 소장 및 대장이 손상될 위험을 줄일 수 있다는 측면에서 후복막 접근이 복강 내 접근 보다 유용한 방법일 수 있다. 저자들은 후복막 접근을 통해 성공적으로 절제한 일차성 후복막 점액성 낭선종의 경험을 보고한다. We present a case of a primary retroperitoneal mucinous cystadenoma, which is a relatively rare tumor found exclusively in women. This tumor is difficult to correctly diagnose preoperatively. Although there is little published information regarding the CEA levels in the cystic fluid of cystic tumors arising in the retroperitoneum, a high CEA level in the cystic fluid is a useful diagnostic marker for a primary retroperitoneal mucinous tumor. The appropriate management of retroperitoneal mucinous cystadenomas is the total removal of the cyst. The retroperitoneal approach for retroperitoneal cystic tumors is useful, has a lower risk of traumatizing the bowel than the intra-abdominal approach, and does not require compression of the other organs. We report the successful resection of a retroperitoneal mucinous cystadenoma through the retroperitoneal approach.

외상후 발생한 복막강내, 후복막강내 고형장기 손상의 임상적 특성

김중헌,홍정석,이종화,홍은석,김선휴 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.5

Purpose: The aim of this study was to analyze the characteristics and prognosis of intraperitoneal and retroperitoneal solid organ injuries after trauma. Methods: We analyzed computed tomography (CT) data for 232 patients who had injury to solid abdominal organs between January 2002 and June 2009. The patients who had solid organ injury on CT were categorized into intraperitoneal,retroperitoneal and intra/retroperitoneal injury groups. Medical records were reviewed retrospectively, and data regarding the sex and age of patients, mechanism of injury, initial hemodynamic status, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission rate to intensive care unit (ICU), and mortality were collected and analyzed. Injury severity of solid organs was classified according to the American Association for the Surgery of Trauma (AAST) grading system. Results: The intraperitoneal injury group had 131 patients,the retroperitoneal injury group 49 patients, and the intra/retroperitoneal injury group 52 patients. The intra/retroperitoneal injury group exhibited low blood pressure,a large number of packed red blood cells that were transfused, and high ISS and abdominal AIS. They tended to stay longer in the ICU and showed a higher mortality. Conservative management was the most common therapeutic modality for all 3 groups. Conclusion: The intra/retroperitoneal injury group showed higher fall for the mecahnism of injury, a lower initial blood pressure and a larger number of packed red blood cells that were transfused compared with the other groups. Therefore,physicians should rapidly identify those with a poor prognosis at initial presentation and make a decision quickly when they are caring for intra/retroperitoneal injury patients.

Retroperitoneal Extraskeletal Osteosarcoma without Calcification Mimicking Pancreas Tumor: CT Imaging of a Case Report

김정원,배경은,박경미,김재형,정명자,김성희,김지영,김수현,강미진,이지혜,김태규 대한영상의학회 2018 대한영상의학회지 Vol.78 No.5

Retroperitoneal extraskeletal osteosarcoma is a rare tumor. Typical imaging findings include a soft tissue mass accompanied with internal calcifications. The authors encountered a case involving a 44-year-old woman with a large retroperitoneal extraskeletal osteosarcoma, without calcification, that mimicked a pancreatic tumor. The present report highlights computed tomography features of retroperitoneal extraskeletal osteosarcoma, followed by a brief literature review. It is challenging for radiologists to diagnose retroperitoneal masses. However, in patients who present with large retroperitoneal masses, combined with clinical information including the elevation of serum alkaline phosphatase levels, retroperitoneal extraskeletal osteosarcoma should be considered in the differential diagnosis, even if the mass does not exhibit a gross calcification on the imaging.

Surglcal : Retroperitoneal Hematoma due to Spontaneous Rupture of Lumbar Artery in Patients Taking Anticoagulant and/or Antiplatelet: A Retrospective Analysis

( Kun Moo Choi ),( Jae Young Kwak ) 대한응급의학회 2014 대한응급의학회지 Vol.25 No.3

Purpose: The main purpose of this study was to achieve a broad perspective of the clinical problem with regard to its overall presentation and relation to anticoagulant and antiplatelet therapy, and to describe common management strategies and clinical outcomes. Methods: We initially screened 262 patients who were admitted from the Emergency Department between June, 1996 and June, 2013, with International Classification of Diseases code of K66.1 (hemoperitoneum), R58 (retroperitoneal hemorrhage) and D68.3 (hemorrhagic disorder due to anticoagulants). We excluded patients with retroperitoneal hemorrhage (RH) associated with trauma, vascular lesions, tumors, liver cirrhosis, renal failure, and surgical complications. A total of 24 adult patients were found to have retroperitoneal hematoma due to spontaneous lumbar artery rupture and were included in the study for further analysis. Results: Male to female ratio was 14:10 and the mean age was 75.3±10.4 years old. Overall, 19 patients (79.1%) were taking warfarin, 20 patients (83.3%) were taking aspirin and/or clopidogrel, and 15 patients (62.5%) were taking both anticoagulant and antiplatelet medications. The most common presenting symptom was acute back pain. CT scan showed extravasation of contrast in 20 patients. The mean hematoma size was 12.5±6.4 cm. Eleven patients (55%) underwent arterial embolization and 22 patients (91.6%) received blood transfusion. No surgical intervention was performed. Conclusion: Retroperitoneal hematomas caused by spontaneous rupture of the lumbar artery showed a strong association with use of anticoagulant and/or antiplatelet therapy. For patients, particularly elderly patients, who present with acute back pain or hemodynamic instability and who are on anticoagulant and/or antiplatelet therapy, ER physicians should consider retroperitoneal hematoma as a differential diagnosis and to rule it out vigilantly.

진행성 위암과 동반된 후복막 섬유화증 7예의 임상적 고찰

장재영,천영국,최우봉,김진오,조주영,이준성,이문성,심찬섭 순천향의학연구소;Soonchunhyang Medical Research Institute 2000 Journal of Soonchunhyang Medical Science Vol.6 No.1

Background/Aims: Retroperitoneal fibrosis is a fibrosing disease process which frequently develops ureteral obstruction. Malignant retroperitoneal fibrosis has been reported that various types of cancer including cancer of the breast, stomach, prostate, lung, cervix, uteri, colon, pancreas, ovary, and even Hodgkin's disease. While the pathogenesis remains obscure, small foci of metastatic neoplasm in the retroperitoneal space can elicit a desmoplastic reaction in secondary form to malignancy. Methods: Recently we experienced 7 cases of retroperitoneal fibrosis with advanced gastric cancer. So, we report 7 cases of retroperitoneal fibrosis with clinical and radiologic characteristics. Results: The most common signs and symptoms were related irreversible renal dysfunction. The urologic finding noted medial deviation of the involved ureters and hydronephrosis Conclusions: Clinical manifestations are abdominal pain, back pain, hydronephrosis, and uremia. When sudden back pain and hydronephrosis develop in advanced malignancy, physicians should be considerd for retroperitoneal fibrosis.

Retroperitoneal Leiomyoma With Exophytic Growing into the Lesser Sac: A Case Report

Lee Hyeontak,Park Mihyun 대한자기공명의과학회 2023 Investigative Magnetic Resonance Imaging Vol.27 No.2

Leiomyoma is a common benign tumor of smooth muscle cells that rarely occurs in the retroperitoneum. Here, we report a retroperitoneal leiomyoma with exophytic growing into the lesser sac incidentally diagnosed in a 69-year-old woman. In this case, the retroperitoneal leiomyoma presented as a well-circumscribed mass with heterogeneous signal intensity and mild progressive enhancement on magnetic resonance imaging. Differential image diagnosis of this retroperitoneal leiomyoma from other retroperitoneal tumors was difficult due to an overlap in imaging appearances with other retroperitoneal tumors.

신생아에서 발견된 후복막강 폐격리증 −1예 보고−

이형채,조광현,최광호,윤영철,이양행,황윤호 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.3

Retroperitoneal pulmonary sequestration is an extremely rare congenital malformation. It is more frequently diagnosed in the antenatal period due to routine ultrasonic examinations that are conducted for a fetus or during the first 6 months of life, although retroperitoneal pulmonary sequestration is incidentally discovered in adults on rare occasions. Because the location and radiological findings of retroperitoneal pulmonary sequestration are very similar to those of another retroperitoneal masses, retroperitoneal pulmonary sequestration, although they are very rare, should be included in the differential diagnosis of a retroperitoneal suprarenal mass. Although fine needle aspiration may be considered as an aid for making the preoperative diagnosis, surgery remains the treatment of choice for symptomatic lesions and this surgery is associated with excellent results and a good prognosis. 후복막강 폐격리증은 극히 드문 질환으로 보통은 임신 6개월경에 시행하는 태아 초음파로 발견되며 드물지만 성인에서 우연히 발견된다. 후복막강 폐격리증은 그 위치와 방사선학적인 소견이 신경아세포종 등의 다른 후복막강 종괴와 아주 유사하기 때문에 그 발생 빈도가 극히 드물더라도 후복막강 종괴가 의심될 때 감별을 요한다. 세침 흡입 검사가 수술 전 진단에 도움이 된다고 하지만, 수술적 제거가 환자의 예후나 경과를 생각 했을때 좋은 치료 방법이라고 생각된다.

급성 신부전과 흉수를 동반한 원발성 후복막강 섬유화증 1예

구승원,김미애,김주환,유광호,박현정,김경호,김형종 대한내과학회 2011 대한내과학회지 Vol.80 No.-

Idiopathic retroperitoneal fibrosis (IRF) is characterized by a fibrotic process and chronic inflammation of the retroperitoneal area and aorta. The development of retroperitoneal inflammation and fibrosis often results in periureteral encasement, ureteral obstruction, acute renal failure, and subsequent chronic renal failure and, rarely, mediastinal, pericardial, or pleural involvement. Our patient presented with left flank pain and abdominal computed tomography (CT) showed a retroperitoneal mass encompassing the aorta and both ureters. IRF was diagnosed after a biopsy of the retroperitoneal mass. A complicating left pleural effusion and acute renal failure developed and the patient underwent a percutaneous nephrostomy and was treated with prednisolone. After this, the patient’s symptoms, renal failure, and pleural effusion improved and the retroperitoneal mass decreased in size. We report a case of IRF with a pleural effusion and acute renal failure that improved with steroid treatment, with a literature review. (Korean J Med 2011;80:S263-S267) 저자들은 50세 남자 환자에서 요관 폐쇄에 의한 급성 신부전과 편측성 흉수를 동반한 원발성 후복막강 섬유화증을 진단하고, 요관내 카테터 삽입술을 시행받았으나 신부전 악화되어 경피적 신루술 및 steroid 투여 후에 급성 신부전 및 편측성 흉수의 호전을 보인 1예 경험하였기에 문헌고찰과 함께 보고하는 바이다.