Colorectal cancer is extremely rare in children. Unlike adult colorectal cancer, the overall prognosis of colorectal cancer in children is poor. Delayed diagnosis, advanced stages of the disease at presentation, and mucinous type of histology are the major determinants of poor outcome in childhood. A 13-year-old boy with abdominal pain visited our hospital. Physical examination andabdominal ultrasonography identified acute appendicitis with perforation. He underwent appendectomy and then the pathologic findings revealed mucinous adenocarcinoma. The cancer was located at the transverse colon and had metastases on peritoneal wall at 2^nd laparotomy. Extended right hemicolectomy was performed. He underwent palliative chemotherapy. After 4 months later, hepatic metastasis and aggravated peritoneal seedings developed. He died of renal failure and pneumonia 13 months after operation. We need to have a high index of suspicion for the possibility of a malignant colorectal tumor in any childhood case with nonspecific signs and symptoms.

To evaluate the clinical characteristics and results of treatment of fistula-in-ano and perianal abscess in childhood, we analyzed 95 cases of fistula-in-ano and/or perianal abscess seen in childhood, between January 1995 and June 2001 at the Department of General Surgery of Ewha Womans University Mokdong Hospital. Perianal abscess was in 25 patients, anal fistula in 62 and combined disease (perianal fistula and abscess) in 8. Male predominance was noted (95 %). Median age was 8 months and 78 % of cases were presented under the age of 1 year. Median duration of symptoms was 60 days. Twenty four abscesses (77 %) and 18 lesions (72 %) of combined disease (n=25) were located on both lateral sides of the anus, and fistulas located on both lateral sides were 33 (53 %). Multiplicity of the lesion was noted in 25 % of cases. Sixteen percent of abscess, 81 % of fistula and 88 % of combination group have had previous perianal abscesses. The perianal abscesses were treated with incision and curreTage and fistulas were treated with fistulotomy or fistulectomy. There were no recurrent diseases and no complications after surgical treatment. Although the progresses of the perianal abscess and fistula in ano in childhood may be self-limitied, surgical management was safe and curable.

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.

Mesenchymal hamartoma of the liver is a rare benign tumor, usually presenting in early childhood. Five children with mesenchymal hamartoma of the liver pathologically verified at Seoul National University Children's Hospital between 1978 and 2000 were analyzed retrospectively. There were two girls and three boys, and their mean age at the operation was 16.0months (range, 4 - 32 months). Three patients presented with abdominal distension. A patient was detected incidentally, and another was detected by prenatal ultrasongraphic examination. Tumor size ranged from 10x8.5cm to 34x29cm. Three tumors were located in the right lobe and two in the left lobe. Four cases underwent complete surgical resection, and the other one underwent incomplete surgical resection and marsupialization. Recurrence or malignant transformation was not noted. Five patients survived without evidence of disease for 35, 36, 38, 142 and 228 months. In conclusion, although mesenchymal hamartoma of the liver is benign lesion, it may be confused, and mixed with embryonal sarcoma. A recent report showed recurrence or malignant transformation after partial excision of the tumor. Therefore, complete excision of the tumor with surrounding normal liver tissue is recommended.

Gastrointestinal duplications are rare congenital malformation that may require surgical intervention in the neonate, infant, and occasionally the older child. Symptoms produced by duplications vary according to their location, size, type and histology. We report the clinical characteristics and the surgical results of 9 cases of the gastrointestinal duplications treated at at Asan Medical Center between 1989 and 2000. Five patients were boys and four were girls; age of patients ranged from 5 days to 10 years. Eight duplications were cystic and one was tubular. One involved the stomach; five were in the ileum, and two in the cecum. The most common presentation was intestinal obstruction. There was associated anomaly in one patient, pulmonary sequestration and double ureter. Ectopic gastric mucosa was found in two. All patients underwent surgical resection. There was no perioperative mortality or morbidity. Although gastrointestinal duplication is a rare entity, consideration of associated anomalies and being familiar with the anatomy and clinical features are required for adequate management. In cystic form, complete excision is recommended but planned surgery is required for long segment tubular lesion.

Laparoscopic appendectomy is relatively well-established as an alternative to conventional open appendectomy by many laparoscopic surgeons. However, experience in the pediatric population remains limited. Over a period of 2 years, a total of 155 pediatric patients with acute appendicitis or complicated appendicitis were studied to compare laparoscopic and open appendectomies in childhood. Laparoscopic appendectomy was attempted in 49 patients and completed in 48 patients(98.0%). Open appendectomy was performed in 107 patients. The severity of disease, age, and male to female ratio were similar in both groups. The operation time was shorter in the laparoscopic group than open group but the difference was not significant statistically(43.7±11.3 minutes versus 49.0±21.4 minutes, p=0.066). In the laparoscopic group, the mean duration of surgery for the former half patients was significantly longer than for the latter half(49.6±9.2 minutes versus 38.1±10.3 minutes, p=O.OOl). The mean number of doses of analgesia required postoperatively was significantly less in patients undergoing laparoscopic appendectomy(2.4±1.8 versus 3.3±2.5, p=0.021). There were only 2 (4.2%) wound infections after laparoscopic appendectomy compared with 10(9.3 %) complications including 7 wound infections, 1 intestinal obstruction, and 2 pulmonary complications after open appendectomy, but the difference was not significant( p=0.614). Patients undergoing laparoscopic appendectomy had a shorter period of hospitalization(3.2±2.2 days versus 6.4±1.6 days, p=O.OOl). The present study suggests that laparoscopic appendectomy shortens operating time and hospital stay with diminished postoperative pain. Laparoscopic appendectomy in children offers advantages over open appendectomy as noted in adults. The authors consider laparoscopic appendectomy to be the reasonable alternative to open appendectomy in children.

Anal fistula and perianal abscess in pediatric patients have been reported to have several characteristics, e.g. prevalent in less than 2 years of age, male preponderence, straight course of tract, and low type of fistula. We performed a retrospective study of twenty nine pediatric patients to see these characteristics comparing with the transitional age group of adolescents. Between June 1989 and December 1993, twenty-nine pediatric (<15 year-old) and sixteen adolescent patients(≥ 15, < 25 year-old) with anal fistula and perianal abscess were treated by surgical intervention. Twenty-one(87.5%) and 10(66.7%) enteric bacterial colonies were isolated from 16 pediatric and 11 adolescent patients, respectively. Considering the predominance of low type and the organisms cultured in the pediatric group, crypt-glandular infection seems to be a major preceding event. Incision and drainage were sufficient for cure in 15 among 16 perianal abscesses, and fistulas were cured by either fistulotomy or fistulectomy in all the 14 patients. The importance of effective drainage of perianal abscess and fistulotomy including internal opening cannot be overemphasized.