Foreign body ingestion is a common problem among paediatric populations. Most of the ingested foreign bodies spontaneously pass through the gastrointestinal tract, but approximately less then 10% of them remain without being discharged, and trigger complications. Therefore, proper evaluation and treatment according to the situation is required. In this study, clinical progress and complications were analyzed according to the clinical features and treatment in children who ingested foreign bodies. Among pediatric patients under 18 who were admitted to Chonnam National University Hospital after ingesting foreign bodies between January 2008 to June 2012, only the patients who had their foreign body in the gastrointestinal tract were included in this study. Based on medical records, age, type of foreign body, time spent till admission, and whether the endoscopy was done or not, complication were researched retrospectively. According to symptoms and plain abdomen X-ray findings, treatment was chosen and conducted among endoscopy, observation and emergency operation. Among 273 patients, 9 (3.3%) of them had surgical removal. Seven (2.6%) of them had an emergency operation on the day of admission, and the rest 2 (0.7%) had operation during observation. Removal through initial endoscopic approach was tried in 157 (57.5%) patients. Eleven (70.8%) of them had their foreign body removed at the initial trial, and 5 (4.9%) of them at the second trial. Among 109, who were on observation status, 9 (8.3%) of them needed endoscopic removal, and 2 (1.8%) of them suffered from surgical removal. It is thought to be better to approach slowly considering the type, size and symptoms in foreign body ingestion of pediatric patients, rather than immediate and invasive removal.

Herniorrhaphy of Indirect inguinal hernia (IIH) is one of the most frequently performed surgical procedures in children. The overall incidence of inguinal hernias in childhood ranges from 0.8 to 4.4%. The incidence is up to 10 times higher in boys than girls, especially much higher in premature infants. IIHs in children are basically an arrest of embryologic development rather than an acquired weakness, which explains the increased incidence in premature infants. In normal development, the processus vaginalis closes, obliterating the peritoneal opening of the internal ring between 36th and 40th week of gestation. This process is often incomplete, leaving a small patent processus in many newborns. However, closure continues postnatally, and the rate of patency is inversely proportional to age of the child. The presence of a patent processus vaginalis is a necessary but not sufficient variable in developing a congenital IIH. In other words, all congenital IIHs are preceded by a patent processus vaginalis, but not all patent processus vaginalis go on to become IIHs. The overall incidence of IIH in population is approximately 1 to 2% and the incidence of a processus vaginalis is approximately 12 to 14%, clinically appreciable IIH should develop in approximately 8 to 12% of patients with a patent processus vaginalis. Although the classic open inguinal hernia repair remains the gold standard for most pediatric surgeons, laparoscopic repair is being performed in many centers. Like open technique, laparoscopic technique is fundamentally a high ligation of the indirect hernia sac with or without internal ring ligation. The advantages of laparoscopic approach include the ease of examining the contralateral internal ring, the avoidance of access damage to vas and vessels during mobilization of cord, decreased operative time, and an ability to identify unsuspected direct or femoral hernias. Almost all groin hernias in children are IIHs and occur as a result of incomplete closure of processus vaginalis. The treatment is repair by high ligation of hernia sac, which can be done by an open or laparoscopic technique. The contralateral side can be explored by laparoscopy or left alone, open exploration is no longer indicated due to potential risk of infertility.

Splenic abscess is a rare clinical condition with a reported incidence of 0.14 % to 0.70 % in various autopsy series. Primary tuberculosis of the spleen as a cause of splenic abscess is even rarer, especially in the antitubercular era. Infants and children have a higher predisposition to extra-pulmonary tuberculosis than adults and tend to develop severe extra-pulmonary disease such as miliary tuberculosis and meningitis. The diagnosis of tuberculosis in infants and children can be difficult because of nonspecific symptoms and clinical findings. Computed tomography establishes the diagnosis of splenic abscess and demonstrates the number and location of abscesses. Splenectomy is the standard of care in most clinical setting. We present a 4-year-old girl who had multiple tuberculosis splenic abscesses and was treated successfully with splenectomy.

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the “American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)”. For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to ‘wait and see’ until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.

The teratoma is a unique complex neoplasm and is one of the most frequent pediatric tumors originated from the extragonadal germ cells. Mature teratoma is composed of mature differentiated tissues, while immature teratoma always contains embryonic tissues of variable degrees of immaturity, especially in the neuroepithelial elements. Diagnosis of teratoma is relatively easy by conventional radiologic study, but the immaturity can be identified only by histopathological examination. Between January 1993 to December 2002, 63 cases of teratoma were operated and analysed retrospectively at the Chonnam University Hospital Female to male ratio was about 3:1 and age distribution was relatively even. Among 63 cases, gonadal teratoma was the most common (52.4%), followed by sacrococcygeal (25.4%), retroperitoneal (9.5%) and mediastinal teratoma (9.5%). Fifty-six cases were mature teratomas and seven were immature teratomas. Alpha-fetoprotein (AFP) was elevated in 4 of 6 immature cases, but in 2 of 51 mature ones Elevated AFP progressively returned to normal range by 1 month after operation in all. Complete excision of the mass was performed, and major complication was not noticed. In five immature cases, PEB chemotherapy (Cisplatin, Etoposide, Bleomycin) was performed. Two of 2 cases in histological grade II were well tolerated to the aggressive chemotherapy. One of three cases in grade III expired due to severe bone marrow depression, and two of them expired by tumor recurrences. In conclusion, immature teratoma in histological grade III showed high potentiality of recurrence. Therefore, postoperative chemotherapy has to be applied to the high graded immature tumors.

No abstract available.

Gastroduodenal intussusception, an invagination of a part of the gastric wall through the pyloric canal into the duodenum is a rare condition. Gastroduodenal intussusception is caused by a mobile usually benign gastric tumor. However, gastroduodenal intussusception by gastric submucosal hemangiomatosis is not documented. We have managed a case of gastric submucosal tumor leading to gastroduodenal intussusception in 2 years and 10 months old boy. The tumor was 10 × 5 × 3 cm in size in posterior wall of gastric antrum. Laparotomy, manual reduction of the intussusception, and wedge resection of posterior gastric wall including the tumor were performed. Pathologic diagnosis was a submucosal hemangiomatosis.

This is a clinical review of 2,191 pediatric surgical patients under the age of 15 years, operated upon at the Division of Pediatric Surgery, Department of Surgery, Chonnam University Hospital from January 1988 to December 1997. The total number of operations in the pediatric age for all specialties were 13,144(13.2 %). The total operations including those performed on adults were 99,555. The most common age group operated upon was under 5 year of age(44.4 %). The number of operations in Division of General Pediatric Surgery were 2,191(16.7 %) out of total 13,144 operations in all pediatric specialties. The patients under 1 year of age in general pediatric surgery was 42.9 %(941/2,191). The most common diseases in neonates were anorectal malformation(20.6 %) and hypertrophic pyloric stenosis( 20.3 %). Infants older than neonates most commonly were operated upon for inguinal hernia(32.4 %) and intussusception(19.6 %). The total mortality rate in the neonatal intensive care unit was 31.3 %. Gastroschisis had the highest mortality.