Purpose : Although intra-abdominal abscess remains a significant cause of morbidity following appendectomy, little information has been available as to the risk factors of intra-abdominal abscess. The goal of this study is to analyze risk factors for the development of postappendectomy intra-abdominal abscess (PAIAA) in cases with perforated appendicitis. Methods : Thirty-seven patients with perforated appendicitis of 200 acute appendicitis patients between 1988 and 1998 were divided into two groups, PAIAA (+) group (n=6) and PAIAA (-) group (n=31), and then their records were reviewed retrospectively. Results : Diarrhea was predominantly observed and the serum level of CRP at admission was higher in the PAIAA group. The duration of symptoms prior to admission, body temperature and WBC count at admission, bacteriology of the peritoneal fluid, drainage at operation, and antibiotics used after the operation did not affect the incidence of PAIAA. The WBC count decreased immediately after the operation in the PAIAA (-) group, whereas it remained at a high level through the postoperative period in the PAIAA group. On the other hand, the serum CRP value declined in the same manner in the two groups. Conclusion : Diarrhea and a high level of serum CRP at admission are risk factors for the development of PAIAA, and prolonged leukocytosis is the most reliable indicator of PAIAA in the postoperative period.

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Infantile cholelithiasis, which occurred in a 2-month-old female after extirpation of retroperitoneal teratoma, is presented. On the 15th postoperative day, acholic stool and elevation of serum bilirubin level were noted. A gall stone was confirmed by abdominal X-ray, ultra-sonography, and CT scanning. With continuation of oral intake and administration of ursodeoxycholic acid, the stone disappeared in 3 weeks. As predisposing factors for stone formation, peri-operative transfusion, starvation, transparenteral nutrition, and usage of furosemide were considered. Our case indicates that, with exposure to predisposing factors, infants are likely to form a gall stone in a short period, however this can be resolved conservatively. The possible causes and therapy of infantile cholelithiasis are discussed.

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A 4 year-old boy was referred to our hospital because of a porto-caval shunt found by galactosemia. Hyperammonemia also appeared. Doppler ultrasound and angiography were performed and he was diagnosed to have patent ductus venosus (PDV). After banding and sectioning of the ductus venosus, the patient's cheek hemangiectasis disappeared and his activity has improved.

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A 7-month-old boy was transferred to our hospital under the diagnosis of irreducible intussusception. A laparotomy revealed an ileal duplication cyst closely associated with a diverticulum of the terminal ileum. Neither lesion was located at the mesenteric side attatchment to the ileum. We performed diverticulectomy and wedge resection of the duplication cyst to preserve the ileal valve. There have been some theories about the embryogenesis of alimentary tract duplication, however, close association of duplication and diverticulum, like that presented our case, might be explained by Lewis & Thyng's "embryonic diverticula" theory.

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A 16-year-old female suffering from ulcerative colitis for 9 years underwent stapled ileoanal canal anastomosis because of rectal stenosis and frequent defecation, more than 20 times a day. The colon was dissected using laparoscopy-assisted surgery and removed through a small lower abdominal incision. Bowel reconstruction was achieved using a double-stapling technique without diverting ileostomy. She recovered uneventfully except for an intestinal obstruction which was resolved conservatively. Her quality of life was noticeably improved with bowel movements 6 to 7 times per day. She had no soiling or nocturnal leakage. This one-staged operation provides good cosmetic results, shortened period for operative treatment and excellent postoperative anal function, and may be the treatment of choice for ulcerative colitis. However long-term surveillance of the retained colonic mucosa and biopsies are required.

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Paracecal hernia is an uncommon cause of intestinal obstruction. Four kinds of peritoneal recesses of various sizes and depths occur in the paracecal area : superior ileocecal recess, inferior ileocecal recess, retrocecal recess, and retroappendiceal recess. We report a rare case with paracecal hernia. A 12-year-old boy was admitted to our hospital with abdominal pain and bilious vomiting. Abdominal X-ray, CT, and Ba-enema showed an intestinal obstruction. At the time of the emergent operation, this obstruction was confirmed to be a paracecal hernia ; specifically inferior ileocecal hernia. The incarcerated ileum was reduced successfully without intestinal resection, and the hernia's hilus was released. The postoperative course was uneventful, with no complications. In addition, the diagnosis and treatment of this disease was reviewed in Japanese literature.

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