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[Malrotation]

[2014-11-1. ¾Öµ¶ÀÚ Áú¹®]

óÀ½ °æÇèÀ̶ó ÀÌ·¸°Ô ¿©Âã½À´Ï´Ù. 30´ë ÃÊ¹Ý ³²ÀÚ°¡ ¿ÞÂÊ ÇϺ¹ºÎ ºÒÆí°¨À¸·Î ³»¿øÇÏ¿´´Âµ¥, CT¿¡¼­ intestinal malrotationÀÌ Àǽɵ˴ϴÙ. ȯÀÚ°¡ ´ëÀå³»½Ã°æ °Ë»ç¸¦ ¿øÇÕ´Ï´Ù. º¸Åë ¼ºÀÎ ³²ÀÚó·³ ¹«¸®¾øÀÌ ÇÒ ¼ö ÀÖ´ÂÁö ¾Æ´Ï¸é ¾î¶² Ưº°ÇÑ ÁÖÀǸ¦ ÇØ¾ß ÇÏ´ÂÁö ±Ã±ÝÇÕ´Ï´Ù.

[2014-11-1. Àü¹®°¡ ´äº¯ (Â÷Àç¸í ±³¼ö´Ô)]

Àúµµ intestinal malrotation ȯÀÚÀÇ ´ëÀå³»½Ã°æ °æÇèÀº 5ȸ ¹Ì¸¸ÀÌ¶ó ¹¹¶ó°í ¸»¾¸µå¸± ÀÔÀåÀÌ ¾Æ´Õ´Ï´Ù. Incomplete study°¡ µÉ ¼ö ÀÖ´Ù´Â °ÍÀ» »çÀü¿¡ ¼³¸íÇÏ°í, long scope¿¡ capÀ» ºÎÂøÇÏ¿© °Ë»ç¸¦ ÁغñÇÏ´Â Á¤µµ ÇÏ°í ÀÖ½À´Ï´Ù. ¾ÆÁ÷±îÁö´Â ¿îÀÌ ÁÁ¾Æ complete study°¡ °¡´ÉÇß´ø °ÍÀ¸·Î ±â¾ïÇϸç, Á¶±Ý Èûµé±â´Â ÇÏÁö¸¸ ÇÒ¸¸Çß´ø °Í °°½À´Ï´Ù. ¹«¸®ÇÏÁö ¾Ê°í ¸Å¿ì Èûµé¸é Áß°£¿¡ °ú°¨ÇÏ°Ô Æ÷±âÇÑ´Ù´Â ¸¶À½À¸·Î °Ë»ç¿¡ ÀÓÇÕ´Ï´Ù.

¸ðµç °Ë»ç°¡ risk benefitÀ» µûÁ®¾ß Çϴµ¥ intestinal malrotation ȯÀÚ´Â ´ëÀå³»½Ã°æ °Ë»çÀÇ indicationÀ» º¸´Ù ¾ö°ÝÇÏ°Ô µûÁ®¾ß ÇÑ´Ù°í »ý°¢ÇÕ´Ï´Ù. Àú °°À¸¸é CT¿¡¼­ ƯÀÌ º´ÀÌ ¾ø°í, ±×³É ÇÏ°í ½Í¾î¼­ ÇÏ´Â ´ëÀå³»½Ã°æ °Ë»ç¸¦ 30´ë ÃÊ¹Ý ³²ÀÚ¿¡°Ô ±ÇÇÏÁö´Â ¾ÊÀ» °Í °°½À´Ï´Ù. Áõ»ó, ´ëÀå¾Ï °¡Á··Â ¿©ºÎ, °ú°Å °Ë»ç ¿©ºÎ, intestinal malrotation¿¡ ´ëÇÑ insight µîµî ¿©·¯ °¡Áö¸¦ °í·ÁÇÒ °Í °°½À´Ï´Ù.

¸¸Á·ÇÒ ¸¸ÇÑ ´äº¯À» µå¸®Áö ¸øÇØ Á˼ÛÇÕ´Ï´Ù. ³ª¸§ °Ë»öÀ» Çصµ »ÇÁ·ÇÑ ´äº¯À» ãÀ» ¼ö ¾ø¾î °æÇèÀûÀÎ ´äº¯À» µå¸± ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù.


1.Malrotation

JejunumÀÌ right side¿¡ À§Ä¡ÇÏ°í ÀÖÀ¸¸ç ascending colon°ú hepatic flexure°¡ lower abdomen¿¡¼­ transverseÇÏ°Ô traceµÇ¸ç hepatic flexure´Â midline¿¡¼­ upward·Î ¹æÇâÀ» Àâ°í ÀÖÀ½. Small and large intestine¿¡ malrotationÀÇ °¡´É¼ºÀÌ ÀÖÀ½.


2. Gastric volulus (EndoTODAY 20131015)

³»½Ã°æ »ðÀÔÀÌ ¾î·Á¿ï ¼ö ¹Û¿¡ ¾ø´Â µå¹® °æ¿ìÀÔ´Ï´Ù. ³»½Ã°æ °á°ú´Â ÀÌ·¸°Ô ³Â½À´Ï´Ù. "³»½Ã°æ ¼Ò°ß»ó, ÇϺΠ½Äµµ¿¡´Â ¿­»óÀÌ º¸ÀÌ´Â ½Äµµ¿° ¼Ò°ßÀ» º¸¿´À¸³ª, ±Ë¾çÀ̳ª Å»ÀåÀÇ ¼Ò°ßÀº ¾ø¾ú´Ù. ½Äµµ¸¦ Áö³ª ³»½Ã°æÀ» À§³»·Î ÁøÀÔ½Ã, Á¡¸·Àº ÆòÈ°Çϸ鼭 À±ÅÃÀÌ ÀÖ°í À§Ã¼»óºÎ·Î »ý°¢µÇ´Â ºÎÀ§¿¡ ÀÛÀº ¿ëÁ¾ÀÌ¿Ü¿¡ ¹Ì¶õÀ̳ª ±Ë¾ç¼º º´º¯Àº º¸ÀÌÁö ¾Ê¾Ò´Ù. ±×·¯³ª Á¡¸· À¶±â ÁÖ¸§ÀÌ Á¤»óÀûÀÎ È­¸é»óÀÇ ¿À¸¥ÂÊ¿¡¼­ À§ÂÊÀ¸·Î ¹Ù²î¾î ÀÖ¾úÀ¸¸ç ÀÌ °÷ÀÌ ¸Å¿ì Á¼¾ÆÁ® Àִµ¥ ³»½Ã°æÀº Åë°úµÇ¾ú°í ÀÌ ºÎÀ§¸¦ µû¶ó ³»½Ã°æÀ» ´õ ÁøÀÔÇßÀ»¶§ ÀüÁ¤ºÎ·Î »ý°¢µÇ´Â Á¼¾ÆÁø ºÎÀ§°¡ °üÂûµÇ¾úÀ¸³ª À¯¹®À¸·ÎÀÇ ³»½Ã°æ ÁøÀÔÀº ºÒ°¡´ÉÇÏ¿´´Ù."


3. Diaphragmatic evantration (EndoTODAY 20131015)

°æÇèÀÌ ¸¹Áö ¾Ê¾Æ¼­ ±³°ú¼­(Grainger & Allison's Diagnostic Radiology, 5th ed.)¿¡¼­ ÀϺΠ¿Å±â¸é ¾Æ·¡¿Í °°½À´Ï´Ù.

Incomplete muscularization, known as eventration, is also common. An eventration is composed of a thin membranous sheet replacing what should be muscle. Usually it is partial, involving one-half to one-third of the hemidiaphragm. The lack of muscle manifests itself radiographically as elevation of the affected portion of the diaphragm, and the usual appearance is one of a smooth hump on the contour of the diaphragm. Total eventration of a hemidiaphragm, which is much more common on the left than the right, results in elevation of the whole hemidiaphragm; on fluoroscopy hemidiaphragm movement is poor, absent, or paradoxical, and severe cases of congenital eventration cannot be distinguished from acquired paralysis of the phrenic nerve.

Congenital evantration°ú °¨º°ÇØ¾ß ÇÏ´Â °ÍÀ¸·Î phrenic nerve palsy°¡ ÀÖ½À´Ï´Ù. EvantrationÀ» ÀÏÀ¸Å°´Â phrenic nerve palsyÀÇ °¡Àå ÈçÇÑ ¿øÀÎÀº open heart surgery¿Í °°Àº ÈäºÎ¼ö¼úÀÔ´Ï´Ù. ÀÌ¿Ü¿¡µµ cervical spine ¼ö¼ú, °æºÎ ¿Ü»ó, birth trauma, von Recklinghausen's disease, cervical osteoarthritis, aortic aneurysm, substernal thyroid, bronchogenic or mediastinal tumors, pleurisy, pneumonia, herpes zoster infection, vasculitis, ÈäºÎ ¹æ»ç¼±Ä¡·á µîµµ °í·ÁÇØ¾ß ÇÕ´Ï´Ù.

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