Online Exclusives
Radial artery perforator flap and external fixation after gunshot injuries in a 10-year-old boy
Air-powered guns can cause serious trauma to body structures. We describe a 10-year-old boy who suffered injuries to his gluteal and thenar regions as a result of a single gunshot. Surgical management included cleansing of the gluteal region, as well as an external fixation device and a fasciosubcutaneous flap based on a perforator branch of the distal radial artery. To the best of our knowledge, this case illustrates the youngest patient to benefit from this kind of perforator flap. We also underline the long-term risk of lead toxicity for this kind of injury.Acute gastric volvulus: An unreported long-term complication of pericardial drainage
We report the case of a girl who had tetralogy of fallot (TOF) repaired at birth without any associated diaphragmatic hernia. At the age of 2½ years, she experienced an upper gastrointestinal occlusion. At laparoscopy an organoaxial gastric volvulus was observed related to a peritoneal adhesion secondary to pericardial drainage that had been performed at the time of the TOF repair. After reduction of the volvulus, a phrenofundopexy was done. Postoperatively, the child has remained asymptomatic with a follow-up of 24 months.Chronic biloma after right hepatectomy for stage IV hepatoblastoma managed with Roux-en-Y biliary cystenterostomy
We report the complex case of a 12-month-old girl with stage IV hepatoblastoma accompanied by thrombosis and cavernous transformation of the portal vein. After neoadjuvant chemotherapy, she underwent right hepatectomy, which was complicated by iatrogenic injury of her left hepatic duct, and subsequently developed a postoperative biloma and chronic biliocutaneous fistula. Concomitant with multiple percutaneous interventions to manage the biloma nonoperatively while the child completed her adjuvant chemotherapy, she progressed to develop chronic malnutrition, jaundice, and failure to thrive.Double H-type tracheoesophageal fistulas identified and repaired in 1 operation
Isolated tracheoesophageal (“H-type”) fistula is a relatively uncommon congenital anomaly that can be difficult to identify and, at times, challenging to repair. We present a very unusual case of an infant with 2 distinct H-type tracheoesophageal fistulas (TEFs) identified and repaired in 1 operation. A newborn male infant presented with coughing with feeds. Contrast esophagram demonstrated an intrathoracic H-type fistula without esophageal atresia. In the operating room, rigid bronchoscopy was performed, and a second TEF was identified in the cervical region.Stump appendicitis after childhood incidental appendectomy
Stump appendicitis is a rare late complication of appendectomy. Most cases present months to years following surgery for acute appendicitis. Cases of stump appendicitis after incidental appendectomy are very rare. We present a case of stump appendicitis after incidental appendectomy during a procedure for duodenal obstruction as an infant.Laparoscopic management of colonic complications in Ehlers-Danlos syndrome type IV
Ehlers-Danlos syndrome type IV, also known as the vascular type, is the most severe form of the disease. It may cause spontaneous bowel perforation and rupture of major arteries. The treatment of bowel perforation in this population remains controversial because they are at risk for major wound complications owing to poor healing. We report the first use of laparoscopy in children with Ehlers-Danlos syndrome.Brachial plexus palsy, a rare delayed complication of the Nuss procedure for pectus excavatum: a case report
We report a rare complication after the Nuss procedure for the correction of pectus excavatum in a 15-year-old adolescent boy. He began to have delayed right brachial plexus injury on the 15th postoperative day. Careful physical check-up revealed a painful and enlarged subaxillary lymph node. He was successfully treated using anti-inflammatory medications and physical therapy.Bilateral xanthogranulomatous funiculitis and orchiepididymitis in a 13-year-old adolescent boy
Xanthogranulomatous orchitis is an extremely rare inflammatory nonneoplastic lesion of the testis. We report a case of a 13-year-old adolescent boy who presented a painless left hemiscrotal swelling. The subsequent ultrasonography and magnetic resonance imaging revealed the presence of abnormal expanding tissue located in both testes and spermatic cord, reaching the internal inguinal ring. Testicular tumor markers were normal. The frozen section examination of the surgical specimen showed only inflammatory tissue and not neoplastic tissue.Hydrothorax following delayed extravascular migration of a totally implantable venous access device in a child
Totally implantable venous access devices are widely used in pediatric oncology. The authors encountered a 10-year-old boy with implantation of the device at the age of 7 years owing to acute lymphoblastic leukemia. In the recent half-year, the device was not used except for regular heparin flushing. However, hydrothorax occurred when fluid therapy was required from the device during this admission. Thoracoscopic approach showed extravascular migration and intrapleural malposition of the catheter.Post–serial transverse enteroplasty bowel redilatation treated by longitudinal intestinal lengthening and tailoring procedure
The serial transverse enteroplasty (STEP) is a safe and successful procedure to lengthen the small bowel. Several patients develop postoperative bowel redilatation with loss of bowel adaptation. We describe a 2-month-old male infant with short bowel syndrome who developed dilatation of the lengthened segment after STEP, which was successfully treated by a longitudinal intestinal lengthening and tailoring procedure. To the best of our knowledge, this is the first described case of longitudinal intestinal lengthening and tailoring procedure after STEP.Pelvic Wilms tumor in a child with an absent right kidney and spinal malformations
Wilms tumor rarely occurs in other sites outside the kidney. Various congenital malformations often accompany Wilms tumor, but spinal deformations are rarely seen. We report a very rare association of multiple spinal malformations, right kidney absence, and pelvic Wilms tumor in a 21-month-old girl. The report includes a brief review of relevant literature.Perinatal hemorrhage complicating neonatal hepatoblastoma: case report
Hepatoblastoma is the most common malignant liver tumor of infancy and presents most frequently at a median age of 18 months. Presentation in the neonatal period is rare, and there are very few reports of an antenatal diagnosis of hepatoblastoma. We recently encountered a neonate who presented with hemoperitoneum after rupture of a congenital hepatoblastoma during vaginal delivery. After successful right hepatectomy and adjuvant cis-platinum–based chemotherapy, the child is doing well. We draw attention to rarity of this condition and difficulty in definitively establishing a diagnosis both in the antenatal and neonatal periods and discuss the management dilemmas in congenital presentations of hepatoblastoma.Colon perforation caused by a foreign body in Hirschsprung disease
Accidental ingestion of foreign bodies is a common emergency in the pediatric population. The foreign body generally passes through the whole gastrointestinal system spontaneously without causing an obstruction. This is the first case report in the literature of Hirschsprung disease associated with a radio-opaque foreign body lodged at the site of a perforated sigmoid colon. This case highlights the fact that, in the case of an impacted radio-opaque foreign body in a child, the possibility of an obstructive congenital anomaly should be kept in mind in the differential diagnosis.Intraosseous angioma: a rare cause of a rib mass in childhood
Rib tumors are uncommon and represent 5% to 10% of all bony tumors. Regarding the benign rib lesions, costal angioma is very rare in childhood. We report a case of a rare angioma of a rib complicated by bone erosion in a young boy.Early diverting colostomy for perianal sepsis in children with acute leukemia
Perineal sepsis is a life-threatening complication of acute leukemia. Although conservative management (antibiotics, incision, and drainage, alone or in combination) is considered the criterion standard, it provides an outcome that is not fully satisfactory, with an overall mortality of roughly 30%. This report presents a case series of 4 children who underwent early defunctioning colostomy for the treatment of perineal sepsis during leukemia. This management proved to be successful and allowed prompt reestablishment of chemotherapy, thus improving overall results.Angiodysplasia (vascular malformations) of the colon presenting as an acute abdomen
Angiodysplasia (vascular malformations) of the colon is extremely rare in children, and, as in adults, present with lower gastrointestinal hemorrhage. Here we report an unusual pediatric case of angiodysplasia of the terminal ileum and cecum presenting as an acute abdomen with radiological features suggestive of lymphoma.Penetrating fetal trauma with late complications: a case report
Survival after direct penetrating trauma to a fetus is very unusual. Our case below illustrates nonoperative management of a penetrating thoracoabdominal gunshot injury to the retroperitoneum with a late complication arising 15 years after the initial incident.An unusual case of small bowel obstruction in a child caused by ingestion of water-storing gel beads
Foreign body ingestion occurs most commonly in the pediatric population. Small bowel obstruction is a rare complication that can occur, and surgical intervention is required. We present the first report of a case of an 18-month-old child with a jejunal obstruction caused by ingestion of water-storing gel beads used for botanical arrangements. The child presented with obstipation and nonbloody, nonbilious emesis. Symptoms resolved after a large bead 3 cm in diameter was retrieved via laparoscopic-assisted excision.Extraskeletal Ewing sarcoma of the mesocolon in a child
Ewing sarcoma (ES) is a malignant neoplasm usually affecting the skeletal system. Extraskeletal ES is a rare tumor. To date, only 1 case of primary mesocolon ES has been previously reported in an adult. Herein, we present the first case of ES in the mesocolon in a child.Dopamine-secreting adrenal ganglioneuroma in a child: beware of intraoperative rebound hypertension
Ganglioneuromas are benign tumors originating from the neural crest and are composed of mature ganglion cells. We describe a 15-year-old normotensive adolescent girl with a 2-month history of left flank pain. Imaging revealed a left suprarenal mass with elevated urinary dopamine level. During laparoscopic adrenalectomy, intraoperative rebound hypertension occurred. After resection, dopamine levels normalized. The pathologic diagnosis revealed an adrenal ganglioneuroma.Treatment of chest wall osteosarcoma presenting as second primary after treatment of neuroblastoma
Only 2 cases of osteosarcoma as a second primary malignancy after neuroblastoma have been reported in the literature. We present a case of chest wall osteosarcoma that developed in a 14-year-old boy 7 years after completion of chemotherapy, autologous peripheral blood stem cell transplantation, radiation, and resection for stage 3, high-risk neuroblastoma. A biopsy of a painful chest wall mass arising from the right third rib diagnosed osteosarcoma. He went on to have preoperative chemotherapy followed by wide local excision and chest wall reconstruction.Successful tracheobronchial reconstruction of communicating bronchopulmonary foregut malformation and long segment congenital tracheal stenosis: a case report
Communicating bronchopulmonary foregut malformation (CBPFM) and congenital tracheal stenosis (CTS) are difficult developmental disorders especially when they are presented simultaneously in a patient. The authors report a case of a newborn boy born at 37 weeks of gestation weighing 2356 g with CBPFM (right esophageal lung) and long segment CTS. Staged surgical repair (by-force endotracheal intubation for securing the airway followed by bronchotracheal anastomosis for CBPFM, tracheostomy with handmade, length-adjustable tracheostomy tube, and slide tracheoplasty) was performed.Failure of sclerotherapy in the treatment of thyroglossal duct cyst in children: 2 case reports and review of the literature
Thyroglossal duct cyst (TGDC) is one of most common congenital diseases of the midline of the neck. Most TGDC cases require treatment in the cases of cosmetic problems or recurrent infection, and a Sistrunk operation is considered to be the standard treatment. However, less invasive treatments are sometimes used, and sclerotherapy with OK-432 or ethanol is one such method. However, the validity or use of sclerotherapy as a TGDC treatment is controversial because cases of TGDC that have been successfully treated with sclerotherapy are rare, and the follow-up period is short, and there are no statistical reports about the reoccurrence of symptoms after sclerotherapy.Female double urethra: a case report
Female double urethra is a very rare anomaly, with less than 40 cases reported since 1970. Most reported cases of double urethra are in the sagittal plane and tend to be stenotic. We describe a 4-year-old girl with double urethra, which was not stenotic and was in the coronal plane. Double urethra should be excluded among other causes in any girl who is incontinent beyond the continence age.Intradiaphragmatic hybrid lesion in an infant: case report
Hybrid lesions have elements of both congenital cystic adenomatoid malformation and bronchopulmonary sequestration. We report an unusual case of an infant treated for an intradiaphragmatic hybrid lesion. Although computed tomography remains the criterion standard imaging examination for planning the operation, the exact localization of such lesions may be discovered only at surgical exploration.Gastrointestinal stromal tumor: a very rare cause of jejunoileal intussusception in a 6-year-old girl
A 6-year-old girl was admitted to the emergency department with abdominal pain and bilious vomiting of 3 days in duration. Abdominal ultrasound examination showed an 8-cm-long intussuscepted intestinal segment with a target sign. There was a 26 × 28 × 23 mm nonperistaltic anechoic cystic mass suggestive of a duplication cyst. At laparotomy, the ileocecal region was normal with many enlarged lymph nodes from which biopsies were taken. There was a 20-cm-long intussuscepted segment at the proximal ileum close to the jejunum.Swyer-James-MacLeod syndrome in a surgically treated child: a case report and brief literature review
Swyer-James-Macleod syndrome (SJMS) is a rare, complex disease characterized by unilateral hyperlucent lung or lobe owing to loss of pulmonary vasculature and alveolar hyperdistention. Treatment is generally conservative, and surgical management is rare. In fact, only 4 reports on surgically treated children with SJMS are available in the literature. We describe an 8-year-old patient with a history of recurrent respiratory infections since 2 months old. The patient presented with cough and dyspnea on effort.Metanephric stromal tumor: a challenging diagnostic entity in children
A case with a renal mass diagnosed as metanephric stromal tumor is presented. A 6-year-old boy presented with frequently recurring urinary tract infections. He had been followed up at different medical centers for the last 2 years with a 2 × 2 cm simple cyst localized in the inferior pole of the left kidney. At our center, ultrasonography revealed a heterogeneous mass in the left kidney with a central cystic component. The patient underwent operation for left renal mass, and heminephrectomy was performed.Pediatric synchronous bilateral ovarian torsion: a case report and review of the literature
Ovarian torsion is a surgical emergency that can present with a variety of symptoms and hence is difficult to diagnose. We present the first case of a pediatric synchronous bilateral ovarian torsion in ovaries without pathology and review its presentation, diagnosis, treatment, outcome, and the associated literature.Sigmoid perforation and bucket-handle tear of the mesocolon after bicycle handlebar injury: a case report and review of the literature
We describe an unusual case of sigmoid colon perforation secondary to a bicycle handlebar injury. Because the patient presented 2 days after the initial injury, we suspected that the colon perforation was not the immediate result of the bicycle accident but, rather, was secondary to devascularization. At operation, we found a bucket-handle tear of the colonic mesentery, which was the patient's primary injury and cause of the perforated colon.Colon atresia and frontal encephalocele: a rare association
The association of colonic atresia with craniofacial anomalies has been well described and probably represents a malformative event that occurs in the early embryonal period. We present a case of an infant with colonic atresia and a frontal encephalocele and believe this to be a newly reported association. We review possible pathogenic mechanisms.Bi-caval dual lumen venovenous extracorporeal membrane oxygenation and high-frequency percussive ventilatory support for postintubation tracheal injury and acute respiratory distress syndrome
Bi-caval dual lumen venovenous extracorporeal membrane oxygenation (VV-ECMO) as a nonoperative approach to postintubation tracheal injury has not been described. We report the case of a 7-year-old boy who sustained a postintubation tracheal injury, developed acute respiratory distress syndrome from aspiration and viral pneumonitis, and was supported on bi-caval dual lumen VV-ECMO for 16 days until the trachea healed without surgical repair. Before ECMO decannulation, high-frequency percussive ventilation using a volumetric diffusive respiration ventilator was used for lung recruitment and airway clearance without disruption of the healed trachea.Teratoid Wilms' tumor: case report of a rare variant that can mimic aggressive biology during chemotherapy
Teratoid Wilms' tumor is considered by some as a variant of Wilms' tumor containing at least 50% heterologous differentiated tissue. Fewer than 30 cases have been described. We report a 9-month-old boy with bilateral Wilms' tumors who did not respond to multiagent chemotherapy and underwent right nephrectomy that showed a teratoid Wilms' tumor. The patient continued to survive despite cessation of treatment. The overall predominance of differentiated stromal elements in this subtype of Wilms' tumor might explain the poor response to chemotherapy yet generally favorable outcome.Endovascular stenting of blunt thoracic aortic injury in an 11-year-old
Blunt traumatic thoracic aortic injury in children is very rare. Open surgical repair is the definitive treatment. Thoracic endovascular aortic repair (TEVAR) for trauma has been performed in adults with good outcomes. Its use has been adopted in pediatric population, and its role is evolving. We report a successful TEVAR in a critically injured 11-year-old boy. To our knowledge, this is the youngest patient to be successfully treated with TEVAR.Malignant phyllodes tumor in an 11-year-old premenarchal girl
Phyllodes tumor is uncommon in children, and the malignant form is rare. There have only been a few cases of benign phyllodes tumor reported in peripubertal children and only one malignant case. We report the second case of malignant phyllodes tumor in a premenarchal 11-year-old girl.Laparoscopic extraction of an intrahepatic foreign body after transduodenal migration in a child
We report on a 3-year-old boy who, after ingestion of turpentine, had an x-ray and was incidentally diagnosed with an intrahepatic needle. He was asymptomatic with no history of needle ingestion. Imaging (ultrasound and computed tomographic scans) showed a needle in segment 1, close to the inferior vena cava, with a proximal end in contact with the superior angle of the duodenum. Because of the localization of the needle and subsequent risks of complications, removal was proposed. Laparoscopy showed dense adhesions between liver and duodenum, confirming the migration route.Pancreatic tissue in congenital segmental dilatation of intestine: case presentation and recommendation for treatment
Segmental dilatation of intestine (SDI) is a very uncommon condition affecting children. The case that we present suggests that SDI may have may histologic findings in common with vitellointestinal remnants. A limited resection or other minimal procedure to preserve bowel length is usually undertaken for SDI. However, this case illustrates that the dilated segments of small bowel should be completely excised, in the same fashion as for vitellointestinal duct remnants, because of the possible presence of ectopic gastric mucosa and exocrine pancreatic tissue.Neonatal oral tumors: congenital epulis and epignathus
Oroparyngeal tumors in neonates protruding from the mouth are extremely rare. They have the potential to cause respiratory distress, or even death of the child during the perinatal period owing to airway obstruction and may need a multidisciplinary team approach at the time of birth. Congenital epulis and epignathus are the 2 rare lesions usually presenting like this and clinical manifestations depend on their position and size. They have an excellent prognosis, if treated properly. This paper will discuss our experience with these 2 lesions and review the literature.A complex congenital anomaly: liver eventration because of intrathoracic rib and vertebral segmentation disorder—a case report
The complicated processes of chest development and differentiation frequently lead to malformations of the ribs and vertebrae. An intrathoracic rib is a rare anomaly. We report here, for the first time, a complex congenital malformation with liver eventration because of a right intrathoracic rib and vertebral segmentation disorder of the spine in a 7-year-old girl without respiratory impairment. Diagnostic features and therapy for congenital rib anomalies are described.Supernumerary testis: a case report and review of literature
Supernumerary testis or polyorchidism is a rare anatomical and congenital anomaly, and approximately 100 cases have been reported in the literature so far. It is often associated with processus vaginalis anomalies and with increased risk of malignancy and infertility. We report a case and its management, having left-sided duplex testis and found incidentally during inguinal hernia repair, and review the literature.Development of bile duct cancer in a 26-year-old man after resection of infantile choledochal cyst
Anomalous arrangement of the pancreaticobiliary duct is considered to be a high-risk factor for biliary tract malignancy. We report a case of intrahepatic cholangiocarcinoma in a 26-year-old man after total resection of choledochal cyst with anomalous arrangement of the pancreaticobiliary duct at the age of 5 months. He had been doing well after total resection of the choledochal cyst; however, he suddenly presented with a spiky fever and abdominal pain in the right upper quadrant at the age of 26 years.Staged esophageal lengthening with internal and subsequent external traction sutures leads to primary repair of an ultralong gap esophageal atresia with upper pouch tracheoesophagel fistula
Primary repair of very long gap esophageal atresia (EA) with almost complete absence of thoracic esophagus has usually been thought impossible. Thus, esophageal replacement with colon or gastric interposition seemed inevitable. In contrast, J. Foker described a technique of lengthening the pouches with traction sutures and making primary repair possible. To contribute clinical experience to this discussion, we report about esophageal elongation in a child with long gap EA and an upper pouch tracheoesophageal fistula (TEF).Successful treatment of congenital esophageal web by endoscopic electrocauterization and balloon dilatation
We report a 3-year-old boy who presented with a foreign body impacted in the esophagus and had a poor tolerance of solid food since he was 5 to 6 months old. In the last 2 years, he developed progressive dysphagia, anorexia, vomiting, and poor weight gain. An esophagoscopy and barium esophagogram revealed an esophageal web in the distal third of the esophagus. Three courses of endoscopic balloon dilatation resulted in transient improvement in his dysphagia and vomiting; a follow-up barium esophagogram and esophagoscopy showed limited improvement of the esophageal stenosis.Volvulus of a jejunal lymphatic vascular malformation presenting with bilious vomiting and the radiological appearances of malrotation
Bile-stained vomiting in infancy is abnormal. Malrotation with small bowel volvulus is probably the most worrying of possible causes because if untreated for too long, it can result in massive bowel necrosis. As a consequence, if examination or plain radiography does not suggest another cause, an upper gastrointestinal (GI) series is often performed to exclude malrotation. If the examination is normal however and symptoms settle, should investigation stop, or how far should it be pursued? Small bowel lymphatic vascular malformations in children are extremely rare but carry a risk of obstruction, volvulus, and loss of small bowel.Prenatally diagnosed patent urachus with bladder prolapse
We report 2 cases of patent urachus with bladder prolapse, which has a characteristic finding of “disappearance of cyst” antenatally. In the first case, a 34-year-old woman presented at 14 weeks gestation for evaluation of a cyst. Prenatal ultrasonography revealed a cystic mass at the base of the umbilical cord, communicating with the bladder. At 26 weeks gestation, the cyst had disappeared, and a solid mass bulged out inferior to the umbilical cord. At term, the patient delivered a male infant.An unusual case of neuroblastoma with angiomatoid features
Neuroblastoma is the most commonly occurring solid tumor in children. Most of these neoplasms are diagnosed within the first few years of life. The diagnosis of neuroblastoma may be difficult because of its ability to arise in different locations, its propensity to metastasize, and variable clinical signs and symptoms. Therefore, accurate and timely pathologic diagnosis is imperative. Herein, we present the rare description of an angiomatoid neuroblastoma. Only 1 other case has been previously reported.Spermatic cord hydatid cyst: an unusual localization
Lesions of the groin include hernia, hydrocele, spermatic cord cyst, undescended testes, lymphadenopathy, and abscess. Hydatid cysts are endemic in certain regions of the world. They are usually located in the liver, lung, spleen, brain, and kidney. Although many uncommon locations have been reported, hydatid disease has been reported 3 times in the spermatic cord. This is the first report of a child with hydatid disease in the spermatic cord. A 9-year-old boy with a spermatic cord cyst proven to be a hydatid cyst is reported.Adenomyoma of the stomach mimicking infantile hypertrophic pyloric stenosis
We report a case of gastric adenomyoma in a 1-month-old girl. This patient presented with gastric outlet obstruction simulating infantile hypertrophic pyloric stenosis. Histologic examination of the excised specimen showed irregularly arranged glands and interlacing smooth muscle bundles surrounding the glandular elements. We suggest that this lesion is not just heterotopia, but hamartoma composed of abnormal mixture of endoderm-derived epithelial component and mesoderm-derived smooth muscle.Laparoscopic cystojejunostomy as a treatment option for pancreatic pseudocysts in children—a case report
Pancreatic pseudocysts are a rare entity in children for which many approaches have been described. We report on the case of a 5-year-old boy with a pancreatic pseudocyst after blunt abdominal trauma. The patient's clinical and laboratory examination findings had also revealed an acute pancreatitis. His diagnostic workup included ultrasound examination and magnetic resonance cholangiopancreatography. Two large cysts were found at the tail of the pancreas. No injury of the pancreatic or bile duct was found.Hallucinations after hypospadias repair
The authors report a case of a 4-year-old child who developed hallucinations after hypospadias repair. He was brought to the emergency department the morning after outpatient surgery where the diagnosis of central anticholinergic syndrome was made. We review oxybutynin overdose and the importance of providing clear instruction to parents and caregivers about the administration of medications.Kasabach-Merritt syndrome: dangers of interferon and successful treatment with pentoxifylline
A girl aged 3 months presented with thrombocytopenia and bruising around a large vascular malformation of her posterior abdominal wall. Treatment was started with corticosteroids and platelet replacement, but with no improvement and a platelet count persistently less than 10 × 109/L over 3 weeks, α-interferon was added. There was an immediate increase in bruising, a fall in platelet count, and an increase in platelet transfusion requirement until interferon was discontinued 11 days later. After a further week, the platelet count returned to the levels before interferon, but the patient did not develop any further symptoms.Laparoscopic repair of neonatal gastric perforation
Gastric perforation is a rare, life-threatening condition in neonates. To avoid deterioration, prompt surgical treatment is mandatory.Giant T-shaped duplication of the transverse colon. A case report
A case of long diverticular colonic duplication producing acute abdominal pain in a 6-year-old girl is presented. Physical examination showed no signs of acute abdomen at the initial presentation. After a pain-free interval, there was a sudden onset of severe abdominal pain and a large tumor in the lower abdomen was observed. A plain x-ray showed an enormously dilated colonic pouch filled with gas. Excision of the T-shaped duplication and small part of the transverse colon was successful. Because of extensive fibrotic changes in the colon near the opening of duplication, a resection margin of at least 2 cm is recommended.Fibrobronchoscopic treatment of foreign body aspiration in children: an experience of 5 years in Hangzhou City, China
The aims of the study were to evaluate duration of symptoms, clinical manifestation, radiological findings, fibrobronchoscopic findings, and the complications of airway foreign body (FB).Penile torsion repair by suturing tunica albuginea to the pubic periosteum
The aim of the study was to evaluate the effectiveness of a new technique to repair penile torsion in children.An 11-year-old male patient demonstrating cholangiocarcinoma associated with congenital biliary dilatation
We herein report an 11-year-old male patient demonstrating advanced cholangiocarcinoma associated with congenital biliary dilatation (CBD). This Japanese boy presented with abdominal pain lasting a few days, and a diagnosis of type IV-A CBD was made based on the findings of imaging studies using ultrasonography, computed tomography, and magnetic resonance imaging. These studies also revealed a wide flat lesion associated with a few small round masses in the dilated choledochus. Intraoperative cholangiography revealed the presence of pancreaticobiliary maljunction of CP type.Extensive cervical-mediastinal cystic lymphatic malformation treated with sclerotherapy in a child with Klippel-Trenaunay syndrome
Klippel-Trenaunay syndrome is a rare congenital disorder characterized by combined vascular malformations, varicosities, and limb enlargement. A child case of Klippel-Trenaunay syndrome with a large cervicomediastinal cystic lymphatic malformation and a vascular mass on the chest wall has been presented to demonstrate combined use of conservative and surgical approaches in this syndrome. Cystic lymphatic malformation was treated by sclerotherapies including ultrasound-guided transthoracic bleomycin injection into mediastinal cyst, which was tried for the first time in the literature, and vascular chest wall tumor necessitated surgical excision.Total laparoscopic left lateral sectionectomy performed in a child with benign liver mass
Despite the increasing number of recent reports on laparoscopic liver resection in adults, there are only rare reports on such a procedure being performed in children. The authors report here on a total laparoscopic left lateral sectionectomy that was performed in a 5-year-old girl who had a cystic tumor of the liver. The operative time was 150 minutes, the estimated blood loss was about 100 mL, and no intraoperative transfusion was required. The patient was discharged on postoperative day 11 without any significant complications.Diaphragmatic lipoma in a 4-year-old girl: a case report
A lipoma of the diaphragm is extremely rare. Although most congenital diaphragmatic lipomas are encountered in middle or old age because of their typical asymptomatic nature, none have been reported in patients younger than 14 years. We report the case of a large diaphragmatic lipoma in a 4-year-old patient.Lumbosacral parasitic rachipagus twin
A rare case of a newborn girl presenting with a mass representing an aborted parasitic twin attached to the back in the midline over the lumbosacral region (parasitic rachipagus) is reported. Rudimentary digits were attached to the mass, and in one area, the overlying skin resembled scrotal skin. A depression resembling an anal dimple was also present on the surface of the mass. Investigations showed a well-developed long bone and other small bones within the parasite, and sacral spina bifida in the autosite.Endobronchial migration of prosthetic patch after congenital diaphragmatic hernia repair
Surgical repair of congenital diaphragmatic hernia (CDH) can be performed by means of either direct suturing of the diaphragm or positioning of a prosthetic patch. However, half of all prosthetic patches show evidence of reherniation. We describe the case of an 8-year-old girl who presented with prosthesis dislocation and fistulization in the right lower bronchus as a complication of a CDH repair that she underwent when she was 1 year old. Abdominal ultrasound and magnetic resonance imaging suggested a hernia relapse, whereas chest computed tomographic scan failed to identify the diaphragmatic defect.Malignant vascular tumors of liver in neonates
Malignant vascular tumors of the liver are rare in children, especially in neonates. We report two cases. One was initially diagnosed as infantile hemangioendothelioma. Rapid growth and appearance of pulmonary metastasis while on aggressive medical treatment suggested malignant transformation. The other neonate presented with intractable ascites and liver biopsy showed histological features of angiosarcoma. Ascites has rarely been reported as a presenting feature of angiosarcoma in literature. Both patients died.A new case of male Y-type urethral duplication and review of literature
Urethral duplication is a rare congenital anomaly, affecting mainly boys. Generally, the duplication develops on the sagittal plane; the accessory urethra may run dorsally or ventrally to the orthotopic one. The embryology of this pathology is still controversial. In the English medical literature, approximately 175 cases have been reported. We report here a new case of urethral duplication type II A2 “Y” in a 14-year-old boy and review the current literature of this rare entity.Management of splenic abscess in children by percutaneous drainage
Isolated splenic abscesses are rare in pediatric patients. The recommended treatment in the literature has been in favor of splenectomy, although conservative treatment with splenic preservation is being increasingly reported. We report successful management of 4 pediatric patients with splenic abscess by needle aspirations and antibiotics.Bilateral adrenal neuroblastoma and nephroblastoma occurring synchronously in a child with Fanconi's anemia and VACTERL syndrome
Fanconi's anemia (FA) is an autosomal recessive inherited syndrome with a predisposition to malignancy. The association between FA and solid pediatric tumors is extremely rare. The authors report a rare case of VACTERL syndrome associated with FA and multiple solid pediatric tumors occurring in a very young girl. This child had numerous congenital anomalies (horseshoe kidney, cerebella hypoplasia, microcephaly, sacral agenesis) and esophageal atresia, which was repaired in neonatal period. Such association led quickly to the diagnosis of FA.Retroperitoneal hemangioma of infancy
A premature infant presented with an incidental finding of a mass in the retroperitoneum adjacent to the adrenal gland seen on a renal ultrasound study. A clinical diagnosis of neuroblastoma was made based on imaging and laboratory studies; however, upon resection, histological examination revealed a cellular capillary hemangioma of infancy. Hemangioma should be considered in the differential diagnosis of asymptomatic retroperitoneal mass lesions in infants.Nodular periorchitis masquerading as a malignant parafunicular tumor in an adolescent
We report on a case of nodular periorchitis, an uncommon perifunicular mass in a 13-year-old adolescent accompanied by contralateral hydrocele. Nodular periorchitis is a rare, fibroproliferative, benign mesenchymal neoplasm of the paratesticular tissues of the scrotum with a low risk for recurrence. Testis-preserving surgery is the treatment of choice.Pediatric cystadenoma of the mesocolon
A 14-year-old adolescent girl presented to her PCP with increasing epigastric pain and abdominal fullness. She had epigastric pain for approximately 6 months before coming to the hospital. Her initial workup included an upper GI study, which revealed no signs of reflux. Over the ensuing 6 months, her complaints waxed and waned and then they became more severe. On presentation to our office, she was afebrile and her vital signs were stable. Her physical examination was remarkable for a soft, nontender abdomen with a mobile left-sided mass.Nonoperative treatment of traumatic pancreatic duct disruption in children with an endoscopically placed stent
The presence of ductal injury is the main determinant of consequence and a cause of significant mortality and morbidity in children with blunt pancreatic trauma. Proper treatment must be initiated on the basis of accurate anatomic diagnosis of the type and location of the injury. Computed tomography is an insufficient method for the diagnosis of the type and location of pancreatic ductal injury. Endoscopic retrograde pancreatography (ERP) is a reliable technique for determining the status of the pancreatic duct in children and may allow for definitive treatment of ductal injury by stenting in selected patients.Thoracoscopic treatment of pulmonary hydatid cyst in a child
Hydatid disease has a wide geographic distribution around the world. In human, the lungs are the second most commonly affected sites. Pulmonary hydatidosis is much more frequently encountered in children than in adults. Surgical treatment has remained the standard option in the management of hydatid disease. However, surgeons were able to replicate the principles of conventional surgery using minimally invasive techniques. Herein, we report a case of pulmonary hydatid cyst in a 9-year-old girl treated successfully using the thoracoscopic approach.Management of an epidermoid cyst of the intrahepatic ducts
Epidermoid cysts of the biliary tree have not previously been described. A baby boy presented with a prenatally diagnosed echolucent intrahepatic cyst. Postnatal radioisotope study of the liver demonstrated that the cyst communicated with the biliary tree. Follow-up ultrasound at 6 months demonstrated that the cyst was filled with echogenic material consistent with either blood or biliary debris. Due to the potential for obstruction and cholangitis, surgery was planned. The cyst was located at the confluence of the right and left hepatic ducts and involved all of the common hepatic duct.Secretion and expression of epithelial markers supports the biliary origin of solitary nonparasitic cyst of the liver in infancy
Solitary nonparasitic cyst of the liver (SNPCL) is rare in children. Although there are several hypotheses regarding the pathogenesis, the true origin of SNPCL remains unknown. The authors present an infant with a huge SNPCL in whom the epithelial markers, CA19-9, DU-PAN-2, and SPan-1, were elevated in the serum and cystic fluid. The presence of CA19-9 and DU-PAN-2 was shown by immunohistochemistry in the cystic epithelia. These indicate that the classical idea of biliary origin of SNPCL is supported.Aortobronchial fistula from invasive Aspergillus infection of the lung: an endovascular approach to repair
We report the case of an 11-year-old girl with an aortobronchial fistula as a complication from an invasive aspergillosis in the lung. This very rare problem has not been reported in children, to our knowledge. Management of Aspergillus infections of the lung in children and aortobronchial fistulas is reviewed.Complete surgical resection of inflammatory myofibroblastic tumor with carinal reconstruction in a 4-year-old boy
Inflammatory myofibroblastic tumor of the carina and the main bronchus is a rare tumor. The authors report here on a case of a 4-year-old boy with an inflammatory myofibroblastic tumor at the carina and extending to the left main bronchus. He presented with fever and a cough of 2 months' duration. Preoperative assessment of the tumor revealed an intraluminal round mass arising from the carina and extending into the left main bronchus, and this caused near-total obstruction of the left main bronchus and the subsequent total collapse of the entire left lung.The impact of 3-dimensional ultrasonography on perinatal management of a large epignathus teratoma without ex utero intrapartum treatment
We report a case of epignathus teratoma diagnosed at 22 weeks of gestation in which 3-dimensional ultrasound (3DUS) was useful to plan perinatal management. A significant enlargement of the tumor, associated with polyhydramnios and preterm labor, was observed at 35 weeks of gestation. After amniotic fluid evacuation, 3DUS was performed in the presence of pediatricians, obstetricians, and otolaryngologists. Three-dimensional ultrasound revealed that great part of the tumor was located outside the fetal mouth and anterior to fetal mandible, suggesting that the newborn could breathe spontaneously by nasal via.Hemothorax: an unusual complication of costal exostosis
We report a case of a spontaneous hemothorax in a 15-year-old girl because of costal exostosis. This possibly may have been provoked by a nontraumatic rupture of markedly dilated pleural vessels because of long-standing friction between the exostosis and the pleura. The authors conclude that exostosis of the rib is a rare cause of hemothorax in children and should be considered among possible etiologies in diagnosis.Horner syndrome due to first rib fracture after major thoracic trauma
A case of Horner syndrome diagnosed during the follow-up after major thoracic trauma is presented in this report. A 10-year-old boy was admitted to the emergency service with severe thoracic trauma with left clavicular and first rib fracture after a traffic accident. During the follow-up, myosis and ptosis were recognized in his left eye. Cranial tomography and neurological examination were all normal. The symptoms were thought to be caused by compression of the local hematoma to the cervical ganglia.Ingestion of magnets: innocent in solitude, harmful in groups
Foreign body ingestion is frequent in children and generally associated with little morbidity. However, some foreign bodies are innocent when ingested as a single object, but may have harmful effect if numerous. We report a 9-year-old girl who swallowed 5 magnets, causing acute intestinal obstruction. At laparotomy, 2 magnets were found in the cecum and 3 in the transverse colon, attracting each other and clasping a segment of ileum in between, causing a complete obstruction of the small intestine.Congenital diaphragmatic hernia in a patient with tetrasomy 9p
Tetrasomy of the short arm of chromosome 9 constitutes a rare condition resulting in a well clinically recognized syndrome. In our case, in addition to the characteristic phenotype at birth, the existence of a hernia-type Bochdalek diaphragmatic defect was found. Cytogenetic analysis revealed a nonmosaic case of an isochromosome of the entire short arm of chromosome 9 with no involvement of the heterochromatic region of the long arm: 47, XX, +i (9p). Because chromosome 9 contains several gene locus for enzymes and receptors of the retinoid pathway, this case potentially contributes to retinoid hypothesis in the etiology of congenital diaphragmatic hernia.Congenital symptomatic intrahepatic arteriovenous fistulas in newborns: management of 2 cases with prenatal diagnosis
Fetal and neonatal hepatic arteriovenous fistulas are rare and associated with a high mortality rate; they can be prenatally detected by ultrasonography. Management of these malformations can be a challenge for pediatric surgeons.Penetrating esophageal injury by ingestion of a wire bristle
Esophageal foreign bodies are frequently encountered in the pediatric population, and a high degree of suspicion should be maintained in the setting of postprandial dysphagia. We report the case of a 14-year-old boy with a penetrating esophageal injury after the accidental ingestion of a wire bristle from a grill brush.Exhaust system burn injuries in children
The authors had noted a number of children who had sustained burn injuries from the exhaust systems of recreational vehicles and wished to document the incidence of pediatric burn injury sustained from the exhaust systems of a wide scope of motorized vehicles.Traumatic handlebar hernia: A rare abdominal wall hernia
Traumatic abdominal wall herniation (TAWH) caused by direct trauma from bicycle handlebars are rare. There are only 21 reported cases of handlebar hernias. An 11-year-old boy presented to the emergency room soon after falling from his bicycle and hitting his right lower quadrant on the handlebars. The patient’s vital signs and initial laboratory studies were normal. Physical exam showed a soft tissue bulge in the right lower quadrant with superficial ecchymosis and tenderness to palpation. Computed tomography showed intestinal loops protruding through a defect in the abdominal wall into the subcutaneous space.Inflammatory myofibroblastic tumor (inflammatory pseudotumor) of the neck infiltrating the trachea
Inflammatory myofibroblastic tumor (IMT), popularly known as inflammatory pseudotumor, is a slow growing quasi-neoplastic lesion with a distinct histologic appearance and benign clinical course. A case of a neck IMT with infiltration into the trachea causing asthmalike symptoms in a 12-year-old girl is described. Both tracheal and neck IMT have been described, but no other case has displayed this infiltration. A review of the pertinent literature and the etiology, diagnosis, treatment, and outcomes of this tumor are discussed.Left colon stenosis caused by tuberculosis
The authors present a case of intestinal tuberculosis affecting exclusively the left colon causing severe undernourishment, abdominal pain, and bowel obstruction with a sealed colonic fistula in a 10-year-old child. These clinical characteristics and difficulties led to a diagnosis of intestinal tuberculosis in childhood. Intestinal tuberculosis affecting exclusively the colon is very rare, and differential diagnosis with Crohn’s disease is difficult. Surgical complications are frequent, especially intestinal obstruction, and can be treated in most cases by resection of the affected segment and primary anastomosis.Multilocular cystic renal cell carcinoma in a child
Multilocular cystic renal cell carcinoma is an extremely rare condition in adults with no previous case reports in the pediatric age group. The authors report on an 8-year-old girl who underwent nephrectomy for a right-sided renal cystic disease because of extensive involvement of the kidney. Subsequent histopathologic examination findings showed presence of renal cell carcinoma in all the cysts. Awareness of this malignancy in a child is extremely important in the background of recent reports advocating conservative wait and watch management in unilateral renal cystic disease, which has similar clinical and imaging findings.Laparoscopic excision of a gastric duplication cyst detected on antenatal ultrasound scan
The authors report a gastric duplication cyst detected antenatally and its subsequent laparoscopic removal at 2 months of age. Before birth, a cystic mass was detected behind the stomach on fetal ultrasound scan (US). After birth, an US, barium meal, nuclide scan, and cervical and thoracic vertebral x-rays suggested that the most probably diagnosis was a gastric duplication cyst. At 2 months of age, laparoscopic removal of the cyst was performed with closure of the muscle defect in the stomach wall.Congenital segmental dilatation of the colon with anorectal malformation
Segmental dilatation of the colon is a rare entity. The authors report unique case of segmental dilatation of the cecum and ascending colon with high anorectal malformation in a newborn, and the possible embryogenesis of this condition is discussed.Management of ventral hernia after giant exomphalos with external pressure compression using helmet device
The aim of this study was to evaluate an alternative technique of reducing a ventral hernia that follows the primary conservative treatment of a giant omphalocoele.Treatment issues in pediatric gastric adenocarcinoma
Gastric adenocarcinoma is a rare diagnosis in children. Modern treatment includes chemotherapy, radiotherapy, and surgery and has evolved over the past decade. The authors report a case of an 8-year-old girl with gastric adenocarcinoma. The case will be followed by a brief discussion of the presentation, current management guidelines, and prognosis of this rare pediatric entity.Congenital cystic adenomatoid malformation connected to an extralobar pulmonary sequestration in the contralateral chest: Common origin?
Extralobar pulmonary sequestration (ELS) and congenital cystic adenomatoid malformation have been reported to coexist in several variations. This suggests a common embryologic origin. A 6-month-old boy presented with a history of recurrent pneumonias. The patient was diagnosed with a right lower lobe congenital cystic adenomatoid malformation (CCAM) and a left lower lobe ELS/CCAM. The diagnosis was made with the aid of a multidetector computed tomography (CT). Three-dimensional CT reconstruction showed the presence of a right lower lobe CCAM, a left lower ELS with an aberrant arterial supply from the celiac axis, and possible venous drainage into the right CCAM.Further evidence for an ischemic origin of perforation of the appendix in the neonatal period
A full-term baby girl presented on the 14th day of life with an appendiceal abscess on a basis of appendicular perforation. Pathologic examination found focal transmural coagulation necrosis suggesting an ischemic origin for the perforation. It is argued that appendiceal perforation in the newborn period is a different disease entity than appendiceal perforation later in life. In the newborn, ischemia seems to be the leading pathogenetic factor, and neonatal appendiceal perfora-tion seems, therefore, related to neonatal necrotizing enterocolitis.Full-thickness skin necrosis after arginine extravasation—a case report and review of literature
The arginine test is highly useful in the evaluation of short-stature children and adolescents. Extravasation of arginine can cause full-thickness skin necrosis that requires serious surgical intervention with aesthetic and functional sequellea. The authors describe a case of distal forearm skin necrosis caused by arginine extravasation that was treated by wide debridement and a combination of groin flap and later with split-thickness skin graft. The authors emphasize the need for early and active management of arginine extravasation injuries.Bronchoplasty for bronchial stenosis in a neonate: a case report
Bronchial stenosis is an uncommon problem in children. Management can be difficult because of the small luminal diameter and proximity of the lung parenchyma to the bronchial lesion. Bronchoplasty procedures have obvious advantages in children because of their long life expectancy. Long-term functional results are superior compared with pneumonectomy because of preserved lung tissue. A premature neonate weighing only 779 g at birth was born with severe respiratory distress syndrome complicated with hyperbillirubinemia and bronchopulmonary dysplasia.Core excision of the foramen cecum for recurrent thyroglossal duct cyst after sistrunk operation
The recurrence rate for thyroglossal duct cysts after a Sistrunk operation is 5% compared with 20% if the hyoid cartilage is not removed. However, few guidelines exist when a lesion recurs after an adequate Sistrunk operation. A 2-year-old boy was referred for recurrent thyroglossal duct cyst after complete and adequate resection. Reexploration of the wound and wider excision of the midline cervical tissues failed to treat the problem. Using a combined transoral/cervical approach, a core of tongue around the foramen cecum was removed.Teratoma arising from anomalous common bile ducts: a case report
Teratoma arising from extrahepatic common ducts is very rare entity. The authors found 2 teratoma cases originating from common bile duct in the literature. As a third case, the authors report on a 4-month-old girl with benign cystic teratoma arising from distal common hepatic bile duct and with anomalous common bile ducts. Surgical management of the patient also is discussed.Patent urachus with bladder eversion
An infant was born at term after having received a diagnosis of omphalacele on prenatal ultrasound scan. She did not have an omphalacele but rather had a patent urachus with bladder eversion onto the abdominal wall. The remainder of the genitourinary tract was normal, and it was possible to pass a soft catheter through the urethra and out of the evaginated bladder. The prolapse was repaired without complications, and the infant recovered uneventfully. A voiding cystourethrogram and renal ultrasound scan were normal at 2 month follow-up.A case of inflammatory pseudotumor of the liver hilum successfully treated with aggressive hepatectomy
Inflammatory pseudotumor (IPT) of the liver is a rare, benign tumor. When the tumor involves the hepatic hilum, however, the clinical course of the patient becomes problematic because of obstructive jaundice and portal hypertension. Complete removal of the tumor sometimes is difficult when the hepatic hilum is extensively involved, and liver transplantation becomes necessary for such an unresectable tumor. This report concerns a 7-year-old boy who presented with obstructive jaundice and portal hypertension owing to an inflammatory pseudotumor of the hepatic hilum and was treated successfully with aggressive hepatectomy, vascular reconstructions of both the portal vein and the hepatic artery, and biliary reconstruction.Extravasation of hyperalimentation into the liver parenchyma from a peripherally inserted central catheter
A neonate receiving hyperalimentation through a peripherally inserted central catheter (PICC) had acute abdominal distension and respiratory distress. She was found to have extravasated a 9-cm × 9-cm pocket of hyperalimentation into the liver parenchyma, most likely caused by arterial placement of the PICC. She had severe anasarca and markedly decreased synthetic liver function. After 3 weeks of intensive care, she began to diurese. Her respiratory status subsequently improved, she started feeding, and her liver function test results returned to normal.Esophageal diverticulum in an infant with Down's syndrome and type III esophageal atresia
An 18-month-old infant with Down's syndrome presented with a symptomatic esophageal diverticulum (ED) located at the cervical esophagus. He had been operated on successfully for an esophageal atresia and distal tracheoesophageal fistula in the newborn period. Neither surgical maneuvers nor esophageal trauma could explain the ED, which was resected through a cervical approach. J Pediatr Surg 38:E9. Copyright 2003, Elsevier Science (USA). All rights reserved.
