Online Exclusives
Splenic hemangiopericytoma in a one-month-old infant
Hemangiopericytoma is an uncommon tumor that occurs mostly in middle-aged adults. There have been only sporadic case reports of splenic involvement, and in all but one the treatment has been total splenectomy. We present a one-month-old boy with splenic hemangiopericytoma treated with partial splenectomy. This is the youngest case in the literature, and there has been no recurrence noted after two years of follow up.Gastric hamartoma of the pylorus in an infant
Gastric hamartomata, alternatively called adenomyomata, are rare, benign lesions of the gastric wall. They can present with a wide spectrum of symptomatology. Pure pyloric adenomyomata are exceedingly rare. We are reporting a 13-day-old infant with a gastric hamartoma at the pylorus presenting with gastric outlet obstruction mimicking infantile hypertrophic pyloric stenosis.Percutaneous management of bile-plug syndrome: a case report
Bile-plug syndrome is defined as an obstruction of the common bile duct by bile sludge in full-term infants. It is a correctable cause of obstructive jaundice in infants and is generally treated surgically. Here, we present a case of a 5-month-old infant with bile-plug syndrome, which was treated by percutaneous biliary interventions. To the best of our knowledge, percutaneous treatment of bile-plug syndrome is reported for the first time in an infant. This minimal invasive treatment modality may be a useful alternative to surgery in infants with bile-plug syndrome.Laparoscopic detorsion and colopexy for splenic flexure volvulus in an infant
Primary splenic flexure volvulus is a rare entity. We describe the first case of splenic flexure volvulus managed by a laparoscopic approach. A previously healthy 32-month-old girl presented with constipation, appetite loss, and nonbilious vomiting of 15 days of duration. Contrast enema and 3-dimensional computed tomography revealed a “bird's beak” sign at the splenic flexure, consistent with the diagnosis of splenic flexure volvulus. Attempted detorsion during colonoscopy was unsuccessful, and a laparoscopic procedure was performed, and 180° torsion of the splenic flexure with a distal caliber change was observed.Diagnosis and laparoscopic treatment of ileoileal intussusception secondary to heterotopic pancreas in an infant: case report and review of the literature
Small bowel intussusception in infancy owing to a pathologic lead point is a rare event requiring immediate surgical attention. We report a case of a 7-month-old patient presenting with ileoileal intussusception with isolated heterotopic pancreas as the lead point. We review the literature of small bowel intussusception focusing on diagnosis and treatment. In contrast to comparable previous reports of infants with heterotopic pancreas and intussusception, the diagnosis was based solely on ultrasound findings followed by operative management using a laparoscopically assisted surgical approach.Perinatal evolution of mesenchymal hamartoma of the chest wall
Mesenchymal hamartoma of the chest wall (MHCW) is a rare condition. Previously, surgical resection has been advocated with considerable post-operative morbidity. Evidence for conservative management is lacking because the natural history of MHCW is unknown. We present serial measurements of an antenatally detected MHCW (8 antenatal ultrasounds and 2 postnatal computed tomographic scans). The study demonstrates that the relative tumor size peaked at birth and then decreased postnatally. Based on this evidence, we believe that MHCW can be managed conservatively in an asymptomatic patient.Severe gastric damage caused by button battery ingestion in a 3-month-old infant
Ingestion of a button battery has been considered a serious problem, causing necrosis and perforation, when impacted in the esophagus. However, such batteries in the stomach rarely cause any harm to the gastric wall, which is regarded as evidence supporting the use of conservative treatment. We present the rare case of a 3-month-old infant with severe gastric wall injury caused by a button battery lodged in the stomach. The present case suggests that button batteries located in the stomach should be removed as soon as possible, especially in infants.Endobronchial chondroid hamartoma in an infant
Endobronchial tumors in infants are uncommon. The clinical and radiologic findings and management of a rare case of endobronchial chondroid hamartoma in an infant is presented along with a review of the literature.Solitary hepatic lymphangioma in a 22-day-old infant
Lymphangiomas are congenital malformations of the lymphatic system composed of dilated endothelial lined spaces of varying sizes containing lymph. Hepatic lymphangioma is a rare finding, exclusively present in children and adolescents. Most reported cases occur as part of diffuse lymphangiomatosis. Solitary lymphangioma of the liver in infants is extremely rare. This report describes a case of unilocular, solitary hepatic lymphangioma in a 22-day-old infant.Solid cervical ectopic thymus in an infant
Cervical ectopic thymus presenting as a neck mass is rare in a neonate. Just more than 100 cases have been reported in the literature with less than 10% occurring in infants. We report a case of solid cervical ectopic thymus in an asymptomatic 2-month-old boy. We review the literature and discuss the embryology, pathophysiology, diagnosis, and management of an infantile ectopic thymus.Repair of huge incisional hernias intentionally made during infantile living donor liver transplantation
In some small infants who are transplanted with a large-for-size graft by living donor liver transplantation, an incisional hernia is intentionally made to decrease the tension on the graft. The procedure and timing for repair of this type of hernia were retrospectively evaluated.Ischemic gallbladder perforation in a premature infant
Gallbladder perforation is an extremely rare condition in infants. We present a premature infant who had congestive heart failure and renal failure owing to complex congenital heart disease and developed gallbladder perforation at 60 days of age. The patient showed neither signs of peritonitis nor impaired liver function; however, we found bile drainage from the peritoneal dialysis tube. Emergent laparotomy revealed a 3-mm perforation with surrounding tissue necrosis over the gallbladder neck. Cholecystectomy was performed after patent common bile duct was demonstrated using intraoperative cholangiography.Superior mesenteric artery syndrome in an infant: case report and literature review
Superior mesenteric artery syndrome (SMAS) is an obstruction at the third portion of the duodenum by compression between the superior mesenteric artery and the aorta. In infancy, SMAS is extremely rare; and for its diagnosis, other duodenal obstructive diseases including congenital duodenal stenosis and intestinal malrotation must be ruled out. We present the case of a 7-month-old girl with frequent bilious vomiting after the resolution of acute gastroenteritis. Superior mesenteric artery syndrome was finally diagnosed at laparotomy, and duodenojejunostomy was performed.Bilateral intralobar pulmonary sequestration in a newborn, case report and review of the literature on bilateral pulmonary sequestrations
We describe a rare case of bilateral intralobar pulmonary sequestration in a newborn with both sequestrations vascularized from a vessel arising from the celiac trunk of the abdominal aorta. The larger sequestration on the right side was diagnosed antenatally, the left side postnatally. At the age of 7 months, the child underwent successful bilateral thoracotomy. In follow-up at the age of more than 1 year, no complications have occurred.Congenital lingual cysts
Congenital lingual cysts are rare congenital tumors of the oropharynx, which should be suspected when the tongue appears enlarged by a mass. Prenatal diagnosis by ultrasound allows for an optimal management at the time of delivery because the mass can obstruct the airways. Unless the cyst enlarges and hinders feeding or breathing, surgical treatment is indicated only a few months after birth because spontaneous regression can sometimes be observed.The second and third right posterior intercostal veins: an alternate route for central venous access with an implantable port in children
Some children dependent on total parenteral nutrition for long periods have no more axillary, internal jugular, external jugular, saphenous, and femoral veins available for cannulation. In such patients, the central venous system can still be accessed via the azygos vein by placing an implantable port catheter through one of the right posterior intercostal veins. This is the first known description of such procedure.
