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Motoi Mukai, Hideo Takamatsu, Hiroyuki Noguchi, Hiroyuki Tahara, Tatsu ...
Article type: Article
2003 Volume 39 Issue 4 Pages
579-584
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Purpose and Methods: Gastrointestinal (GI) duplication is a rare congenital abnormality of the GI tract and is usually found in the small intestine. We examined seven patients with intestinal duplication, taking into consideration the background of the patients, clinical manifestations and pathological findings. Results: There were four males and three females ranging in age from 1 mo to 4 yr. Four patients showed clinical symptoms, vomiting in three, abdominal pain in two and loss of appetite in one. In one patient, intestinal duplication resulted in intussusception. Ultrasonography, prior to surgery was responsible for identifying five of the six cases of duplication. In one case, the duplication was found coincidentally during surgery for an ovarian cyst. All of the duplications were cystic and located in the ileum. Four of them were located on the mesenteric side and three were located on the antimesenteric side. Six patients whose duplications shared a common muscular wall (CMW) with the normal ileum were under one-year old. One patient with duplication that did not share a CMW developed clinical symptoms later than other patients. Conclusion: The sharing of a CMW with a normal intestine may affect the age at which clinical symptoms occur in cases of intestinal duplication.
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Kazuhiro Ohtsu, Yasuhiko Furuta, Yuichiro Soga
Article type: Article
2003 Volume 39 Issue 4 Pages
585-592
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Purpose: We have been performing inguinal herniorrhaphy on premature infants and present a study review of our experiences. Materials and methods: Between 1997 and 2001, 42 children weighing under 1,500 g birth and diagnosed with inguinal hernia were operated on in our department. Results: Of 42 cases, 21 were males and 21 were females. Their birth weights ranged from 349 to 1,498 g. Seventeen cases were diagnosed with right inguinal hernia, 11 with left inguinal hernia, and 14 with bilateral inguinal hernia. The post-conceptional age at operation ranged from 41 to 60 wk for 26 cases. Fourteen cases were treated before NICU discharge. The body weight at operation ranged from 2.18 to 4.0 kg for 17 cases. Only one case had one episode of incarceration. The operations were conducted using the Mitchell Banks method. The mean operating time required for the unilateral procedure in VLBW children was 20 min. There was no major complication after operations. Conclusion: Our approach now is to wait until the infant is otherwise ready for release from the hospital, which typically means that all comorbid conditions have stabilized. Infants must be at least 45 wk post-conceptional age, and weigh at least 2.5 kg.
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Takao Shiseki, Yasuo Ito, Yuji Nirasawa, Yoshiko Watanabe
Article type: Article
2003 Volume 39 Issue 4 Pages
593-597
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Purpose: The aim of this study is to determine the operative indication for retractile testis that ascend during interval scrotal examination. Methods: Sixty-five children (106 testes) were followed up with the initial diagnosis of retractile testis. We divided retractile testis into two categories, true retractile testis and high-scrotal undescended testis. High-scrotal undescended testis was defined as a higher and often smaller testis, which is usually located below the external ring and can be pulled down into the scrotum with tension. We reviewed the children's clinical courses and timing for operation. Results: Ascended testis was observed in five children (6 testes). An initial diagnosis of retractile testis was made for three cases (4 testes) and that of high-scrotal undescended testis for two cases (2 testes). Orchidopexy was performed for all cases by either conventional or transscrotal approaches. Conclusions: Because of the presence of ascended testis among children with retractile testis, including high-scrotal undescended testis, follow-up in the form of interval scrotal examination should be conducted during childhood. High-scrotal undescended testis is possibly an indication for operation. Orchidopexy is possible using the transscrotal approach for high-scrotal undesrended testis.
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Makoto Komura, Toshirou Honna, Yoshihiro Kitano, Hiroki Kamata, Jyun M ...
Article type: Article
2003 Volume 39 Issue 4 Pages
598-602
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The cervical thymus should be preserved because the thymus is an important immunologic organ. Recently, two aberrant cervical thymuses were removed in our department. We investigated literature to distinguish cervical thymus from cervical tumors and select the proper treatment. Case 1 was a 14-month-old male A It. cervical mass was noted after birth, and the mass was observed in our outpatient clinic. The mass size did not change It was resected after a preoperative diagnosis of nuerofibroma, but thymus tissue was revealed Case 2 was a two-month-old male A rt. cervical mass was noted two weeks after birth. It was removed after a preoperative diagnosis of submandibular gland tumor, but aberrant cervical thymus was confirmed by pathological study Twenty-three cases of aberrant cervical thymuses are reported in Japanese literature. Twelve cases were noted as cervical mass at first and the thymus tissue was removed. All of the cervical aberrant thymuses were in the cervical anterior triangle. We have operated on 157 cases of anterior cervical triangle masses in our unit We reviewed these 157 cases. Precise diagnosis of cervical anterior mass can be achieved by imaging and needle biopsy. Care should be taken to accurately diagnose aberrant cervical thymus when a mass is detected in the anterior cervical triangle.
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Masahito Sato, Akihide Tanano, Kohei Takada, Yoshinori Hamada
Article type: Article
2003 Volume 39 Issue 4 Pages
603-606
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Although ventriculoperitoneal shunts (VPS) are the most frequent operation for patients with hydrocephalus, children with VPS sometimes require shunt revisions. We investigated the efficiency of laparoscopic surgery for abdominal shunt revisions. Four children (6 months to 9 years of age) were treated laparoscopically for VPS revision. Disruption of the abdominal part of the VPS system was seen in two patients. The disrupted tubes were removed through the laparoscopic port and a new catheter was inserted into the peritoneal cavity under laparoscopic assistance. Shunt obstruction caused by peritoneal adhesion was seen in one patient and a new catheter was inserted laparoscopically. Laparoscopic VPS revisions can be performed safely and effectively in children with hydrocephalus from the viewpoint of observation capability and minimal invasive manuevers.
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Hiromitsu Matsuda, Tatsuo Kuroda, Miwako Nakano, Nobuyuki Morikawa, Mo ...
Article type: Article
2003 Volume 39 Issue 4 Pages
607-612
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A 7-month-old asymptomatic girl was admitted to our hospital because of a cardiac murmur detected during a routine infant examination at the age of 1 and 3 mo. Echocardiography showed abnormal artery supply to the left lower lobe from the aorta. Physical examination revealed a continuous vascular murmur at the left thoracic wall, especially strong at the posterior wall. A chest X-ray film showed normal conditions. Angiographic examinations revealed an anomalous artery arising from the descending thoracic aorta and supplying the left basal segments, which lacked pulmonary arteries. Broncho-fiberscopy and bronchogram showed no abnormal findings in the bronchial trees. The diagnosis of intralobular seqestration of the lung (Pryce Type-I) was made, and a left lower lobectomy with ligation of the anomalous artery was performed at the age of 11 mo Pathologically, the anomalous artery showed muscular type and hypertensive pulmonary arteriopathy in the peripheral area of the basal segments. The postoperative course was uneventful. The clinical features of this type of pulmonary sequestration were discussed with a review of 43 cases in other literature.
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Makoto Goto, Takasi Matuno, Satomi Idenoue, Tomomi Maeda, Akihiro Nui, ...
Article type: Article
2003 Volume 39 Issue 4 Pages
613-618
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We describe the clinical course of an infant with colonic strictures following suspected neonatal necrotizmg enterocohtis A 1498 g boy at 33 weeks gestation developed vomiting and hematochezia on day 8. His abdomen was softly flat and abdominal radiographs did not demonstrate pneumatosis intestinahs or other abnormal findings Therefore, the diagnosis of neonatal necrotizmg enterocohtis was not confirmed. He recovered with medical management, and enteric feedings were begun six days after the onset On day 22, abdominal distension, vomiting of bilous liquid and apnea were developed A barium enema revealed a colonic stricture at the splenic flexture A transverse colostomy was then performed on day 26 Two months later, the other stricture was demonstrated at the transverse colon near the stoma by barium enema At 8 months of age, resection of the strictures involving the stoma was conducted Colonic stricture is a well known complication after definite or advanced necrotizing enterocohtis. But it is not clear whether or not suspected necrotizing enterocohtis may cause intestinal strictures. We should recognize that even suspected necrotizing enterocohtis may cause intestinal strictures, and careful observation is needed for one to two months after the onset of suspected neonatal necrotizing enterocolitis.
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Aya Nishimori, Katsuhiro Asonuma, Toshiya Izaki, Hajime Ohshiro, Rieko ...
Article type: Article
2003 Volume 39 Issue 4 Pages
619-622
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Typical symptoms of Meckel's diverticulum are related to bleeding, intussusception or diverticuhtis. We report a case with atypical symptoms and imaging studies of Meckel's diverticulum. A five-year-old boy was admitted to our hospital because of intermittent and colicky abdominal pain without any positive physical findings Abdominal US, CT and MRI disclosed a cystic mass in the pelvic cavity. As there were no symptoms related to either gastrointestinal bleeding or infection, a mesenteric cyst or intestinal duplication seemed more probable Technetium 99m scintigram done for the exclusion of Meckel's diverticulum unexpectedly revealed a hotspot in the pelvic cavity. At laparotomy, a diverticulum, 45 cm in diameter with a 3-cm long stalk was found in the ileum 45 cm oral from the ileocecal valve and resected. The patient recovered uneventfully. The edema and hypertrophy of the stalk indicated that the intermittent abdominal pain might have been related to the loose torsion of the stalk It is suggested that Meckel's diverticulum should be considered as a differential diagnosis in the case of cystic lesion presented in the pelvic cavity with atypical clinical symptoms.
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Shinya Kawano, Yutaka Sanada, Yasuo Yoshizawa, Masahiro Chiba, Masayuk ...
Article type: Article
2003 Volume 39 Issue 4 Pages
623-629
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Sclerosmg mesententis is an uncommon inflammatory pseudotumor of the abdominal mesentery, characterized by chronic inflammation and fibrosis that usually results in thickening and retraction of the lesion. We report three cases of this rare condition in children. The cases were in a 1-year-5-month-old boy, a 3-year-8-month-old boy, and a 6-year-old girl Because of duration of mild unknown fever and palpation of an abdominal mass, all cases underwent laparotomy without any definitive diagnosis. At laparotomy, an abnormal mass lesion was located in the mesentery of the transverse colon to the splenic flexure, and the mass and involved colon were resected in all cases. All pathological specimens revealed high-grade fibrosis and chronic inflammation, and were diagnosed as sclerosmg mesententis. The possibility of sclerosmg mesententis in childhood, even though a rarity, must be entertained in the differential diagnosis of children who have bizarre abdominal mass lesions. Although there are many reports of medical treatment with steroids in adult cases, because of the difficulty to discriminate from malignant disease, surgical resection is often chosen in the case of children.
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Yuki Ogasawara, Toshihiro Yanai, Hiroyuki Kobayashi, Atsuyuki Yamataka ...
Article type: Article
2003 Volume 39 Issue 4 Pages
630-635
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We experienced a case of esophagotracheal fistula caused by a button-shaped lithium battery that had been lodged in the esophagus of a 15-mo-old boy for 12 d. The infant was taken to another hospital with vomiting and dysphagia. Chest radiography showed a button-shaped battery in the esophagus. Careful questioning established that the period since accidental mgestion was 12 d The battery was removed using direct esophagoscopy under general anesthesia. An ulcer was present Gastrograffm swallow performed three days after the battery was removed showed an esophagotracheal fistula, and he was transferred to our institution Endoscopy performed two weeks later showed there was a fistula 1 mm in diameter located 3 cm from the esophageal orifice. There was no associated ulcer or stricture. Percutaneous endoscopic gastrostomy was performed, and the infant was managed conservatively with parenteral and enteral nutrition, Famotidme, factor XIII, and Juzendaiho-to, a Chinese herbal medicine. Five weeks after removal, the fistula was found to have closed spontaneously, and oral feeding was recommenced the following week An esophagogram performed seven month after removal showed a normal esophagus. Lithium batteries may cause severe esophageal injury within hours of ingestion, and must be removed as quickly as possible. Management must be intensive and through to avoid any complications.
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Yoshiyuki Kisaki, Hiroo Uchida, Junko Fujino, Hideki Yamamoto, Yuki Is ...
Article type: Article
2003 Volume 39 Issue 4 Pages
636-638
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The authors present a case of lymphangioma accompanying duplication of the ileum A 5-month-old female patient complaining of bilious vomiting underwent an operation with a preoperative diagnosis of intestinal obstruction due to ileal duplication. A double cystic lesion was found at the mesentenc side of the terminal ileum and ileocecal resection was performed. Histopathologically, the lesion was composed of deal lymphangioma adjacent to duplication of the ileum. Although lymphangioma of the intestine is uncommon, it is worthy of noting that intestinal lymphangioma may be a cause of intestinal obstruction in children.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 39 Issue 4 Pages
639-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 39 Issue 4 Pages
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 39 Issue 4 Pages
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Article type: Article
2003 Volume 39 Issue 4 Pages
639-640
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Article type: Article
2003 Volume 39 Issue 4 Pages
640-
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2003 Volume 39 Issue 4 Pages
640-
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Article type: Article
2003 Volume 39 Issue 4 Pages
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2003 Volume 39 Issue 4 Pages
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Article type: Article
2003 Volume 39 Issue 4 Pages
640-641
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Article type: Article
2003 Volume 39 Issue 4 Pages
641-
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Article type: Article
2003 Volume 39 Issue 4 Pages
641-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 39 Issue 4 Pages
641-
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2003 Volume 39 Issue 4 Pages
641-642
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