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2008 Volume 44 Issue 5 Pages
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2008 Volume 44 Issue 5 Pages
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Article type: Index
2008 Volume 44 Issue 5 Pages
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Norio Hasuda, Kunio Takano, Noboru Oyachi, Takeyuki Suzuki, Naruaki Mo ...
Article type: Article
2008 Volume 44 Issue 5 Pages
651-654
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Background/Purpose: To discuss the surgical management of the patient with short-segment Hirschsprung's disease in childhood and over school age. Methods: Between December 1984 and December 2005, we performed anorectal myectomy for children and those over school age with Hirschsprung's disease who were diagnosed with short-segment Hirschsprung's disease. We discuss age of the diagnosis, sex, level of aganglionosis, and prognosis. Results: We performed anorectal myectomy for 4 patients. The patients ranged from 9 years 4 months to 19 years 6 months at the age of diagnosis by contrast enema and histological findings. Three were male and 3 were female. Four of them were diagnosed with short-segment aganglionosis, 2 of them had rectosigmoid aganglionosis. The diagnosis was confirmed by histological findings. Two rectosigmoid aganglionosis patients had had pull-through procedures and their symptoms had started in infancy. Four received anorectal myectomy and 3 of them showed improvement of bowel habits. They were short-segment aganglionosis and their symptoms had started after the age of infancy. Conclusions: Anorectal myectomy may be useful for short-segment Hirschsprung's disease in the child whose symptoms started after the age of infancy.
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Yasuhiro Matsukawa, Kentarou Watanabe
Article type: Article
2008 Volume 44 Issue 5 Pages
655-660
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Purpose: We received many labial adhesion (LA) referrals from the public regular health check for infant (PRHC) and noticed a high occurrence in 3-month-old babies. This is an initial report of LA in early infancy. Method: Clinical features of 84 infants with LA during a 3.6 year period were observed. All the adhesions were bluntly opened and kept open and clean by their mothers. Results: Forty-one babies were referred 3 months after birth by PRHC, 22 after 6 months, 9 after 9-10 months, 1 after 18 months, and 11 were referred from outpatient clinics. Seventy-one were from PRHC in Amagasaki City. At the peak period, we experienced 7 patients per month, and 38 per year. The ages seen during consultations were 2 months old (m.o.) in 1 case, 3 m.o. in 23 cases, 4 m.o. in 17 cases, 5 m.o. in 3 cases, 6 m.o. in 11 cases, 7 m.o. in 8 cases, 8 m.o. in 4 cases, 9 m.o. in 5 cases , 10 m.o. in 3 cases, and over 1 year in 9 cases. The third month of age was the peak month. The estimated frequency of LA using PRHC data was 0.86 %, 0.76%, and 0.59% in 3 m.o., 6 m.o., and 9- 10 m.o. infants, respectively. Seventy-seven were asymptomatic, of which 72 were under 1 year old. Forty-seven showed full length LA and 26 were under 4 months old. Pinhole openings were observed at the upper edges in 53 cases. The recurrences of small adhesions were observed in 17 cases. Conclusion: LA is common in early infancy. Fulllength LA can occur at 3 months of age. LA should be checked by PRHC. Prophylaxis is the best treatment. It is recommended to advise mothers to keep their babies' labias clean during early childhood.
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Yoichi Takano, Masao Yasufuku
Article type: Article
2008 Volume 44 Issue 5 Pages
661-666
Published: August 20, 2008
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Purpose: Meckel's diverticulum is a common congenital anomaly of the gastrointestinal tract. Although scintigraphy has high positive and negative predictive values for the diagnosis, the preoperative diagnosis of Meckel's diverticulum remains difficult because of its diverse symptoms. Moreover, the sensitivity of scintigraphy is low in patients with anemia and in patients without gastric mucosa in Meckel's diverticulum. In this report, we discuss the usefulness of ultrasonography for Meckel's diverticulum. Method: We retrospectively studied sonographic findings of Meckel's diverticulum in eight patients who were admitted to our hospital from 2003 to 2006. Result: The five symptomatic cases were preoperatively diagnosed by ultrasonography. In one patient, Meckel's diverticulum was present as a cystic-like structure the wall of which consisted of two layers. In two patients, a gut-like structure was attached to the umbilical region. In one patient, the perforated Meckel's diverticulum had a pseudocyst formation. In another patient, inverted Meckel's diverticulum was detected. Four of them received scintigraphy evaluation, and were suspected as Meckel's diverticulum. The one resulting case had a false negative because of anemia. Ultrasonography could not detect the Meckel's diverticulum in two cases without symptoms and one case of ileus. These three patients did not have preoperative scintigraphic examination. Conclusion: For the patients with Meckel's diverticulum, ultrasonography is a useful tool, especially in patients with anemia and in patients without gastric mucosa in Meckel's diverticulum. We know of a few previous study that has described the ultrasonographic appearances of Meckel's diverticulum, and it is important to know the findings of complicated Meckel's diverticulum.
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Shinsuke Hata, Keigo Nara, Motonari Nomura, Reiko Oshima, Sakae Maeda, ...
Article type: Article
2008 Volume 44 Issue 5 Pages
667-671
Published: August 20, 2008
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Purpose: To investigate the effectiveness of ultrasound scan (US) for detecting contralateral patent processus vaginalis (CPPV) in pediatric patients with unilateral inguinal hernia. Moreover, we performed a preventive operation against subsequent contralateral occurrence and investigated whether the operation reduces the incidence of contralateral hernia. Methods: Between August 1998 and December 2002, among 348 patients with unilateral inguinal hernia, 74 patients were diagnosed with CPPV by US, and they underwent bilateral surgery. The remaining 274 patients were classified as the Operation group. Between January 2003 and December 2005, among 245 patients with unilateral inguinal hernia, 53 patients were diagnosed with CPPV by US, but they did not undergo contralateral operation. All 245 patients were classified as the Observation group. The incidence of subsequent contralateral occurrence was compared between the two groups. Results: Among the 274 patients in the Operation group, 3 (1.1%) presented with contralateral hernia. Among the 245 patients in the Observation group, 22 (9.0%) presented with contralateral hernia. There was a significant difference between the two groups (p<0.0001). Among the 22 patients with contralateral hernia in the Observation group, 19 patients were diagnosed with CPPV by preoperative US. The incidence of contralateral occurrence in the CPPV-negative patients in the Observation group was 1.6% (3/192) , and the overall incidence of CPPV-negative patients in both the Operation and Observation groups was 1.3% (6/462). Conclusions: Preoperative evaluation of contralateral side by US in pediatric patients with unilateral inguinal hernias reduces the incidence of subsequent contralateral occurrence.
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Hiroshi Kawashima, Tadashi Iwanaka, Yoshihiro Kitano, Hiroo Uchida, Ka ...
Article type: Article
2008 Volume 44 Issue 5 Pages
672-678
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Purpose: There has been discussion about the value of laparoscopic pyloromyotomy (LP) for the treatment of hypertrophic pyloric stenosis (HPS). The influence of experience with LP on the learning-curve of operation time and complication rate is evaluated. Methods: Between 1998 and 2007, 181 infants underwent LP for HPS at Saitama Children's Medical Center. The foci of this study were operation time and complications. The outcome of 181 LPs performed was compared with the outcome of 175 right upper quadrant open pyloromyotomies and 71 circumumbilical open pyloromyotomies before June 1997. Statistical analysis was performed using Student's t test and chisquare analysis, and a p-value of less than 0.05 was considered significant. Results: There were no significant differences in the ratio of complications among three groups but one case each of mucosal perforation, duodenal perforation, and insufficient pyloromyotomy was experienced in the initial series of LP. The mean operation time for all surgeons dropped significantly from 46 minutes in 1998 to 35 minutes in 2001. After about 8 LPs, the operation time of each surgeon was approximately 34 minutes. An instructor is necessary in order to perform LP more safely and precisely. Conclusions: Laparoscopic pyloromyotomy, when performed at a high-volume pediatric surgical center, is a safe and effective alternative to the traditional open procedure.
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Mureo Kasahara, Akinari Fukuda, Syuichi Sato, Takanobu Shigeta, Kazuna ...
Article type: Article
2008 Volume 44 Issue 5 Pages
679-688
Published: August 20, 2008
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Purpose: We reviewed our initial experience of pediatric living-donor liver transplantation (LDLT) in National Center for Child Health and Development and report the results herein. Subjects and methods: We have done 48 cases of LDLT during November 2005 through February 2008 in National Center for Child Health and Development. Variables including surgical/infectious/immunological outcome were reviewed. Results: The indication for liver transplantation was biliary atresia in 41.6%, followed by metabolic liver disease (29.2%) and fulminant hepatic failure (18.8%). The mean operative time and blood loss were 5 hr 31 min, 281 ml in donors and 9 hr 46 min, 139 ml/kg in recipients. Immunosuppression consisted of tacrolimus and low-dose steroids. The graft and patient survival were 90.7%. Conclusion: Satisfactory results can be achieved in the LDLT program in National Center for Child Health and Development. Long-term observation may be necessary to collect sufficient data for the establishment of the treatment modality.
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Junko Nomura, Kenji Iio, Junji Kato, Norihiro Niimi, Syuichi Tanaka, T ...
Article type: Article
2008 Volume 44 Issue 5 Pages
689-694
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The case is a boy 3 years old. With his difficulty in breathing due to cerebral palsy, he has tracheostomy. Gastro-esophageal reflux was detected as the factor of frequent upper airway infection. Two days after Boerema-Filler fundoplication and gastrostomy, he showed panperitonitis due to cecal rupture. We supposed that the cecum twisted and internal pressure of the cecum had risen, which then caused cecal rupture. Ileo-cecal resection and drainage was conducted. Cecal volvulus is rare in children's acute abdomen. Although patients of cerebral palsy or bedridden children will contract this disease more often than others, it is difficult to diagnose this disease without specific symptoms. In cases that the cecum is viable, releasing and cecopexy is common, but sometimes it causes recurrence. It is considered feasible to resect intestine when it is difficult to fix the cecum. We propose that it is important to keep cecal volvulus in mind when we see an acute abdomen in cerebral palsy patients.
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Eiichi Deguchi, Naomi Iwai, Osamu Kimura, Yoshihiro Kubota, Ryoichi Fu ...
Article type: Article
2008 Volume 44 Issue 5 Pages
695-699
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The authors analyzed the outcome for 55 infants with esophageal atresia and 5 with long gap atresia treated from 1983 through 2005. Of these 5 long gap cases, there are 2 Gross A type, one Gross B type and 2 Gross C type atresia. The length of gap measured from 25 mm to longer than 35 mm. We applied the elongation technique of the upper pouch according to the Howard-Myers method in 4 of the 5 cases. In 3 of the 4 Howard-Myers' elongation cases, we performed esophago-esophagostomy when both upper and lower pouch elongated enough to cross over. The other case of elongation, complicated by severe congenital heart disease, received repair of heart diseases primarily followed by secondary repair of esophageal atresia using the Rehbein-Kato method at the age of 7 years old. One case received cervical esophagostomy by another surgeon, who applied multi-staged extrathoracic elongation of upper part of the esophagus; then we performed esophago-esophagostomy. All 5 cases were complicated by postoperative anastomotic stenosis and required dilatation. Two of 3 cases followed up for more than 10 years are doing well and have no complaints, whereas the other case of B type tracheoesophageal fistura was complicated by gastroesophageal reflux and required fundoplication. The case is under training in swallowing. We think that it is safe and possible to anastomose patients' own esophagus despite anastomotic stenosis even in cases of long gap esophageal atresia.
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Tatsuo Nakaoka, Yoshikiyo Nakagawa, Tsunehiro Yano, Sadashige Uemura, ...
Article type: Article
2008 Volume 44 Issue 5 Pages
700-703
Published: August 20, 2008
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A one-year-old girl presented with acute vomiting and abdominal pain. Computed tomography (CT) performed at a local hospital showed swelling of the pancreas which suggested acute pancreatitis. The biliary duct was not dilated. Enhanced coronal reconstructive CT performed at our hospital revealed that the pancreatic duct joined to the common bile duct forming a common channel. She was diagnosed with pancreatobiliary maljunction (PBMJ) without bile duct dilatation. She underwent excision of the gallbladder and the extrahepatic bile duct followed by a Roux-en-Y hepaticojejunostomy. For the diagnosis of PBMJ, endoscopic retrograde cholangiopancreatography (ERCP) is commonly used. However, ERCP requires general anesthesia in infants and radiation exposure, and has a risk of pancreatitis after the procedure. Recently, magnetic resonance cholangiopancreatography (MRCP) has been applied for the diagnosis of choledochal cysts. The disadvantage of MRCP for children is that they require deep sedation for a relatively long period and the imaging resolution is not always adequate for detecting PBMJ. Enhanced coronal reconstructive CT is performed easily even in infants, and its resolution is much superior to that of MRCP. Multi-detector CT can reduce radiation exposure and scanning time to eliminate motion artifact. We report the possibility of CT imaging for the diagnosis of PBMJ in infants.
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Naoto Urushihara, Hisanori Matsuoka, Morimichi Tani, Kouji Fukumoto, K ...
Article type: Article
2008 Volume 44 Issue 5 Pages
704-708
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In children with bilateral Wilms' tumor (BWT) , it is necessary to consider the possibility of partial nephrectomy for preservation of renal function. We report our experience with bilateral partial nephrectomy for BWT using a combination of the hook-shaped Harmonic Scalpel^[○!R] (HS) and the bipolar cautery equipped with a channel for water dripping (BC). A 16-month-old girl with BWT was admitted to our hospital. After 12 weeks of chemotherapy, bilateral partial nephrectomy without renal vascular clamping using HS and BC was performed. During the resection of the tumors, this technique allowed us less bleeding loss and thermal damage under adequate visual control. She remains disease free with preservation of renal function 11 months after surgery. A hook-shaped HS is a useful modality for coagulation and cutting of the renal parenchyma in partial nephrectomy for BWT.
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Isamu Saeki, Naomi Saho, Keiko Ogita, Noritoshi Handa, Shogo Urabe
Article type: Article
2008 Volume 44 Issue 5 Pages
709-713
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A one-day-old girl who showed bilious vomiting was sent to our hospital. An abdominal X-ray demonstrated a double bubble sign. Duodenal atresia was suspected preoperatively by gastrointestinal study. Emergency laparotomy revealed a cystic jejunal duplication associated with 360° torsion of the intestine. Complete excision of the cyst without adjacent bowel resection was done and the postoperative course was uneventful. Intestinal duplication is a relatively rare entity of congenital diseases and occurs at any region of the alimentary tract. It shows a variety of symptoms. In our case, because of the intestinal volvulus it was difficult to rule out duodenal atresia. We describe this unique case and the surgical treatment of cystictype small bowel duplications.
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Tomoko Hatata, Youkatsu Ohama, Masato Shinkai, Hiroshi Take, Norihiko ...
Article type: Article
2008 Volume 44 Issue 5 Pages
714-718
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We describe two cases with a primary lung tumor in which preoperative diagnosis was difficult. An 8year-old boy presented with hemoptysis. He underwent a resection of the left lower lobe with a preoperative diagnosis of congenital cystic adenomatoid malformation. The pathology was inflammatory myofibroblastic tumor (IMT). In the other case, a 15-yearold girl presented with an asthma attack and hemoptysis. The chest X-ray showed an abnormal shadow, suggesting hamartoma or lymphoma. Resection of the right upper lobe was performed, and the pathological diagnosis was IMT. Although IMT is rear, one should consider IMT as a differential diagnosis of primary lung tumors.
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Shuichiro Uehara, Toshio Sawai, Yoshiyuki Ihara, Takashi Sasaki, Noria ...
Article type: Article
2008 Volume 44 Issue 5 Pages
719-722
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We herein report a case of antenatally suspected congenital colonic atresia. A full-term girl was born byvaginal delivery. Before delivery, neonatal ultrasonography showed isolated intestinal dilatation at the right lower quadrant at 33 weeks gestational age. We confirmed colonic atresia of the ascending colon with abdominal US and barium enema after her birth, and then an emergency operation was performed. The proximal colon was hugely dilated and there was marked discrepancy in the size of the proximal and distal colon either side of the atretic segment. A temporary colostomy was made at both ends of the colon. The distal colon was grown using continuous feeding of dietary fiber supplemented with saline. The anastomosis of the colon was made end to end on the 53rd day and the patient was discharged from the hospital at 74 days after birth. When primary anastomosis may not be safe, we would advocate a staged procedure to avoid significant loss of colon and Bauhin's valve. In addition, antenatal diagnosis has a significant importance in the management of colonic atresia since surgical management is needed immediately after the delivery.
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Tomoya Takao, Yoshinobu Iwamura, Takahumi Goto, Yasuo Nakahara, Takesh ...
Article type: Article
2008 Volume 44 Issue 5 Pages
723-727
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We present a case of a four-year-and-two-month-old girl who showed abdominal pain and vomiting. An abdominal X-ray showed gastrectasia and bowel gas elimination. Treatment of gastrectasia was performed in fasting and gastric tube insertion. But abdominal distension was not improved and she was transferred to our hospital. An abdominal X-ray and an upper GI series suggested a diagnosis of gastric volvulus. After gastric decompression by a nasogastric tube, we performed a gastric wall fixation by a circumumbilical arcuate skin incision, which we thought to be less invasive and cosnnetically superior to a laparoscopic surgery.
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Akira Hatanaka, Tadashi Iwanaka, Hiroshi Kawashima, Yutaka Kanamori, M ...
Article type: Article
2008 Volume 44 Issue 5 Pages
728-731
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The thymus plays an important role in the pathogenesis of myasthenia gravis and thymectomy is established as an effective therapy for myasthenia gravis. Thoracoscopic thymectomy has recently been introduced as a minimally invasive procedure, although many other approaches have been described. There was no literature reporting that thymectomy was completed thracoscopically for juvenile myasthenia gravis without an additional thoracotomy in Japan before. We describe a case of myasthenia gravis successfully treated by thoracoscopic thymectomy in a twelve-year-old girl. Under general anesthesia with selective one-lung ventilation, the patient was placed in hemi-lateral position on her right side. The entire mediastinum was explored with three ports on the left chest wall and the thymus was dissected with excellent visualization. The operation time was 196 minutes and the blood loss was 150 ml. The postoperative course was uneventful without complications. It has been reported that outcomes of thoracoscopic thymectomy are similar to those with open surgery. In addition, thoracoscopic thymectomy has the advantage of minimally invasive surgery and more favorable cosmesis. Taken together, thoracoscopic thymectomy could be a standard operation for myasthenia gravis, although more cases are required to draw a conclusion.
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Satoshi Ieiri, Ryuichiro Hirose, Takanori Nakatsuji, Junko Akiyoshi, Y ...
Article type: Article
2008 Volume 44 Issue 5 Pages
732-736
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We reported three infantile cases of laparoscopic herniorraphy for late-presenting congenital diaphragmatic hernia in this paper. Case 1: A 1-year, 4-monthold boy was diagnosed by chest X-ray with bronchitis. Case 2: An 8-month-old girl was diagnosed by chest Xray with RS virus infection. Case 3: A 5-month-old boy was diagnosed by computed tomography for evaluation of bilateral hydronephroureter. Case 1 was a pouch-existence type and was completely repaired by intra-corporeal knot tying. Case 2 had no pouch and was repaired by extra-corporeal knot tying combined with anchor sutures. Case 3 also had no pouch and was repaired by only extra-corporeal knot tying. It is important to decide the trocar positions for control of the needle holder in laparoscopic herniorraphy of latepresenting congenital diaphragmatic hernia. We arranged the trocar positions based on intra-operative laparoscopic findings and the defect shape of the diaphragm. So we could perform the knot tying safely in all 3 cases.
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Article type: Article
2008 Volume 44 Issue 5 Pages
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2008 Volume 44 Issue 5 Pages
737-738
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