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Article type: Cover
2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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Article type: Appendix
2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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Article type: Index
2010 Volume 46 Issue 4 Pages
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Toru Yamazaki, Yasuhiro Okada, Masatoshi Miyamoto, Hisashi Kaneda, Mas ...
Article type: Article
2010 Volume 46 Issue 4 Pages
707-713
Published: June 20, 2010
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Purpose: Intussusception is one of the most common causes of acute abdomen in childhood. The purpose of this study is to evaluate our results in treating intussusception. Method: The records of 129 intussusceptions in 103 children, who were treated at Toyama City Hospital from 1992 to 2007, were reviewed. Patient demographics, clinical features, treatments, pathologic lead points, and recurrences were analysed. Results: There were 69 males and 34 females, giving a male to female ratio of 2.0:1.0. 67.0% of them occurred within the first 2 years of life. The mean birth weight and current weight were within normal range. Hydrostatic reduction was attempted in 122 cases with a success rate of 88.5%. The duration of symptoms seemed to have little influence on the success rate. In 4 patients intussusception was induced by pathologic lead points (intestinal duplication cyst in 2, Meckel's diverticulum and juvenile polyp in 1). There were 17 patients with one or more episodes of recurrence, including 4 patients with pathologic lead points. Conclusion: It is believed by some that an obese child would be the perfect "poster-child" for intussusception in children. In our study, however, there was no statistically significant relationship between body weight, either at birth or disease onset, and the frequency of intussusceptions. Some children have recurring intussusceptions without obvious pathological leading points; therefore, it is highly recommended that further examination be done to locate additional abnormalities such as a Meckel's diverticulum or polyps.
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Reisuke Imaji, Yoshiteru Takada, Wataru Mukai, Takashi Akiyama
Article type: Article
2010 Volume 46 Issue 4 Pages
714-718
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Purpose: Extremely low birth weight (ELBW) infants have a high incidence of necrotizing enterocolitis (NEC) and high mortality rate. However the strategy of surgical management is still debated. The authors examined the current status of NEC in ELBW infants who required surgical intervention at our institution. Methods: The authors reviewed the medical records of ELBW infants who had surgical intervention for NEC with clinical and radiological evidence (Bell's stage II or III) between January 1993 and December 2008 at Hiroshima City Hospital. Patients with focal intestinal perforation, meconium-related ileus or other causes were excluded. Results: Nine ELBW infants were operated on for NEC. Five were boys and four girls. The median gestational ages were 25 weeks and two days (23 weeks and four days-28 weeks and three days). The median birth weights were 670g (460-914g). Loop enterostomies were performed in five patients, primary resection of necrotic intestine and anastomosis in three and peritoneal drainage in a single patient as an initial treatment. Multiple long bone fractures were seen in two patients and four patients developed subglottic stenosis (two required tracheostomies). The survival rate was 44.4% (4/9) overall, 66.7% (2/3) in patients with primary resection of necrotic intestine and anastomosis, and 40% (2/5) in patients with enterostomies. Conclusions: A survival rate of 44.4% is not satisfactory and severe complications were seen in four patients. It is probable that the survival was more dependent on the severity of NEC rather than the type of operation. The surgical strategy for ELBW infants with NEC has to be adjusted and improved in each case to decrease the mortality rate and morbidity.
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Tooru Arima, Takaharu Yamada, Takeshi Shono
Article type: Article
2010 Volume 46 Issue 4 Pages
719-727
Published: June 20, 2010
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Purpose: To clarify the present state of diagnosis and treatment for cryptorchidism in the Kyushu area. Patients and Methods: A questionnaire survey carried out at the member institutions of the Kyushu Pediatric Surgical Congress. The questionnaire included clinical features of cases from January 2002 to December 2006, and the strategy of diagnosis and treatment. In addition, experiences of tumor genesis, fertility acquirement and application of artificial testis were asked concerning cases until December 2006. Results: Information was obtained from 22 institutions. Experienced cases in a recent 5-year period totaled 1,093, including 873 cases (73%) of undescended testis and 246 cases (21%) of retractile testis. The most frequent answer to the question for optimal age of surgery was around 1 year old. In fact, however, the cases operated on at more than 3 years old amounted to 32% of all cases. The replies varied in the definition of retractile testis and its surgical indication. The impalpable testis was recognized in 133 cases. The most frequent answer concerning the strategy for impalpable testis was the inguinal exploration in all cases, followed by the secondary laparoscopy, if necessary. Tumor genesis was recognized in 3 cases. Fertility acquirement was confirmed in only one case. The artificial testis was applied in 9 cases at 4 institutions. Conclusion: This survey revealed several differences in the strategy of diagnosis and treatment for cryptorchidism among the institutions of pediatric surgery in the Kyushu area. It attracts our attention whether the strategy will be standardized or not in the near future.
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Ryuta Saka, Akihide Sugiyama, Yusuke Ohashi, Akira Gomi, Yutaka Sanada ...
Article type: Article
2010 Volume 46 Issue 4 Pages
728-733
Published: June 20, 2010
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Purpose: The purpose of this study was to assess the feasibility of CT colonography (CTC) using the fecal tagging method in children and tagging performance. Methods: A total of 11 outpatient patients were subjected to this study. All patients underwent bowel preparation using amidotrizonic acid at a dose of 0.8±0.1ml/kg/day for three days prior to CTC. After colonic air insufflations, CT was scanned in both supine and prone position. In six colon segments and between different patients, the degree of fecal tagging was evaluated and graded in six point scale by two independent radiologists. Results: All studies were performed without any complications. All patients needed no sedatives. Tagging performance was "good" or "moderate" in 86% of evaluated residual segments. Conclusion: In conclusion, CTC with fecal tagging method is safe and feasible in children.
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Koji Fukumoto, Naoto Urushihara, Komei Suzuki, Takanori Matsuoka, Hiro ...
Article type: Article
2010 Volume 46 Issue 4 Pages
734-737
Published: June 20, 2010
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A seven-year-old girl was born weighing 690g and intubated for 121 days. She usually had stridor after extubation. At the age of 4 years, laryngeal fiberscope was performed and she was diagnosed with laryngomalacia with hyperplastic mucosa of the left arytenoids. Necrosis of left arytenoid cartilage was also suspected, so she received a tracheostomy. At the age of 6 years, she was diagnosed with left arytenoid cartilage dislocation by examination of the larynx using a direct laryngoscope. She underwent resection of the hyperplastic mucosa by laryngomicrosurgery. After the operation, she was weaned from the tracheostomy and has no respiratory symptoms.
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Taro Goda, Katsunari Takifuji, Mikihito Nakamori, Takashi Watanabe, Hi ...
Article type: Article
2010 Volume 46 Issue 4 Pages
738-743
Published: June 20, 2010
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A 12-year-old girl presented with hypertension and a 4-year history of flare of both palms. The patient underwent radiological examinations which demonstrated a 5×3cm solid mass located under the right hilum of the kidney. The endocrine studies revealed an elevation of catecholamines, leading to a diagnosis of extra-adrenal pheochromocytoma. After α and β adrenergic blockade was administered, and blood pressure was well controlled, we resected the tumor with a retroperitoneoscopic procedure. She made a rapid recovery, and she was discharged at POD 8. Recently, endoscopic resection became recognized as the standard in the management of adrenal pheochromocytoma; however, there are few reports about extra-adrenal and pediatric pheochromocytoma, and an indication of endoscopic resection is controversial. We discuss the retroperitoneal approach for abdominal pheochromocytomas.
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Mizuho Machida, Katsumi Yoshizawa, Junichi Yoshizawa, Shigeru Takamiza ...
Article type: Article
2010 Volume 46 Issue 4 Pages
744-748
Published: June 20, 2010
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A 9-year-old boy visited a nearby hospital with intermittent abdominal pain. An abdominal ultrasonography revealed intussusception. He was transferred to our hospital and hydrostatic reduction was performed with gastrographin. Although intussusception was reduced, a mass as a leading point was suspected after a contrast enema study. Four days after hydrostatic reduction, he had a recurrent episode of abdominal pain. Since hydrostatic reduction failed, a laparotomy was performed. At laparotomy, ileo-ileo-colic intussusception was found and reduced. A mass palpated in the intussusceptum was excised. The mass was a solid 4×2cm in diameter. The pathological diagnosis was lipoma. The postoperative course was uneventful and the patient was discharged from the hospital 7 days after the operation. He has been well for 20 months without any symptoms. We should examine older children with intermittent abdominal pain with a high index of suspicion for a intussusception due to pathologic lead points including a rare ileal lipoma.
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Kyeong Deok Lee, Eiji Miyazaki, Shigeo Tobayama, Sumio Kohno
Article type: Article
2010 Volume 46 Issue 4 Pages
749-753
Published: June 20, 2010
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The utility of a central venous catheter is particularly well recognized in patients starting home parenteral nutrition (HPN). A catheter-related blood stream infection (CR-BSI) remains the most common complication of central venous catheter in HPN patients and is the most frequent indication for its removal. Additionally, in some patients CR-BSI results in significant morbidity and mortality. Ethanol-lock therapy (ELT) is a treatment modality that has been used to treat CR-BSI in patients with indwelling catheters for HPN. We report the success in treating CR-BSI in short bowel syndrome patients using ELT. An 8-year-old patient undergoing HPN who developed central venous catheter infections resistant to conventional management with antibiotics was treated by ELT according to the institutional technique. This patient responded well to ELT, which caused the improvement of the central venous catheter infection. There were no adverse side effects. The role of ELT needs to be investigated in larger studies for treatment of CR-BSI.
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Shohei Honda, Youkatsu Ohhama, Masato Shinkai, Hiroshi Take, Norihiko ...
Article type: Article
2010 Volume 46 Issue 4 Pages
754-758
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The STEP (serial transverse enteroplasty) procedure was performed for a 14-year-old boy with short bowel syndrome (SBS) who had needed long-term parenteral nutrition. It elongated the severely dilated small bowel from 67cm to 119cm (+78%) and increased the total length of the small bowel from 98cm to 150cm (+53%). We placed the staple lines with 4cm intervals, which was identical to the diameter of the residual small bowel. The postoperative course was uneventful, and 2.5 months after the operation, he transitioned off parenteral nutrition. Postoperatively, the level of rapid turnover proteins, biochemical parameters of intestinal absorptive function, substantially increased and remained within normal range for 5 months after discontinuation of parenteral nutrition. The present case demonstrated the safety, feasibility, and effectiveness of the STEP procedure for children with SBS associated with significantly dilatated small bowel, which can promote withdrawal from parenteral nutrition.
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Mariko Yoshida, Hiroo Uchida, Hiroshi Kawashima, Chikashi Goto, Kaori ...
Article type: Article
2010 Volume 46 Issue 4 Pages
759-764
Published: June 20, 2010
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A 4-month-old boy was referred to our hospital because of an abdominal mass. Ultrasonography showed a 5cm cystic tumor in S4 and S5 of the liver. However, computed tomography revealed multiple other small nodules in S4, S5 and S6 of the liver, as well as swollen lymph nodes in the hepatic hilum and the retroperitonium, which findings suggested malignancy. We then elected to perform a needle biopsy, which demonstrated rhabdoid tumor of the liver. Chemotherapy with ifosfamide, carboplatin, and etoposide was initiated, but was not effective. Subsequently, the tumor progressed relentlessly and his general condition deteriorated. Eventually he died a month after referral despite intensive care with controlled ventilation and continuous hemodiafiltration. Rhabdoid tumor of the liver is a rare aggressive neoplasm that has poor prognosis. Only 33 cases of this type of tumor were reported in the literature, and a review of such cases is herein provided.
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Mitsugu Owari, Takuya Kosumi, Takaharu Oue, Yoshio Ohta, Takeo Yonekur ...
Article type: Article
2010 Volume 46 Issue 4 Pages
765-769
Published: June 20, 2010
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Infantile cricopharyngeal achalasia is rare condition in which a child presents with dysphagia, failure to thrive, aspiration pneumonia and salivation. This condition is often overlooked in children and some cases remain undiagnosed, leading to sudden death. The patient was a 2-year-old boy. Oral feeding was decreased and finally the patient took only small quantities of enteral nutrition. The cine-fluoroscopic swallow test showed pooling of the contrast medium in the hypopharynx and the lower esophagus was not detected. A manometric study of the upper esophageal sphincter (UES) showed an increased pressure of 300mmHg. Under general anesthesia, esophagoscopy was attempted before the operation. Thick and hard fibrous tissue was found at the level of the cricopharyngeal muscle. Therefore cricopharyngeal myotomy was carried out easily. The postoperative cine-fluoroscopic swallow showed no stenosis and the manometric study showed mean UES pressure had decreased to 60mmHg. The differential diagnosis of cricopharyngeal achalasia is important to rule out associated gastro-esophageal reflux disease (GERD). Esophageal fibroscopy, manometry and pH-metry are essential tests to rule out the associated GERD. It is necessary to achieve rapid diagnosis and treatment for child growth.
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Akihide Tanano, Naoko Hayashi, Hideyuki Ooe, Yuji Miyajima, Akimasa Og ...
Article type: Article
2010 Volume 46 Issue 4 Pages
770-776
Published: June 20, 2010
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The case is a 2-month-old girl. We performed emergency surgery at the age of 77 days because she presented with the symptom of mechanical ileus with bilious vomiting. At 100cm anal side from Treitz's ligament, a 75cm dilated tubular duplication that was adjacent to the collapsed normal intestine was present on the anti-mesenteric side. The duplication and adjacent normal intestine were removed, and an end-to-end anastomosis was performed. The patient left the hospital 9 days after the operation; she has been well and developed normally. The small intestine is the most common location for alimentary tract duplications, and most of them are of the cystic type. In general, surgical treatment of the alimentary tract duplication is complete resection of that with the adjacent normal intestine. It is considered that the resection of the duplicated intestine with the adjacent normal intestine is desirable as long as it is possible, even in a patient with a long tubular duplication such as our case, in order to prevent postoperative complications.
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Hiroyuki Kawashima, Kiminobu Sugito, Shinsuke Yoshizawa, Shota Uekusa, ...
Article type: Article
2010 Volume 46 Issue 4 Pages
777-782
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A 15-year-old girl was referred to our hospital with suspicion of pheochromocytoma or paraganglioma. Abdominal CT scans showed a retroperitoneal mass and multiple pancreatic cysts, and the mass was visualized on ^<123>I-metaiodobenzylguanidine scintigraphy. Under suspicion of the paraganglioma, we performed an open biopsy of the tumor and diagnosed it as paraganglioma. After the open biopsy of the tumor, we achieved complete tumor resection with left nephrectomy because of the encasement of the left renal vein by the tumor mass. Although she did not fulfill the criteria for von Hippel Lindau (VHL) disease, we considered that she was suffering from VHL disease. We analyzed the VHL gene aberrations and its expression status in the kidney and tumor specimen. A nonsense mutation as a germline mutation of the VHL gene locus was identified in the kidney specimen. Other mutations of the VHL gene locus were identified as somatic mutations in the tumor specimen. Moreover, the tumor specimen showed a loss of VHL gene expression, and the VHL gene was confirmed as a candidate gene in the tumor specimen. Accordingly, she might have developed VHL disease. It is important to analyze the VHL gene and observe carefully for paraganglioma patients who do not fulfill the criteria for VHL disease.
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Akihiro Fujino, Takeshi Hirabayashi, Kazuhiko Hagane
Article type: Article
2010 Volume 46 Issue 4 Pages
783-786
Published: June 20, 2010
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Here, we report a case of interparietal hernia, a rare variant of inguinal hernia, with a review of the literature. The patient was a 2-month-old boy who had a large swelling in his left flank that only appeared while he was crying. His left testicle was not found in the scrotum. Imaging by ultrasonography and CT scanning revealed that the bowel was herniated through the internal inguinal ring lying between abdominal wall muscles and that the left testicle was undescended. An operation was done at the age of 9 months. The hernia sac was found to protrude through the left internal inguinal ring going upward into the internal abdominal oblique muscle instead of going downward through the external inguinal ring. The left testicle was found on the hernia sac. After dissection, the sac was tightened at the internal ring and removed; then, orchidopexy was performed. The postoperative course was uneventful.
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Chikashi Gotoh, Hiroo Uchida, Yoshihiro Kitano, Hiroshi Kawashima, Kao ...
Article type: Article
2010 Volume 46 Issue 4 Pages
787-790
Published: June 20, 2010
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A 3-year-old boy with severe abdominal pain and distension was admitted to our hospital 12 hours after symptoms developed. He had undergone laparoscopic fundoplication for gastroesophageal reflux disease (GERD) at 6 months of age and laparoscopic redo fundoplication for a recurrence of GERD at 20 months. Since enhanced computed tomography showed a diaphragmatic hernia with an incarcerated transverse colon, an emergency operation was immediately conducted. At exploration, the transverse colon was herniated through the diaphragmatic defect at the left of the esophageal hiatus. The incarcerated colon was reduced without resection. The diaphragmatic defect was directly sutured. The close investigation of video in the two laparoscopic operations he had undergone suggested that the small diaphragmatic injury by laparoscopic coagulating shears in the redo fundoplication yielded a late-onset diaphragmatic perforation. In patients with severe abdominal pain, who have laparoscopic surgery of the upper abdomen, iatrogenic diaphragmatic hernias due to intraoperative diaphragmatic injury must be taken into account.
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Article type: Appendix
2010 Volume 46 Issue 4 Pages
791-796
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
Article type: Article
2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
797-798
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Article type: Article
2010 Volume 46 Issue 4 Pages
798-
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2010 Volume 46 Issue 4 Pages
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Article type: Article
2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
798-799
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
799-800
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2010 Volume 46 Issue 4 Pages
800-
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
800-
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Article type: Article
2010 Volume 46 Issue 4 Pages
800-801
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2010 Volume 46 Issue 4 Pages
801-
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2010 Volume 46 Issue 4 Pages
801-
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
801-802
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
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2010 Volume 46 Issue 4 Pages
802-
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2010 Volume 46 Issue 4 Pages
802-803
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