Journal of the Japanese Society of Pediatric Surgeons
Online ISSN : 2187-4247
Print ISSN : 0288-609X
ISSN-L : 0288-609X
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Volume 50, Issue 7
Displaying 1-17 of 17 articles from this issue
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Originals
  • Symptomatic Meckel’s Diverticulum in Children
    Naoki Hashizume, Tomomitsu Tsuru, Takahiro Asakawa, Hiroaki Tanaka, Na ...
    2014 Volume 50 Issue 7 Pages 1087-1091
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1087
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    Purpose: The cases of symptomatic Meckel’s diverticulum in children who underwent surgical treatment were retrospectively investigated.
    Method: The subjects were patients with symptomatic Meckel’s diverticulum who underwent surgical treatment in our department from January 2001 to December 2012. The investigated items were gender, age, chief complaints, preoperative diagnosis, postoperative diagnosis, site of the diverticulum, and pathological findings.
    Result: Thirteen patients (9 males and 4 females) were investigated, ranging in age from 20 days to 14 years. The ages of 8 patients (61.6%) were less than 5 years. Nausea and vomiting were the most common chief complaints, seen in 11 patients (84.6%), followed by abdominal pain in 9 patients (69.3%) and melena in 4 patients (30.8%). Two patients were diagnosed on the basis of imaging findings, including one by 99mTcO4 scintigraphy inspection and one by ultrasonography and computed tomography. The following were the postoperative diagnoses: intestinal obstruction by a mesodiverticular band in 5 patients (38.5%); intestinal obstruction by the vitellointestinal duct in 1 patient (7.7%); intussusception in 2 patients (15.4%); Meckel’s diverticulitis in 3 patients (23.1%); and torsion of Meckel’s diverticulum in 1 patient (7.7%).
    Conclusion: Symptomatic Meckel’s diverticulum was found to be the cause of intestinal obstruction in many patients. Meckel’s diverticulum is difficult to diagnose preoperatively even by ultrasonography and computed tomography. Therefore, it should be considered as a possible cause of intestinal obstruction in children.
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  • Non-IgE-mediated Gastrointestinal Food Allergy in Six Pediatric Surgical Patients
    Kan Suzuki, Chizue Uotani, Tetsuya Ishimaru, Jun Fujishiro, Masahiko S ...
    2014 Volume 50 Issue 7 Pages 1092-1098
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1092
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    Purpose and Methods: The major symptoms of gastrointestinal (GI) food allergy in neonates and infants are vomiting and bloody stools. Because these symptoms are common in other diseases, confusion and delayed diagnosis and treatment tend to occur, especially in pediatric surgical patients. We experienced treating six patients with co-incidence of GI allergy and pediatric surgical diseases. This is a retrospective investigation based on medical records with the aim of clarifying the problems encountered in the diagnosis and treatment of such patients.
    Results: The patients were four males and two females. Two were extremely very low birth weight infants. The underlying surgical diseases were GI tract disease in 4, congenital heart disease in 3, and omphalocele in 1. GI allergy was observed at 1.5 to 15 months of age. The initial symptoms were bloody stools in 3, diarrhea in 2, vomiting in 1, inactivity in 1, and poor body weight gain in 6. The following were obtained: positive findings of ALST in 6, positive findings of DLST in 2, fecal eosinophilia in 2, and positive findings of intestinal mucosal biopsy in 1. They all recovered after elimination of milk protein in their diet or alteration of the formula.
    Conclusions: In these six patients, the symptoms occurred after surgical intervention, which possibly indicate that the operative stress and/or postoperative antibiotic administration affected their intestinal immunities resulting in GI allergy. For patients with gastrointestinal symptoms, it is important that we always keep in mind the possibility of allergy for early diagnosis and prompt treatment.
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  • Validity of Laparoscopic Percutaneous Extraperitoneal Closure for Pediatric Hydrocele Based on the Findings of Processus Vaginalis
    Hisako Kuyama, Sadashige Uemura, Atsushi Yoshida, Mayumi Yamamoto
    2014 Volume 50 Issue 7 Pages 1099-1103
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1099
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    Purpose: In order to elucidate the validity of laparoscopic percutaneous extraperitoneal closure (LPEC) for pediatric hydrocele, we studied the patency of the processus vaginalis (PV) and the operative results.
    Methods: We conducted a retrospective study of pediatric patients with hydrocele, who underwent LPEC at our institution between April 2005 and December 2013. During the operation, the orifice of the PV was measured using Maryland forceps. The size of the orifice, findings of the PV, and surgical outcomes were collected from medical records.
    Results: We operated on 96 boys with hydrocele, including 7 with hydrocele in bilateral regions by LPEC. All the boys with hydrocele except 1 showed patent PVs, and the average size of the orifice was 5.2 ± 2.9 mm. After closure of the PV, the remaining fluid in the hydrocele was aspirated by percutaneous puncture. No postoperative complications and recurrence occurred.
    Conclusions: In pediatric patients with hydrocele, their PVs were patent at the internal inguinal ring. They were therefore treated by closing the PV by LPEC. These results suggest that the etiology could depend on the communication between the abdominal cavity and the hydrocele. LPEC is reasonable as the standard therapy for pediatric hydrocele.
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Case Reports
  • Case of Appendiceal Carcinoid Tumor Followed by Ileocecal Resection in a Child
    Shohei Maekawa, Toshio Sawai, Hideki Yoshida, Koki Kimura, Makoto Yagi
    2014 Volume 50 Issue 7 Pages 1104-1108
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1104
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    We report a rare case of appendiceal carcinoid tumor in a child who was treated by ileocecal resection. A 13-year-old girl presenting with suspected acute appendicitis because of fever and abdominal pain was referred to our hospital. CT examination showed a perforated appendix with fecal stone surrounded by intestines. She was treated conservatively with antibiotics and then discharged on the 7th day. Interval appendectomy was performed by our designed trocarless single-incision laparoscopic surgery (TLSILS) 2 months after her first admission. Histopathological examination showed carcinoid tumor of the appendix, and lymphatic invasion was found at the surgical margin. Three weeks after the appendectomy, she underwent ileocecal resection with lymphadenectomy by TLSILS.
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  • Case of Mediastinal Lymphangioma Diagnosed in Infection and Resected by Thoracoscopic Surgery
    Yusuke Yamane, Yasuaki Taura, Taiichiro Kosaka, Masayuki Obatake, Take ...
    2014 Volume 50 Issue 7 Pages 1109-1112
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1109
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    We report the case of a mediastinal lymphangioma that was resected by video-assisted thoracic surgery (VATS). A 14-year-old boy presenting with chest pain and high fever was admitted to our hospital. He showed high inflammatory reactions and his CT and MR images revealed a multiple cystic lesion with wall thickening in the anterior mediastinum at the left heart-diaphragm angle. We diagnosed the patient as having infection of the cystic lesion, and antibiotic therapy was initiated immediately. His fever and inflammatory reactions decreased, but his chest pain was not relieved completely. We decided to perform VATS to remove his chest pain. The postoperative course was uneventful and the resected cystic lesion was pathologically diagnosed as mediastinal lymphangioma. It is difficult to confirm the diagnosis on the basis of radiographic findings. A surgical operation could provide an accurate diagnosis and an effective treatment of symptomatic patients. VATS might be a cosmetically acceptable and suitable procedure for patients with benign lesions.
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  • Conservative Management of Appendicitis With Abscess Formation in Six Pediatric Patients Followed Up by Ultrasonography
    Miho Fukui, Yasuhiko Iiboshi, Hitoshi Mizuno, Tasuku Kodama, Noriyuki ...
    2014 Volume 50 Issue 7 Pages 1113-1118
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1113
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    Some cases of appendicitis with abscess formation can easily be treated by interval appendectomy (IA) after a reduction of the appendiceal mass by conservative therapy, whereas others require emergency operation while under conservative therapy. The method of studying the effect of conservative therapy on such cases has not yet been determined. This is a retrospective study of clinical reports of conservative therapy of appendicitis with abscess formation in pediatric patients followed up by ultrasonography (US). From 2008 to 2013, we carried out the conservative therapy of appendicitis with abscess formation in 6 (5 males, 1 female) pediatric patients followed up by US. Their ages ranged from 3 to 12 years. We applied conservative therapy to the six appendicitis patients with abscess formation, but one patient was excluded from the study (dropout case) owing to the increasing size of the abscess cavity that required emergency surgery. The five other patients subjected to conservative therapy improved and their abscess decreased in size. A first observation by US showed that the layers of the appendiceal wall were preserved (except the point of perforation) in the 5 improved patients and damaged in the dropout case. It is possible that the observation of the layers of the appendiceal wall and diachronic evaluation of the size of the appendiceal abscess are useful for studying the effect of conservative therapy.
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  • Case of Congenital Chylous Ascites in Which Lymphatic Scintigraphy Was Effective for Determining the Course of Treatment
    Hironori Fukumoto, Miyuki Kohno, Tsuyoshi Kuwahara, Sadayoshi Takahash ...
    2014 Volume 50 Issue 7 Pages 1119-1122
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1119
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    Congenital chylous ascites is a rare disease. Conservative treatments, including oral administration of an elemental diet for pediatrics (ED-P) and medium-chain triglyceride (MCT) milk, have been performed to decrease the volumes of total parenteral nutrition and lymphatic discharge. When conservative treatment is inadequate, surgical treatment is selected. However, the effective terms of conservative treatment have not been confirmed and it is difficult to identify the region of lymphatic discharge during the operation. We report a case of congenital chylous ascites in which sequential lymphatic scintigraphy using 99mTc-HAS (human serum albumin) confirmed the changes in lymphatic discharge volume and the patency of the thoracic duct.
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  • A Case of Gastric Teratoma Presenting With Perinatal Rapid Growth
    Takashi Watanabe, Katsunari Takifuji, Yasuyuki Mitani, Akio Kubota, Hi ...
    2014 Volume 50 Issue 7 Pages 1123-1127
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1123
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    A male infant was born with a birth weight of 3,697 g at 38 weeks and 4 days of gestation. An antenatal ultrasound revealed a solid mass in his left abdomen close to the stomach at 36 weeks of gestation. Postnatal CT and MRI demonstrated a calcified tumor immediately below his cardia. An upper GI series showed an extramural projection at the fundus. Results of these examinations suggested the presence of gastric teratoma. The tumor enlarged rapidly from 28 mm in diameter at 36 weeks of gestation to 40 mm at birth and 78 mm at the time of operation. The tumor was resected by laparotomy at the age of 16 days. This case suggested that gastric teratoma diagnosed antenatally may grow rapidly and require early surgery.
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  • Case of Tracheal Weblike Stenosis Treated With Nd-YAG Laser Photoablation
    Yuki Yamamoto, Koji Komori, Naoki Shimojima, Seiichi Hirobe
    2014 Volume 50 Issue 7 Pages 1128-1131
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1128
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    We present the case of a 9-year-old girl who developed inspiratory stridor after the reimplantation of the left pulmonary artery for the pulmonary artery sling when she was 2 years old. Her condition was treated as bronchial asthma by the previous doctor, but her symptoms did not improve. Thus, she was referred to our hospital for further treatment. Bronchoscopy revealed mild tracheal stenosis with a complete tracheal ring from the middle of the trachea to the tracheal bifurcation, and severe spiral membranous tracheal stenosis at the proximal end of the complete tracheal ring. We considered that the membranous tracheal stenosis was caused by tracheal intubation. We treated the membranous stenosis by Nd:YAG laser photoablation with flexible bronchoscopy under general anesthesia. The symptoms and respiratory function test results markedly improved after the treatment. In conclusion, Nd:YAG laser photoablation is effective and safe for the treatment of membranous tracheal stenosis.
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  • Two Cases of Congenital Duodenal Atresia With Postoperative Anastomotic Ulcers
    Daisuke Masui, Yutaka Hirayama, Yasushi Iinuma, Hisataka Iida, Shinich ...
    2014 Volume 50 Issue 7 Pages 1132-1136
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1132
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    Duodenal atresia and stenosis have a good prognosis with few postoperative complications. We encountered 2 patients who developed anastomotic ulcers after undergoing diamond-shaped anastomosis for duodenal atresia. Case 1: A 10-year-old boy was hospitalized owing to tarry stools. An endoscopic examination showed consecutive pocketlike lumina and ulcer with active bleeding near the anastomosis. Case 2: A 9-year-old boy was hospitalized owing to coffee-ground vomit. An endoscopic examination showed a hemorrhagic anastomotic ulcer and consecutive pocketlike lumina near the anastomotic region. An upper gastrointestinal series showed dilatation of the proximal duodenum. Both patients demonstrated gradual resolution following treatment with a proton pump inhibitor and nutritional management without surgical treatment. Regarding the patients’ backgrounds, both boys had autism in conjunction with Down’s syndrome. Because they had been consuming an extremely unbalanced diet, chronic malnutrition induced delayed wound healing, which might be related to ulceration. Clinicians must consider the potential for late complications, such as anastomotic ulcers. It is ideal to regularly perform imaging and nutritional assessments for a long-term follow-up.
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  • A Case of Recurrent Intussusception Caused by Appendiceal Intussusception: Pitfall of Air Reduction
    Jiro Kimura, Kiyoshi Sasaki, Takuo Noda
    2014 Volume 50 Issue 7 Pages 1137-1140
    Published: December 20, 2014
    Released on J-STAGE: December 20, 2014
    DOIhttps://doi.org/10.11164/jjsps.50.7_1137
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    Air reduction was performed for intussusception in a 4-year-old boy. On the following day, however, intussusception recurred twice. On the second recurrence on that day (i.e., recurrence of intussusception for the third time), we attempted laparotomy because structural disorders were suspected. After reducing ileocolic intussusception, we detected appendiceal intussusception. It was considered that appendiceal intussusception caused recurrent ileocolic intussusception in our patient. Appendiceal intussusception could not be reduced by noninvasive reduction because the air leaks out to the ileum owing to pressure. In the case of air reduction, the contrast effect is insufficient; thus, appendiceal intussusception is easily overlooked.
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