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Volume 50, Issue 2
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2014 Volume 50 Issue 2 Pages 001-010
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSDownload PDF (473K)
Originals
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Kazuo Ishida, Saori Nakahara, Eriko Takeyama, Tadashi Kawakami2014 Volume 50 Issue 2 Pages 201-205
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSPurpose: Although the survival rate of infants with congenital duodenal atresia has improved, some unique problems remain unresolved. Analysis of duodenal atresia and stenosis: a 34-year experience with 79 cases.
Methods: We have experienced 79 (male: 34; female: 45) cases with duodenal atresia and stenosis in the past. Of these cases, 34 (42.5%) had Down’s syndrome, 39 were atresia, 25 were stenosis, 15 had annular pancreas, 2 were multiple atresia, 2 suffered from apple-peel configuration of the jejunum, 45 (57%) had associated anomalies including cardiac defect, malrotation, esophageal atresia, anal atresia sites inversus, and alveolar capillary dysplasia (ACD).
Results: The operation procedures included duodenoduodenostomy (62), excision of the web (6), duodenojejunostomy (7), and so on. Of the operated cases, 68 survived. The causes of death were a combination of sepsis, cardiac anomaly, ACD, and extremely low-birth weight infants. Only one patient required reoperation for anastomotic obstruction.
Conclusion: When we manage duodenal atresia and stenosis, we always consider not only the associated anomalies but also variations of atresia, and the anomalous biliary ductal system.View full abstractDownload PDF (475K) -
Norihiko Kitagawa, Masato Shinkai, Hiroshi Take, Kyoko Mochizuki, Fumi ...2014 Volume 50 Issue 2 Pages 206-210
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSPurpose: We report the usefulness of navigation surgery using the indocyanine green (ICG) fluorescence method to discover metastatic and primary lesions of hepatoblastoma.
Method: Seven pediatric hepatoblastoma cases were analyzed. Operations included partial lung resection for multiple lung metastases (n=1), extirpation for mediastinal lymph node metastasis (n=1), hepatectomies for primary or recurrent hepatoblastoma (n=4), and liver transplantation for recurrent disease (n=1). ICG (0.5 mg/kg) was administered intravenously to all patients 24 hours prior to surgery. Fluorescence emitted by ICG in the tumor tissue was portrayed by Photodynamic Eye (PDE)®.
Results: Eight lung metastatic lesions were identified by this method and extirpated. The smallest lesion, which was not palpable, was 0.4 mm in diameter. This method could distinguish a mediastinal metastatic lymph node from other normal nodes. Primary liver tumors, which were exposed to the liver surface, emitted fluorescence; however deep lesions were not detectable. We could not confirm residual tumor in the stump of residual liver by this method. The gallbladder and extrahepatic bile ducts were depicted well. We applied ICG as a non-radioactive contrast medium to confirm bile leakage from the stump of the liver.
Conclusion: This method is extremely useful to discover metastatic lesions of hepatoblastoma in the lung and lymph nodes. Moreover, this is a useful method to discover residual lesions in the liver of primary hepatoblastoma.View full abstractDownload PDF (561K) -
Koichi Ohno, Tetsuro Nakamura, Tatsuo Nakaoka, Yuichi Takama, Atsushi ...2014 Volume 50 Issue 2 Pages 211-216
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSPurpose: We investigated the operative time (OP) of conventional inguinal hernia repair (CIHR) performed by residents in order to determine the number of operations required to master this surgical technique.
Methods: We compared chronological changes in the OPs of CIHRs for male patients with unilateral inguinal hernia performed by residents A, B, and C who were trained before the adoption of laparoscopic percutaneous extraperitoneal closure (LPEC). These results were compared with the number and OPs of CIHRs performed by residents D and E who were trained after the adoption of LPEC.
Results: Residents A, B, and C performed 127, 124, and 131 CIHRs over a 3-year period, respectively. The OPs for the 61st to 80th CIHRs were significantly shorter than those for the 41st to 60th (A: 35 ± 6 vs. 41 ± 10, B: 27 ± 7 vs. 33 ± 11, and C: 32 ± 10 vs. 40 ± 15 min; p < 0.05). The 3 residents performed 80 CIHRs for their respective period of 21, 25, and 19 months, and their total numbers of CIHRs for male patients, including those excluded from later analysis, were 93, 104, and 92 in same period. In contrast, residents D and E respectively performed only 34 and 30 CIHRs over 24 months; the OPs of their last 20 CIHRs (40 ± 11 and 39 ± 14 min) were longer than those of the 61st to 80th CIHRs performed by residents A, B, and C.
Conclusions: To master the CIHR technique, 100 CIHRs for male patients may be required. It has become difficult for residents to perform a sufficient number of CIHRs since the widespread adoption of the LPEC technique.View full abstractDownload PDF (456K)
Case Reports
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Genshiro Esumi, Yukiko Takahashi, Atsuhisa Fukuda, Takeshi Shono2014 Volume 50 Issue 2 Pages 217-222
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSA five-year-old male was referred to our hospital because of a high fever and bloody vomit, with pneumoperitoneum noted on CT examination. As the pneumoperitoneum was limited within the upper abdomen, especially around the liver and the duodenum, we diagnosed the child had anupper gastrointestinal tract perforation. Because the symptoms started less than 24 hours prior to admission, the amount of ascites was low, and the hemodynamic status and pain were under control, conservative treatment was performed initially. The treatment consisted of total parenteral nutrition with administration of antibiotics and the use of anti-ulcerogenic drugs. The patient’s body temperature recovered to within the normal range by the next day after treatment. An upper gastrointestinal endoscopy revealed a duodenal ulcer at the first portion of the duodenum on day 7, and oral feeding was then started on day 8 before the patient was discharged without any adverse events on day 12 after admission. Conservative treatment for duodenal perforations in pediatric patients has been rarely reported. In addition to our case report, we herein review 13 previously reported cases of conservatively treated perforated duodenal ulcers in pediatric patients with their clinical features.View full abstractDownload PDF (551K) -
Yoshiko Usui, Kosaku Maeda, Shigeru Ono, Satohiko Yanagisawa, Katsuhis ...2014 Volume 50 Issue 2 Pages 223-225
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSWe report two pediatric patients with Meckel diverticulum diagnosed by double-balloon enteroscopy (DBE). Case 1 was an 8-year-old boy with congenital heart disease complained of general fatigue and tarry stools. His hemoglobin level was 4.5 g/dl. Although Tc 99m-labeled red blood cell scintigraphy showed active bleeding around the ileocecal area, upper and lower ileocecal endoscopy could not detect the source of bleeding. Negative results were obtained with Tc-99m pertechnetate scintigraphy. Case 2 was a 12-year-old boy presented with massive tarry stools and required blood transfusion. Findings of Tc-99m pertechnetate scintigraphy were negative. These two patients were diagnosed with Meckel diverticulum by DBE. Meckel diverticles were subsequently resected through small incisions. DBE is feasible for the diagnosis of pediatric small-bowel bleeding of unknown origin, and accurate diagnosis of Meckel diverticulum can provide adequate treatment.View full abstractDownload PDF (437K) -
Waka Yamada, Toshihiko Watanabe, Hideaki Tanaka, Kaori Sato, Michinobu ...2014 Volume 50 Issue 2 Pages 226-229
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSWe report three cases of acute gastroenteritis complicated with perforated duodenal ulcer. Case 1 was a 1-year-old girl, case 2 was a 2-year-old boy, and case 3 was a 2-year-old girl. Case 1 suffered from fever, diarrhea and vomiting, with suspected viral gastroenteritis. Cases 2 and 3 suffered from duodenal perforation following rotavirus infection. All three patients underwent an emergency operation using simple closure and omental patch technique. Viral gastroenteritis in small children may become a trigger of duodenal perforation, and warrants attention from pediatric surgeons.View full abstractDownload PDF (450K) -
Tomohiro Ishii, Keiichi Morita, Jiro Tsugawa, Shiiki Satoh2014 Volume 50 Issue 2 Pages 230-234
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSA two-year-old girl who had undergone ventriculo-peritoneal shunt (VPS) surgery visited our hospital because of tube protrusion through the anus. On admission, she had no fever and did not show any sign of peritonitis or meningitis. Although abdominal X-ray findings confirmed anal protrusion of the shunt tube, no free air was detected. Laboratory data did not show any sign of peritonitis. She was diagnosed as having intestinal perforation by the VPS tube. A laparoscopic exploration revealed that the intraperitoneal VPS tube was completely covered by fibrous tissue, and had penetrated the sigmoid colon without stool leakage. The tube was exposed and cut at the right anterior chest wall. The proximal part of the tube was exteriorized, and the distal part was removed transanally. Fibrous tissue around the tube was laparoscopically ligated and cut. Enteral feeding was restarted shortly after surgery, and operation-related intraabdominal complications did not occur. The laparoscopic approach was very useful for peritoneal exploration in case of intestinal perforation due to VPS, and its treatment may be appropriated by our aforementioned procedures.View full abstractDownload PDF (447K) -
Kaori Sato, Waka Yamada, Toshihiko Watanabe, Michinobu Oono, Yukihiro ...2014 Volume 50 Issue 2 Pages 235-240
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSA 14-year-old Japanese girl presented to a local physician with dyspnea and left omalgia. She underwent chest radiography and echocardiogram which revealed massive pericardial effusion with evidence of cardiac tamponade. She underwent chest computerized tomography to identify the cause of acute cardiac tamponade, and a mass in the anterior mediastinum was revealed. She was diagnosed with teratoma perforating the pericardial sac, and it was decided that surgery should be performed on the patient. Resection of the mediastinal teratoma was performed 38 days after appearance of symptoms. The mass appeared to not have ruptured, and there was no communication with the pericardial space. However, inflammatory granulation tissue was found in the tumor and pericardial space. These signs are consistent with the diagnosis of mature teratoma perforating the pericardial sac. The patient had an uneventful postoperative course, and was discharged on day 12 after surgery. The patient was followed-up for 15 months, and showed no sign of recurrence. Mediastinal teratoma in children younger than 2 years often causes symptoms related to tracheal compression; however, clinical indications later in childhood are less frequent. Their masses are usually discovered incidentally on chest radiography. Although mediastinal teratoma occasionally perforates adjacent organs such as the lungs, bronchi, mediastinum, and pleural cavity, reports of its perforation into the pericardial sac are rare. We report a rare case of mature mediastinal teratoma perforating the pericardial sac.View full abstractDownload PDF (633K) -
Tomoko Hatata, Shigeru Takamizawa, Katsumi Yoshizawa, Mizuho Machida, ...2014 Volume 50 Issue 2 Pages 241-244
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSUmbilicoplasty is considered to be of secondary importance for the repair of hernia in the umbilical cord (HUC). The authors report a case of HUC subjected to primary abdominal wall closure and umbilicoplasty simultaneously. A zero-day-old male weighing 2,724 g, diagnosed as omphalocele prenatally, was extracted by cesarean section at 37 weeks 6 days gestation. The size of the abdominal wall defect was 3 cm in diameter, and the hernia sac was undamaged. He had no other anomalies. He was brought to the operating room to repair the HUC on the day of birth. Since the herniated bowel was easily reduced manually and the vital signs were stable, and we performed umbilicoplasty to complemente the abdominal wall closure. The hernia sac was excised and the peritoneum and fascia were closed longitudinally. Following the abdominal wall closure, three skin flaps (left, right, and caudal to the defect; each 1.5 cm in length) were created along the contour of the umbilical ring with the excess skin excised. The tips of each of the three skin flaps were anchored to the closed fascia, and the sides of each adjoining flap were sutured. The cranial part of the umbilicus was sutured longitudinally. He started oral feeding three days and was discharged 12 days after the operation. His umbilicus portrayed a nearly-normal appearance without other events for 1 year after operation.
Our study suggests that umblicoplasty utilizing three triangular skin flaps with primary closure of HUC is a safe and feasible technique with a cosmetically appealing outcome.View full abstractDownload PDF (814K) -
Gen Matsuura, Jun Iwai, Yasuyuki Higashimoto, Katsumi Yotsumoto2014 Volume 50 Issue 2 Pages 245-250
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSPneumatosis cystoides intestinalis (PCI) is a rare condition associated with various diseases. Here we report a case of PCI that occurred during chemotherapy for leukemia. A 12-year-old boy, diagnosed with acute lymphoblastic leukemia, had undergone chemotherapy for 4 years including two rounds of bone marrow transplantation. He required continuous administration of predonisolone and tacrolimus because of severe graft-versus-host disease. At the age of 16 years, he presented with abdominal distention, and radiographic examinations revealed intramural pneumatosis extending from the ascending colon to the sigmoid colon. Although his abdomen was distended and tympanitic by percussion and his bowel peristalsis decreased, he had neither fever nor peritoneal signs. Meeting the diagnosis criteria of PCI, he underwent continuous high concentration oxygen inhalation therapy. The lesion disappeared in 7 days after diagnosis. We therefore suggest a therapeutic strategy (through a literature review in relation to the primary symptoms) for underlying diseases and treatments for PCI, although most cases of PCI may recover with conservative treatment. We emphasize the importance of making a correct diagnosis to avoid unnecessary surgery.View full abstractDownload PDF (599K) -
Masaki Horiike, Tatsuo Nakaoka, Tetsuro Nakamura, Koichi Ono, Yuichi T ...2014 Volume 50 Issue 2 Pages 251-256
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSCecal volvulus is a disease that requires emergency treatment because it can lead to necrosis of the cecum and parts of the ascending colon if left untreated. This disease is relatively uncommon in children. An 8-year-old boy visited our hospital with complaints of stomachache and vomiting. Abdominal X-ray in the standing position showed an abnormally large amount of intestinal gas. The patient was diagnosed with simple ileus, and received conservative therapy after hospitalization. However, the patient showed abdominal distention and signs of extensive peritoneal irritation on the day after hospitalization. After detection of an cecal volvulus by review of the X-ray images at admission, the patient underwent emergency surgery for torsion. Septic shock occurred after surgery; however, it was subsequently controlled, and the patient was eventually discharged. The diagnosis of childhood cecal volvulus tends to be delayed because it is mainly detected in severely multiply handicapped children, and abdominal symptoms are rarely reported. It is most important to apprehend the characteristic X-ray imaging findings of cecal volvulus for early precise diagnosis. Based on the diagnosis acknowledgement, the disease should then be carefully treated.View full abstractDownload PDF (622K) -
Reina Hoshi, Kiminobu Sugito, Yosuke Watanabe, Shinsuke Yoshizawa, Sho ...2014 Volume 50 Issue 2 Pages 257-262
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSWe performed transcatheter arterial chemoembolization (TACE) and hepatectomy on two cases of hepatoblastoma (Pre-Treatment Extent of Disease (PRETEXT) III) showing chemoresistance. The histopathological findings showed that it was replaced with necrotic tissues around the tumor vessels with lipiodol embolized at the tumor margins. The histopathological findings showed that the areas around the tumor vessels embolized with lipiodol at the tumor margins were replaced with necrotic tissues. These two cases developed metachronous lung metastasis after treatment. Vascular endothelial growth factor (VEGF), as well as matrix metalloproteinases (MMP)2 and MMP9 expression levels are implicated in angiogenesis, local progression, and distant metastasis. All of VEGF, MMP2, and MMP9 expression levels at hepatectomy were low compared with the expression levels on tumor biopsy. Although the influence of TACE on distant metastasis is controversial, our findings suggest that TACE suppressed angiogenesis and local progression.View full abstractDownload PDF (1126K) -
Kiyokazu Kim, Shigehisa Fumino, Koji Higuchi, Shigeyoshi Aoi, Taizo Fu ...2014 Volume 50 Issue 2 Pages 263-266
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSWe report two cases with intestinal volvulus subsequent to infected mesenteric lymphangioma. Both a 4-year-old boy and a 3-year-old girl presented acute abdomen due to infected mesenteric lymphangioma, and they were treated conservatively. Both the boy and girl presented intestinal volvulus caused by the mesenteric lymphangioma 4 and 2 months after the first onset, respectively. They underwent emergent laparotomy, and the cysts were removed with affected bowel resection. Once the above definitive diagnosis is made, prompt surgical intervention is advocated for infected mesenteric lymphangioma because acute abdomen, such as intestinal voluvuls, could occur early as a secondary event.View full abstractDownload PDF (511K) -
Megumi Kobayashi, Masaru Mizuno, Shuhei Yoshida, Shusaku Sasaki, Atsuh ...2014 Volume 50 Issue 2 Pages 267-272
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
JOURNAL FREE ACCESSWe report two patients with small bowel obstruction due to kelp candy impaction that required open-abdominal surgery. Patient 1 was a 1-year-old girl. She developed frequent vomiting and abdominal pain, and was brought to our hospital. She was dehydrated, and abdominal CT revealed ascites with extensive small bowel dilatation. These findings led to a diagnosis of intestinal obstruction. She did not respond to conservative treatment, and underwent laparotomy, which showed a jejunal mass. A piece of undigested kelp was removed through a small jejunal incision. Postoperatively, the patient was confirmed to have eaten kelp candy. Patient 2 was a 14-year-old girl who developed abdominal pain and vomiting on the day she finished eating a pack of kelp candy, and was brought to our hospital. Abdominal CT showed ascites and small bowel dilatation. Our experience with the treatment of the previous patient led us to suspect small bowel obstruction due to food impaction. However, the presence of peritoneal irritation could not exclude strangulating small bowel obstruction. Therefore, we performed emergency laparotomy, and found extensive dilatation of the bowel proximal to the terminal ileum in addition to Meckel’s diverticulum caused by feces pooling. A piece of undigested kelp was removed through a small jejunal incision, and the diverticulum was resected. Although the incidence of small bowel obstruction caused by food impaction is low, pediatric surgeons should be aware of this type of small bowel obstruction in performing differential diagnosis of acute abdomen.View full abstractDownload PDF (802K)
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[in Japanese]2014 Volume 50 Issue 2 Pages 273-278
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
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2014 Volume 50 Issue 2 Pages 279-295
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
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2014 Volume 50 Issue 2 Pages 9999
Published: April 20, 2014
Released on J-STAGE: April 20, 2014
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