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Volume 51, Issue 7
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2015 Volume 51 Issue 7 Pages 7_0001-7_0008
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSDownload PDF (400K)
Case Reports
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Eriko Saito, Yasuyuki Higashimoto, Yoshiharu Sato, Keita Terui, Kensuk ...2015 Volume 51 Issue 7 Pages 1147-1152
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSA 9-year-old boy had been suffering from severe constipation with soiling and incontinence since he was an infant. Contrast enema demonstrated an enormously dilated rectosigmoid caused by fecal impaction. After fecal disimpaction under general anesthesia, rectal biopsy was performed and Hirschsprung’s disease and other organic diseases were ruled out. Although we considered that long-term management with laxatives and enemas was necessary to improve the patient’s condition, this treatment was practically difficult because of his family background problem and his psychological trauma from enemas. Ultimately, surgery was considered partly because of his family’s request. We resected the dilated rectosigmoid colon and performed stapled colorectal anastomosis. His postoperative course was good, and not only his defecation condition but also his quality of life was significantly improved. Two years after the surgery, medication was discontinued and constipation did not recur thereafter. After appropriate consideration of the operative indication and surgical procedure, a satisfactory functional outcome can be achieved in some patients with severe constipation.View full abstractDownload PDF (744K) -
Shunsuke Watanabe, Tatsuya Suzuki, Toshihiro Yasui, Takazumi Kato, Mas ...2015 Volume 51 Issue 7 Pages 1153-1157
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSWe report the case of a 6.4-year-old female who was referred to our department with a lower abdominal mass and acute abdomen due to ileus. Abdominal computed tomography suggested a mesenteric tumor of 10 cm length, comprising fat components accompanied by mesenteric torsion. Therefore, laparoscopic emergency surgery was performed. The tumor was located in the small intestine mesentery, and torsion of the small intestine centering on the tumor area was observed. Because the tumor was in contact with and was exerting pressure on the small intestinal wall, it was excised along with parts of the small intestine. Histopathological findings indicated a lipoma comprising mature fat cells. Reports on mesenteric tumors in children involve lipoblastomas, but lipomas are extremely rare; for that reason, we were unable to make a differential diagnosis on the basis of preoperative imaging findings. The patient is progressing well with no evidence of relapse 7 months after surgery.View full abstractDownload PDF (726K) -
Tsubasa Shironomae, Miyuki Kohno, Yoshitomo Yasui, Takahiro Oshikiri, ...2015 Volume 51 Issue 7 Pages 1158-1163
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSA 3-month-old male was admitted to our hospital for examination of a hydrocele of the left testis with progressively increasing left scrotal swelling and left leg edema. Ultrasonography and magnetic resonance imaging (MRI) yielded the presumptive diagnoses of left abdominoscrotal hydrocele (ASH) and scrotal lymphatic malformation. The patient was intraoperatively confirmed to have ASH, and ASH repair was performed. His left scrotal swelling and left leg edema gradually improved after the operation. The patient’s clinical course indicates that the huge abdominoscrotal hydrocele contributed to the progressive left scrotal swelling and left leg edema owing to the compression of veins and lymphatics.View full abstractDownload PDF (999K) -
Yoko Mizota, Koji Kumori, Soichi Nakada, Yoshitsugu Tajima2015 Volume 51 Issue 7 Pages 1164-1167
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSYolk sac tumor, one of the germ cell tumors, often occurs in infants under 3 years of age. Although conventional surgical treatment with chemotherapy has contributed to a good prognosis of patients with vaginal yolk sac tumor, the patients usually become infertile after curative treatment. An 8-month-old female infant presented with bleeding in a diaper, and imaging studies demonstrated a solid pelvic tumor of 50 mm diameter. The tumor was consistent with the diagnosis of yolk sac tumor because of a marked elevation of serum α-fetoproten level and a histopathological feature of Schiller-Duval bodies on biopsy specimens under laparotomy. However, the primary site of the tumor could not be identified as either the vagina or the uterine cervix. After multiagent chemotherapy including CDDP, VP-16 and BLM, the tumor was reduced in size and confirmed to be of vaginal origin by vaginoscopy. Thereafter, we performed a partial resection of the vagina as a fertility-conserving surgery on the patient, followed by adjuvant chemotherapy with VBL, IFM and CDDP. The patient has been doing well without relapse 21 months after completion of treatment. Vagina-sparing operation after neoadjuvant chemotherapy might be a treatment of choice for vaginal yolk sac tumor in cases with a good response to chemotherapy.View full abstractDownload PDF (849K) -
Daiki Shorin, Yasuhiko Iiboshi, Akiko Nishitani, Kumiko Uji, Noriyuki ...2015 Volume 51 Issue 7 Pages 1168-1172
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSWe report a rare case of infantile duodenal perforation after acute gastroenteritis complicated by hypophosphatemia. The duodenal perforation induced by acute gastroenteritis is rare in children. Moreover, its pathology has not been explained. A 3-year-old boy suffered from fever, vomiting and hematemesis, and his ultrasonography and computed tomography revealed free air in the abdomen, which indicated perforation of the gastrointestinal tract. He underwent an emergent omental implantation for duodenobulbar perforation. Because he experienced vomiting and appetite loss for 5 days before operation, peripheral parenteral nutrition was applied after operation. He showed a low level (2.1 mg/dl) of serum phosphorus for infants, and the hypophosphatemia seemed to be induced by gastroenteritis and abnormality in electrolyte or glucose load. The level of phosphorus was normalized by infusion of sodium phosphate. The measurement of serum phosphorus level is important in infants suffering from vomiting and appetite loss for a long time, and we should pay attention to the fact that the reference value of phosphorus is higher in children than in adults. Even though most children with gastroenteritis recover without severe complications, we should be aware that some of them occasionally suffer from malnutrition, dehydration, conditions due to abnormally low levels of electrolytes including hypophosphatemia, and duodenal perforation.View full abstractDownload PDF (450K) -
Toshihiro Yasui, Tatsuya Suzuki, Fujio Hara, Shunsuke Watanabe, Naoko ...2015 Volume 51 Issue 7 Pages 1173-1176
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSPediatric incarcerated inguinal hernia is an acute abdominal condition that requires surgery. Here, we report on 2 rare cases of Amyand’s hernia in which the appendix was in the hernia sac. Case 1: A 1-month-25-days-old boy was brought to the Pediatrics Department of our hospital because of poor suckling and repeated vomiting. He was referred to our department 4 days later because his abdominal X-ray showed niveau. Physical examination revealed a swelling extending from the right inguinal region to the scrotum. We performed an emergency laparoscopy to reduce the hernia and diagnose the causes of bowel obstruction. We found the appendix along with the ileocecum in the right internal inguinal ring. The hernia was reduced by pulling with bowel forceps combined with manual reduction. The ileocecum region was normal in color and a portion of the appendix showed necrosis; thus, we performed aseptic appendectomy. Case 2: An 11-month-old boy, with a left inguinal hernia and who was awaiting elective surgery, was presented to our hospital after developing croup. Because his left inguinal hernia was irreducible, an emergency surgery was performed by the inguinal approach and the ileocecum and normal appendix were found in the hernia sac.View full abstractDownload PDF (449K) -
Junichiro Sato, Yuji Nirasawa, Etsuji Ukiyama, Yoshiko Watanabe, Yoshi ...2015 Volume 51 Issue 7 Pages 1177-1180
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSMost cases of odontogenic tumors occur as intraosseos odontoma, and extraosseous odontoma is rarely observed. In this report, we describe a unique case of extraosseous odontoma. A male neonate, 13 days after birth, was examined owing to a tumor on the right side of the oral cavity as the primary symptom. A pedunculated elastic hard tumor of 20 mm diameter was recognized. Ultrasonographic findings showed a round low-echoic tumor with calcification. CT scans showed a protruding tumor of 15 × 10 × 17 mm size without intracranial extension. Upon diagnosis of epignatus, total excision was performed under general anesthesia 3 months after birth. The pathologic diagnosis was extraosseous odontoma. The postoperative course was uneventful. Although extraosseous odontoma is extremely rare, it is important to consider it as a differential diagnosis.View full abstractDownload PDF (434K) -
Masataka Takahashi, Akihiro Fujino, Noriko Takeda, Hideo Ishihama, Koj ...2015 Volume 51 Issue 7 Pages 1181-1185
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSA 4-year-3-month-old girl presented with upper abdominal pain and vomiting. Plain abdominal roentogenogram and abdominal CT scan showed an “upside-down stomach” as a result of mesenteroaxial volvulus of the stomach. Since decompression of the stomach by introducing a nasogastric tube was insufficient for its reposition, we performed endoscopic restoration of the volvulus. Multiple deep ulcers were ascertained by endoscopic observation, suggesting severe ischemic status. One month after treatment, complete gastric obstruction appeared and the patient could not take anything orally. The gastric obstruction gradually improved; then, she could resume a normal diet four months after admission. Upper GI series six months after treatment again showed slight gastric volvulus. Exploratory laparoscopy was performed, and slight focal adhesion and gastric mobility were found. To reduce the risk of retorsion, laparoscopic gastropexy was additionally performed. In this patient, conservative therapy was successful for treating the complete obstruction of the stomach after a severe ischemic episode. The entire course of this patient provides us with an important indication for deciding the treatment strategy in patients with severe gastric volvulus.View full abstractDownload PDF (587K) -
Yuki Muta, Sadashige Uemura, Hiroshi Nouso, Hisako Kuyama, Mayumi Yama ...2015 Volume 51 Issue 7 Pages 1186-1189
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSFamilial pancreaticobiliary maljunction (PBM) is rare, and its genetically inheritable character is unproved. An 8-year-old girl, whose mother and maternal aunt had a history of PBM, visited our hospital for repetitive abdominal pain. Ultrasonography showed a cystic lesion of 2.5 cm diameter adjacent to the gallbladder neck, resembling a type II congenital biliary dilatation based on Todani’s classification. MRCP suggested the existence of PBM. Laparoscopic cholecystography revealed dilatation of the cystic duct, a common channel of 8 mm length, and a visualized main pancreatic duct. With the final diagnosis of type VI choledochal cyst, the laparoscopically assisted excision of the extrahepatic bile duct followed by Roux-en-Y hepaticojejunostomy was successfully performed. Inflammation was histopathologically demonstrated on the excised gallbladder and cystic duct. This is the first case report of a type VI choledochal cyst in Japan, and it showed the implication of a genetic predisposition in some types of PBM. We recommend the examination of PBM in those who have a strong family history of this anomaly.View full abstractDownload PDF (503K) -
Sachie Ohno, Tomoro Hishiki, Takeshi Saito, Keita Terui, Tetsuya Mitsu ...2015 Volume 51 Issue 7 Pages 1190-1197
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSPleuropulmonary blastoma (PPB) is a rare neoplasm originating from intrathoracic mesenchymal tissue that usually affects children under 5 years of age. Here, we present a case of PPB that developed into adenomatous goiter after the complete response of PPB. A 2-year-old girl presenting with left chest pain and fever was referred to our hospital. Chest radiography and computed tomography scan images showed a large solid mass in the left hemithorax. Excisional biopsy of the mass was diagnostic of PPB (type II). Metastatic work-up showed negative findings. Chemotherapy produced a partial response, and radical tumor resection was performed. After surgery, high-dose chemotherapy followed by peripheral blood stem cell transplantation was applied and reimaging showed no evidence of the disease. Forty months after the completion of therapy, she presented with multiple thyroid nodules in both lobes. She underwent a subtotal thyroidectomy; however, residual thyroid tissue was found to have developed multiple nodules. Two years later, the size of nodules had increased and a total thyroidectomy was carried out. Histopathologic examination showed adenomatous goiter, which was the same diagnosis as in the previous thyroidectomy. She remained without clinical evidence of recurrence for 7 years after the initial diagnosis.View full abstractDownload PDF (748K) -
Takato Sasaki, Kouji Masumoto, Yasuhisa Urita, Naoya Sakamoto, Chikash ...2015 Volume 51 Issue 7 Pages 1198-1204
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSA 1-year-old boy, who had been suffering from irregular saccades of the eyes, limb myoclonus after falling asleep, and gait ataxia, was referred to our hospital for further examinations and was diagnosed as having opsoclonus-myoclonus-ataxia syndrome (OMS). Computed tomography revealed a retroperitoneal tumor. Imaging findings showed difficulty and a high risk of complete resection; thus, we performed the subtotal resection of the tumor. Histopathological examinations revealed that the tumor is a ganglioneuroblastoma. He was subjected to oral high-dose dexamethasone pulse therapy after surgery and all the OMS symptoms disappeared after the third course. No adverse effects and relapses were observed during the 21 courses of the therapy; thus, we considered stopping the therapy. Even if it was impossible to perform a complete tumor resection, as in our patient, a subtotal resection and postoperative immunosuppressive therapy might be effective for OMS in neuroblastoma patients.View full abstractDownload PDF (664K) -
Kenji Fukunaga, Taizo Furukawa, Jyunnosuke Maniwa, Shizu Miura, Mayumi ...2015 Volume 51 Issue 7 Pages 1205-1209
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSTrichobezoars are formed by the ingestion of hair and by the accumulation of hair in the stomach, which can cause intestinal obstructions due to migration into the small intestine. We herein report a pediatric case of trichobezoars with small bowel obstruction, which were completely removed by laparoscope-and-endoscope-assisted surgery. A 5-year-old girl was admitted to our hospital owing to acute abdominal pain and nausea. She had mild abdominal distension, and a hard mass was detected in the right abdominal region by abdominal palpation. Abdominal CT showed ascites formation and dilated small intestine, which we considered to be indications for emergency surgery. By laparoscopic inspection, a foreign body was seen through the intestinal wall. We pulled the intestine, together with the foreign body, out from the umbilical wound of a laparoscope port. The foreign body was determined to be trichobezoars by enterotomy. Subsequently, oral upper gastrointestinal endoscopy was performed, which also showed huge trichobezoars in the stomach. After enlarging the umbilical wound, the anterior wall of the stomach was pulled out and incised, and the residual trichobezoars were removed. The postoperative course was uneventful, and the patient had no recurrence.View full abstractDownload PDF (585K) -
An Experience of Bladder Augmentation Applying Bianchi Procedure in a Patient With Cloacal ExstrophyTakeshi Asai, Koji Aoyama, Yasuo Nakahara, Takafumi Goto, Yoshinobu Iw ...2015 Volume 51 Issue 7 Pages 1210-1213
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSWe report the case of a 9-year-old boy with cloacal exstrophy. We performed bladder and abdominal wall closure and end-colostomy at 5 days of age, followed by tube-cystostomy 6 months after. His hindgut gradually dilated, and then he was repeatedly hospitalized because of ileus. This time, we performed colon tailoring and augmentation cystoplasty. At surgery, the vascularized flap of the colon divided by the Bianchi procedure was used for bladder augmentation. Tailoring of the colon was carried out by suturing the remaining wall of the colon, and colostomy was performed. The postoperative course was uneventful. In the initial surgical management of cloacal exstrophy, end colostomy should be used. However, the preserved colon can sometimes dilate because of insufficiency of intestinal peristalsis or physical blockage, and the bladder capacity can be small, which is associated with urinary incontinence. In this case, intestinal division by the Bianchi procedure can be used successfully.View full abstractDownload PDF (444K) -
Saki Sakamoto, Naoki Hashizume, Minoru Yagi, Kimio Asagiri, Suguru Fuk ...2015 Volume 51 Issue 7 Pages 1214-1219
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSThe patient was an 11-year-old female diagnosed as having a mixed germ cell tumor of the right ovary and peritoneal disseminations. The patient underwent a resection of the right ovary and chemotherapy. However, multiple dissemi nations enlarged despite the normalization of her serum AFP level after chemotherapy. The majority of the peritoneal metastases were resected, and a histopathological examination led to the discovery of a mature teratoma. We diagnosed the patient as having growing teratoma syndrome (GTS). GTS has excellent prognosis when completely resected; however, if incompletely resected, multiple operations may be necessary. We describe our experience with a difficult case of GTS and a review of the literature.View full abstractDownload PDF (815K) -
Shunsuke Fujii, Kouji Masumoto, Yasuhisa Urita, Kentaro Ono, Takato Sa ...2015 Volume 51 Issue 7 Pages 1220-1224
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSLongitudinal pancreaticojejunostomy with coring out of the pancreatic head (Frey’s procedure) has been known to be a safe and effective method for chronic pancreatitis. We report the case of a patient who underwent reoperative surgery for recurrent pancreatitis after Frey’s procedure was performed when he was a child. A Japanese 19-year-old male had been experiencing a recurrent epigastric pain associated with chronic pancreatitis since he was 8 years of age, and he underwent Frey’s procedure at the age of 11.Three years later, he relapsed with inflammation in the pancreatic tail and required distal pancreatectomy. Because of severe adhesion around the pancreatic tail, it was impossible to preserve the spleen. In the postoperative course, he had complications, such as pancreatic fistula and adhesive ileus. Therefore, further operations were required for such complications. Although Frey’s procedure is known to be effective for children, we need to take more precaution in order to avoid reoperations due to recurrent pancreatitis.View full abstractDownload PDF (886K) -
Yoshiko Watanabe, Yuji Nirasawa, Etsuji Ukiyama, Yoshitomo Samejima, J ...2015 Volume 51 Issue 7 Pages 1225-1229
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSA 1-year-old boy visited our hospital with the complaint of right scrotal swelling. Ultrasonography showed a cystic tumor of 27 × 18 × 11 mm size in the right testis. With the diagnosis of benign testicular tumor, we performed tumor enucleation. Histopathologically, the inside of the cyst was lined with squamous epithelium, and the final pathological diagnosis was intratesticular epidermoid cyst. The incidence of the testicular epidermoid cyst is only 3% of all pediatric testicular tumors and they could be diagnosed by characteristic radiological examination. Testis-sparing surgery should be considered if preoperative evaluation suggests a cystic benign tumor with salvageable normal testicular parenchyma.View full abstractDownload PDF (635K) -
Shigeyuki Furuta, Hideaki Sato, Shiho Tsuji, Shutaro Manabe, Hiroaki K ...2015 Volume 51 Issue 7 Pages 1230-1233
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
JOURNAL FREE ACCESSAn 8-year-old girl was brought to our hospital with a chief complaint of purulent bloody vaginal discharge that had persisted for 6 months. Magnetic resonance imaging revealed findings indicative of perforation of the vaginal wall by an intravaginal foreign body. When the Douglas pouch was laparoscopically inspected to confirm the location of a portion of the foreign body outside of the vagina and in preparation for a peritoneal intervention, a tumorlike process with the appearance of a foreign body was found to protrude from around the posterior vaginal fornix into the posterior peritoneal cavity. We were not able to find the vaginal foreign body by the adhesion of the vagina wall with a vaginoscope. However, complete transvaginal removal of the foreign body was achieved with a hysteroscope. The removed foreign body was a conical plastic toy measuring 1.5 cm in length. Because sexual abuse was also suspected as a cause of foreign body insertion, a staff member from a child consultation center investigated this case. However, because the possibility of sexual abuse was determined to be low, the girl was placed on follow-up. At present, 6 months after hysteroscopic removal, there is no evidence of sexual abuse and no recurrence of vaginal discharge.View full abstractDownload PDF (503K)
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[in Japanese]2015 Volume 51 Issue 7 Pages 1234-1245
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
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2015 Volume 51 Issue 7 Pages 1246-1254
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
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2015 Volume 51 Issue 7 Pages 1255-1282
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
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2015 Volume 51 Issue 7 Pages 1283-1297
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
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2015 Volume 51 Issue 7 Pages 7_9999-
Published: December 20, 2015
Released on J-STAGE: December 20, 2015
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