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Volume 51, Issue 5
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2015 Volume 51 Issue 5 Pages 5_0001-5_0011
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSDownload PDF (402K)
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[in Japanese]2015 Volume 51 Issue 5 Pages 863-
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSDownload PDF (173K)
Originals
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Reisuke Imaji, Tomoyo Ohira, Reiko Kato, Shintaro Hashimoto, Wataru Mu ...2015 Volume 51 Issue 5 Pages 864-867
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSPurpose: Guidelines recommend early orchiopexy up to 18 months of age in the United States and up to 2 years in Japan in patients with cryptorchidism. However, this strategy might not be widely adopted in Japan. We report a retrospective analysis of the timing of orchiopexy, the reason for the delay and testicular atrophy in our department to clarify the current status.
Methods: From April 2008 to March 2014, we reviewed the medical records of patients who underwent orchiopexy in our department in terms of the timing of surgery, the reason for the delay and testicular atrophy. Testicular atrophy is defined as a more than 20% volume loss as determined by ultrasonography or apparent clinical findings. Reoperated patients, those with Pradder-Willi syndrome or Charge syndrome, or patients with retractile testis were excluded.
Results: A total of 109 patients underwent orchiopexy. The mean age at surgery was 2 years and 3 months (median: 1 year and 7 months). Testicular atrophy was confirmed in 15 of 76 patients who underwent orchiopexy under 2 years of age and in 15 of 33 patients who underwent orchiopexy at the age of 2 years or older. There was a greater risk of testicular atrophy in patients older than 2 years (p = 0.01).
Conclusions: Many orchiopexy procedures are still carried out at later dates than suggested by guidelines. Communication should be improved not only during medical checkups, but also between pediatricians, urologists and pediatric surgeons as well as for the education of the general public.View full abstractDownload PDF (384K) -
Yoshiko Usui, Shigeru Ono, Katsuhisa Baba, Yuki Tsuji, Insu Kawahara, ...2015 Volume 51 Issue 5 Pages 868-872
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSPurpose: We assessed the validity of aggressive surgical intervention in the management of trisomy 13 and trisomy 18.
Methods: The clinical records of 21 patients with trisomy 13 or 18 admitted to our neonatal intensive care unit between 2008 and 2014 were retrospectively analyzed.
Results: All 21 patients were diagnosed as having some abnormalities, and 9 patients (42.9%) were diagnosed as having chromosomal anomalies prenatally. Eleven patients (52.4%) were diagnosed as having pediatric surgical diseases postnatally: intestinal malrotation, esophageal atresia, gastroesophageal reflux disease, diaphragmatic hernia, hepatoblastoma, anorectal malformation, omphalocele, and inguinal hernia. Two patients with intestinal malrotation and 1 patient with esophageal atresia had radical operation and have survived for 2–5 years at home. A patient with hepatoblastoma as well as congenital heart disease made the transition to palliative care. Three patients with poor prognosis underwent palliative procedure, and 2 patients died without undergoing surgical treatment. Tracheostomy for long-term endotracheal intubation was carried out in 4 patients. Cardiovascular surgery including intracardiac repair was performed in 3 patients. Heart disease in 20 patients (95.2%) was the major prognostic factor, and neonatal intensive care affected short-term mortality. Procedures by pediatric surgeons did not seem to have a direct effect on the patients’ prognosis and did not disturb the time shared with their families.
Conclusions: Recent reports focus on long-term survivors with trisomy 13 and trisomy 18 suggesting the necessity of appropriate treatment in accordance with individual condition. It is ethically reasonable that pediatric surgeons provide aggressive surgical intervention on the basis of objective medical evaluation.View full abstractDownload PDF (396K) -
Masaya Yamoto, Koji Fukumoto, Hiroshi Nouso, Hiromu Miyake, Masakatsu ...2015 Volume 51 Issue 5 Pages 873-878
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSPurpose: Thoracoscopic repair (TR) of esophageal atresia and tracheoesophageal fistula (EA/TEF) in newborns is increasing in popularity. The potential benefits and contraindication of TR of EA/TEF with cardiac anomalies, particularly atrial septal defect (ASD) and ventricular septal defect (VSD), are still unclear. The aim of this study was to investigate whether thoracoscopic surgery is beneficial and safe for EA/TEF with ASD/VSD in newborns and to determine the perioperative outcome after undergoing TR versus open repair (OR) of EA/TEF with ASD/VSD.
Methods: A retrospective chart review was conducted for 39 consecutive neonates who underwent EA/TEF repair between 2001 and 2014 in our clinic. Patients in this study had ASD/VSD and birth weights > 2.0 kg, and did not have chromosomal aberrations or severe cardiac anomaly. Of the 12 newborns who met the selection criteria, 5 underwent attempts at TR whereas 7 underwent OR.
Results: Overall, the mean operative time was 180 min in the TR group versus 159 min in the OR group. There were no intraoperative complications or deaths in either group. The median intraoperative levels of blood gas and EtCO2 were not significantly different. There were no significant differences in intra- and perioperative complications between the two groups.
Conclusion: In our study, TR appeared to be superior to OR for EA/TEF with ASD/VSD.View full abstractDownload PDF (875K) -
Takashi Watanabe, Akio Kubota, Yasuyuki Mitani, Katsunari Takifuji, Hi ...2015 Volume 51 Issue 5 Pages 879-883
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSPurpose: The purpose of this study is to determine whether LPEC can be a standard surgical procedure for pediatric inguinal hernia (IH) in both male and female patients by comparing with the Potts method.
Method: One hundred seven patients (44 males, 63 females) underwent LPEC from 2011 to 2014. Seventy-one patients (38 males, 33 females) underwent the Potts method from 2008 to 2010. The clinical records were reviewed retrospectively.
Results: In male unilateral IH patients, the mean operation times of LPEC and the Potts method were 35 and 28 min (p < 0.05), whereas in bilateral IH patients, they were 43 and 59 min (p < 0.05), respectively. In female unilateral IH patients, the mean operation times of LPEC and the Potts method were same 27 min, whereas in bilateral IH patients, they were 36 and 42 min, respectively. No surgical complication was observed for both LPEC and the Potts method. During laparoscopic observation, the incidences of contralateral patent processus vaginalis were 42.9% in males and 60.3% in females. No metachronous contralateral inguinal hernia developed in patients who underwent LPEC; however, 6 patients (8.5%) who underwent the Potts method developed this type of hernia. As to the completion rate of day surgery, there were no significant differences between the two groups (LPEC, 98.7%; Potts method, 94.4%).
Conclusions: The presented clinical comparison between LPEC and the Potts method showed no disadvantage of LPEC. An advantage of LPEC was found, namely, it can prevent contralateral IH. Thus, the authors conclude that LPEC can be a standard surgical procedure for inguinal hernia in both male and female patients.View full abstractDownload PDF (580K) -
Yasuyuki Mitani, Akio Kubota, Katsunari Takifuji, Takashi Watanabe, Ta ...2015 Volume 51 Issue 5 Pages 884-888
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSPurpose: The differentiation of biliary atresia (BA) from nonsurgical prolonged jaundice in neonates and infants is essential. Laparotomic cholangiography has been commonly performed for the diagnosis of BA when biochemical and imaging studies fail to diagnose it. The method is desirable as it is less invasive than other procedures. Therefore, we applied fine-needle puncture cholangiography (FNCG) as a less invasive method and evaluated its feasibility and usefulness. We discuss the advantages of FNCG for neonates and infants.
Methods: We conducted FNCG in six patients (3 boys and 3 girls) suspected of having BA from 2011 to 2014. Their ages ranged from 28 to 78 days, with an average of 47.5 days, and their body weights ranged from 3.1 to 4.3 kg, with an average of 3.7 kg. FNCG was performed by laparoscopy or laparotomy under general anesthesia, followed by liver biopsy. The pin hole of FNCG was not repaired.
Result: Uneventfully, FNCG was performed laparoscopically in 5 patients and laparotomically in 1 patient. The final diagnoses were neonatal hepatitis in 1 patient, neonatal hepatitis without the gallbladder in 1 patient, and biliary atresia (III-b1-ν) in 4 patients. No hepatobiliary complications associated with FNCG were observed in 2 patients with neonatal hepatitis.
Conclusion: FNCG is a simple, safe, and useful technique for diagnosing the cause of prolonged jaundice in neonates and infants.View full abstractDownload PDF (434K) -
Kenichiro Konishi, Makoto Komura, Kaori Morita, Chizue Uotani, Tetsuya ...2015 Volume 51 Issue 5 Pages 889-894
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSPurpose: Laparoscopic fundoplication for neurologically impaired patients (NIPs) occasionally results in complication caused by severe infection during the perioperative period. The purpose of this study was to investigate the risk factors for perioperative infection after surgery in NIPs for safe perioperative management.
Methods: Fifty-three NIPs who underwent laparoscopic fundoplication in our department between June 2006 and December 2011 were retrospectively evaluated. The primary diseases of NIPs were severe neonatal asphyxia, chromosomal abnormality, and refractory epilepsy among others. We examined the risk factors for perioperative infection in NIPs who underwent laparoscopic fundoplication, such as bacterial factors, patient factors, and surgical management factors.
Results: Thirteen patients developed perioperative infection. Univariate analysis was carried out on the above-mentioned risk factors, and no significant difference was observed. However, infection with low-virulence bacilli, operation during infancy, low height-to-weight ratio, and absence of tracheal diversion were suggested as risk factors. Multivariate analysis showed that infection with low-virulence bacilli (p = 0.02) and absence of tracheostomy or laryngotracheal separation (p = 0.04) were significant risk factors.
Conclusion: In laparoscopic fundoplication in NIPs, infection with low-virulence bacilli and absence of tracheostomy or laryngotracheal separation were risk factors for perioperative infection. We should perform adequate management of NIPs with these risk factors.View full abstractDownload PDF (404K)
Case Reports
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Rei Matsuura, Yuko Tazuke, Taro Goda, Hideki So, Tomohiro Ishii, Hiroa ...2015 Volume 51 Issue 5 Pages 895-900
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSThe anomalous systemic arterial supply to the normal basal segment of the left lung, classically called Pryce’s type I intralobar pulmonary sequestration, rarely causes severe symptoms during early infancy. A male newborn with 21 trisomy developed tachypnea at 8 days of age and required management by nasal directional positive airway pressure (DPAP). A chest X-ray showed cardiomegaly, and echocardiography showed an atrial septum defect (ASD) accompanied by right heart failure. Contrast-enhanced computed tomography found an anomalous vessel arising from the descending thoracic aorta and returning to the left pulmonary vein through the left lower lung. These findings led to a diagnosis of anomalous systemic arterial supply to the normal basal segments (intralobar pulmonary sequestration Pryce type I). His pulmonary hypertension deteriorated owing to aortopulmonary shunting through the anomalous vessel and left-to-right intracardiac shunting through the ASD. The medical treatments for the right heart overload were ineffective and, as a result, nasal DPAP continued to be required. On postnatal day 43, the anomalous vessel was transected surgically, and a subsequent left lower lobectomy was avoided because the blood supply seemed to be maintained by the bronchial arteries. Soon after the surgery, the patient’s circulatory and respiratory systems were stabilized. The patient’s respiratory support was discontinued on postoperative day 3. The patient’s course remains good 7 months after surgery.View full abstractDownload PDF (778K) -
Wataru Mukai, Takashi Akiyama, Reisuke Imaji, Isamu Saeki, Tomoyo Ohir ...2015 Volume 51 Issue 5 Pages 901-904
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSBall valve syndrome (BVS) appears with gastric pain, vomiting, and distension caused by the invagination of a gastric polyp into the duodenum. We report a case of BVS in a 6-year-old boy with a characteristic pigmentation of the lips, severe anemia (Hb level 4.6 g/dl) and a family history of Peutz-Jeghers syndrome (PJS), which is characterized by pigmentation of the lips and severe anemia (Hb level, 4.6 g/dl). The patient complained of continual and intermittent abdominal pain and malaise owing to severe anemia, possibly caused by BVS. An enhanced abdominal CT scan showed a large polyp invagination into the duodenum, and esophagogastroduodenoscopy was performed for diagnosis. A cauliflower-like polyp of approximately 50 mm size was detected at the posterior wall of the mid-lower gastric body. The polyp was resected successfully by endoscopic mucosal resection (EMR). In order to remove the polyp from the stomach without laparotomy, it was divided into 10 pieces using a bipolar electrocautery snare. Since new and recurrent polyp growth is common in PJS patients, EMR with bipolar snare division is a useful method of preventing repeated laparotomy procedures in pediatric PJS patients, particularly in those with BVS caused by a large polyp.View full abstractDownload PDF (521K) -
Nobuhiro Takahashi, Ken Hoshino, Hideo Ishihama, Takumi Fujimura, Hiro ...2015 Volume 51 Issue 5 Pages 905-909
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSWe report the case of a 17-year-old male who underwent living-donor liver transplantation for liver cirrhosis of unknown origin (left-lobe graft, graft-to-recipient weight ratio: GRWR 1.05). After transplantation, he developed prolonged cholestasis, refractory ascites and pancytopenia, requiring daily blood transfusion. Liver biopsy examination on postoperative day (POD) 7 showed cholestasis and centrilobular necrosis. Doppler ultrasound examination showed a decrease in hepatic artery velocity and an increase in pulsatility index. A condition similar to small-for-size syndrome (SFSS) was suspected, and proximal splenic artery embolization was performed on POD 37, resulting in a marked improvement of hepatic artery hemodynamics. His liver function gradually normalized and he was discharged on POD 93. SFSS is considered as the condition wherein the graft volume is insufficient to sustain metabolic demands in the recipient. Portal hyperperfusion contributes to the clinical and histopathological manifestations of SFSS. Some surgical strategies for portal flow modulation to prevent SFSS for high-risk cases, such as splenectomy and splenic artery ligation, can be performed. In the current case, the graft size was sufficient, and we were unable to predict the development of SFSS. We performed angiography and proximal splenic artery embolization for therapeutic diagnosis and his condition was improved by a less invasive procedure.View full abstractDownload PDF (637K) -
Kei Nakayama, Kazuya Ise, Hirofumi Shimizu, Michitoshi Yamashita, Shou ...2015 Volume 51 Issue 5 Pages 910-916
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSCongenital biliary dilatation can be found after biliary peritonitis owing to the perforation of the bile duct. The sites of perforation are mainly the common bile duct; the rupture of the gallbladder itself is very rare. We describe the case of a patient treated for gallbladder perforation (penetrating the liver) complicated by congenital biliary dilatation. A girl aged 1 year and 8 months presented with fever, vomiting, and abdominal distension. An abdominal ultrasonography and computed tomography showed thickening of the gallbladder wall and ascites. A laparoscopic abdominal exploration was performed with the probable diagnosis of acute cholecystitis. At the time of exploration, bile-stained fluid was found with perforation in the neck of the gallbladder. An intraoperative cholangiography revealed fusiform dilatation of the common bile duct, pancreaticobiliary maljunction, and protein plugs in the common channel. Cholecystectomy and abdominal cavity drainage were carried out, and radical surgery for congenital biliary dilatation was performed 3 months after the initial operation. In this case, a possible mechanism of gallbladder perforation would be an abrupt and abnormal increase in the intraluminal pressure of the gallbladder as well as of the bile duct induced by protein plugs in the common channel.View full abstractDownload PDF (846K) -
Masahiro Kawasaki2015 Volume 51 Issue 5 Pages 917-920
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSIn this report, we describe the case of a 7-month-old boy who presented with major symptoms of Kawasaki disease (KD) following a radical operation for Hirschsprung disease. He had a persisting high fever after the operation and developed characteristic signs of KD 5 days later. Therefore, he was treated with intravenous immunoglobulin with good results, such that the echocardiogram revealed normal-caliber coronary arteries. It is recommended that KD is considered in the differential diagnosis of any child with postoperative prolonged fever and/or fever of unknown origin. Because therapeutic delay for KD raises the morbidity of cardiovascular complications, early diagnosis and appropriate treatment are mandatory to prevent such complications.View full abstractDownload PDF (480K) -
Kazunori Tahara, Mariko Hasegawa, Masahiro Hatanaka, Akihiro Igarashi, ...2015 Volume 51 Issue 5 Pages 921-926
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSWe report on the case of a 10-year-old girl who was diagnosed as having pancreaticobiliary maljunction without biliary dilatation. She presented with upper abdominal pain and vomiting and showed high levels of blood pancreatic enzymes. Magnetic resonance cholangiopancreatography (MRCP) showed a long, slightly dilated common channel of the bile duct and pancreatic duct, suggesting the presence of pancreaticobiliary maljunction. Although drip infusion cholecystocholangiography-CT (DIC-CT) and endoscopic retrograde cholangiopancreatography (ERCP) were not useful in making a definitive diagnosis, cholangiography via the gallbladder revealed that the junction of both ducts was apart from the sphincter of Oddi, and there was a reflux of contrast medium into the pancreatic duct. On the basis of these findings, she was diagnosed as having pancreaticobiliary maljunction. It was also shown that the levels of pancreatic enzymes in the bile of the gallbladder were markedly elevated. The presented case suggests that it is sometimes difficult to detect the presence of pancreaticobiliary maljunction in patients whose common channel is not extremely long, and that several diagnostic tests including cholangiography should be performed so that a definitive and correct diagnosis of pancreaticobiliary maljunction could be made.View full abstractDownload PDF (602K) -
Yukari Sakae, Yoshiki Morotomi, Miwa Satomi2015 Volume 51 Issue 5 Pages 927-931
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSAn 11-year-old boy with a history of biliary atresia had received a living-donor liver transplant at 8 months of age. Although he had splenomegaly, a routine ultrasonography revealed normal blood flow of the portal vein in the liver, and upper gastrointestinal endoscopy showed no varices that required treatment. Ten years after the transplant, the patient was admitted to our hospital with pancytopenia, ascites, bloody stool, and hyperammonemia. To improve his pancytopenia and decrease the pressure in the portal vein, we performed partial splenic embolization. During this procedure, stenosis of the portal vein and drainage into the left gastric vein were evident. He was treated by placement of a transmesenteric venous stent in the portal vein and coil embolization of competitive collaterals. Eighteen months after the interventional radiological procedure, the pancytopenia, ascites, bloody stool, and hyperammonemia showed improvement, and the stent remained patent.View full abstractDownload PDF (548K) -
Yoshitomo Samejima, Yuji Nirasawa, Etsuji Ukiyama, Yoshiko Watanabe, T ...2015 Volume 51 Issue 5 Pages 932-936
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSFamilial adenomatous polyposis (FAP) is characterized by autosome-dominant inheritance and has a high tendency of cancerous change. Prophylactic total colectomy decreases the chance of developing colorectal cancer in FAP patients. The presence of extracolonic lesions, particularly duodenal papilla cancer, also affects the prognosis. A 19-year-old male, whose father died because of FAP, was diagnosed as having FAP by a genetic examination at 6 years of age. Multiple polyps in the colon were confirmed by colonoscopy when he was 13 years of age. At the same time, multiple polyps in the stomach and a polyp of Vater papilla were found by upper gastrointestinal endoscopy. Total colectomy was performed at 14 years of age. After the operation, he was admitted again because of acute pancreatitis. An enlarged Vater papillary tumor seemed to be the cause of the pancreatitis. Transduodenal papilla resection was performed. The tumor was revealed to be a well-differentiated tubular adenocarcinoma. After the papilla resection, the tumor near the bile duct orifice and pancreatic duct orifice increased in size. We suspected the recurrence of the cancer and performed pylorus-preserving pancreaticoduodenectomy 1 year and 10 months after the first operation. No sign of recurrence was found 2 years after the surgery. The occurrence of Vater papilla cancer at a young age is rare in FAP patients. To the best of our knowledge, this is the youngest patient with this condition in Japan.View full abstractDownload PDF (967K) -
Kosuke Endo, Akiko Yokoi, Akihiko Tamaki, Junkichi Takemoto, Keiichi M ...2015 Volume 51 Issue 5 Pages 937-941
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
JOURNAL FREE ACCESSCastleman’s disease is a polyclonal lymphoproliferative disorder, and pediatric cases are rare. Herein, we report the case of a 7-year-old boy with unicentric Castleman’s disease of the mediastinum. He was referred to our hospital owing to fever of unknown origin and high serum CRP level. A CT scan revealed an enhanced lymphadenopathy of 2 × 4 cm size in the mediastinum, and the lesion showed an increased FDG uptake in FDG-PET (SUVmax: 3.586). We completely resected the lesion by thoracoscopic surgery. The diagnosis of hyaline-vascular-type Castleman’s disease was established by histopathological examination. His fever resolved and the CRP level became normal immediately after the operation. He is free of disease 9 months after the surgery. Although unicentric Castleman’s disease is rare, it is important to consider it in the differential diagnosis of localized lymphadenopathy, and when suspected, complete resection is required.View full abstractDownload PDF (652K)
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[in Japanese]2015 Volume 51 Issue 5 Pages 942-944
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
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2015 Volume 51 Issue 5 Pages 945-959
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
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2015 Volume 51 Issue 5 Pages 5_9999-
Published: August 20, 2015
Released on J-STAGE: August 20, 2015
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