Purpose: The accidental ingestion of coin-type lithium batteries has been observed to result in severe gastrointestinal disorders such as esophagotracheal fistula. A warning on this matter has been included on the Japan Society of Pediatric Surgery website; however, accidents continue to occur. Owing to a lack of detailed data, such as the number of cases and their severity, we decided to conduct a nationwide survey.

Methods: We conducted surveys at 202 facilities affiliated with the Japanese Society of Pediatric Surgery, Japanese Society for Pediatric Emergency Medicine, and Japanese Society for Pediatric Endoscopy. The questions included the (1) number of cases of accidental ingestion of button or coin-type batteries at each facility in the five-year period between January 1, 2011 and December 31, 2015, (2) type of battery in each case (button or coin type), (3) location of the battery at the time of discovery (esophagus, stomach, or beyond the duodenum), (4) how the battery was extracted (natural excretion, magnet, endoscopy, others), and (5) prognosis (good/bad; complications such as stenosis or perforation).

Results: We received replies from 116 facilities (57.4%). A total of 939 cases of accidental ingestion of batteries were encountered, 806 involved button-type batteries and 133 coin-type batteries. Only one (8.3%) of the 12 cases of accidental ingestion of button-type batteries that were lodged in the esophagus resulted in a gastrointestinal disorder. Furthermore, none of the cases in which the batteries were discovered in the stomach resulted in any gastrointestinal disorders (excluding the six cases whose prognoses were unknown). Similarly, none of the cases in which the batteries were discovered in the duodenum or beyond resulted in any gastrointestinal disorders (excluding the two cases whose prognoses were unknown). Of the 45 cases of accidental ingestion of coin-type batteries discovered in the esophagus, 14 (31.1%) were observed to have resulted in gastrointestinal disorders. No damage was found in the 71 cases in which the coin-type batteries were discovered in the stomach (disregarding the two cases whose prognoses were unknown), and no damage was found in the 17 cases in which the batteries passed the duodenum.

Conclusions: We can conclude that, in cases of accidental ingestion of button-type batteries, it is essential to check both the battery’s location in the body and the battery type. Moreover, immediate extraction is advisable in cases in which a coin-type battery is determined to be stuck in a patient’s esophagus.

Purpose: Cases of prenatally diagnosed congenital biliary dilatation (CBD) with the symptoms of obstructive jaundice and gastrointestinal obstruction should be treated as soon as possible. However, there is no standard protocol for these symptoms. We report the effect and favorable results of choledocheal cyst enterostomy on prenatally diagnosed CBD in the early period after birth.

Methods: CBD was prenatally diagnosed in five patients from January 2014 to January 2019. The symptoms were found in all the patients after birth; thus, two-stage radical surgery (choledocheal cyst excision and hepaticojejunostomy) was performed after choledocheal cyst enterostomy. We retrospectively reviewed and evaluated the patient background characteristics and surgical results.

Results: All cases were detected by fetal ultrasonography at an average gestational age of 25 weeks. The average gestational age at birth was 38 weeks and 6 days, and the average birth weight was 3,380 g. On the basis of Todani’s classification, three cases were of type Ia and two cases were of type IV-A. All the patients underwent choledocheal cyst enterostomy in the early period after birth. There were no postoperative complications and the patients’ symptoms improved. Two-stage radical surgery was performed in four patients (average age, 11.5 months; average body weight, 8.8 kg). One patient at the time of this writing is waiting for radical surgery.

Conclusions: All the patients showed symptoms in the early period after birth. Thus, we performed cyst enterostomy; after which, the symptoms improved. Two-stage radical surgery was safely performed in four patients and favorable results were obtained. Two-stage radical surgery after choledocheal cyst enterostomy may be considered a choice of treatment for symptomatic patients with prenatally diagnosed CBD.

Torsion of the vermiform appendix is relatively rare, but sometimes emergency surgery is required because of the risk of necrosis. It should be included in the differential diagnosis of patients presenting with prolonged abdominal pain, especially while waiting for appendectomy. We report a case of laparoscopic appendectomy for torsion of the vermiform appendix in a child. An eight-year-old boy was admitted to our hospital because of prolonged abdominal pain after conservative medical treatment for appendicitis. We describe him as presenting with abdominal tenderness and peritoneal signs, despite a negative inflammatory reaction in a laboratory test. After a course of antibiotics, the abdominal pain disappeared and he was discharged. However, he was admitted again on the next day because of the recurrence of abdominal pain. At the time of laparoscopic surgery, the appendix was twisted anticlockwise by 180° and adhered to the omentum. An appendectomy was performed. The resected specimen of the appendix had a shortened mesoappendix and showed accumulation of serous fluid at the distal tip. A histopathological examination revealed a narrow lumen of the distal appendix, which was thick-walled without neoplastic changes. No recurrence has been observed up to the present.

A 9-year-old boy was brought to our hospital because of epigastric pain caused by blunt abdominal trauma. Computed tomography showed a small amount of fluid accumulation around the pancreas, and a conservative treatment with antibiotics and a protease inhibitor was initiated owing to suspicion of pancreatic injury. On the second day of hospitalization, contrast computed tomography revealed a low-density discontinuity in the pancreatic body, and he was diagnosed as having traumatic pancreatic injury; however, we were unable to determine the presence or absence of the main pancreatic duct injury. On the third day, endoscopic retrograde pancreatography confirmed the disruption of the main pancreatic duct in the pancreatic body, with extravasation of contrast medium. He was diagnosed as having type IIIb pancreatic injury according to the criteria of the Japanese Association for the Surgery of Trauma, and emergency laparotomy was performed. At the site of pancreatic laceration, distal pancreatectomy with splenectomy was performed. The postoperative course was uneventful, and he was discharged 11 days after injury. Even in children, when there is a suspicion of main pancreatic duct injury, endoscopic retrograde pancreatography should be performed immediately. In addition, when the main pancreatic duct disruption is confirmed in the early stage of injury, surgical treatment should also be considered in children.

A 45-day-old female infant presenting with vomiting and abdominal distension was admitted to our hospital. She was born at 37 weeks of gestation with a birth weight of 2,180 g. Although bowel dilatation was detected on a fetal ultrasound test, her developmental course was uneventful after birth. An abdominal plain radiograph revealed ileus. Her abdominal distension was not improved by nasogastric tube drainage. An emergency operation was performed because an abdominal CT scan indicated obstruction at the terminal ileum. During laparotomy, the small intestine was found to be dilated, but no intestinal necrosis was detected. Ileal atresia 40 cm proximal to the ileum end was caused by a single adhesion band. The ileocecal valve and dilated intestine were resected and anastomosed. After the surgery, she had an uneventful course and was discharged on the 11th postoperative day. Seven years have passed after the operation, and she has grown normally. We experienced treating a rare case of postnatally acquired ileal atresia due to enteric vascular ischemia caused by a prenatal single adhesion band.

A two-year-old boy was diagnosed as having appendicitis and referred to our hospital because he had developed abdominal pain and was found to have appendiceal swelling on an imaging examination at a previous hospital. Laparoscopic exploration revealed that the tip of the swollen appendix was attached to the umbilical artery cord, and the cord was swollen. Because the inflammation of the appendix was suspected to have extended to the abdominal wall, the appendix was resected after dissecting the adhesion to the abdominal wall during surgery. A histopathological examination revealed that the inflammation of the appendix had spread from an external source. From these operative and histopathological findings, it was suspected that an infection of the umbilical artery cord had spread to the inflammation of the appendix. Infection of the umbilical artery cord is very rare, and to the best of our knowledge, there have been no other reports of an infection of the umbilical artery cord spreading to cause secondary appendicitis.

We present the case of Ewing’s sarcoma in a patient who was successfully treated by surgery after chemotherapy. The patient was a 9-year-old girl with a very large tumor on her left chest. Chemotherapy was very effective and the tumor size decreased considerably. Therefore, we decided to perform surgery as a curative measure. We performed chest wall resection and left lung pneumonectomy. Moreover, because the defect in part of the chest wall caused by the surgery was large, we performed chest wall reconstruction with orthopedic and plastic surgeons. A histopathological examination after the surgery revealed that the surgical margins were negative. Eighteen months after the surgery, she showed neither evidence of recurrence or metastasis nor complications associated with the surgery. Surgical treatment is effective for localized Ewing’s sarcoma as a local treatment.