Journal of the Japanese Society of Pediatric Surgeons
Online ISSN : 2187-4247
Print ISSN : 0288-609X
ISSN-L : 0288-609X
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  • Etsuko Osawa, Norihiko Kitagawa, Masato Shinkai, Kyoko Mochizuki, Jiro ...
    2020 Volume 56 Issue 6 Pages 906-913
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    Purpose: The aim of this study was to review the clinical courses of patients with lipoblastoma and to determine the appropriate treatment.

    Methods: A retrospective study was carried out on 51 patients with lipoblastoma removal at our institute between April 1981 and March 2019. The following data were studied: lesions, symptoms, surgical findings (whether there were capsulation, adhesion, invasion, and partial or complete removal), recurrence, postoperative complications, and histopathological images of recurrent tumor.

    Results: Lipoblastoma occurs commonly in the extremities and trunk, and most of them grow without pain. In four patients, it occurred in the body, and three of them presented symptoms such as coughing and vomiting caused by compression of the surrounding organs. Two patients had recurrence. Both had an unclear capsule or showed adherence to nearby tissue, but were completely resected at the time of the first surgery. In the patients subjected to partial removal, no recurrence or growth was observed, and in the patients in whom the surrounding tissue was removed, some had functional impairment due to scarring.

    Conclusions: Lipoblastomas have risks of recurrence. However, they are benign tumors and may disappear or differentiate. Therefore, we should not stick to complete resection, especially in cases wherein the tumors adhere to or invade the surrounding tissue. Moreover, this tumor may recur long after surgery with or without a total resection, so careful follow-up is required for at least five years after surgery.

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  • Kenta Ishimoto, Katsumi Muramori, Atsuhisa Fukuta
    2020 Volume 56 Issue 6 Pages 914-920
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    Purpose: In some children who are operated for acute nonperforated appendicitis, peritoneal fluids collected during operation subsequently become positive for bacteria in cultures. The postoperative recovery empirically often takes longer in patients with bacteria-positive cultures than in those with bacteria-negative ones. We examined the patients whose peritoneal fluids became bacteria-positive in cultures and the effects of being bacteria-positive on postoperative recovery.

    Methods: We retrospectively examined 67 patients, who were operated for acute nonperforated appendicitis and from whom we collected peritoneal fluids and contents of the appendix for bacterial culture between April 2015 and December 2018, in terms of the following aspects: patient characteristics, preoperative clinical symptoms, laboratory data, operative findings, and postoperative course.

    Results: Peritoneal fluids from 15 patients became bacteria-positive in cultures. No relationship was seen between being bacteria-positive and patient characteristics, preoperative clinical symptoms, laboratory data, operative findings, or complications. On the other hand, there were significant differences in maximum body temperature, postoperative febrile period, postoperative fasting duration, and length of hospital stay.

    Conclusions: It seemed difficult to predict whose peritoneal fluids would become bacteria-positive in cultures. On the other hand, the postoperative recovery significantly took longer for patients with bacteria-positive cultures than for those with bacteria-negative cultures. Contamination of peritoneal fluids worsens the postoperative recovery; thus, it would be useful to carry out a bacteriological examination of peritoneal fluids as part of postoperative observation, even in patients with nonperforated appendicitis.

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  • Tamaki Iwade, Masao Yasufuku, Elena Yukie Uebayashi, Yoshitomo Samejim ...
    2020 Volume 56 Issue 6 Pages 921-925
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    Purpose: There are few reports on laryngeal mask airway (LMA) in pediatric laparoscopic surgery. In our study, we analyzed the airway management of laparoscopic percutaneous extraperitoneal closure (LPEC) and reported the utility of LMA in pediatric laparoscopic surgery.

    Methods: We performed a retrospective review of the cases of 84 female patients over 3 years of age between January 2017 and December 2018. The patients were divided into two groups: Group A (endotracheal tube) and Group B (LMA). We retrospectively reviewed the duration of anesthesia (including induction, operation, and recovery) and intra-postoperative complications.

    Results: Groups A and B comprised 54 and 30 patients, respectively. The duration of anesthesia was longer in Group A than in Group B (54.8 ± 10.83 vs 45.6 ± 9.09 min). Anesthesia induction was longer in Group A than in Group B (21.8 ± 4.00 vs 17.5 ± 3.52 min). There was no significant difference in operation duration between Groups A and B (20.6 ± 7.82 vs 20.9 ± 6.59 min). Recovery duration was longer in Group A than in Group B (12.5 ± 5.17 vs 7.3 ± 2.22 min). Overall, there were 10 (18.5%) postoperative complications in Group A and 2 (6.7%) in Group B. The durations of anesthesia, induction, and recovery were statistically significantly different between Groups A and B (p < 0.05).

    Conclusions: In this study, we demonstrated that LMA in LPEC reduced the duration of anesthesia compared with an endotracheal tube. We suggest that LMA is one of the useful airway management tools in short-lasting pediatric laparoscopic surgery such as LPEC.

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  • Takatoshi Abe, Katsutoshi Makino, Kiyokazu Kim, Taku Yamamichi, Ai Tay ...
    2020 Volume 56 Issue 6 Pages 926-931
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    Purpose: Late-presenting congenital diaphragmatic hernia is a good indication for endoscopic surgery. However, congenital diaphragmatic hernia with a large diaphragmatic defect does not commonly indicate endoscopic repair because of the high recurrence rate. In this study, we aimed to elucidate the relationship between defect size and the surgical procedure performed in patients with late-presenting congenital diaphragmatic hernia repaired by endoscopic surgery.

    Methods: We reviewed the medical records of patients with late-presenting congenital diaphragmatic hernia treated in our hospital between October 2015 and September 2019. The underlying diseases, preoperative care, surgical procedures, and operative outcomes were retrospectively reviewed.

    Results: Seven patients (five men and two women) were included in this study. The underlying diseases were contralateral neonatal congenital diaphragmatic hernia in one patient, trisomy 21 in one, and tetralogy of Fallot in one. Two patients underwent laparoscopic surgery, and five, thoracoscopic surgery. Defect size was categorized using the Congenital Diaphragmatic Hernia Study Group classification. Two patients had an “A defect,” and five had a “B defect.” All patients underwent diaphragmatic repair without a patch. Two patients with large B defects underwent surgery combined with a direct suture and hernia sac plication. All patients underwent endoscopic surgery without any complications or recurrence.

    Conclusions: This report demonstrates that late-presenting congenital diaphragmatic hernia could be repaired by endoscopic primary closure of the diaphragm without a patch. When the diaphragm is difficult to repair with direct closure, a combination of direct suture and hernia sac plication can be used instead.

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  • Kengo Nakaya, Akiyoshi Nomura, Akihiro Makino, Risa Kanai, Susumu Yama ...
    2020 Volume 56 Issue 6 Pages 932-938
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    Purpose: The optimal management for pancreatic injuries in children involving a laceration of the main pancreatic duct remains to be established. We generally treat children with pancreatic injury by non-operative management whenever possible. We herein evaluate our management protocol.

    Methods: Eighteen children were treated at our institution from January 2000 to December 2019.

    Results: The median age was 7.1 years (range, 0.9~14.5 years). The pancreatic injuries in these children classified in accordance with the Japanese criteria comprised type I in nine, type II in two, type IIIa in two, and type IIIb in five. All five patients with pseudocysts underwent either open or percutaneous drainage. Type I/II patients included one with hemorrhagic ascites, who underwent open pseudocyst drainage, and one with deep hepatic injury, who underwent open hemostasis and drainage. Two type IIIb patients included one with deep hepatic injury, who underwent open hemostasis and drainage, and one who demonstrated compensated shock with massive ascites and underwent distal pancreatectomy and drainage as the initial treatments. In the other two type IIIb patients, one with leaking pancreatic juice underwent the Letton-Wilson procedure, and one with a residual pancreatic pseudocyst underwent cystogastrostomy during the treatment course. Endoscopic retrograde pancreatography was performed in three patients, but all of them were carried out more than one week after the injury, and pancreatic duct stenting beyond the injured area was difficult.

    Conclusions: Operative management was required in almost all type IIIb patients, and early surgical intervention should be considered in type IIIb cases.

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Case Reports
  • Yu Ueno, Syuichi Katayama, Takahumi Goto, Yasuo Nakahara, Kosuke Hitom ...
    2020 Volume 56 Issue 6 Pages 939-943
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    A three-year-old girl with Sotos syndrome was found to have liver enzyme deviations when she was evaluated for a fever of unknown origin. She was admitted to the Pediatric Surgery Department where contrast-enhanced computed tomography revealed a tumor in the S8 area of the liver and bordering the diaphragm. Histopathological evaluation of a tumor biopsy specimen led to the diagnosis of fetal-type hepatoblastoma. Subsequent tumor stage evaluation confirmed the absence of lymph node or distant organ metastasis and the tumor was classified into group I hepatoblastoma by a PRE-Treatment EXTent of disease system classification. Cis-platin (CDDP) (80 mg/m2) was administered as preoperative chemotherapy to decrease the tumor size before performing a right lobectomy. Two postsurgery courses of CDDP (80 mg/m2) completed the treatment. The patient showed good progress without recurrence of hepatoblastoma.

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  • Takato Aikoh, Naoki Hashizume, Suguru Fukahori, Shinji Ishii, Nobuyuki ...
    2020 Volume 56 Issue 6 Pages 944-948
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    We present the case of an 11-year-old girl who was admitted to our hospital with the complaint of abdominal pain and vomiting. Abdominal CT scan disclosed accumulated small intestine with converging mesenteric hernia. She was treated because no recognizable ischemic changes were seen in the small intestine. On laparotomy, adhesion of small intestine was found to be located in the fossa of the transverse mesocolon. However, after 5 days of the first surgery, she had tenderness in the upper abdomen and vomiting. Laparotomy was performed again because of the ischemic changes of the small intestine. It showed that the jejunum was included into the hernia sac on just the left side of the ligament of Treitz. Finally, left paraduodenal hernia was diagnosed. The incarcerated jejunum showed no ischemic change. After repositioning of the jejunum, the hernia orifice was closed with interrupted sutures avoiding mesenterial ischemia. This case suggests that recurrent abdominal complaints of uncertain origin might be caused by paraduodenal hernia.

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  • Keita Ito, Daisuke Ishii, Hisayuki Miyagi, Masatoshi Hirasawa, Kazutos ...
    2020 Volume 56 Issue 6 Pages 949-954
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    Laryngotracheal separation (modified Lindeman’s procedure) is a procedure that can prevent intractable aspiration in neurologically impaired patients. We experienced treating a rare case of tracheocutaneous fistula caused by a foreign body nine years after a modified Lindeman’s procedure. The patient was a 12-year-old girl with Miller–Dieker syndrome. We performed fundoplication with gastrostomy for gastroesophageal reflux disease (GERD) and dysphasia at 1 year of age, and a modified Lindeman’s procedure for chronic respiratory failure at 2 years of age. A 1-mm-diameter hole with respiratory saliva outflow was observed in the upper tracheostoma at 11 years and 4 months of age. Percutaneous fistula imaging showed a fistula that connected the blind end of the trachea to the hole, and a foreign body was observed at the blind end of the trachea. We removed the foreign body, but the fistula was not closed. Next, we sutured the fistula and performed gauze compression, but the saliva outflow persisted. Therefore, cyanoacrylate filling was performed, after which the saliva outflow improved and the fistula closed. Our search of the relevant literature revealed only one case in Japan in which a tracheal blind foreign body was found after a modified Lindeman’s procedure. There have been no reports implicating a trachea-blind foreign body as the cause of fistula formation. Oral care should be considered to prevent complications in patients undergoing laryngotracheal separation. Cyanoacrylate filling was an effective treatment.

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  • Hirofumi Shimizu, Kazuaki Takiguchi, Keiichi Kakuta, Kakeru Machino, S ...
    2020 Volume 56 Issue 6 Pages 955-960
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    A 5-year old boy with autism spectrum disease (ASD) was referred to us for the treatment of fecal incontinence due to fecal impaction. Bowel disimpaction followed by administration of oral laxatives and enemas temporarily relieved the symptoms, which recurred six months after the suspension of the outpatient visits. He became completely unable to defecate because of defecation-related anxieties, and he required hospitalization for the management of the obstructive symptoms. Periodical rectal irrigation of the clay-like feces was started on the outpatient basis twice a week at the age of seven, but he still refused to defecate. Polyethylene glycol (PEG) became available in Japan for treatment of constipation and was started at the age of ten, which gradually improved the fecal condition to muddy feces. Two months after the introduction of PEG, he was finally able to defecate by himself while sitting on the toilet and has not required rectal irrigation since then. His bowel movement has been well managed with PEG monotherapy during the follow-up period of half a year. The causal relationship between ASD and constipation remains unclear, but sensory hypersensitivity and compulsive behaviors due to ASD in this patient may have worsened his defecation-related anxieties. PEG administration seemed to have made the patient recognize the softened stool, which led to a successful behavioral change from refusing to defecate to self-defecation. Furthermore, from the standpoint of fewer side effects, such as abdominal pain or distention with other laxatives, the maintenance therapy with PEG is effective for intractable constipation in children with ASD.

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  • Reiko Yatabe, Tsubasa Goshima, Mariko Yoshida, Saori Nakahara
    2020 Volume 56 Issue 6 Pages 961-965
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    A 5-year-old girl presented with a growing mass on the right sternoclavicular joint, which was noticed at 3 years of age. A physical examination revealed a soft subcutaneous mass measuring approximately 3 cm located over the right sternoclavicular joint and right clavicle. Ultrasonography demonstrated the mass to be highly echogenic and mostly well-defined capsuled, which is usually seen in lipoma. To evaluate tumor extension, MRI was carried out, which revealed that the tumor extended from the subcutaneous tissue to the right axilla through the space between compartments of the greater pectoralis muscle. The tumor showed a high signal intensity and fat suppression on T1- and T2-weighted MR images. On the basis of these findings and her age, lipoblastoma was highly suspected. The well-circumscribed tumor was excised completely under general anesthesia using a microneedle radiofrequency device. This tumor was histopathologically diagnosed as lipoblastoma. Five months after tumor resection, no evidence of recurrence was found. Although the tumor was initially suspected to be localized subcutaneously on physical examination, further investigation revealed its rare location. On the basis of our experience with treating this case, we consider that preoperative imaging and tumor excision with a microneedle radiofrequency device are useful for the successful treatment and prevention of local recurrence of lipoblastoma.

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  • Toko Shinkai, Kouji Masumoto, Kazuki Shirane, Hinako Horiguchi, Yuri N ...
    2020 Volume 56 Issue 6 Pages 966-970
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    Introduction: Tsudosan (TJ-105, Tsumura & Co., Tokyo), a traditional Japanese Kampo medicine, is indicated for treating blood stasis caused by microcirculation disturbances. We report on the effectiveness of TJ-105 in treating patients with traumatic or postincisional subcutaneous swelling and pain. Case 1: A 14-year-old boy was admitted to our hospital with traffic injuries. He had contusions in his left arm and leg. His left 7th rib was fractured. He complained of pain at the injury sites and headache. TJ-105 (5.0 g/day in 2 divided doses) for contusion and TJ-17 (5.0 g/day in 2 divided doses) for headache were begun on day 1. The patient was discharged on day 3 after injury because his condition improved. The swelling and pain decreased on day 6; therefore, TJ-105 and TJ-17 were taken at a reduced dose (2.5 g/day) for 7 days. His injury site swelling disappeared on day 13. Case 2: A 10-year-old boy was admitted and treated in our hospital for a subcutaneous facial tumor. The tumor was confirmed be Kimura’s disease, and thus resected. TJ-105 (2.5 g/day) was administered to prevent subcutaneous swelling. He took TJ-105 from POD 2 to POD 7. The swelling at the incision site decreased soon after taking TJ-105 and it disappeared by POD 9. There were no side effects in both cases. Conclusion: From our experience, TJ-105 improved the patients’ conditions by reducing the subcutaneous swelling and pain caused by injury or incision.

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  • Yuji Baba, Shuichi Ashizuka, Takeyuki Misawa, Kentaro Ueno, Yasuyuki W ...
    2020 Volume 56 Issue 6 Pages 971-976
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    A 6-year-old girl was brought to our hospital owing to intermittent abdominal pain that started 3 hours earlier. Abdominal Computed Tomography showed intussusception at the hepatic flexure. A noninvasive reduction was performed. On hospital day 3, the intermittent abdominal pain recurred. Abdominal ultrasonography showed a target sign at the hepatic flexure and a low-echoic lesion in the advanced part of the intussusception. We diagnosed that intussusception had recurred and performed noninvasive reduction again. Thus, we performed an operation. Surgical findings revealed ileoileocolic intussusception. A 23 × 22 × 9 mm raised lesion was found in the ileum. We performed a partial resection of the ileum, followed by end-to-end anastomosis. Histopathological findings revealed an ileal lymphangioma. Her postoperative course observed over six months was uneventful. Ileal lymphangioma is rare in children, but if ultrasonography indicates a low-echoic lesion in the advanced part of the intussusception, it is important to operate as early as possible because lymphangioma or other organic diseases may be present.

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  • Junkichi Takemoto, Satoshi Obata, Yuichi Shibui, Ryota Souzaki, Tomoko ...
    2020 Volume 56 Issue 6 Pages 977-981
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    We present the case of a 6-year-old boy with penile condyloma acuminatum, who was referred to our hospital with the initial diagnosis of papillary tumor of the penis. Diagnosis based on only the gross appearance was difficult, although we consulted a dermatologist and a urologist. Surgical resection and cystoscopy were performed. No abnormal findings were seen in the urinary bladder and ureter by cystoscopy. Diagnosis of condyloma acuminatum was obtained by histopathologic examination. Recurrence of condyloma acuminatum was seen four months after operation and cryotherapy was performed. Diagnosis of condyloma acuminatum in children is challenging because of its low incidence rate, and condyloma acuminatum is sometimes suspected of being a malignant tumor, such as rhabdomyosarcoma. However, condyloma acuminatum is a non-neoplastic disease, and highly invasive surgical therapy is unnecessary. Therefore, in diagnosing penile tumor, it is necessary to first ensure that the patient does not in fact have condyloma acuminatum.

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  • Shohei Maekawa, Kenichi Suda, Shota Fukuda, Shuhei Kogata, Takashi Sas ...
    2020 Volume 56 Issue 6 Pages 982-987
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    The patient was an 11-year-old female who presented with osteosarcoma of the left femur. Before treatment, a 3-mm nodular shadow was observed in the right lung (S8). The patient was initially treated with a limb-sparing radical operation and adjuvant chemotherapy, but the lung mass did not disappear. As a result, surgery was indicated for diagnostic treatment. The operation was performed in a hybrid operating room. Cone beam computed tomography (CBCT) was performed before the thoracoscopic surgery, which indicated through which area the lesion could be reached in the shortest distance possible. Next, a 23G needle was inserted into the chest wall at the same site, and CBCT was performed again. After confirmation of the lesion’s location on the needle tip, the needle was advanced into the lung, and indocyanine green was subsequently injected locally. Thoracoscopic surgery was started, and CBCT was performed to provide a support thread and a clip on the marked lung tissue. After confirmation that the clip was sufficiently close to the lesion, the targeted area was resected. The lesions were found to be well contained within the resected tissue, and the postoperative course was satisfactory. No previous studies have shown the use of hybrid operating rooms to perform CBCT marking and thoracoscopic partial lung resection in children. This method seems to be an effective and viable option.

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  • Noriko Yokota, Hiroki Ishibashi, Hiroki Mori, Mitsuo Shimada, Hideko E ...
    2020 Volume 56 Issue 6 Pages 988-991
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    The patient was a 3-year-old boy, who was referred to our department because of spindle-shaped subcutaneous masses on the lateral side of the bilateral inguinal region and on the right back. Similar subcutaneous masses were detected in the left axilla and right hypochondrium during follow-up. The tumor on the back was extirpated and was histopathologically diagnosed as lipoblastoma. Therefore, all four remaining subcutaneous tumors were extirpated and histopathologically diagnosed as lipoblastoma, which occurred simultaneously and metachronously. There was no recurrence after follow-up of 1.5 years. Early extirpation is commonly carried out for lipoblastoma, but patients should be carefully followed up because of the possibility of simultaneous and metachronous occurrence such as in this patient.

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  • Takanori Oyama, Takuo Noda, Morimichi Tani, Hiroshi Nouso, Terutaka Ta ...
    2020 Volume 56 Issue 6 Pages 992-997
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    A female infant was born at the gestational age of 38 weeks and 1 day with a birth weight of 3,036 g. She had an anterior mediastinal cystic mass of 14 mm diameter, which was identified by prenatal ultrasound at 28 weeks of gestation. The size of the cystic mass and internal findings did not change prior to birth. A postnatal computed tomography scan and magnetic resonance imaging showed a heterogeneous mass including a cystic lesion at the right lower pole of the thymus and a homogeneous cystic mass at the left lower pole of the thymus. Both masses were attached at the midline. It was suspected that the teratoma in the right lobe of the thymus perforated and formed a cystic mass in the left lobe. The baby was asymptomatic at birth, but she began to experience a decrease in the level of percutaneous arterial oxygen saturation when crying at 18 days of age. Mass resection with median sternotomy was performed at 22 days of age, and the thymus was preserved. Histopathology revealed that the right mass was a mature teratoma. The left mass was not a perforated cystic lesion, but a unilocular thymic cyst. The postoperative course was uneventful. Various masses arise in the anterior mediastinum, but both teratomas and unilocular thymic cysts are rarely detected prenatally. Moreover, there have been no reports of cases of both conditions occurring concurrently.

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  • Masaki Horiike, Yoshiki Morotomi, Tomohiro Kitada, Atsushi Higashio
    2020 Volume 56 Issue 6 Pages 998-1004
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    Pancreaticobiliary maljunction (PBM) with pancreatic stones is relatively rare, and there is no established treatment for PBM with giant pancreatic stones. We report a case of PBM with giant pancreatic stones of 10 mm diameter or more with marked pancreatic duct dilation. The patient was a 12-year-old girl who had sudden abdominal pain three days prior to her hospital visit, and she was suspected of having acute pancreatitis by a previous physician. Abdominal ultrasonography and MRCP showed a giant pancreatic stone with dilation of the pancreatic duct in addition to PBM. The patient was diagnosed as having an acute pancreatitis-like attack due to incarceration of the pancreatic stone, and drainage of the pancreatic duct and bile duct was performed. As a result of an examination of the operation procedures, the pancreatic stone was to be removed endoscopically. Extrahepatic bile duct resection and hepaticojejunostomy were performed simultaneously with transpapillary endoscopic quarrying. The postoperative course was good and she was discharged 12 days after the operation. Transpapillary endoscopic quarrying may be effective in cases of PBM in children in whom intraoperative quarrying is difficult to perform owing to giant pancreatic stones.

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  • Wataru Mukai, Shoichi Nishida, Isamu Saeki, Takanori Oyama, Reisuke Im ...
    2020 Volume 56 Issue 6 Pages 1005-1009
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    We report a case of urachal abscess penetrating the urinary bladder and sigmoid colon. A 14-year-old boy complaining of lower abdominal pain underwent ultrasonography at a nearby clinic. A mid-lower abdominal cystic mass was detected. Abdominal enhanced CT scan showed a 90 × 67 × 46 mm abdominal mass with a thick enhanced solid wall extending from the abdominal wall and pressing against the urinary bladder to the caudal side. Antibiotic treatment effectively relieved symptoms despite growth of the abscess itself. Ultrasonography and MRI revealed penetration of the abscess into the urinary bladder and sigmoid colon, and the abscess was consequently resected. Histopathological findings demonstrated inflammatory granulation tissue penetration of both organs. Although penetration by a urachal abscess is very rare, it is important to be aware of this serious complication as it may simulate abdominal actinomycosis. Surgical treatment is essential when conservative treatment proves unsuccessful.

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  • Yoshiko Watanabe, Etsuji Ukiyama, Kiyotomo Abe
    2020 Volume 56 Issue 6 Pages 1010-1015
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    We encountered three cases of tongue base cysts. All three patients had respiratory symptoms, such as inspiratory wheezing, apnea, and depressed breath from the neonatal period, and were diagnosed by laryngeal fiberscopy, CT, and MRI examinations. In all the patients, fenestration was performed with traction of the base of the tongue, but in patient 2, the glottis could not be observed owing to the elimination of the cyst at the time of induction of anesthesia during the first operation, and an emergency tracheotomy was performed; fenestration was performed at a later date. All patients recovered without recurrence. Since this disease can cause sudden death, surgery is required as soon as possible after diagnosis. When infants have wheezing and other respiratory disorders, it is important to proceed with medical examination with the tongue base cyst in mind. Emergency airway maintenance may be necessary before surgery, and airway maintenance at the time of anesthesia induction may be a problem during surgery. Thus, collaboration among pediatricians, anesthesiologists, and otolaryngologists is important regarding preoperative airway evaluation and preparation, including tracheotomy in case of emergency, as emergency airway maintenance is necessary before surgery or if airway security during surgery becomes a problem.

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  • Issei Kawakita, Masato Shinkai, Shota Shinohara, Yukihiro Tsuzuki, Yum ...
    2020 Volume 56 Issue 6 Pages 1016-1020
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    A baby boy with pleural effusion was delivered at 33 weeks of gestation. Because of pleural effusion at 31 weeks of gestation, he was referred to our hospital. Because of reaccumulation of pleural effusion after thoracentesis and aspiration, thoraco-amniotic shunting (TAS) was performed, but the entire double-basket catheter apparently dropped into the pleural cavity. After birth, one basket end of the catheter was found within the thoracic wall, and the catheter was surgically removed at 26 days of age. Because the catheter could not be released by dissection of the basket within the thoracic wall, the other basket end, firmly stuck to the mediastinal pleura in the thoracic cavity, was dissected and removed by a thoracoscopy-assisted procedure. Dislodgement of a double-basket catheter is one of the complications of TAS. Not all catheters with one basket buried in the thoracic wall can be removed just by thoracic wall dissection. In that case, thoracoscopic assistance is very useful to inspect the catheter in the pleural cavity and remove it safely.

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  • Motofumi Torikai, Mitsuru Muto, Hiroyuki Noguchi, Koshiro Sugita, Toku ...
    2020 Volume 56 Issue 6 Pages 1021-1026
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    We herein report the first case of neonatal intussusception that we have experienced, which was treated by enema reduction, in our neonatal intensive care unit that supports over 700 cases per year. The patient was a three-day-old full-term male infant. On the second night of life, some red mucus was found mixed with his green feces. The next morning, he was referred to our hospital with a moderate amount of bloody mucous stool. There was no abdominal distention, but a sausage-like mass was palpable on the right side of his abdomen. Abdominal ultrasonography revealed multiple concentric ring signs, on the basis of which he was diagnosed as having ileo-colic intussusception. An enema reduction was attempted 19 h after the onset, and the patient was cured noninvasively. There was no subsequent recurrence. Although intussusception in the neonatal period is rare, the diagnosis of this case was easily made by ultrasonography. In cases of ileo-colic intussusception in full-term neonates with a good general condition and no findings suggesting intestinal necrosis, it seems reasonable to attempt enema reduction safely under preparation of an emergent laparotomy at the time of perforation.

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  • Natsumi Tanaka, Masahiro Zenitani, Satoko Nose, Takaharu Oue
    2020 Volume 56 Issue 6 Pages 1027-1031
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    A boy aged 3 years and 7 months with bulging of the left inguinal area was referred to our department. He had undergone laparoscopic percutaneous extraperitoneal closure (LPEC) for the right inguinal hernia at the age of 2 years and 2 months, and no contralateral patent processus vaginalis (PPV) was detected during the first operation. The postoperative course was uneventful, and the patient was asymptomatic for 17 months. The bulging in the left groin area gradually increased in size, and ultrasonography showed left inguinal hernia involving the small intestines. The laparoscopic reoperation revealed the presence of left inguinal hernia without PPV. He was diagnosed as having de novo inguinal hernia, and underwent LPEC for the hernia. The hernial sac orifice was closed extraperitoneally by circuit double ligation around the internal inguinal ring including the processus vaginalis using an LPEC needle. His postoperative course was uneventful without recurrence and complication for 22 months. De novo inguinal hernia in children is very rare. Laparoscopic reoperation revealed that de novo inguinal hernia without PPV can be acquired in children. LPEC is very useful for the diagnosis and repair of de novo inguinal hernia in children.

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  • Motofumi Torikai, Takashi Asada, Kazuhiro Kondo, Hiroshi Sameshima, Sa ...
    2020 Volume 56 Issue 6 Pages 1032-1036
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    The patient was a 0-day-old boy. At 29 weeks of gestational age, jejunal atresia was suspected because of the findings of hydramnion and the triple bubble sign in fetal ultrasonography. The patient was born at 35 weeks of gestational age, with a weight of 2,090 g, via normal vaginal delivery. Abdominal X-ray showed the triple bubble sign, and gastrointestinal contrast enema series showed malrotation and a non-contrasted cyst beneath the duodenal bulb. An abdominal plane computed tomography showed no relationship of the cyst with the liver and bile duct. We preoperatively diagnosed the patient as having congenital duodenal stenosis and congenital duodenal atresia and malrotation. A laparotomy revealed that the malrotation and duodenal stenosis were due to annular pancreas and type II duodenal atresia 5 cm distal to the stenotic lesion, both in the second portion of the duodenum. Ladd’s procedure and double duodeno-duodenotomy with the placement of a trans-anastomotic tube were performed. The post-operative course was uneventful, and the patient was discharged at 42 days of age.

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  • Toshimichi Hasegawa
    2020 Volume 56 Issue 6 Pages 1037-1045
    Published: October 20, 2020
    Released: October 20, 2020
    JOURNALS FREE ACCESS

    Pediatric intestinal failure (IF) is a condition in which water and nutrients cannot be absorbed owing to functional disorder or short bowel syndrome due to massive resection of the intestines. Long-term parenteral nutrition (PN) is required to prevent loss of water and nutrients and to support growth, and may often cause catheter-related bloodstream infection, thrombosis, and intestinal failure-associated liver disease (IFALD), which may make the prognosis of pediatric IF patients very poor. An intestinal rehabilitation program (IRP) was introduced in the 1980s in North America and Europe for pediatric IF patients. IRP involves a pediatric surgeon, a pediatric gastroenterologist, a nurse, a dietician, and a pharmacist, who discuss the management of the central venous line, nutritional support, pharmaceutical therapy, surgery, and small bowel transplantation. Five institutes from North America and Europe reported that there have been significant improvements in overall survival rate, septic episode, dependence on PN, and IFALD after the introduction of IRP, compared with before its introduction. In these institutes with IRP, the overall survival rate is 73–95%, rate of weaning of parenteral nutrition is 29–60.8%, and the percentage of patients requiring intestinal transplantation is 5.4–25%. Multidisciplinary IRP may be effective for the achievement of enteral autonomy in pediatric patients with IF.

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