We treated two cases of testicular yolk sac tumor (YST) in infants, who underwent inguinal high orchiectomy combined with a trans-scrotal approach. [Case 1] A 20-month-old boy presented with swelling of his left scrotum and an elevated serum α-fetoprotein (AFP) level of 1,593 ng/ml. Testicular tumor was suspected, and inguinal radical high orchidectomy combined with a trans-scrotal approach was performed. The removed testis was 26 × 23 mm in size. The normal testicular tissue had been replaced by a simple solid tumor. The pathological diagnosis was YST limited to the testis pathologically. [Case 2] A 20-month-old boy presented with a left scrotum mass and elevated serum AFP level of 668 ng/ml. Testicular tumor was suspected, and inguinal radical high orchidectomy combined with a trans-scrotal approach was performed. The removed testis was 35 × 25 mm in size. The tumor had a multinodular component, and normal testicular tissue was partially recognized. The pathological diagnosis was YST limited to the testis. [Conclusion] In both cases, the tumors were completely resected without rupture or tumor spillage, leading to a diagnosis of stage I germ cell tumor (GCT). Basically, stage I testicular GCT requires no additional treatment and shows a good prognosis, but operative procedures sometimes affect both the postoperative diagnosis and prognosis. Radical orchiectomy with a trans-scrotal approach may be effective to ensure a good patient outcome.

The treatment algorithm for traumatic type IIIb pancreatic injury in children is still undetermined. We report two cases of traumatic pancreatic injury in children treated at our hospital. Case 1: A three-year-old girl was initially diagnosed as having type IIIa pancreatic injury on the basis of enhanced CT findings. However, the second enhanced CT performed 13 days after the accident led to a final diagnosis of type IIIb pancreatic injury. Although ascite and peripancreatic cyst drainage was performed, her condition did not improve. A spleen-preserving distal pancreatectomy was performed 83 days after the accident, and her postoperative course was uneventful. Case 2: A nine-year-old boy was diagnosed as having type IIIb pancreatic injury on the basis of enhanced CT findings. As his general condition was good with tolerance for definitive surgery, he underwent a spleen-preserving distal pancreatectomy on the day of his injury. Although he developed a postoperative pancreatic fistula, he recovered with conservative treatment. Initial pancreatectomy may be an alternative for pediatric patients with type IIIb pancreatic injury when drainage of the pancreatic fluid is difficult and their general condition permits surgery.

An 11-year-old girl was taken to an emergency clinic for abdominal pain. She was referred to our hospital because multiple foreign bodies were observed by abdominal X-ray. Re-evaluation of the abdominal X-ray showed 10 foreign bodies in the right lower abdomen. According to her parents’ information, she was suspected of accidentally swallowing a magnetic toy (neodymium magnet) about a month earlier. Since the foreign bodies were not found to move on abdominal X-ray images taken two days after the first visit and abdominal ultrasound showed that the foreign body was present in multiple sites of the intestines, we performed a laparoscopy considering the possibility of intestinal injury caused by multiple magnets. We found an internal fistula between the ileum and the ascending colon and multiple magnets in the fistula. In addition, there were two perforations in the ileum. The magnets were removed, and the fistula was closed. It is important to recognize that accidental ingestion of multiple magnets can lead to serious complications such as penetration or perforation of the bowel. If the symptoms are not severe, laparoscopic treatment is an option. It is also important to keep in mind that magnet ingestion may occur in older children due to the size of magnetic toys.

The patient was a 19-year-old female with allied disorders of Hirschsprung’s disease (isolated hypoganglionosis) and a high jejunostomy. She had been receiving home parenteral nutrition using a central venous port system. She was admitted with chest pain around the central venous port, and a diagnosis of catheter-related bloodstream infection was made. She was treated with antibiotics and central venous port replacement. Twelve days after discharge from our hospital, she developed fever, and two sets of her blood cultures showed Staphylococcus aureus, whereas chest CT showed nodular and cavernous lesions with multiple infiltrative shadows in both lungs. The diagnosis of septic pulmonary embolism associated with catheter-related bloodstream infection was made. Antibiotic therapy was initiated to preserve the catheter because the remaining central venous route was limited; however, the central venous catheter was removed because her respiratory condition worsened. The patient’s respiratory condition improved quickly after the removal of the catheter. Blood cultures were confirmed to be negative for the bacterium, and the patient was discharged after central venous port replacement and four weeks of intravenous antibiotic therapy. In this disease, a diagnosis based on chest CT findings and early intervention with appropriate antimicrobial agents are necessary. Here, we report the clinical course of our patient and a review of literature.

A 20-day-old boy had lumbar hernia on his right side at birth. Abdominal ultrasonography showed hernia content on a part of the right lobe (S7) of the liver. Chest-abdominal X-ray and CT also showed that he had thoracolumbar scoliosis, costal deficit, fused ribs, and hemivertebra. Thus, we diagnosed him as having lumbocostovertebral syndrome (LCVS). At four months of age, he underwent open hernia repair with a polypropylene mesh. There was a peritoneal sac and a part of the liver in it. The surroundings were very thin and weak, so we patched the mesh between the musculature and the preperitoneal layer with an inlay patch, which was fixed with a non-absorbable suture at a certain surrounding musculature. The patient’s postsurgical course was uneventful, and he recovered and was discharged nine days after the operation. At the time of this writing, he developed no complication or showed no recurrence of lumber hernia. LCVS is rare disorder associated with musculoskeletal anomaly and various abnormalities. LCVS patients need long-term observation before and after the operation with other experts.

Maximal preservation of an ischemic but potentially recoverable intestinal tract is attempted during surgery for midgut volvulus to avoid extensive intestinal resection. However, functional disorders of the preserved ischemic intestinal tract might lead to complications in some patients. We report two cases of bowel dysfunction that occurred secondary to ischemia associated with midgut volvulus. [Case 1] A three-day-old male neonate with midgut volvulus was transferred to our hospital and underwent emergency laparotomy. Although we identified an extensive area of ischemic bowel, we resected only the clearly visible necrotic intestine and preserved the ischemic small intestine. The patient developed refractory diarrhea postoperatively, and we suspected nutrient malabsorption in the remaining intestinal tract. [Case 2] A one-day-old male neonate with midgut volvulus was transferred to our hospital and underwent emergency laparotomy. We observed widespread ischemic changes throughout the bowel; however, no necrotic area was detected. We performed a second-look operation the following day, and intraoperatively, the ischemic small intestine appeared to be intact without evidence of progressive necrosis. Therefore, we did not resect any small intestinal segments and preserved the entire bowel. The patient developed frequent postoperative enterocolitis, which suggested intestinal barrier dysfunction of the remaining intestinal tract. Intestinal function was eventually restored in both neonates, and the neonates were weaned off their parenteral nutrition. Clinicians should consider postoperative dysfunction of the ischemic but potentially recoverable intestinal tract that is preserved during a midgut volvulus operation.

We present the case of a 7-year-old boy who was previously operated on for diaphragmatic hernia. At 1 year and 6 months, abdominal ultrasonography showed a malpositioned spleen that was located in the sub-hepatic area. Because of poor migration and no findings of splenic infarction and hypersplenism, we followed him up without surgery. However, at the age of 7, MRI showed movement of the spleen to the pelvis, which caused urinary symptoms (frequent urination and enuresis). Moreover, intestinal malrotation was suspected from CT and enema examination findings; thus, we conducted laparoscopic-assisted splenopexy following a retroperitoneal pouch procedure. Since the operation, the organ has remained in place with good perfusion. To the best of our knowledge, this is the first reported case of laparoscopic-assisted splenopexy for wandering spleen complicated by diaphragmatic hernia in Japan.

Here, we present the case of a 12-year-old girl with hemothorax caused by costal osteochondroma. She was diagnosed as having osteochondroma on limb bones during infancy and monitored since then. She presented with chest pain and difficulty in breathing when she was 12 years old. Chest CT scan revealed right-sided hemothorax and bony spicule on the right seventh and eight ribs. Since there was no recent history of trauma, we diagnosed her as having hemothorax caused by costal osteochondroma. Twenty days after the onset, we performed video-assisted thoracic partial costectomy. There was osteochondroma protruding from the seventh rib into the right thoracic cavity with fibrous adhesion. We considered the lesion as the cause of hemothorax, and we then resected a part of the seventh rib. Her postoperative course was uneventful. She was discharged on the sixth postoperative day. She has had no recurrence of bleeding nor respiratory symptoms after discharge so far. Pediatric surgeons should consider osteochondroma as a differential diagnosis for hemothorax of unknown etiology.

A six-year-old female was referred to the author owing to a recurrence of pyriform sinus fistula following a fistulectomy with left hemithyroidectomy in neonate. The author had a concern for re-operation due to the difficulty of surgery and occurrence of complications. Therefore, the author performed chemocauterization of the fistula. Under general anesthesia with tracheal intubation, the orifice of the fistula was confirmed using a flexible distal hood endoscope. The hood was pushed to the orifice of the fistula to form a cylinder around it. After inserting a fine tube, 0.4 ml of 20% trichloroacetic acid was directed into the fistula. Total chemocauterization of the fistular canal and surrounding orifice was observed, which was endoscopically confirmed. There were no complications. Seven months later, closure of the orifice of the fistula was observed under the same endoscope. Chemocauterization is an effective and recommended treatment for recurrent cases of pyriform sinus fistula.

Case: A 16-year-old girl. Medical history: nothing remarkable. Clinical presentation: She had a bulge in the right inguinal region a few weeks before and she consulted a home doctor, who referred her to our hospital with a diagnosis of inguinal hernia. A bulge in the right inguinal region was observed in the standing position, and omental prolapse was observed by surface ultrasonography. Laparoscopic percutaneous extraperitoneal closure (LPEC) was performed when she was 14. When LPEC was performed, a 5-cm-sized right ovarian swelling was observed. After the operation, she felt pain in the right inguinal region during her menstrual period, which was controlled with an analgesic. She was followed up by ultrasonography considering the effect of swelling of the right ovary on her pain. Gradually, the pain did not match her menstrual period, and we judged that the pain was due to postoperative chronic pain. We administered nerve blockers, but they were not effective. At the age of 16, triple neurectomy, resection of the round ligament, and re-suture of the internal inguinal gate were carried out by the Marcy method. After following up for around 1 year, she felt no chronic pain and was physically well. We report that triple neurectomy and resection of the round ligament are effective for chronic pain after LPEC.

Aortopexy is a widely used technique for tracheomalacia associated with congenital esophageal atresia and tracheoesophageal fistula. We report the case of tracheobronchomalacia in a patient with severe motor and intellectual disabilities (SMIDs), who was successfully treated by aortopexy. The patient was a 20-year-old man with SMIDs due to hypoxic encephalopathy caused by status asthmaticus at the age of eight months. After undergoing gastrostomy and laryngotracheal separation, he had been on home ventilator support. Dying spells due to tracheobronchomalacia occurred at the age of 18. Contrast-enhanced computed tomography showed that the most stenotic part caused by tracheobronchomalacia coincided with the site of compression by the aortic arch and the vertebral body. Tube stenting was performed using a tracheal cannula, but the right main bronchus remained stenotic owing to aortic compression. He continued to have frequent dying spells and underwent aortopexy at the age of 20. Two years postoperatively, at the time of writing, his respiratory status is stable, and the postoperative course has been uneventful with no recurrence of dying spells. Aortopexy can be an effective treatment option for tracheomalacia caused by aortic compression in patients with SMIDs.