Purpose: Only a few reports about pediatric pyogenic lymphadenitis have been written by pediatric surgeons. We retrospectively examined the cases of this disease in our hospital.

Methods: Patients with a white blood cell count ≥8,000/μl and abscess formation on imaging between January 2008 and March 2020 were included. We collected information on the patients’ background characteristics, laboratory findings, and course of treatment from medical records. We also compared the incisional drainage group and the non-incisional group and examined the correlation between abscess diameter and the duration of antimicrobial use.

Results: Thirty-one patients (21 boys and 10 girls) were included in this study, and the age at initial examination was 3.66 ± 2.65 years. The sites of abscess formation were the neck in 25 patients, the axilla in one patient, and the inguinal region in five patients; pyogenic lymphadenitis was unilateral in 25 patients and bilateral in six. The abscess diameter at initial examination was 23.3 ± 7.8 mm, and there was a negative correlation between age and abscess diameter. Drainage was performed in 14 patients, and the number of days to drainage was 6.2 ± 5.9 days counting from the day of the initial examination. MSSA was detected by culture in 10 patients and MRSA was detected by culture in one patient, and neither MSSA nor MRSA was detected in three patients. The patients in the drainage group were younger and their abscess diameters were larger than those in the non-drainage group. The durations of hospitalization and antimicrobial use were longer in the drainage group. There was a significant negative correlation between abscess diameter and duration of antimicrobial use only in the drainage group.

Conclusions: In pediatric pyogenic lymphadenitis, the younger the age, the larger the abscess diameter at the initial diagnosis. In the drainage group, the larger the abscess diameter, the shorter the duration of antimicrobial use. Further studies are needed to select the appropriate antimicrobial agents and determine the indications for incisional drainage.

We report an uncommon case of congenital tracheal stenosis (CTS) with the right main bronchus originating from the distal esophagus in a 7-month-old girl. She was born at 38 weeks of gestation weighing 2,368 g and intubated immediately after birth because of respiratory distress. A series of examinations revealed CTS concomitant with right lung hypoplasia. Difficulty of ventilation prompted us to perform emergency tracheoplasty. We identified the tracheal pouch of the tracheal bronchus and the complete ring between proximal to the tracheal pouch and the left main bronchus. The right main bronchus arose from the lower esophagus and the right lung was unilobar. We resected the right lung and reconstructed the trachea by slide tracheoplasty anterior to the aorta. Aortopexy was also performed to prevent postpneumonectomy syndrome. It is important to prioritize treatment for CTS to save lives in the case of CTS associated with bronchopulmonary foregut malformation.

We report the surgical case of a seven-year-old boy with no significant medical history, who presented with abdominal pain, nausea, and melena, and initially diagnosed as having acute gastroenteritis. As his abdominal pain worsened after every meal, he was diagnosed as having acute cholecystitis by CT and referred to our hospital. His laboratory data were within normal limits, including liver enzyme levels, WBC, and CRP level. US and enhanced CT showed a thickened gallbladder wall. A preoperative diagnosis of gallbladder torsion was made on the basis of magnetic resonance cholangiopancreatography (MRCP) findings, and thus, we performed cholecystectomy. Anticlockwise 360° rotation of the gallbladder was seen during the operation as also shown by MRCP. Gallbladder torsion is a rare acute abdominal condition that requires surgery and is difficult to diagnose. However, MRCP has been used successfully to diagnose gallbladder torsion.

Pyeloureteral duplication is often associated with atrophy of the upper pole of the kidney. We report a rare case of complete pyeloureteral duplication with renal atrophy at the right lower pole. The patient was an eight-year-old girl who had repeated unexplained fever and febrile convulsion from 2 to 3 years of age and was found to have bilateral pyeloureteral duplication by abdominal contrast-enhanced computed tomography when she had another convulsion. Abdominal ultrasound and renal scintigraphy showed severe atrophy in the right lower half of the kidney. Voiding cystourethrography (VCG) showed vesicoureteral reflux (VUR). Cystoscopy and retrograde cystourethrography showed that the medial and caudal orifice in the bladder and the lower renal moiety ureter to the lateral and cranial orifice according to the Weigert-Mayer law. VUR to the right lower kidney was observed. She underwent retroperitoneoscopic resection of the right lower half of the kidney and the affiliated ureter. Six months after the surgery, VCG showed no VUR. She had no symptoms during the period of two years after the surgery.

A ten-year-old girl with a history of two surgeries for meconium peritonitis at neonate was affected with pyosalpinx and was treated with antibiotics. Two years after the treatment of pyosalpinx, she had bilateral hydrosalpinx and the left hydrosalpinx expanded to a diameter of 11.5 cm; therefore, she felt abdominal distension and became anorexic. After consultation with obsterician-gynecologists and obtaining informed consent from her parents, we attempted laparoscopic resection of bilateral hydrosalpinx to improve her quality of life and to increase the success rate of future assisted reproductive treatment. We were able to remove the entire right fallopian tube but only most of the left one owing to firm adhesions near the ureter and ovary. Her postoperative course was uneventful. Because pyosalpinx and hydrosalpinx can occur long after surgeries for organs of the abdomen and pelvis during childhood, we should consider these diseases when encountering cases of abdominal pain with cystic lesions in the pelvis, especially in adolescent girls.

We successfully treated a case of pancreatic pseudocyst caused by type IIIb pancreatic injury via laparoscopic external drainage. [Case] A 14-year-old boy presented with abdominal pain after having his upper abdomen bruised by contact with another player’s knee during a soccer match. Magnetic resonance cholangiopancreatography (MRCP) showed complete rupture of the pancreatic body, and fluid collection was detected around it. The patient was diagnosed as having type IIIb pancreatic injury based on the classification of the Japanese Society of Trauma. We selected a non-operative management approach because the patient was hemodynamically stable. However, after conservative treatment, a pancreatic pseudocyst of 3 cm diameter was found; thus, endoscopic retrograde pancreatography (ERP) was performed on the 11th day of illness. The pancreatic duct was transected at the body of the pancreas, and a pancreatic duct stent was placed into the cyst, but it fell off after three days. After that, the pancreatic pseudocyst tended to grow and increased in size from the subdiaphragm to the lower pole of the kidney. Therefore, we performed laparoscopic external drainage on the 45th day of hospitalization. After the operation, the patient showed no abdominal symptoms, and no recurrence of cysts was recognized. [Conclusion] Laparoscopic drainage of pancreatic pseudocysts can enable the observation of the entire abdominal cavity while also facilitating safe and reliable drainage. Therefore, depending on the patient condition, laparoscopic external drainage of pancreatic pseudocysts may be considered as a treatment option.

The treatment strategy for type IIIb pancreatic injury has not been established, and reports documenting pediatric cases have been scarce. We report the case of a child who underwent the Letton-Wilson procedure using the modified Blumgart method for pancreaticojejunostomy promptly after injury and obtained a good outcome. The patient was a 13-year-old boy who presented with blunt injury in the upper abdomen. Pancreatic head injury was suspected on the basis of abdominal contrast-enhanced computed tomography images. Emergency endoscopic retrograde pancreatography failed to show the main pancreatic duct. On the basis of the computed tomography findings, main pancreatic duct injury was suspected, and emergency exploratory laparotomy was performed. Intraoperative findings showed that the pancreatic head was torn at the right edge of the superior mesenteric vein extending to the main pancreatic duct, and a diagnosis of type IIIb pancreatic head injury was made. The Letton-Wilson procedure using the modified Blumgart method for pancreaticojejunostomy was performed, the pancreatic head stump was sutured, and the omentum was covered. After the operation, a pseudopancreatic cyst of 2 cm diameter was observed in the closed part of the pancreas head stump, but it gradually shrank. The patient was discharged 27 days after the operation. His postoperative course was uneventful during the period of one year after surgery.

We encountered a 14-year-old girl with congenital portal vein deficiency. At 1 month of age, she was diagnosed as having hypergalactosemia, congenital absence of the portal vein, pulmonary hypertension, atrial septal defect, and polysplenia. We suggested liver transplantation because of severe pulmonary hypertension, but the result of lung biopsy showed that it was incompatible owing to pulmonary arteriole hypoplasia. Her subsequent symptoms were relatively stable. At the age of 14, intrahepatic portal vein with hypoplasia was confirmed, and surgical ligation of the vascular shunt was indicated by angiography. The portal vein pressure was not increased at intraoperative measurement, and the small intestine had no congestion findings, so we completely ligated the shunt vessel. After the operation, the shunt rate and pulmonary hypertension were improved, and the patient had no major complications until one year after the operation. Even if the patient is diagnosed as having congenital portal vein deficiency, there are cases in which shunt ligation can be safely performed as in this patient. Therefore, in symptomatic cases, repeated evaluations, such as those by angiography, are important and necessary.

Testicular torsion is an emergency medical condition that requires prompt diagnosis and surgical treatment. However, the correct diagnosis of trauma-induced testicular torsion may often be delayed and the testicular salvage rate is low. We report the case of 14-year-old boy who presented with persistent mild left testicular pain and scrotal swelling five days after blunt scrotal trauma, for which he was brought to the emergency department. Ultrasonography and magnetic resonance imaging suggested swelling of the left spermatic cord with testicular rapture; therefore, surgical treatment was decided. Surgical exploration revealed a 720-degree intravaginal torsion in the lateral direction of the left testis without any injury of the tunica albuginea and hematoma. Detorsion of the affected testis resulted in improvement of testicular appearance; bilateral orchiopexy was then performed. His postoperative course was uneventful, and he was discharged on the fourth postoperative day. Follow-up examination at six months after operation showed good blood flow and no atrophy of the affected testis. Trauma-induced testicular torsion is a rare entity; however, emergency physicians should be aware of the possibility of testicular torsion following blunt scrotal trauma. Pediatric patients with persistent scrotal pain should be actively scrutinized and treated immediately.

We report a rare case of intussusception due to a juvenile polyp in the ileum. A three-month-old boy was admitted to our hospital because of vomiting, bloody stool, and lethargy one hour before admission. His abdominal ultrasonography showed the target sign at the left upper quadrant. Thus, he was diagnosed as having intussusception, and hydrostatic reduction was attempted. However, operative reduction of the ileo-ileal intussusception was performed because of the failure of hydrostatic reduction. Before the operation, we suspected the possibility of the presence of a pathological lead point because his abdominal sonography showed a 10 mm cystic lesion, including some septa in the center of the target sign. After reduction by Hutchinson’s maneuver, a tumor was found in the lumen of the ileum at 7 cm from the ileocecal valve. Partial resection of the ileum including the tumor was performed. The pathological diagnosis of the tumor was a juvenile polyp that had partial necrosis and destruction of the ileum. Since most juvenile polyps occur in the colon or rectum, cases of colo-colic-type intussusception are common, but those of the ileo-ileal or jejuno-jejunal type are extremely rare. In the Japanese literature, only seven cases of intussusception caused by juvenile polyps in the small intestine have been reported.