We experienced treating a neonatal case of intestinal obstruction caused by the spread of inflammation due to appendicitis. The patient, an 18-day-old boy, was brought to our hospital because of vomiting and abdominal dissension. A contrast-enhanced CT scan revealed an intestinal obstruction in the ileum, and emergency laparotomy was performed on the same day. Small bowel strangulation by the adherent band was located 30 cm proximal from the terminal ileum. The appendix was covered with a layer of pus and was extensively perforated, except for the root and tip, suggesting that the adherent band was formed by the spread of inflammation due to appendicitis. The appendix was dissected at the root. The strangulation site in the ileum was resected and anastomosed. The postoperative course was uneventful, and the patient was discharged 16 days after the operation. Neonatal appendicitis is very rare. In this case, there were no symptoms indicative of appendicitis before the onset of intestinal obstruction, and we diagnosed this case as appendicitis on the basis of pathological examination. The possibility of appendicitis as an underlying cause of intestinal obstruction in newborns without a history of laparotomy should therefore be considered.

The patient was a two-month-old girl who was followed up as an outpatient because hematochezia appeared approximately one month after birth. At two months of age, she was admitted to our department because of progressive anemia. A contrast enema showed a mass lesion of 8 mm diameter in the descending colon, which was considered to be the cause of bleeding. Colonoscopy revealed an easily bleeding tumor, and endoscopic mucosal resection (EMR) was performed under general anesthesia with surgical back up. However, a perforation was found at the resection site; thus, laparotomy was carried out. She underwent simple closure of the perforation of 2 cm diameter and drainage. The postoperative course was good, and no recurrence was observed. The histopathological results showed pyogenic granuloma, which is rare in the gastrointestinal tract except in the oral mucosa, and very few cases have been reported in children. Because of the hemorrhagic tendency, pyogenic granuloma should be kept in mind as a cause of gastrointestinal bleeding even in children. It is important to choose a safe and reliable treatment for each case. In this case, endoscopy was difficult because of the small size of the infant, and we should have switched to surgical resection before perforation occurred.

Late-onset congenital diaphragmatic hernia (CDH) diagnosed after infancy often has a good prognosis but can be critical if the intestine is inlaid or strangulated. A 5-month-old girl presented with poor feeding, vomiting, and mucous and bloody stools at the time of admission. An X-ray radiograph showed an indistinct left diaphragm, but no obvious respiratory symptoms. There were no significant findings on abdominal ultrasonography, and enterography was performed for diagnostic and therapeutic purposes on suspicion of intussusception. As soon as the colon was visualized in the left thorax, rapid breathing and poor oxygenation occurred, and the patient was diagnosed as having late-onset CDH and was saved by emergency surgery. When the intestine is distended or strangulated owing to late-onset CDH, clinical symptoms are similar to those of intussusception, and if enterography is performed only for gastrointestinal symptoms, it may induce a fatal condition. If there are findings in the diaphragm, examination of other modalities should be prioritized considering the possibility of late-onset CDH.

The patient was an 11-day-old female who presented with bilious vomiting. Low-allergen formula was given for the putative diagnosis of milk allergy, but the bilious vomiting persisted. She was transferred to our hospital and an upper gastrointestinal contrast study demonstrated a jejunal stenosis 50 cm on the anal side from the ligament of Treitz. She was diagnosed as having congenital jejunal stenosis and laparotomy was performed. A stenotic lesion was found in the jejunum at 45 cm from the ligament of Treitz. The lesion was resected, and the jejunum was repaired by an end-to-end anastomosis. The lumen of the specimen was occupied by a mass, that caused intestinal obstruction. The patient was started on oral feeding on postoperative day 4 and was discharged on postoperative day 25 after an uneventful course. Microscopic examination of the resected mass revealed a bundle-like proliferation of spindle-shaped cells with ellipse nuclei, and the histopathological diagnosis was infantile myofibromatosis (solitary type). Systemic exploration demonstrated no mass lesions elsewhere, and no postoperative treatment was given. She remains healthy without recurrence after six years.

A 15-month-old boy, who has been observed for retractile testis, presented with right scrotal swelling. Scrotal ultrasonography revealed a 20 mm “complex” multicystic mass without a solid component. The levels of serum tumor markers were within the normal range, and imaging studies indicated a simple testicular cyst or a benign testicular tumor. Because the intraoperative frozen section examination ruled out malignancy, we performed testis-sparing surgery. The definitive pathological findings included multiple types of epithelium with airway glands, cartilages, and brain tissue, leading to the final diagnosis of mature teratoma. The patient’s postoperative course was uneventful without recurrence or testicular atrophy.

We herein report a case of an extralobar sequestration with a feeding vessel arising from the pulmonary artery. The patient was born at 36 weeks of gestation after being followed-up for a left pulmonary cystic lesion since 19 weeks of gestation. A 320-row area detector computed tomography at four months showed a mass in his left lung with an aberrant feeding artery branching from the pulmonary artery. He underwent surgery at six months of age. The mass was separated from the normal lungs. The mass was found to be surrounded by its own visceral pleura and a feeding artery branched from the left pulmonary artery and vessels returning to the left superior pulmonary vein. We diagnosed the patient as having extralobar pulmonary sequestration.

Multiple duodenal atresia, as well as Y-shaped bifurcated common bile duct termination, is a rare condition. We experienced treating an extremely rare case of double duodenal atresia combined with Y-shaped bifurcated common bile duct termination. A 0-day-old male baby with trisomy 21 and congenital cardiac anomaly, who was suspected of having duodenal atresia without maternal polyhydramnios as prenatal diagnoses, was born by cesarian section in our hospital. Gastric juice mixed with bile was drained with a gastric tube, and abdominal X-ray showed a double bubble sign of gastric and duodenal bulbus. Therefore, we performed surgery under the diagnosis of duodenal atresia. Laparotomy showed separation-type duodenal atresia. Then, for the diamond-shaped anastomosis, a transverse incision at the dilated proximal duodenum and a longitudinal incision at the narrow distal duodenum were made, which revealed both a pinhole without Oddi’s sphincter at the bottom of the proximal duodenum and a membranous atresia in the lumen of the distal duodenum. The membrane was incised, and bile juice spilled out from the proximal lumen of the distal duodenum. We diagnosed the patient as having double duodenal atresia (separation type and membranous type) combined with Y-shaped bifurcated common bile duct termination and performed a diamond-shaped duodeno-duodenal anastomosis after subtotal incision of the membrane in the distal duodenum. Duodenal atresia is not a rare condition; however, we should remember the possibility of multiple atresia or Y-shaped bifurcated common bile duct termination during surgery.

Laparoscopic ovarian transposition is not commonly performed in Japan. Herein, we report our experience in ovarian transposition surgeries for children with cancer as a method to avoid the need for irradiation therapy (pelvic proton beam therapy). [Case 1] A one-year-old girl with rhabdomyosarcoma underwent chemotherapy and surgical resection. We performed ovarian transposition and administered proton beam therapy at the tumor-positive margin. We transposed the bilateral ovaries out of the irradiation field laparoscopically without resection of the bilateral fallopian tubes. Two months after surgery, the ovaries were repositioned. Currently, the patient is over 6 years old and has no complications. [Case 2] A four-year-old girl with rhabdomyosarcoma underwent chemotherapy. We also included ovarian transposition and proton beam therapy in the treatment protocol owing to residual disease. We transposed the bilateral ovaries out of the irradiation field laparoscopically without resection of the bilateral fallopian tubes. The levels of FSH and LH were appropriate for her age at 14 months after surgery. Currently, she is over five years old and has no complication. [Case 3] An 11-year-old girl with Ewing’s sarcoma received chemotherapy. Ovarian transposition and proton beam therapy were included in the regimen as topical treatments. We resected the left fallopian tube and transposed the bilateral ovaries out of the irradiation field laparoscopically. Nine months after surgery, she died owing to multiple metastatic recurrence. On the basis of the outcomes of these cases, laparoscopic ovarian transposition can be a safe and feasible procedure. However, these patients need long-term follow-up to check their ovarian function.

We report the case of a girl with myotonic muscular dystrophy who developed superior mesenteric artery (SMA) syndrome and underwent duodenojejunal diamond-shaped anastomosis in addition to Strong’s procedure (hereafter, this method). Gastric nutrition became possible after this method. Her clinical course was as follows. Fundoplication and gastrostomy were performed at three years and one month of age. She developed SMA syndrome, and a gastrojejunal (GJ) tube was placed at the age of 6 years and 11 months. Although gastric nutrition became possible with a button-type gastrostomy catheter at the age of 7 years and 3 months, SMA syndrome recurred six months later, and the GJ tube was replaced. Retrograde intussusception had occurred around the tube since the age of 7 years and 11 months. However, given the risks of surgical intervention for muscular dystrophy, close observation was performed until it became difficult to replace the GJ tube at the age of 8 years and 3 months. Thus, Strong’s procedure was performed. Since flexion remained with maximum mobilization of the duodenum, we additionally performed duodenojejunal diamond-shaped anastomosis adopting physiological peristalsis. This method was deemed effective in muscular dystrophy children with significantly impaired gastrointestinal peristalsis.

The patient was a 0-day-old male infant born at 34 weeks of gestation by spontaneous cephalic delivery at a previous maternity hospital. Maternal syphilis infection was found by blood tests at the time of admission. Thus, the patient was suspected of developing congenital syphilis and transferred to our hospital for detailed examination and treatment. Physical examination showed deep wrinkles and exfoliation of fragile skin on the face and epidermal exfoliation and hepatosplenomegaly on the body. A blood test showed a positive syphilis serum reaction and a specific antibody. A diagnosis of congenital syphilis was made, and penicillin G administration was started. Since abnormalities in D-Bil, AST, ALT, and γGTP levels persisted, direct cholangiography and liver biopsy were performed at 86 days of age, leading to a diagnosis of paucity of intrahepatic bile ducts. The blood test data values improved after peaking at 98 days of age, and the patient was discharged at 116 days of age. There are cases in which jaundice and hepatobiliary enzyme levels persist even after antibiotic treatment and liver protection therapy are given to children diagnosed with congenital syphilis. In this case, paucity of intrahepatic bile ducts may be secondary, so cholangiography and liver biopsy are required to identify other diseases.

A 13-year-old boy with vascular Ehlers-Danlos syndrome, who was referred to our hospital, presented with sudden-onset upper abdominal pain and vomiting. Although the patient was ambulatory during the emergency room visit, he went into shock during clinical examination. Bedside ultrasonography revealed a huge hematoma in the right upper retroperitoneum. After stabilization of blood pressure by intra-aortic balloon occlusion in the emergency room, an emergent laparotomy was performed. The abdominal blood vessels were extremely fragile, and even a slight pull consequently tore the blood vessels intraoperatively. As the organ ischemic time had reached the extent of irreversible damage, the operation was terminated. The patient died three hours after the surgery. On the basis of the absence of elastic fibers in the vessel wall in autopsy specimens and the detection of a novel pathological variant of the COL3A1 gene, pathological and genetic mutation analyses, respectively, confirmed the diagnosis of vascular Ehlers-Danlos syndrome. In cases of unexplained, sudden, and massive retroperitoneal bleeding, vascular Ehlers-Danlos syndrome, despite its rarity, should be considered in the differential diagnosis.

A committee for work–life balance was established in 2021 by the Japanese Society of Pediatric Surgery. Gender equality was widely discussed among members of the committee. Some female councilors are elected on the basis of a quota system. The selection of a female director for board membership is widely facilitated by the membership board. The number of female surgeon members of the board is now increasing, thus indicating the sustainability of professional careers coupled with the driving motivation of female pediatric surgeons, which is viewed as an important and key task being tackled by human resources through work style reforms.