Helicobacter pylori infection is known to be the major cause of gastroduodenal ulcer. We report seven cases of pediatric gastroduodenal ulcer secondary to infections other than Helicobacter pylori infection. The patients had a median age of 5 years (1–9 years), and four of the seven patients had underlying diseases. Three developed gastroduodenal ulcer following acute gastroenteritis including rotavirus and norovirus, and the other four developed them after suffering from influenza A infection. Two patients underwent laparoscopic surgery for duodenal ulcer perforation. Five patients were diagnosed as having gastroduodenal ulcer bleeding revealed by endoscopy and all required blood transfusions. Two of them underwent endoscopic hemostasis. In acute abdomen or gastrointestinal bleeding following acute gastroenteritis or influenza infection, the possibility of gastroduodenal ulcer should be kept in mind.

Purpose: We evaluated the efficacy of Movicol^® for treating children with chronic constipation.

Methods: Children with chronic constipation treated with Movicol^® between November 2018 and May 2019 were divided into two groups: the initial treatment group with no prior treatment for chronic constipation and the transitional group post-treated with magnesium oxide and/or sodium picosulfate. We retrospectively analyzed their profiles, availability of oral Movicol^®, improvement in the number of defecations and stool form, and need for glycerin enema after treatment with Movicol^® considering efficacy and side effects. We surveyed patient satisfaction using a questionnaire via telephone.

Results: Of 36 children, eight were in the initial treatment treat and 28 in the transitional group; 33 children (91.7%) could take this medicine orally. The number of defecations increased in both groups, and stool form improved in the transitional group. Almost all children from both groups did not require enema. The efficacy of Movicol^® for chronic constipation was confirmed in six children in the initial treatment group and 21 children in the transitional group 2–4 weeks after starting the treatment. It was also confirmed in five children in the initial treatment group and 25 children in the transitional group one and half to two years after starting treatment. Diarrhea was observed in one patient, but no severe side effects were observed. Thirty-three patients (91.7%) responded to the patient satisfaction questionnaire with an average satisfaction rating of 7.3 on a 10-point scale.

Conclusion: Movicol^® can be administered orally in children (91.7%), is effective in both groups, and can be the first treatment of choice.

We report a pediatric case of external supravesical hernia. A eight-year-old girl was brought to our hospital presenting with a distension of the left groin that, unlike most inguinal hernias, was externally situated. Laparoscopic surgery was performed to determine the differential diagnosis and subsequent treatment. The procedure revealed an enlarged orifice located between the medial umbilical ligament and the left wall of the urinary bladder, leading to the diagnosis of external supravesical hernia. The orifice was closed by reinforcing the medial umbilical ligament to the bladder wall. This is the first report of a pediatric case of external supravesical hernia. No recurrence has been observed in the patient, but long-term evaluation is required.

Proton beam therapy for pediatric cancer has been covered by the Japanese health insurance since 2016, and surgical spacer placement for particle therapy has been covered by this insurance since 2019. The currently approved spacer is a sheet-type absorbable material made from polyglycolic acid (PGA); however, before this type of spacer was developed, non-absorbable medical materials were often used as spacers. During this transition period, we experienced treating a case in which two different types of spacer, one non-absorbable and the other bio-absorbable, were placed. An 11-year-old boy with sacral malignancy underwent spacer placement using a stretched polytetrafluoroethylene sheet for proton beam therapy. This non-absorbable spacer was removed after the completion of irradiation; however, the tumor recurred later. A bio-absorbable PGA spacer was available at the time of recurrence, and this spacer was placed. Because the PGA spacer is absorbed by the body, it does not need to be removed after irradiation, and it is considered to be an excellent material in clinical settings.

Bronchopulmonary sequestration (BPS) is the second most common congenital cystic lung disease. The size of the lesion generally increases until 25 weeks of gestation and decreases after 28 weeks of gestation. This finding is similar to the reported growth trajectory of congenital pulmonary airway malformation (CPAM), for which the mean CPAM volume ratio (CVR) peaks at 25 weeks of gestation. However, the peak of CVR in patients with extralobar BPSs associated with hydrops is lower than that of the CVR associated with hydrops in patients with CPAM. A CVR cutoff of 0.75 has been utilized as a useful predictor of fetal hydrops and a possible requisite of fetal therapies. We report a case of extralobar pulmonary sequestration. The patient initially showed massive pleural effusion and rightward cardiac deviation at 26 weeks of gestation, followed by the development of hydrops with a CVR of up to 1.5 at 28 weeks of gestation. A total of seven fetal therapies, namely, two maternal steroids, three thoracenteses, and two thoracoamniotic shunts, were performed between 26 and 35 weeks of gestation, resulting in the resolution of hydrops by the 35th week of gestation, shrinkage of BPS at a CVR down to 0.23, and full-term birth by vaginal delivery. Stable perinatal management without any emergent surgical intervention was achieved. Aggressive fetal therapies were very useful for the survival of BPS patients with hydrops and safety in perinatal management.

Segmental dilatation of the intestine, characterized by a localized dilated intestinal area, is not associated with any mechanical obstruction or neurological abnormality. The clinical presentation of this anomaly in neonates is referred to as congenital segmental dilatation (CSD) of the intestine. Although resection of the dilated bowel segment is considered the standard treatment for CSD in patients with a dilated sigmoid colon, a few studies have shown the creation of a covering stoma or the Soave pull-through technique with resection of the dilated colon is effective in some patients. We report a case of CSD of the sigmoid colon diagnosed in a neonate who underwent abdominal decompression with elective primary surgery. A male neonate (birth weight, 2,274 g) was delivered at 37 weeks and 3 days of gestation. Plain abdominal radiography revealed intestinal dilatation, and he was transferred to our hospital at one day of age. Contrast-enhanced enema revealed segmental dilatation of the sigmoid colon with normal colonic diameters on the oral and anal aspects of a lesion. Periodic abdominal decompression did not result in enterocolitis, and he underwent primary surgery with resection of the dilated sigmoid colon, followed by end-to-end anastomosis at nine months of age. The patient’s postoperative course was uneventful, and he was discharged 10 days postoperatively. Currently, his body weight is steadily increasing nine months postoperatively, and he is undergoing outpatient follow-up.

We herein report the case of a six-year-old girl who was successfully treated by central pancreatectomy for grade IIIb traumatic pancreas injury. She was transferred to our hospital because of a cystic lesion in the pancreas with abdominal pain persisting for one week. Traumatic pancreatic injury with a pseudopancreatic cyst was suspected, and nonoperative management was selected. Twenty days after admission, a pseudoaneurysm of the left gastric artery ruptured, and emergency embolization was performed using interventional radiology. On the 31st hospitalization day, endoscopic retrograde pancreatography (ERP) revealed the main pancreatic duct injury. We performed surgical treatment for pancreatic injury grade IIIb on the 78th hospitalization day. The pancreas was partially transected at the pancreas head, and the main pancreatic duct was completely transected. The pancreas was completely dissected, the proximal pancreatic stump was closed, and the distal pancreas was anastomosed directly in the posterior stomach wall. She did not require any treatment after the operation. The decision to proceed with surgery was difficult because nonoperative management sometimes results in a better outcome than an operative approach, but the early diagnosis of injury of the main pancreatic duct led to the decision to proceed with surgery. ERP is a feasible option for diagnosing high-grade traumatic pancreas injury, even in pediatric patients.

There are many techniques for esophageal reconstruction for congenital esophageal atresia and tracheal agenesis, for which there is no standard treatment. We present three cases of esophageal reconstruction using part of the stomach as a substitute esophagus. Case 1 was a three-year-old boy who underwent lower esophageal banding, gastrostomy, and dissection of the cervical esophagus for Floyd’s type 1 tracheal agenesis. Esophageal reconstruction was performed using a gastric tube through the retrosternal route. Case 2 was a 10-month-old girl who underwent fistulotomy and salivary fistula for Gross B esophageal atresia. Esophageal reconstruction by the Collis–Nissen technique was performed. Case 3 was a two-year-old boy who developed mediastinal abscess after dilatation of anastomotic stricture after radical surgery for Gross C esophageal atresia. Esophageal reconstruction was performed using a total gastric tube through the retrosternal route. Although anastomotic leakage was observed in all the patients, it was improved by conservative treatment. It is necessary to select the useful technique and approach for esophageal reconstruction according to the individual cases.

We encountered an 11-year-old boy with no history of umbilical hernia. He visited our pediatric surgery outpatient clinic complaining that he had picked at his umbilical skin, inverting it, and had not been able to reduce it. His inverted umbilical skin was found to be congested. The outpatient doctor tried to reduce the umbilicus with the patient conscious, but this was impossible because of the pain he was experiencing. Thus, we performed reduction under general anesthesia. After the reduction, there was no hernia orifice in his navel. His postoperative course was good, and he was discharged the next day. Nine months after the reduction, he showed no recurrence. There has been only one report in Japan in which the umbilical skin turned inside out and became incarcerated. The mechanism is considered to involve the subcutaneous tissue of the inverted umbilical skin being strangulated between the umbilical edge and the scar tissue of the umbilicus, resulting in congestion. It is difficult to consciously invert the umbilical skin. However, in the present case, the patient reported a habit of pulling at the umbilical skin on a daily basis. This habit was considered to have caused the scar tissue of the umbilical fossa to be easily stretched, which contributed to the onset of inversion.

We report the case of an eight-year-old boy with penetrating chest trauma. He fell off his bike and was stabbed in his right precordium with the brake lever. The patient was subsequently taken to our hospital in an air ambulance, and during the flight, a doctor inserted an intercostal drainage tube in the chest because of open pneumothorax. Although he presented with a right chest stab wound, the amount of blood loss over the chest tube was small. In addition, he was hemodynamically stable. Computed tomography (CT) revealed traumatic pneumothorax, hemothorax, and type Ib(rLL) lung injury (Japanese Society of Trauma Classification). We performed lung plication and chest drainage by video-assisted thoracoscopic surgery (VATS). His postoperative period was uneventful. In adults with thoracic trauma, VATS is effective for the accurate and direct evaluation of the entire pleural place, and the penetrating wounds are small, thereby minimizing pain and promoting fast recovery. Our experience suggests that VATS can be effective for both pediatric and adult patients. In the hemodynamically stable state, VATS may be useful for pediatric cases with penetrating thoracic trauma, persistent hemothorax, and diaphragmatic injury.