Purpose: In renal trauma, there is no consensus on the nature of conservative treatment and the choices and methods of surgical intervention. We retrospectively investigated cases of renal trauma in our department.

Methods: Based on the medical records for renal trauma cases treated at our department between January 1990 and December 2018, a retrospective study was conducted on age, gender, cause/classification of renal trauma, other organ damage, abdominal trauma score, time to gross hematuria disappearance, treatment method, and in conservative management, duration of fasting/rest/antibiotics administration, complications, renal prognosis, and follow-up period. The renal trauma classification by the Japanese Association for the Surgery of Trauma (JAST Classification) was used.

Results: A total of 14 renal trauma cases, consisting of 3 class I, 4 class II cases, 6 class III, and one unknown, as graded on the JAST Classification, were included. Conservative management was implemented for 12 cases and surgical intervention in 2 cases who presented hemodynamic instability and got uncontrollable infection. Apart from the nephrectomy, renovascular damage, and lost to follow-up cases after the conservative management, renal function in 8 cases could be preserved. The median fasting period after admission was 2 (0 to 10) days, bed rest was 5.5 (1 to 25) days, and intravenous antibiotic administration was 10.5 (0 to 26) days.

Conclusion: This study found that making conservative management as the first choice of treatment was an effective strategy. Furthermore, suggesting the importance of constantly investigating the need for surgical intervention.

A 2-year-old girl with complaints of abdominal pain, vomiting, and anorexia was referred to our hospital. Abdominal CT scan depicted cystic dilatation of the extrahepatic bile ducts and blood tests showed hyperamylasemia, but no jaundice. The patient was diagnosed with congenital biliary dilatation (CBD). She continued to have abdominal symptoms, and a decrease in oral intake resulted in a significant decline in her nutritional status. The patient underwent percutaneous transhepatic biliary drainage (PTBD) because increased biliary pressure was thought to be a cause of her clinical symptoms. After PTBD, she became asymptomatic and resumed oral intake. The patient safely received a radical surgery after the general condition had improved. PTBD requires an advanced technique and careful management in pediatric CBD patients and it is usually used for those with severe obstructive jaundice or refractory cholangitis which is resistant to conventional treatment. Although the indication for PTBD is restricted to a limited number of pediatric CBD patients, it could be an effective therapeutic option for cases with worsening of general condition due to increased intrabiliary pressure.

Rupture of hepatoblastoma can be fatal due to hemorrhagic shock. We report three cases of ruptured hepatoblastoma treated with transcatheter arterial embolization (TAE) followed by systemic chemotherapy and hepatectomy. A 10-month-old girl was transferred to our institute by helicopter for emergency TAE followed by 4 courses of CITA and right lobectomy. A 6-year-old boy presented with sudden onset of shock during close examination of liver tumor. Emergency TAE was performed, and underwent left lobectomy after 6 courses of CITA. 1.5 years later, resection was performed for local recurrence. A 2-year-old boy went into shock during transfer to the hospital and underwent emergency TAE for hemostasis. He underwent 4 courses of C5VD followed by right lobectomy. Prompt access to and completion of TAE can save lives in cases of ruptured hepatoblastoma. After hemostasis, chemotherapy should be prioritized to reduce the size of the tumor, and then tumor resection should be performed.

The patient was a 24-day-old girl who was born at 38 weeks and 4 days of gestation and weighed 3,055 g. She was admitted to a previous hospital for frequent vomiting. Computed tomography on the next day showed that she had strangulating intestinal obstruction. She was in compensated shock at the time of transfer to our hospital and resuscitation was started immediately. Emergency surgery was essential, but the operating room was not available, so we performed derotation and siloplasty in the neonatal intensive care unit. The patient’s circulatory and respiratory condition was stabilized after the surgery, and radical surgery (second-look operation: SLO) was performed in the operating room three hours after the initial surgery. Intraoperatively, the patient was diagnosed as having intestinal volvulus without malrotation; 130 cm of the ischemic small intestine was resected, and the ileocecum was preserved. Within one year after the surgery, there were no problems with her growth and development. The first priority of treatment of neonatal strangulating intestinal obstruction is to release the strangulation mechanism as soon as possible. Although SLO has been considered the treatment strategy for preserving a strangulated intestine, early derotation and siloplasty until radical surgery are reconfirmed to be very useful as part of emergency resuscitation.

A boy was born 2,641 g in weight at 38 weeks of gestation by planned cesarean section. He was diagnosed as having left pulmonary sequestration at 20 weeks of gestation, and left diaphragmatic hernia was diagnosed on the basis of MRI findings at 34 weeks of gestation. He underwent transabdominal diaphragmatic repair on day 2, but no segmented lung could be seen in the thoracic cavity intraoperatively. Contrast-enhanced computed tomography on day 35 revealed extralobar pulmonary sequestration (ELS) on the left diaphragm, which was fed by the celiac artery and returned to the portal vein. He was asymptomatic, but considering the large size of the feeding artery and the large amount of blood flow to the segmented lung, we performed a thoracoscopic-assisted resection of the segmented lung at 18 months of age. ELS is generally considered to be asymptomatic. ELS with portal venous drainage is extremely rare, and only four cases have been reported in detail, and all of them had infection without specific symptoms. ELS should be resected on the basis of the risks of torsion, infarction, and infection, and thoracoscopic or thoracoscopic-assisted resection is a good indication.

We experienced treating a newborn with pyriform sinus cyst by chemocauterization. A male infant, who had a left cervical cyst as shown by fetal echo and MRI, was referred to our department after cesarean section delivery and diagnosed as having pyriform sinus cyst on the basis of CT and esophagography findings. As the fistula orifice was detected using an endoscope, we tried chemocauterization using 10% AgNO₃ solution with drainage of the cyst 13 days after birth. It was successful and there were no complications after the operation; the patient could start oral feeding from the second postoperative day (POD), and the drainage tube was removed on the seventh POD. For five months thereafter, he had no recurrence or complication; thus, we concluded that chemocauterization is an effective treatment even in newborn patients.