Esophageal achalasia is a rare disease in childhood, and there is still no consensus on its prompt treatment and the appropriate timing of treatment. In this paper, we report a successful endoscopic balloon dilation in an 8-year-old girl with esophageal achalasia. The patient suffered from repeated coughing and vomiting at bedtime, and she was diagnosed as having type II esophageal achalasia (Chicago classification) by high-resolution esophageal manometry. On the basis of this diagnosis, she was considered a possible responder to endoscopic balloon dilatation, the least invasive procedure. Multiple balloon dilatations were performed up to 30 mm in incremental steps. After treatment, the patient was able to eat well and had no symptoms, and esophagography showed a decrease in esophageal diameter. The Eckardt score improved from 4 points before treatment to 0 points after treatment. No recurrence was observed two years after treatment and no additional treatment was necessary.

A 12-year-old girl had been suffering from abdominal pain, constipation, and vomiting for 3 months, and eventually presented failure to thrive. These symptoms worsened suddenly, and she visited a previous hospital and was suspected of having bowel obstruction. She was referred to our department. Abdominal CT showed thickening and narrowing of the jejunal wall, dilation of the proximal intestinal tract, and a closed loop. She was diagnosed as having acute abdomen due to small bowel obstruction, and an emergency laparotomy was performed. During surgery, no ischemic change in the intestine was observed. Massive edema, wall thickening, and dilation of the jejunum were noted, and a mass formation involving the omentum was also observed. The affected jejunum was resected, and the specimen showed a cobblestone appearance and longitudinal ulcers on the mucosa. The histopathological findings revealed a noncaseating granuloma, and her final diagnosis was Crohn’s disease. Her postoperative course was uneventful, infliximab was started from the 14th postoperative day, and she was discharged on the 32nd day. Surgeons should be aware of the possibility of future multiple surgeries and postoperative enteral during emergency surgery for undiagnosed pediatric Crohn’s disease.

We report the case of a 13-year-old boy who presented with ulcerative colitis (UC) and later developed cerebral venous sinus thrombosis (CVST). At the age of 10 years, he visited a hospital with a complaint of bloody stool and was diagnosed as having total colitis-type UC by colonoscopy. He was managed with mesalamine and prednisolone, but he had repeated remissions and relapses. Although remission of his UC was achieved with azathioprine therapy, he was admitted to our hospital for a relapse of abdominal pain and hematochezia. On the 8th day of admission, he complained of numbness and weakness in the left arm and leg. Brain Computed Tomography and Magnetic Resonance Imaging showed CVST. Immediate treatment with heparin for venous sinus thrombosis and mannitol to reduce cerebral edema was started. However, owing to treatment resistance, thrombectomy was performed by endovascular therapy six days after onset. After the thrombectomy, his convulsion symptoms resolved, and his paralytic symptoms were alleviated. The patient’s headache resolved, and he was discharged from the hospital 50 days after onset. CVST is rarely reported in pediatric patients with UC, and we report this case with a review of the literature from Japan.

An 18-day-old female neonate showing abdominal distention was transferred to our hospital. Since X-ray images showed abdominal free air, we performed emergent laparotomy and also performed direct closure of the perforation site located at the end of the ileum. At 1 month after discharge, ileus was recognized; however, she recovered with conservative therapy. At 7 months after birth, she presented with bloody stool and anemia. Contrast-enhanced CT showed enhanced areas at the end of the ileum. We confirmed that bleeding was responsible for the enhancement of these areas; therefore, we performed laparotomy. Since a hemangioma was recognized on the ileum wall and mesentery, we resected the ileocecal portion. The pathological diagnosis was infantile intestinal hemangioma. She was discharged 10 days after the operation. There have been no signs of recurrence or progressive anemia. Infantile intestinal hemangioma shows rapid proliferation from one week after birth, peaking at 1 year of age. In this case, the intestinal perforation in the neonatal period was consistent with the beginning of the proliferation phase. Bloody stool was recognized in the peak proliferation period. We presume that both events were caused by infantile intestinal hemangioma.

Transverse testicular ectopia (TTE) is a relatively rare disorder in which the unilateral testis is displaced beyond the midline and lodged in the contralateral abdominal cavity, inguinal canal, or scrotum. We report a case of TTE in which a surgical treatment plan was decided on the basis of laparoscopy findings. A 10-month-old boy was diagnosed as having left nonpalpable testis at his one-month-old checkup, and a MRI scan showed one testis in the right scrotum and one in the right inguinal canal. Laparoscopic exploration revealed a widely opened right internal inguinal ring and testes in the right scrotal sac and in the abdominal cavity near the right internal inguinal ring. The spermatic cord of the intraabdominal testis crossed the anterior surface of the bladder from near the left internal inguinal ring. Because a large extent of dissection of the spermatic cord was necessary to descend the left testis from the left internal inguinal ring, the bilateral testes were derived from the right inguinal wound, and the right testis with a longer spermatic cord was fixed in the left scrotum through the scrotal septum. The left testicle was fixed in the right scrotum. Six months after surgery, there was no obvious testicular atrophy or malposition.

Congenital midureteral stricture (CMS) is a rare disease, but a detailed evaluation of the urinary tract is important for planning treatment strategies because about half of CMS patients present with other urinary tract abnormalities. In this report, we describe a case of functional solitary kidney with left polycystic dysplasia and right CMS. The patient developed acute postrenal insufficiency in the neonatal period and underwent surgical treatment in a stepwise fashion. The patient was a boy born at 38 weeks of gestation and diagnosed as having right hydronephrosis and hydroureter while still a fetus. At 7 days of age, the patient developed acute postrenal insufficiency and underwent percutaneous nephrostomy. The right CMS was found by postoperative pyelography, and a ureterocutaneous fistula was formed in the lower abdomen at 38 days of age to avoid problems with nephrostomy management. The patient underwent right vesicoureteral neoanastomosis in the same surgical incision at 9 months of age. In CMS, adequate attention should be paid to the possibility of the rapid deterioration of renal function in the neonatal period. Particularly in the case of a functional solitary kidney, surgical treatment should be planned at an early stage, with a view to long-term prognosis.