Purpose: Video-assisted thoracic surgery for spontaneous pneumothorax is widely recognized as one of the standard treatment options. However, there have been few pediatric reports, and its use and indications for nonsurgical treatments (NSTs: drainage or observation) have yet to be established. In this paper, we retrospectively summarize the treatment results of spontaneous pneumothorax at our hospital and verify the treatment policy.

Methods: Medical charts of pneumothorax patients aged two years and older treated at our hospital from 2003 to 2020 were retrospectively reviewed. The patients’ demographics, results of imaging studies, treatments, and outcomes were extracted.

Results: Eighty-seven episodes of pneumothorax in 46 patients were observed. Surgery was performed in 33 episodes (38%) of 21 patients (46%). Recurrence was observed in 9 of 33 episodes (27%) after the surgery and 20 of 54 episodes (37%) after NSTs. Both treatments had a high recurrence rate. The treatments for the first episodes were surgeries for 22 episodes and NSTs for 36 episodes. Of the 36 episodes treated by NSTs, 29 (81%) did not require any surgery during the study period. There was no significant relationship between CT findings and recurrences.

Conclusions: Pediatric surgeons should be aware that their pneumothorax patients tend to have a high recurrence rate of episodes, and more than half of them could be improved by NSTs alone. Thus, NSTs should be given more consideration, and adhesion-inducing procedures should be avoided.

Purpose: In the case of gastrointestinal perforation in ELBWIs in our department, we examined the evaluation of the entire preoperative physical condition and treatment policy with regard to the life prognosis and psychiatric and neurological prognoses of surviving infants.

Methods: In the cases of gastrointestinal perforation in ELBWIs treated in our department, gestational age, birth weight, age at surgery, surgical weight, presence or absence of preoperative renal artery diastolic blood disruption, presence or absence of preoperative DIC, and so forth were compared between surviving and dead infants. In addition, postoperative enteral nutrition and postoperative PN in the presence or absence of psychiatric and neurological abnormalities in surviving infants were examined.

Results: Age at surgery, gestational age, birth weight, and surgical weight tended to be low in infants who died, in whom marked renal artery diastolic blood flow disruption and DIC were observed before surgery. Regarding psychiatric and neurological abnormalities, postoperative enteral nutrition started significantly earlier in normal-weight infants. In addition, although no significant difference was observed between the ELBWIs and normal-weight infants, the end time of postoperative PN was terminated early in normal cases.

Conclusions: Although the number of cases is small and further studies are needed in the future, the findings of this study suggest that the presence or absence of renal artery diastolic blood flow disruption and DIC may be effective indicators in preoperative systemic condition assessment. As for the surgical formula, the superiority of enterostomy was suggested because enteral nutrition can be established at an early stage.

Purpose: To analyze the appropriate bed rest period and examination schedule determined according to the classification of organ injury by the Japanese Association of the Surgery of Trauma, applied to the children with traumatic splenic injury treated with NOM.

Methods: There were 11 children under 16 years old, diagnosed traumatic splenic injury from 2010 to 2019. All the children were hemodynamically stable and managed non-operatively in our hospital. We retrospectively analyzed the clinical findings, including the mechanisms of trauma, the classification of trauma, combined injuries, the number of CTs, the necessity of blood transfusion, the presence of delayed splenic rupture and pseudoaneurysms, the necessity of surgery or TAE, the duration of bed rest, the duration of hospitalization and outcomes, of these children.

Results: The mechanisms of trauma included fall, sports and traffic accident. The grade IIIb was most common. The number of contrast-enhanced CTs during hospitalization ranged 3 to 7 times. The median period of bedrests was 16 days ranging 14 to 21 days. The median period of hospitalization was 25 days ranging 21 to 43 days. There were no cases having delayed splenic rupture or pseudoaneurysms and no cases requiring blood transfusion, TAE or surgery. All the cases discharged alive.

Conclusion: The results of the NOM with the bed rest management and examination schedule performed in our hospital were good.

A 28-eight-year-old female had a history of Ladd surgery for malrotation during her neonatal period and two surgeries for adhesive ileus until the age of two years. At the age of 28, she was diagnosed as having duodenal obstruction during a medical checkup at her workplace and was referred to our hospital for a thorough examination. Contrast-enhanced Computed Tomography showed marked gastric and duodenal dilatation, and the upper gastrointestinal series failed to confirm the progression of the contrast medium from the duodenal bulb in a short period of time. Upper gastrointestinal endoscopy showed a blind end at the distal end of the duodenum with no endoscopic evidence of migration. On the basis of the above, we suspected duodenal stenosis due to postoperative adhesion and decided to perform surgery. When the abdomen was opened, a nonrotational type of malrotation was observed. After the adhesion was released, an attempt was made to advance the nasoduodenal tube from the bulb for the purpose of decompression, but this was unsuccessful. Suspecting a membranous obstruction at this point, the descending duodenal leg wall was incised, and a Windsock-type membranous stenosis with a pinhole in the center was confirmed. Since it was difficult to confirm the duodenal papilla, a bypass with lateral anastomosis of the duodenum–upper jejunum was performed. However, postoperatively, the patient developed a passage obstruction owing to adhesion after the bypass, requiring reoperation, dissection of the duodenal upper jejunal bypass, and resection of the duodenal web. Two years after surgery, Symptoms have not flared up and she is back to work in good health.

We experienced treating a very rare case of extralobar pulmonary sequestration (hereinafter referred to as “this disease”) in a male infant. Preoperatively, he was diagnosed as having extralobar pulmonary sequestration under the diaphragm, and mass removal was performed laparoscopically, but intraoperative findings revealed that the mass was intradiaphragmatic. In this disease, the diagnosis of extralobar pulmonary sequestration is relatively easy if feeding arteries branching from the large circulatory system flowing into the mass can be identified, but its location is not always easy to determine preoperatively. When a mass is located in an unusual place, it is often diagnosed as being close to the diaphragm, such as on or below the diaphragm. Surgical removal is the first choice of treatment owing to the risk of infection and malignancy. Endoscopic surgery is recommended because it is minimally invasive and it has a good field of view. However, the translapse or transthoracic surgical approach may be wrongly selected owing to the difficulty of preoperative location diagnosis. Therefore, in the case of masses close to the diaphragm, it is important to strive for accurate location diagnosis with this disease in mind and to plan surgery with a view to changing the approach during surgery.

Anterior cutaneous nerve strangulation syndrome (ACNES) is a disorder in which the anterior cutaneous branch of the intercostal nerve is injured in the anterior sheath of the rectus abdominis muscle, causing pain at the outer edge of the rectus abdominis muscle. Moreover, it may also include pain arising from other cutaneous nerves throughout the abdominal wall. In this study, we report two atypical cases of ACNES treated surgically. In case 1, a 12-year-old girl complained of chronic abdominal wall pain in the right inguinal region. In case 2, a 15-year-old boy complained of left-sided abdominal pain. Conservative treatment was temporarily effective, and surgery was performed 8 months and 2 years and 4 months after the onset in cases 1 and 2, respectively. In case 1, the inguinal canal was opened and the ilioinguinal nerve was identified for neurectomy. In case 2, a preoperative trigger point injection with indigo carmine dye was used to identify and resect the iliohypogastric nerve behind the transversus abdominis tendon membrane. In both cases, symptoms resolved after surgery. Neurectomy may be effective in atypical ACNES patients who do not respond to conservative treatment, and a treatment strategy needs to be established.

In a 6-month-old boy who presented with cough and fever, an elevation of the right diaphragm was recognized following a chest X-ray. Chest computed tomography demonstrated a herniation of the right liver lobe into the thoracic cavity. Therefore, he was diagnosed as having congenital diaphragmatic hernia (CDH), and thoracoscopic repair of the hernia was performed. A huge hernia sac obstructed the field of view. The hernia sac slid on the right liver lobe, so we judged that there was no adhesion. Thus, the hernia sac was resected using a surgical stapling device, which improved the visibility of the thoracic cavity, and the normal diaphragmatic rim was clearly recognized. The muscle part of the diaphragm was easily sutured linearly. He was discharged on postoperative day 6 without any surgical complications. There were no recurrent signs as of 36 months postoperatively. The resection of a huge hernia sac that interrupts the field of view may be useful for surgery with the restriction of a small working space. We need clear patient criteria and more observations for long-term complications.

We present a rare case of a 1-year-old girl with an omphalomesenteric cyst forming a pseudocyst. She presented with a supraumbilical swelling that increased gradually. Computed tomography and echography revealed an abdominal wall cyst (4 cm in diameter) with a polypoid lesion (1 cm in diameter) in the bottom of the cyst, suggesting an omphalomesenteric cyst in the abdominal wall. When the cyst was surgically removed, the wall of the cyst was found to have strongly adhered, and the border was unclear. The amylase level of the fluid in the cyst was elevated (12,362 IU/ l). Histopathological examination showed that the cyst wall consisted of fibrous, muscular, and adipose tissues, and the polyp in the cyst consisted of intestinal mucosa and pancreas tissue. The definitive diagnosis was an omphalomesenteric cyst in the abdominal wall forming a pseudocyst. Her postoperative course was uneventful, and no recurrence was noted two years after the operation.

Fistulectomy is a radical treatment for pyriform sinus fistula (PSF), which is prone to recurrence depending on the condition of the fistulous tract. Conventional chemocauterization was developed as a treatment option for PSF, but it could obliterate only the internal orifice of PSF, leaving the entire fistulous duct unobliterated. A distal hood endoscope was devised as a treatment option for PSF. A child received chemocauterization using a distal hood endoscope for the treatment of PSF. The operation was completed after confirming that the fistulous tract was influenced by trichloroacetic acid. Postoperatively, the closure of the internal orifice of PSF was confirmed by endoscopy and esophagography, and the shrinkage of the fistulous duct was visualized by ultrasound. The only complication was a transient sore throat. This novel method is more curative than conventional chemocauterization and may be a good treatment option for PSF.

A two-month-old boy, who was prenatally noted as having congenital heart defects and a right supradiaphragmatic mass, was diagnosed after birth as having double outlet right ventricle (DORV) with pulmonary atresia. The supradiaphragmatic mass was unlikely to be malignant on the basis of ultrasonographic findings and tumor markers, and it was initially planned that he undergoes elective surgery. Enhanced computed tomography at one month of age showed an inflow of an aberrant artery from the abdominal aorta into the mass and a prolapse of the right kidney and adrenal gland into the right thoracic cavity. He was diagnosed as having right pulmonary sequestration and right-sided late-presenting congenital diaphragmatic hernia (CDH). Lung surgery and CDH repair were to precede heart surgery because increased pulmonary blood flow and vascular bed development were essential for cardiovascular surgery for DORV. At two months of age, thoracoscopic resection for pulmonary sequestration and diaphragmatic plication were concomitantly performed without complications. There is a controversy over the indication and timing of surgery for pulmonary sequestration, and surgery for late-onset CDH is considered to be elective. The case accompanied by complex cardiac anomaly should be given special consideration, and early definitive surgery is a possible option.

Beckwith–Wiedemann syndrome (BWS) is a congenital disorder with a variety of symptoms such as umbilical hernia, giant tongue, hemihypertrophy, and neonatal hypoglycemia. One of the characteristics of BWS is a tendency to develop fetal malignant tumors such as hepatoblastoma and nephroblastoma. We have experienced a case of hepatoblastoma in infancy followed by fibroadenoma (FA) of the breast during adolescence. When following children with BWS, the possibility of FA as well as malignant tumors should be kept in mind.

We herein report the long-term prognosis of four patients more than 10 years after gastric transposition (GT) for long-gap esophageal atresia (EA) from the perspective of gastrointestinal, respiratory, and cardiovascular findings as well as nutrition and growth. The types of EA were type C in two patients, type A in one patient, and type B in one patient. All of them underwent GT within five months of age. Of the four patients, three still have problems with swallowing, and two still have issues with food intake. All the patients had chronic gastritis, but none of them had esophagogastric reflux. Respiratory physiology showed a decreased vital capacity in two patients, but no abnormalities in cardiac function were observed. In terms of nutrition and growth, the height and weight were below standard in all the patients, but their quality of life was good. After GT, problems with the digestive system, respiratory system, and growth remained, but the patients were able to adapt to their conditions and lead good lives. However, new problems may emerge in the future, so careful follow-up is necessary.

Encapsulating peritoneal sclerosis (EPS) is characterized by diffuse peritoneal fibrosis, progressive intestinal encapsulation, and the clinical spectrum of intestinal obstruction. Although it is a complication of peritoneal dialysis, secondary EPS with other causes is very rare. We herein report a case of EPS secondary to adjuvant chemoradiotherapy for rhabdomyosarcoma in a 21-year-old male. Partial bladder resection and an omentectomy for stage IV rhabdomyosarcoma of the bladder with intra-abdominal bleeding were performed when he was 19 years old. He was transferred to our hospital for adjuvant chemoradiotherapy with a modified ARST0431 protocol (Children’s Oncology Group study). He developed a small bowel obstruction after 12 months of chemotherapy and 6 months of radiotherapy. Conservative treatment did not relieve the symptoms and a diagnostic laparotomy was performed. The laparotomy revealed severe adhesion between the thickened whitish peritoneum and intestines. The entire small intestine was similarly covered with a thickened, white-toned coating. We attempted to dissect the thickened coating but discontinued because the procedure easily damaged the serosa of the small intestine. We resected the ileum at the region where the adhesion and bend were too severe to dissect. The diagnosis of EPS was based on pathological findings of thickened submesothelial tissues and clinical course. Six years postoperatively, there was no recurrence of either small bowel obstruction or the tumor.