Purpose: Early inguinal hernia repair for preterm infants can prevent complications related to incarceration, but may increase technical and respiratory complications. Thus, the optimal timing for repair in preterm infants remains debatable. We aimed to clarify the safety and validity of repair before discharge from the neonatal intensive care unit (NICU).

Methods: From 2009 to 2022, 21 preterm patients whose inguinal hernia was repaired before discharge were studied as the NICU group, and 32 outpatients whose inguinal was diagnosed early but repaired at two months of age were studied as the control group. We collected both clinical data and compared outcomes statistically.

Results: In the NICU group, 15 (71%) of the 21 patients were male, and 10 had bilateral repair, a mean birth weight of 1,330 g, and a mean weight at surgery of 2,860 g. None of the mean unilateral, bilateral, and total operating times had significant differences between both groups (unilateral, 18.0 vs 17.7 min, p = 0.750; bilateral, 38.8 vs 35.4 min, p = 0.432; total, 27.9 vs 21.6 min, p = 0.051). In the NICU group, there was only one postoperative complication, namely, transient desaturation, and no recurrence during the median follow-up period of 42 months. The metachronous contralateral inguinal hernia was found in one patient in the NICU group and four patients in the control group.

Conclusions: Early repair in preterm infants before discharge from NICU is appropriate. To reduce postoperative complications, surgeons and pediatricians should adequately assess the patients’ clinical states.

The accidental ingestion of superabsorbent resin material products may have a different symptom course from that of general foreign bodies in the gastrointestinal tract, and there have been some reports on this in recent years. The patient was a 15-year-11-month-old girl, who was under observation due to psychomotor retardation. Vomiting symptoms appeared 12 days earlier, which gradually worsened, and an imaging examination led to the diagnosis of intestinal obstruction due to a foreign body in the small intestine, which was removed by emergency laparotomy. The usual form of a foreign body was a toy that was about half the size after expansion, and it increased in size by absorbing water from the solution in the digestive tract, becoming immobilized in the small intestine, and causing intestinal obstruction. Superabsorbent resin material products are characterized by being more likely to expand in the intestines, and they can be positioned as a new type of foreign substance, in addition to button batteries and multiple magnets that cause adverse events if accidentally ingested, and it is necessary to pay attention to them.

Lipoblastoma of the scrotum is rare in children. It represents one of several differential diagnoses of scrotal mass, which include malignant tumors. We present a case of intrascrotal lipoblastoma in a child and describe its surgical management. A seven-year-old boy presented with an asymptomatic and palpable mass on the left side of the scrotum for one month. Physical examination revealed an oval mass, distinct from the left testis, measuring approximately 3.0 × 1.5 × 2.0 cm. Ultrasonography demonstrated a heterogeneous and hyperechoic mass with minimal peripheral vascularity in the superior part of the left scrotal cavity. T1- and T2-weighted MRI revealed a mass containing a mixture of hyper- and hypointensities, which was indicative of intrascrotal lipoblastoma. The levels of testis tumor markers were within the normal range. Chest radiography and abdominal CT indicated no metastasis. The mass was approached via a left scrotal incision. A well-encapsulated, soft, round, and yellow mass arising from the lipomatous tissue was free from the ipsilateral testis and spermatic cord. The mass was excised en bloc with the surrounding uninvolved vessels while preserving the normal testis and epididymis. The surgically resected specimen consisted of a nodular mass surrounded by a capsule composed of loose connective tissue. Histopathological examinations confirmed the diagnosis of a lipoblastoma. The patient has been followed up for two years with no sign of recurrence.

A two-day-old girl was transferred to our hospital because of worsening nonbilious vomiting after birth. Abdominal X-ray showed massive free air in the abdominal cavity. Furthermore, abdominal ultrasonography revealed opacified ascites at Morrison’s pouch and a target sign at the right lower abdomen. As these findings suggested gastrointestinal perforation, owing to intussusception, an emergent surgery was performed. The inverted Meckel’s diverticulum was identified, and its oral side was perforated. Resection and end-to-end anastomosis were performed at the same time. After surgery, the patient had an uneventful course and was discharged at 17 days of age. Pathologically, no ectopic gastric mucosa or ulceration was observed at Meckel’s diverticulum. On top of the small-bowel-stenosis-induced inverted Meckel’s diverticulum, an increase in the intestinal pressure due to oral intake seemed to result in the perforation. There were no necrotic lesions around the perforation site, so one-stage anastomosis was possible.

We experienced treating a case of intralobar pulmonary sequestration with two aberrant arteries, both of which branched from the descending thoracic aorta into the sequestered lobe. Histopathologically, each artery ran through its territory and each drained into the inferior pulmonary vein and hemiazygos vein. We assumed that the two arteries have different embryological origins. We reviewed Japanese case reports of pulmonary sequestration with multiple aberrant arteries and venous drainages, and we then discussed the pathogenesis of this case in terms of embryological theories about accessory lung buds and the development of pulmonary arteries and bronchial arteries in this article. The two aberrant arteries presumably originate from a pulmonary artery and a bronchial artery of an accessory lung bud.

Pediatric adrenocortical carcinoma is a rare malignancy. We report a case of adrenocortical carcinoma of the adrenal cortex in a child who presented with acute abdomen and was diagnosed with signs of masculinization. The patient was a 7-year-old girl. She was transferred to our department after a contrast-enhanced CT scan of the abdomen revealed an 11 cm mass in the right retroperitoneum. She had tenderness in the right upper abdomen, palpable elastic induration under the right hypochondrium, and signs of masculinization such as adolescent male-like body odor, acne, and enlarged genitalia. We suspected adrenocortical carcinoma and performed a blood endocrine examination, which revealed a markedly high blood DHEA-S level of 24,680 ng/ml. We performed a right adrenal tumor resection, and histopathological analysis revealed adrenocortical carcinoma. Postoperatively, she received chemotherapy including mitotane. She has been under observation for 1 year and 4 months without recurrence. Pediatric adrenocortical carcinoma is often a functional tumor, and retroperitoneal tumors that present with characteristic symptoms such as masculinizing signs should be diagnosed and treated with this syndrome in mind.

We treated infant congenital duodenal web with malrotation by endoscopic treatment. A three-year-old child presented with repeated vomiting. Blood tests indicated pancreatitis. Computed tomography showed a mass in the duodenum, and an upper gastrointestinal (UGI) series suggested duodenal obstruction. An emergency laparotomy revealed no ligament of Treitz. Under a diagnosis of malrotation of intestine, we undertook Ladd’s operation. Six days later, the UGI series showed contrast stagnation and a double wall in the duodenum. An endoscopic examination revealed a windsock-type web in the duodenum distal to the papilla of Vatter. We cut the membrane using a flush knife. She has been well for two and a half years after the endoscopic surgery.

An 8-year-old boy was treated for hemolytic uremic syndrome (HUS) with intravenous fluids and transfusions. He started oral intake 13 days after the onset of HUS, but 19 days after the onset of HUS, he developed abdominal pain and vomited. A blood test revealed elevated levels of liver enzymes with conjugated hyperbilirubinemia. An abdominal ultrasound demonstrated vesicular sludge. Although fasting and ursodeoxycholic acid relieved him of colic attacks, similar attacks occurred three times whenever oral feeding was attempted. An operation was planned because conservative therapy was considered ineffective. During the waiting period for the operation, fever, right epigastric pain, and vomiting occurred. The blood test showed leukocytosis and CT showed thickening of the gallbladder wall. He was diagnosed as having acute cholecystitis and underwent cholecystectomy. A large amount of highly viscous sludge was found inside the gallbladder, but no stones were found. His postoperative course was uneventful, and he was discharged on the fifth postoperative day. Since the accumulation of gallbladder sludge after HUS is a transient event that can be resolved by conservative therapy, cholecystectomy is rarely used as a treatment option. However, long-term conservative therapy may result in prolonged illness and adhesion during surgery; therefore, early cholecystectomy is recommended.