Purpose: Gastrostomy has become a commonly used procedure for pediatric patients with swallowing difficulty and feeding disorder. The gastrostomy with excessive leakage sometimes requires reconstruction. This study was conducted to investigate related factors and important points to prevent excessive leakage around the gastrostomy in severely mentally and physically handicapped children.

Methods: We conducted a retrospective review of the cases of 218 pediatric patients who underwent gastrostomy between January 2003 and December 2021. Patients who underwent temporary gastrostomy for congenital gastrointestinal disease and those capable of oral intake were excluded from this study. The risk factors were evaluated using clinical archives.

Results: A total of 218 patients were identified. There was no mortality associated with the procedure. Six patients required gastrostomy reconstruction owing to excessive leakage around the gastrostomy after conservative treatment failed. The median interval between the initial gastrostomy and the reconstruction was 76 months (range: 43–158 months). The frequency of excessive leakage around the gastrostomy that required reconstruction was significantly lower in the laparoscope-assisted percutaneous endoscopic gastrostomy (LAPEG) group than in the Stamm gastrostomy group.

Conclusions: Excessive leakage around the gastrostomy is not a common complication but can occasionally become a serious problem in severely mentally and physically handicapped children. LAPEG could be recommended to prevent excessive leakage around the gastrostomy, and it is important to keep paying attention to the condition of the gastrostomy for a long period.

Purpose: In congenital cystic lung disease, pectus excavatum is a common complication not only after but also before surgery. In this retrospective study, we aimed to elucidate the effect of pneumonectomy on patients with pectus excavatum.

Methods: We analyzed the medical records of children who underwent anatomical pulmonary resection in our hospital between July 2008 and June 2021. We reviewed their records for the presence or absence of pectus excavatum, and the preoperative and postoperative thoracic space was measured.

Results: Six patients (three males and three females) were included in the study. There were three patients with congenital pulmonary airway malformation, two with pulmonary sequestration, and one with lung abscess; of these six patients, two had pectus excavatum. For surgery, four patients underwent lobectomy, one patient underwent segmental resection, and one patient underwent pulmonary segmentectomy. In both patients who had pectus excavatum complications, sternum elevation was not conducted at the same time. Although no significant differences in postoperative thoracic cavity deformation were observed, the lateral deviation tended to be small and the craniocaudal deformation tended to be large in patients with pectus excavatum. Postoperative chest CT scans showed mild improvements in the sternum in both patients.

Conclusions: Although compensatory growth of the lung on the unaffected side may be difficult to achieve after lung resection in pectus excavatum patients, the sternum tends to improve after resection. A secondary operation should be considered, especially when the volume of the resected lung is small.

Purpose: In pediatric intussusception, an organic disease may be recognized when repeated intussusception occurs.

Methods: From 2007 to 2022, 18 patients with intussusception who underwent surgery at our hospital’s Pediatric Surgery Department were examined.

Results: (1) Age: 4 months to 11 years; average age, 38 months. Seven patients were younger than 1 year of age. (2) Gender: 12 males and 6 females. (3) Surgical method: 10 patients underwent laparoscopic surgery, 7 underwent open surgery, and 1 underwent transition from laparoscopic surgery to open surgery. (4) Intussusception type: 4 cases of small intestine–small intestine type, 12 cases of small intestine-colon type, and 2 cases without intussusception. (5) Presence or absence of advanced lesions: 10 without and 8 with the lesions; 1 case of Burkitt’s lymphoma, 3 cases of Meckel’s diverticulum, 1 case of Peyer’s patch, 1 case of appendicitis, 1 case of mesenteric lymphadenitis, and 1 case of Peutz–Jeghers polyposis. (6) Recurrent cases of intussusception: 8 patients had repeated recurrences, 6 patients had organic diseases, namely, 2 with Meckel’s diverticula, 1 with Peyer’s patch, 1 with appendicitis, 1 with mesenteric lymphadenitis, and 1 with Peutz–Jeghers polyposis, aged 4 months, 6 months, 8 months, 1 year and 5 months, 3 years, 9 years, and under 5 years of age. In cases of 2 or more repeated recurrences, it seems difficult to say whether pathologically advanced lesions can be diagnosed when there is no intussusception.

Conclusions: When preschool children repeatedly develop intussusception, we believe that staging laparoscopy should be actively performed to investigate the cause.

A boy aged one year and 11 months, who presented with hypoganglionosis and was given parenteral nutrition at home, required prophylactic ethanol lock therapy (pELT) as a regular outpatient because he had recurrent catheter-related bloodstream infection (CRBSI). Four days before his admission, he had no symptoms and a central venous catheter joint wipe culture was carried out. One day before his admission, he had a high fever. He was subjected to outpatient parenteral antimicrobial therapy (OPAT) using ceftriaxone (CTRX) and ELT because Klebsiella was detected in the wipe culture and his treatment was difficult in his home environment. He was intravenously given CTRX at 60 mg/kg body weight and ELT for two hours so that he could be healed in 10 days. When the condition of the patient is stable and the antimicrobial drug to be used is determined, OPAT in a CRBSI patient can become one of the management options.

The main treatment for pediatric Graves’ disease is therapy with antithyroid drugs, and there are only a few cases in which surgery is indicated. Surgical treatment for Graves’ disease can provide a definite therapeutic effect in an early stage even in cases where drug treatment is difficult. Disadvantages such as surgery-related complications, the need for long-term hormone replacement, and the possibility of recurrence should also be considered. In this study, we performed surgery on three patients with Graves’ disease: a 10-year-7-month-old boy who presented with symptoms of airway obstruction due to compression by a goiter during drug therapy, a 12-year-8-month-old girl who was unable to continue drug therapy due to severe side effects of an antithyroid drug, and a 16-year-7-month-old girl with a giant goiter. There were no postoperative complications or recurrence in any of these patients.

We report the case of a three-month-old boy who underwent pulmonary artery banding at 24 days of age and cardiac catheterization at 61 days of age for ventricular septal defect, after which, he had repeated CRP level elevations. A contrast-enhanced CT scan showed partial wall thickening of the ascending colon, and a gastrointestinal contrast study suggested intestinal malrotation and ascending colon stenosis; thus, we performed laparotomy at 100 days of age. Intraoperatively, wall redness and thickening in the ascending colon were observed, in which severe stenosis was revealed by colonoscopy; thus, we additionally performed partial colon resection. Postoperatively, CRP became negative and never elevated. A histopathological examination revealed severe inflammation, ulceration, and ischemic changes in the stenotic area, suggesting that the colon stenosis was caused by chronic ischemia. We found that 14 of the 17 reported cases of infantile colon stenosis with ischemia that was not caused by necrotizing enterocolitis occurred after cardiovascular events such as cardiac surgery or cardiac resuscitation. Although the causal relationship is unclear, since the symptoms in this case became apparent after cardiac surgery and catheterization, it is also possible that these events were related in some way to intestinal ischemia.

Fallopian tube torsion with an adolescent onset is rare, and the lack of specific findings hampers a preoperative diagnosis. We experienced treating a case of fallopian tube torsion at puberty whose definitive diagnosis took a long time. [Case] A 13-year-old girl presented to the emergency clinic with a chief complaint of left lower abdominal pain that had begun one week before this visit. She was diagnosed with acute enteritis and kept under observation. However, she continued to have abdominal pain, and her pediatrician suspected that she had appendicitis with an abscess. Despite treatment with antimicrobial agents, her symptoms did not improve, so she was referred to our department with a suspicion of acute abdomen. Enhanced computed tomography (CT) showed a 4-cm cystic lesion in the pelvic cavity. Diagnostic laparoscopy was performed under suspicion of ovarian torsion or adnexal torsion. A dark-red twisted left fallopian tube was seen on the dorsal side of the uterus. Untwisting the tube laparoscopically proved difficult, so laparotomy of the lower abdomen was performed. The fallopian tube had a torsion of 1,440°, and it remained dark red even after the torsion had been released. Her left ovary was normal. Preservation of the fallopian tubes was impossible, and tubectomy was performed. [Conclusion] Many cases of tubal torsion are difficult to diagnose and ultimately result in tubal resection. An early diagnosis is important for preserving the fallopian tubes.

The percutaneous endoscopic gastrostomy catheter with jejunal extension (PEG-J catheter) is available in small sizes. However, there are no established standards for these sizes and their indications for use in small children. We herein report a complication of penetration from the duodenum to the colon in a 1-year-old, 7.3-kg infant with a 16Fr 400-mm PEG-J catheter placed via a gastrostomy. Two months after placement, the distal end of the catheter prolapsed through the anus. A contrast-enhanced computed tomography revealed the penetration of the duodenum and the colon by the catheter. The penetration was diagnosed as being caused by the continuous compression of the duodenal wall at the horizontal portion of the duodenum by the end of the catheter from the time of placement. After the nonsurgical removal of the catheter followed by medical treatment for two weeks, a gastrointestinal examination confirmed that the fistula was functionally closed. Indications for the size of the PEG-J catheter to be placed in small children should be carefully discussed on the basis of the patient’s body size and device specifications. Tube enterostomy should also be considered, particularly in children weighing less than 10 kg, and close monitoring is necessary to detect intestinal perforation. In addition, stabilized fistulas can be expected to close functionally without surgical intervention.

A 9-year-old boy complaining of back pain was referred to our hospital. An abdominal CT examination revealed a low-contrast-enhancement tumor (20 mm in diameter) with small calcification in the lower pole of the left kidney. First, we performed a left lower hemi-nephrectomy. A rapid pathological examination revealed renal cell carcinoma. Although no obvious tumor exposure was observed at the resection margin, a left total nephrectomy was then carried out owing to an insufficient margin from the tumor to the renal hilum. The pathological diagnosis was papillary renal cell carcinoma with metanephric adenofibroma. BRAF V600E mutation was identified in the tumor by genetic analysis. The tumor was classified as stage I, and no further treatment was performed. No recurrence was observed during the follow-up period of six months. Pediatric renal cell carcinoma associated with the BRAF mutation is extremely rare, but this gene mutation is frequently detected in metanephric tumors. Therefore, this carcinoma might be divided from metanephric tumors. A case of pediatric renal cell carcinoma associated with the BRAF mutation was reviewed with some published reports.

The patient was an 18-year-old boy who underwent Nissen’s fundoplication and gastrostomy at the age of 12 owing to difficulty in swallowing due to cerebral palsy and epilepsy. He underwent emergency hospitalization due to ileus. Because of his severe scoliosis, the small intestine had developed an internal herniation in the space between the right costal arch, the right ilium, and the gastrostomy, resulting in intestinal necrosis. After that, the bowel obstruction was repeated. We considered that the position of the gastrostomy was the cause of the repeated bowel obstruction, so we repositioned the gastrostomy. Owing to his severe scoliosis, simple repositioning of the gastrostomy was difficult, so a Hunt–Lawrence pouch was formed and a replacement gastrostomy was constructed in the jejunum pouch to reconstruct the gastrostomy. Alternative gastrostomy using a Hunt–Lawrence pouch can be an option for patients who have difficulty with gastrostomy repositioning due to scoliosis or who have gastrostomy complications.