Purpose: We experienced treating two cases of intestinal obstruction caused by the accidental ingestion of superabsorbent polymer beads (SAPBs) in 1-year-old children. We conducted two experiments on their size change to understand the characteristics of SAPBs and examine the possibility of conservative treatment for patients who swallowed them accidentally.

Method: Experiment 1: SAPBs were immersed in ten different solutions with pHs ranging from 4 to 13, and six other different solutions, namely, saline, cola, milk, undiluted gastrografin (GGF), triple-diluted GGF, and ionic beverage, and the changes in the size of the SAPBs were measured. Experiment 2: SAPBs sufficiently expanded with tap water were then immersed in six different solutions, namely, undiluted GGF, double-diluted GGF, triple-diluted GGF, saline, milk, and ionic beverage, and the changes in the size of the SAPBs were measured.

Results: Experiment 1: SAPBs expanded faster in the pH 7 solution and cola, and slower in the pH 4 solution and undiluted GGF. Their expansion speed and the maximum size of SAPBs were generally correlated. Experiment 2: SAPBs in undiluted GGF shrank the most, and those in double-diluted GGF shrank as much as those in the other solutions. SAPBs in all solutions reached a trough in size after 12 hours of immersion.

Conclusions: The results of our study suggest that undiluted GGF may effectively prevent or reverse the massive expansion of ingested SAPBs. Although contrast administration for bowel obstruction is controversial and does not necessarily prevent surgeries, our results may help develop a new mitigation strategy that leads to the nonsurgical treatment of cases of intestinal obstruction caused by ingested SAPBs.

Purpose: The umbilicus is used as a common site of entrance into the peritoneum for laparoscopic and gastrointestinal surgery in children, and its anatomically concave and creased structure is expected to make surgical disinfection less effective. We assessed the effectiveness of surgical disinfection of the umbilicus in children.

Methods: This study included 30 children (less than 12 years old) who underwent operations under general anesthesia between July 2020 and February 2021. Operations included inguinal hernia, undescended testis, and other minor surgeries excluding gastrointestinal tract surgery, umbilical hernia, and emergency operations. The patients were divided into three groups: 10 disinfected with 0.5% chlorhexidine gluconate, 10 disinfected with 1.5% lofexidine gluconate, and a control group. After preoperative and antiseptic umbilical preparations, the cup scrub technique was used to collect microbiological samples from the umbilicus.

Results: Staphylococcus epidermidis was detected in 29 of the 30 patients, and Corynebacterium species was detected in 11. There was no significant difference in the number of colonies of all species including S. epidermidis among the three groups. Twenty-six patients had a residual umbilical plaque. No postoperative surgical site infection occurred and no adverse events were observed.

Conclusions: Preoperative and antiseptic skin preparations did not reduce the umbilical microflora. Although umbilical disinfection is necessary in terms of the disinfection of the surgical field, preoperative umbilical preparations are not critical.

A safe approach is required for tumor resection at the thoracic outlet area, where blood vessels, nerves, muscles, and bones are concentrated. The trap-door procedure, also known as the Hemi-clamshell procedure, is reported as such an approach and can also be applied to cases requiring the careful dissection of mediastinal blood vessels. There are limited reports on the use of this technique in children. We present our experience with this technique.

We retrospectively reviewed the medical records of five patients who underwent tumor resection by the trap-door procedure between 2012 and 2023. The median age at surgery was 13 (3–16) years. The trap-door procedure involved an L-shaped incision connecting the cranial partial median sternotomy incision to an intercostal thoracotomy, and the unilateral chest wall was elevated by traction threads to obtain an operative field. Of the five patients, three had tumors in the thoracic outlet (desmoplastic small round cell tumors, neuroblastoma, and mixed germ cell tumor), one required careful dissection from mediastinal vessels (choriocarcinoma), and one required open-heart surgery with simultaneous mediastinal tumor resection and lung lobectomy (BCOR-related sarcoma). In one patient, resection was performed utilizing intraoperative neuromonitoring. All patients underwent complete tumor resection, and no complications, including brachial neuropathy, Horner’s syndrome, and wound infection, were observed, except for transient diaphragmatic paralysis in one patient. The trap-door procedure is a safe approach for tumor resection at the thoracic outlet and in cases where the dissection of the mediastinal vessels is required because of the excellent field of view it provides.

A 1-year-and-3-month-old boy was referred to our department for a detailed examination after an abdominal mass was pointed out when he visited a nearby hospital for the common cold. An ultrasound scan revealed a multilocular cystic mass in the left kidney. Right pneumothorax was suspected on the basis of plain chest X-ray images. A thoracoabdominal Magnetic Resonance Imaging (MRI) revealed a pulmonary cystic tumor and bilateral cystic kidney tumors. The plan was to perform resection for each of the tumors, and right upper lobectomy was performed first. Histopathological examination revealed that pleuropulmonary blastoma (PPB) of type I was most likely a regressed lesion. Two months later, a left nephrectomy and enucleation of the right renal mass were performed, and histopathological examination revealed cystic nephroma. Considering the possibility of DICER1 syndrome, genetic analysis was performed, and on the basis of the results, a diagnosis of DICER1 syndrome was made. When tumors in multiple organs are found, the possibility of DICER1 syndrome should also be considered.

A three-year-old boy was brought to an emergency hospital because of vomiting. His mother noticed that he had bitten off his father’s magnetic necklace. Abdominal X-rays revealed that two foreign bodies, measuring 6 mm in diameter, suspected of being magnets from the necklace, were attached to each other in the upper abdomen. The patient’s general condition was stable, and outpatient follow-up was performed. However, the foreign bodies were not excreted, so the patient was referred to our hospital for endoscopic removal 15 days after ingestion. On the basis of the findings of serial X-rays and computed tomography performed at the previous hospital, gastroduodenal penetration was suspected. Therefore, one day after the referral, we performed upper gastrointestinal endoscopy and laparoscopic surgery. Endoscopy revealed no foreign bodies in the stomach, but an ulcer scar was found on the posterior wall of the antrum of the stomach. On laparoscopy, the posterior wall of the stomach and the ascending part of the duodenum were found to adhere to each other. Two encapsulated magnets were located between the two tracts and were successfully removed laparoscopically. Endoscopy confirmed the absence of fistula formation, allowing the operation to be completed with minimal detachment of adhesions and covering of the omentum. By endoscopy in conjunction with laparoscopy, we were able to reduce the degree of surgical invasiveness.

Neonates presenting with perineal masses are uncommon. In the case of perineal masses, it is difficult to make a diagnosis on the basis of external findings alone, because a variety of diseases can be considered differential diseases. We report a case of perineal mature teratoma in a neonate with a red mucous-membrane-like surface. A 2,438 g female neonate was born at 37 weeks and 4 days without abnormalities on prenatal ultrasonography. She was found to have a multifocal mass in the perianal region after birth and was transferred to our neonatal intensive care unit on the day of birth. The external appearance of the lesion revealed a red mucous-membrane-like surface. A more detailed examination revealed that the mass was localized in the perineal region (between the vagina and the anus). No anorectal malformations were detected as the vaginal, anal, and urethral orifices were confirmed. On the basis of these external findings, rectal prolapse, vaginal polyp, and fetal rhabdomyosarcoma were considered as differential diagnoses. Biopsy results indicated that the mass was a benign tumorous lesion, such as a hamartoma, and not a rectal prolapse. The tumor was resected to confirm the diagnosis. The boundary between the tumor and the surrounding tissues, such as those of the vaginal wall, rectal wall, or anal sphincter muscles, was relatively clear during tumor resection. The mass was dissected completely without injuring the surrounding organs. The tumor was covered with a stratified squamous epithelium and was pathologically diagnosed as a mature teratoma. A mucosal-like appearance may be present in masses arising under the stratified squamous epithelium in the perineal lesion.

Catheter-related bloodstream infection (CRBSI) is one of the serious complications in patients with chronic idiopathic intestinal pseudo-obstruction (CIPO). Moreover, septic pulmonary embolism (SPE) is a very rare complication in patients on home parenteral nutrition (HPN). Herein, we report a case of CIPO with SPE complicated by CRBSI due to Rhodococcus erythropolis, which is a naturally occurring bacterium.

The patient was a 36-year-old woman with CIPO on HPN. She had a one-month history of continued fever and cough of unknown origin. Chest computed tomography showed multiple nodules in both her lungs, and R. erythropolis was isolated from a peripheral blood culture. She was diagnosed as having CRBSI and SPE. She underwent antibiotic therapy for eight weeks, and her blood culture results became negative. However, the patient repeatedly had a fever with positive blood culture results. We replaced the catheter, after which her fever resolved. Moreover, the multiple lung nodules were further reduced in size.

We present the case of a one-day-old girl who was brought to the hospital owing to postnatal symptoms, including mucous-like defecation upon anal stimulation and bilious vomiting six hours after birth. The patient was admitted to our hospital with abdominal distention; plain abdominal X-ray imaging and gastrografin enema revealed intestinal dilatation and microcolon, respectively. Laparotomy was performed via a transverse right upper abdominal incision; this revealed a completely dissected colonic atresia and a microcolon below the splenic flexure in the ascending colon, with no evidence of intestinal atresia elsewhere. Although the difference in caliber was over 1:10, a diamond anastomosis was performed and an umbilical ileal loop ostomy was created as a diverting stoma. The patient was readmitted to the hospital four months after the surgery. After confirming the improvement of the anastomotic caliber difference, the patient underwent stoma closure and umbilical plasty, and the postoperative course was good. Thus, we present a unique case of a successful staged surgery involving the complete dissection of the ascending colon obstruction and umbilical ileostomy. The surgery was safely completed while maintaining a good cosmetic appearance, and the patient had a favorable outcome.