Purpose: Ovarian torsion, a condition requiring surgical intervention because it causes acute abdomen, is often treated by pediatric surgeons. Although ovarian preservation is the preferred approach, many institutions still opt for oophorectomy in cases of ovarian torsion. In this study, we retrospectively examined ovarian surgeries at our institution to assess the potential for ovarian preservation in cases of ovarian torsion.

Methods: We retrospectively reviewed 68 cases of ovarian surgery in patients under 20 years old between 2002 and March 2021, excluding seven neonates. The patients were categorized into those with ovarian torsion (T+ group) and those without torsion (T− group).

Results: Seventy-four surgeries were performed on 68 patients (T+ 30, T− 44). Emergency surgeries for suspected torsion were conducted in 31 patients (T+ 23, T− 8), whereas seven non-emergent cases were also identified in the T+ group. In the T+ group, one patient had detorsion, none of the patients had oophoropexy, 14 had enucleation, and none of the patients underwent two-step ovarian preservation surgery. Fifteen patients in the T+ group who underwent oophorectomy included nine with benign tumors without complete necrosis, suggesting the potential for ovarian preservation. In the T− group, oophorectomy was performed on nine patients, including three with benign tumors, although all of which were suspected to be malignant,

Conclusion: In ovarian torsion cases where malignancy cannot be ruled out preoperatively, a strategy prioritizing ovarian preservation, including two-step surgery, can increase the number of cases where preservation is possible.

We experienced treating a case of neonatal milk allergy presenting with haematemesis, shock, and hepatic portal venous gasemia. The patient was an 8-day-old male infant, born at 39 weeks and 4 days of gestation, weighing 3,020 g. He vomited on day 1 of life and passed a small amount of fresh blood in his stool on day 3. He was observed by a local physician but presented to his previous doctor on day 8 with poor feeding, somnolence, frequent vomiting, and red-brown watery stools. Haematemesis, portal vein gas on plain abdominal radiographs, and intestinal dilatation on contrast-enhanced CT raised suspicion of strangulated bowel obstruction, prompting his transfer to our hospital for emergency surgery. However, ultrasonography and contrast-enhanced CT revealed generalized thickening of the intestinal wall without signs of obstruction or necrosis. On the basis of these findings, milk allergy was suspected, and conservative treatment was initiated. The patient’s symptoms rapidly improved, and allergen-specific lymphocyte stimulation tests showed strong positivity for κ-casein, β-casein, and lactoferrin, confirming the diagnosis of milk allergy. This case highlights the importance of thoroughly evaluating abdominal findings and imaging studies to establish a differential diagnosis, including milk allergy, even in the presence of shock and hepatic portal venous gasemia.

In this article, we present a case of giant lymphatic malformation of the liver, which was successfully resected with no recurrence. A boy aged 1 year and three months presented with a complaint of abdominal distension. A diagnosis of abdominal lymphatic malformation was made on the basis of magnetic resonance imaging and ultrasonography findings. Three weeks later, he was admitted with progressive abdominal distension and vomiting, which caused respiratory failure. Ultrasound-guided drainage was performed in the intensive care unit, resulting in an improvement in his condition, and he was discharged in a week. However, he was readmitted three days after discharge owing to the recurrence of symptoms, which indicated the necessity of more advanced treatment. During laparotomy, we resected the mass arising from the visceral surface of the left lobe of the liver, extending into the abdominal cavity. The histopathological diagnosis was hepatic lymphatic malformation. Currently, he is symptom-free with no evidence of recurrence. Lymphatic malformation of the liver is rare. Although guidelines do not specify a certain strategy, this case suggests that surgical resection is effective for the lymphatic malformation of the liver.

In this report, we present the case of a neonate who was prenatally diagnosed with a congenital hiatal hernia and who underwent laparoscopic surgery in the neonatal period, despite being asymptomatic. A fetus at a gestational age of 37 weeks was referred to our department because of an intrathoracic cystic lesion. Fetal ultrasonography and MRI revealed a congenital hiatal hernia. At 37 weeks and 6 days of gestational age, the fetus weighing 2,441 g was delivered via cesarean section owing to fetal distress, and the Apgar scores at 1 and 5 min after birth were 8 and 9, respectively. An upper gastrointestinal tract contrast examination revealed a hiatal hernia with complete herniation of the stomach without a short esophagus. The neonate underwent laparoscopic repair and Boerema–Filler fundoplication at 18 days of age. Feeding was initiated 34 days after the surgery for dysphagia associated with laryngomalacia, and the neonate was discharged 76 days after the operation. A year after the surgery, the infant fed normally without vomiting, and no evidence of hernia recurrence was observed. Prenatally diagnosed congenital hiatal hernia is rare; however, laparoscopic surgery can be performed safely during the neonatal period with careful perinatal management.

The patient was a 17-year-old female. Two and a half months after undergoing surgery by the Nuss procedure for pectus excavatum, she suddenly experienced dyspnea that gradually worsened over time. She was diagnosed as having bilateral pneumothorax on chest radiography and thus was brought to our hospital as an emergency case. When the patient came to our hospital, increased respiratory frequency, orthopnea, and decreased oxygen saturation in the supine position were observed, thus indicating the onset of tension pneumothorax. A chest computed tomography (CT) scan revealed a bulla in the right upper lobe and the presence of several other suspicious lesions. Conservative treatment failed to improve her condition, and a thoracoscopic right pulmonary brachythectomy was performed on the 17th day of hospitalization. There were no obvious bulla lesions other than those in the right upper lobe. The patient was discharged from the hospital on the fifth postoperative day and is currently observed as an outpatient for one year and five months after surgery. Patients presenting with bilateral spontaneous pneumothorax are at risk of developing tension pneumothorax, which requires both hospitalization and prompt treatment. Drainage is often unsuccessful, and early surgical intervention should therefore be considered.

As medical technology advances, the indications for surgical airways have become more diverse. Cricotracheostomy is a new surgical technique that allows the shortest route to the airway and creates a tracheostomy at a high cervical position. Case 1 was an 11-year-old male with congenital myotonic dystrophy, and case 2 was a 16-year-old male with hypoxic encephalopathy. In cases 1 and 2, extubation was difficult after pneumonia, and a surgical airway was considered. However, because there was a high risk of a tracheo-innominate artery fistula (TIF), cricotracheostomy was performed. Case 3 was a 39-year-old woman with osteogenesis imperfecta. Extubation was difficult after an asthma attack, and a surgical airway was considered. However, because of the extremely short neck and low larynx, cricotracheostomy was performed. None of the three patients experienced any adverse events during or after surgery, and they have been speaking or having oral intake the same as before. It is believed that cricotracheostomy should be indicated in cases of high-risk TIF or short neck and low larynx in pediatric surgery.

The patient was a 14-year-old male. At 2 weeks of age, he went into shock after the first formula feeding and was rushed to the hospital. A laparotomy performed after resuscitation revealed massive necrosis of the small intestine, resulting in short bowel syndrome with 38 cm of the small intestine remaining, and a histopathological examination revealed small-intestine-type Hirschsprung’s disease. At 4 months of age, a right colon patch was performed by the Kimura method; however, he could not be weaned from parenteral nutrition via a central venous catheter (CVC). Owing to the malabsorption of nutrients by the short intestine, home parenteral nutrition was continued, and the CVC was replaced 11 times in 9 years because of infection and other reasons, and it became difficult to manage skin problems on the chest wall where a subcutaneous tunnel was created. A subcutaneous tunnel was placed in the upper arm based on the indwelling CV port in the upper arm. The technique was similar to PICC and CV port placement, and the subcutaneous tunnel could be placed without any trouble. It has been well received by families as it allows the skin on the chest wall to rest and allows easy management of the upper arm. In cases where it is difficult to create a subcutaneous tunnel in the chest wall, an indwelling Broviac^® catheter in the upper arm was considered an option for older children or patients with severe mental and physical disabilities.

Only a few detailed reports exist on the treatment course for large sacral yolk sac tumors (YST) with metastases. In this report, we present the case of a young girl with sacral YST and multiple metastases who achieved remission through a multidisciplinary approach without significant complications. The patient was a 1-year-and-7-month-old girl diagnosed with a large sacral YST (Altman type III) with metastases to the lymph nodes, lungs, and liver. Preoperative BEP chemotherapy successfully reduced the tumor size, allowing for surgical intervention. Abdominal exploration and lymph node biopsy were conducted laparoscopically, and the tumor was excised from the buttocks to the tailbone. No significant postoperative complications were observed. Postoperative chemotherapy eliminated the pulmonary metastases, while the liver metastases showed residual shadows but no signs of activity. The patient was discharged on postoperative day 109. At approximately 11 months after completing treatment, there was no evidence of recurrence. This case underscores the importance of combining effective chemotherapy with tailored surgical strategies to achieve complete tumor resection, a key prognostic factor in the management of large sacral YSTs.