The patient was an 8-year-old girl. She was transferred to our hospital by air ambulance because of a traffic accident. She sat on the left rear seat in the car and was inappropriately secured with only a lap belt. She had seatbelt marks on the lower abdomen, and symptoms of peritoneal irritation were observed. Computed tomography revealed gastrointestinal perforation, and emergency surgery was performed. Laparoscopic examination revealed damage around the cecum, and the procedure was converted to open laparotomy. A cecum rupture was found on the opposite side of the ileocecal valve, and simple suture closure was performed. Although she experienced postoperative ileus, it gradually improved, and she was discharged on postoperative day 9. When treating patients who have been involved in a traffic accident, emergency physicians should understand the mechanism and characteristics of abdominal organ injury caused by a seat belt and consider the possibility of abdominal organ injury. Adults should be aware of the dangers of children wearing seat belts improperly.

More than half of children with IgA vasculitis suffer abdominal pain, and some of them have surgical complications. We present the case of a four-year-old boy with IgA vasculitis. He developed small intestinal intussusception and was admitted to our hospital after failure to treat the condition by hydrostatic methods. His abdominal symptoms improved after open reduction. However, he developed an intestinal perforation while receiving intravenous treatment with prednisolone, and reoperation was performed on postoperative day 10. During treatment for IgA vasculitis, especially with intravenous treatment with prednisolone, it is necessary to be careful of changes in abdominal symptoms and to keep in mind the possibility of intestinal perforation.

Treatment for Graves’ disease in children primarily involves medication, with few cases requiring surgical intervention. We report a case of a 5-year-old girl with Graves’ disease presenting with severe airway stenosis, managed through multidisciplinary collaboration. A 5-year-old girl was diagnosed as having trisomy 21 and cretinism at birth. At the age of 2 years, her condition progressed to Graves’ disease, and she was treated with antithyroid drugs. At 4 years and 5 months of age, she developed stridor, and imaging revealed tracheal narrowing caused by a goiter. She was referred to our department for treatment. The narrowest part of the trachea measured 2.6 mm, indicating severe stenosis and posing a significant risk of intubation difficulty in general anesthesia. After a multidisciplinary conference, it was decided to proceed with surgery under preparation for extracorporeal circulation. Intubation was successfully performed under light sedation, preserving spontaneous breathing, and subtotal thyroidectomy was completed as planned. Severe airway stenosis caused by Graves’ disease in children is rare. This case highlights the necessity of multidisciplinary collaboration for perioperative management in such complex cases.

We report a pediatric case, which developed renal hypertension following the development of a subcapsular renal cyst, not related to urinary extravasation or hematoma, after blunt renal trauma. A 5-year-old boy was brought to a local hospital after falling from playground equipment, hitting his right flank, and subsequently developing hematuria. Imaging examination revealed a renal capsular injury and perirenal hematoma formation at the upper pole of the right kidney, and the patient was diagnosed with grade II renal injury. The patient was treated conservatively in the hospital. During follow-up as an outpatient, progressive enlargement of a subcapsular renal cyst was noted, and he was referred to our department. Initially suspected to be urinary leakage, we punctured the cyst and placed a double-J ureteral stent. The cyst temporarily decreased in size but subsequently enlarged. The patient developed renal hypertension, likely due to compression of the enlarging cyst (i.e., Page kidney). Antihypertensive medication was initiated, and a drainage catheter was placed. The cyst gradually became smaller within three months of drainage. However, even two years after the drainage catheter was removed, antihypertensive therapy was required. This case demonstrates that post-traumatic subcapsular renal cysts can be a cause of renal hypertension. Careful follow-up is required after renal trauma.

A 14-year-old girl was diagnosed as having a tracheoesophageal fistula during long-term tracheostomy management for spinal muscular atrophy type 1, due to recurrent aspiration pneumonia and the difficulty in changing the cannula, and she was transferred to our hospital. Flexible/rigid bronchoscopy and upper gastrointestinal endoscopy revealed a tracheoesophageal fistula extending 4 cm caudally from the tracheostomy site. A cervical approach was used to resect the necrotic tracheal wall, repair the esophageal fistula, and perform a laryngotracheal separation with the infrahyoid muscles interposed to prevent direct contact between the repaired esophagus and the trachea. The postoperative course was uneventful, and the patient was transferred back to the previous hospital on the 16th postoperative day. Benign acquired tracheoesophageal fistula is a rare condition, primarily caused by chronic mechanical compression from tubes or cuffs. It is important to thoroughly evaluate the location, size, and condition of the trachea and esophagus prior to surgery and to consider treatment options tailored to the individual case. This case suggests that laryngotracheal separation surgery may be an effective treatment option.