Purpose: The work styles of pediatric surgeons in Japan are expected to considerably change because of work style reforms. In this study, we aimed to examine their current working conditions.

Methods: A questionnaire survey was administered to members of the Japan Society of Pediatric Surgeons Under-45 Working Group to assess their working conditions before implementing the work style reforms.

Results: Overall, 31 responses were obtained (response rate: 49%). Among the respondents, 55% were in their 30s, and 45% were in their 40s. In terms of overtime, 57% of respondents reported working more than 45 hours, and 21% reported working more than 90 hours per month. Additionally, 36% of respondents experienced health problems owing to overwork. Dissatisfaction with compensation relative to working hours was reported by 64% of respondents. Regarding institution type, 89% of respondents at university hospitals expressed dissatisfaction; however, no such dissatisfaction was reported by respondents working at children’s hospitals. Regarding shift duties, 20% of respondents reported working six or more overnight or holiday shifts per month, and 32% were responsible for first-call duties 10 or more times per month. When combining first- and second-call duties, 58% were responsible for on-call shifts 10 or more times per month.

Conclusion: The study findings revealed that Japanese pediatric surgeons are working many overtime hours and on-call duties. As work style reforms progress, improvements in the working environment of pediatric surgeons are anticipated.

Purpose: Testicular torsion is a common pediatric urological emergency requiring prompt diagnosis and intervention. The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, based solely on physical findings, has been proposed as a rapid diagnostic tool. Although its utility has been evaluated in several studies, reports from Japan remain limited. In this study, we aimed to assess the usefulness of the TWIST score in patients with testicular torsion treated at our institution.

Methods: We retrospectively reviewed 43 patients who underwent surgical treatment for testicular torsion between 2016 and 2024. Clinical background, TWIST score and individual components, surgical procedures, and outcomes were analyzed. Patients were classified into the good-prognosis group (G group: orchiopexy without atrophy) and the poor-prognosis group (P group: testicular atrophy or orchiectomy). Findings were compared between the two groups.

Results: Testicular swelling was documented in 42 cases (97.6%), hard testis was observed in 31 (72.1%), and absent cremasteric reflex, nausea/vomiting, and high-riding testis were found in 33 (76.7%) each of these symptoms. TWIST scores were calculable in 25 cases; 5 patients had a score of 2. No significant difference in overall TWIST scores was observed between the G and P groups. Testicular swelling (p = 0.004) and hard testis (p = 0.036) were significantly less frequent in the G group. Even in the absence of testicular swelling, at least one other positive finding was present.

Conclusions: Testicular torsion may occur with low TWIST scores, warranting careful evaluation. However, the TWIST-score-based assessment may help reduce missed diagnoses, even in atypical cases lacking testicular swelling.

Genital edema is a commonly reported complication in patients undergoing peritoneal dialysis (PD). It is typically caused by leakage of dialysis fluid into the subcutaneous tissue. This condition may be caused by a previous abdominal surgical wound or by a fragile peritoneal site such as an inguinal hernia. In this report, we present a case of occult inguinal hernia in a 1-month-old girl, whose primary symptom was genital edema. This symptom ultimately led to the diagnosis of an inguinal hernia. The patient experienced subcutaneous leakage of dialysate, which resulted in inadequate ultrafiltration. We performed inguinal hernia surgery and replacement of the PD catheter. The procedure successfully resolved the dialysis fluid leakage. No recurrence of dialysate leakage has been observed since the operation. In pediatric PD patients, peritoneal injuries can contribute to dialysate leakage; therefore, such injuries should be avoided whenever possible. Furthermore, recurrence of inguinal hernia is more common in pediatric PD patients than in the general pediatric population. Careful selection of surgical procedures is essential to minimize complications in this population.

The patient was a 5-year-old boy who started vomiting five months earlier and became worse during the last three weeks, concomitantly with upper respiratory tract inflammation. Chest computed tomography scan revealed total esophageal dilation, which indicated esophageal achalasia. Delayed esophageal emptying of contrast medium was noted on esophagography, and the integrated relaxation pressure of the lower esophageal sphincter was high (16.7 mmHg) on high-resolution manometry. On the basis of these findings, the patient was diagnosed as having type I (Chicago classification) esophageal achalasia. His preoperative Eckardt score was 4. Three balloon dilatations were performed up to 30 mm in incremental steps. His symptom was resolved, and he was discharged three days after the last operation. After discharge, he occasionally had exacerbated vomiting. We performed additional balloon dilation 14 months after the first operation, which was chosen over laparoscopic Heller myotomy, which was considered over-invasive for his Eckardt score of 1 (regurgitation), after which he showed no difficulty with food intake, and he gained weight. Sixteen months after the first operation, he tolerated a regular diet with a body weight gain of 7 kg.

We report the case of a 5-year-old boy who was referred to our institution, presenting with bulging of the left inguinal area, fever, and pain. An infected scrotal lymphangioma was suspected. Antibiotic administration failed to improve the symptoms, and transscrotal drainage was performed the next day. The fever and pain disappeared promptly after drainage. Total surgical excision and adhesiolysis of the cystic lesion were performed one and a half months after drainage. Histological examination revealed that the cystic lesion was a lymphangioma. He developed a symptomatic postoperative lymphorrhea, and his quality of life was impaired for one month. The Kampo medicine eppikajutsuto markedly reduced the size of the inguinal lymphocele. During the follow-up period of 3.5 years, the patient remained asymptomatic. The Kampo medicine eppikajutsuto has an irrigation effect that normalizes the disequilibrium of fluids in the body; therefore, it is effective against lymphatic malformations. We assume that eppikajutsuto is also effective against inguinal lymphorrhea.

Teduglutide, a recombinant analogue of glucagon-like peptide-2, has recently gained attention as a therapeutic agent for pediatric short bowel syndrome. Although there have been an increasing number of reports on its efficacy in such cases, there are no published case reports in Japan on treatments involving the use of teduglutide from infancy in patients with extensive Hirschsprung disease, leading to a successful definitive surgery. A male infant was born at 37 weeks and 6 days of gestation, weighing 2,994 g. He was transferred to our hospital on day 3 because of abdominal distension and bilious vomiting. Laparotomy on day 4 led to a diagnosis of extensive-type Hirschsprung disease. An ileostomy was created 75 cm distal to the Treitz ligament. Postoperative management was complicated by enteritis and a persistent high-output stoma, resulting in fluid and electrolyte imbalance and poor weight gain. At seven months of age, teduglutide therapy was initiated. Gradual improvement in stool consistency and intestinal adaptation was observed. Despite an episode of mucous fistula prolapse and infectious endocarditis requiring prolonged antibiotic treatment, parenteral nutrition was discontinued by 17 months of age. At 19 months, a laparoscopic pull-through was performed. The postoperative course was uneventful, and the patient was sent home. This case highlights the potential utility of teduglutide in promoting intestinal adaptation and improving stoma output in infants with extensive Hirschsprung disease, ultimately facilitating weaning from parenteral nutrition and enabling a definitive surgery. Our experience suggests that teduglutide can be a valuable adjunctive therapy in selected patients.

There have been only a few reports of open abdominal management (OAM) using ABTHERA^® in children. We report a case in which transcatheter arterial embolization (TAE) and OAM using ABTHERA^® were performed for severe liver injury in a child, and the patient’s condition improved without liver resection. A 10-year-old boy was transported to our hospital after accidentally falling off a playground equipment and sustaining a bruised abdomen. On the basis of the results of contrast-enhanced CT, we diagnosed the patient as having severe liver injury. Although his hemodynamics were stabilized with rapid infusion, TAE was unable to completely stop bleeding. We suspected non-arterial bleeding, so we performed damage control surgery (DCS). While performing OAM using ABTHERA^®, the patient was transferred to a higher-level medical institution and underwent second-look surgery, and he was saved without any complications. We used ABTHERA^® for the first time in a child with severe liver injury. It was effective in children because it allowed us to quickly control bleeding and contamination and implement a planned DCS strategy.

We report a very rare pediatric case of reduction en masse (REM) of an inguinal hernia diagnosed preoperatively by ultrasonography. The patient was a 1-year-old boy who had undergone manual reduction for a right incarcerated inguinal hernia at a previous hospital. Despite the manual reduction, vomiting persisted, and he was transferred to our hospital for further evaluation and treatment. Physical examination revealed no swelling in the inguinal region, but a right undescended testis was noted. On the basis of his medical history and ultrasonographic findings, a diagnosis of REM was made. Emergency laparoscopic surgery was performed on the same day, and the incarcerated terminal ileum was preserved. The morphology of the hernial orifice led to a diagnosis of REM of a de novo external inguinal hernia. Owing to a marked thickening of the peritoneum and difficulty in identifying the vas deferens and testicular vessels, the initial surgery involved simple closure of the hernial orifice. A staged surgical approach was adopted, planning the subsequent high ligation of the internal inguinal ring and orchiopexy. The patient’s postoperative course was uneventful, and the second-stage surgery was carried out four months later via an inguinal approach. REM should be considered as a complication following the manual reduction of incarcerated inguinal hernias, although it remains uncommon in pediatric patients. Abdominal ultrasonography proved highly useful for accurate diagnosis in this case.

A two-year-old boy was brought to our hospital with intermittent abdominal pain and vomiting. Ultrasonography showed a 58 mm cystic tumor with the echogenic inner rim sign at the right lateral region of the abdomen, and we suspected a duplication cyst. The following day, he was discharged because the cyst size decreased by 30 mm and his pain had improved. However, one week later, he came back because his pain worsened and the cyst size increased by 63 mm, and thus an emergency operation was performed on him the next day. Laparoscopic observation revealed a twisted cyst that connected with the umbilicus by a narrow band on the distal side and connected with Meckel’s diverticulum at 50 cm from the ileocecal region on the proximal side. Thus, we diagnosed him as having a torsion of the omphalomesenteric cyst coexisting with Meckel’s diverticulum, and we then performed partial ileal resection, including the lesion. A histological analysis revealed that the twisted cyst had necrotized tissue with the gut component. Reports of an omphalomesenteric cyst connecting with the diverticulum are rare, and we can explain that the change in the cystic size in the present case was caused by the communication between the cyst and Meckel’s diverticulum. If we find an abdominal enteric cyst that changes its size, we should perform surgery as early as possible because there is the risk of ischemic changes, perforation, and bowel obstruction due to the torsion of this cyst, besides the enteric duplication cyst.

A 7-year-old girl had a chief complaint of an abdominal bulge from the navel to the lower abdomen. Ultrasound and MRI revealed a cystic mass originating from the left ovary, with some solid components, suggesting a mature ovarian cystic teratoma. Laparoscopic ovarian cystectomy was performed, and histopathological analysis revealed a mature teratoma. The patient was discharged on the third day after surgery, but after another three days, the patient experienced severe abdominal pain after eating lunch and visited the emergency room. An abdominal X-ray revealed a small amount of gas in the small intestine, and a contrast CT scan revealed that this was a postoperative change; the patient was admitted to the hospital. Vomiting continued after admission, and the patient began to complain of upper abdominal pain. Laparotomy was performed on the 10th postoperative day, and the small intestine was found to have been twisted 180 degrees clockwise. The Treitz ligament was not formed, and the ileocecal area, ascending colon, and right half of the transverse colon were not fixed to the retroperitoneal cavity. The cecum and ascending colon were fixed to the retroperitoneum, and the patient was discharged on the 12th day after the second operation. We report a case of small intestinal volvulus associated with mesenterium commune that developed immediately after laparoscopic ovarian cystectomy.