Purpose: Owing to increases in the number of dual-career couples and nuclear families in recent years, it has become difficult to adjust the schedule of operations in pediatric patients. Another problem is that pediatric patients often become suddenly ill, and the day of surgery may need to be rescheduled. To solve these problems and increase convenience to their parents, we introduced an Internet reservation system for booking the schedule of surgery and assessed its effectiveness.
Methods: We introduced the Internet reservation system, which was developed by Doctor Cube Co., Ltd., for the management of reservations of elective operations such as radical operation of inguinal hernia from September 2017. The patients’ families’ satisfaction and the operation waiting period were investigated to determine the effect of the Internet reservation system.
Results: The patients’ families’ satisfaction with the reservation method was significantly higher in the Internet group (n = 12) than in the conventional group (n = 28) (4.8 ± 0.4 and 4.1 ± 0.9, respectively, p = 0.027). The operation waiting period was significantly longer in the Internet group (n = 13) than in the conventional group (n = 28) (176 and 75 days, respectively, median, p = 0.004).
Conclusions: The Internet reservation system of the operation day could be introduced without significant problems, and satisfaction of the patients’ families was higher with the Internet reservation system. However, since the operation waiting period may become longer with the Internet reservation system than with the conventional reservation method, when using the Internet reservation system, special consideration should be given to patients with diseases that require early operation.
Purpose: To discuss the treatment of neuroblastoma in infants, we retrospectively reviewed the cases of patients with unresectable, non-MYCN-amplified neuroblastoma by comparing those with clinical symptoms and those without them.
Methods: Eighteen consecutive patients with non-MYCN-amplified neuroblastoma were examined in this study. The neuroblastoma was detected in seven patients without symptoms preclinically and in 11 with symptoms, during the past 28 years. Their clinical and tumor characteristics, the reasons for tumor unresectability, risk classification, treatment, and outcome were reviewed.
Results: The reasons for the difficulty in tumor resection in seven patients without clinical symptoms included local invasions and lymph node and liver metastases, and the presence of IDRFs and IDRF-equivalent factors was the reason in three of the seven patients (43%). Excluding one patient who was observed without treatments, six patients were treated with standard protocols. All the seven patients showed NED. On the other hand, among the 11 patients diagnosed with symptoms, seven were in oncologic emergencies. The reasons for tumor unresectability were local invasions and metastases to lymph nodes, liver, and other distant organs, and the presence of IDRFs and IDRF-equivalent factors were the reasons in nine of the 11 patients (82%). Radiotherapy was conducted in addition to surgery and chemotherapy in four patients. While eight and two patients were in NED and AWD, respectively, one patient died of the disease. OS for all 18 patients was 94.4% and EFS was 83.0%.
Conclusion: The findings in infants with unresectable, non-MYCN-amplified neuroblastoma suggest that treatment options could include observation without treatments and chemotherapy following biopsy in patients who present no symptoms. In patients with clinical symptoms, chemotherapy should be promptly given following biopsy, and radiotherapy may be considered in case of oncologic emergencies.
Purpose: The aim of this study was to elucidate the clinical features and treatment outcomes of infants with acquired colonic stenosis or colonic atresia.
Methods: We reviewed the medical records of patients with acquired colonic stenosis or colonic atresia, who were treated in our hospital between July 2009 and June 2019. The underlying disease, the localization and histopathological findings of lesions, and treatment outcomes were retrospectively reviewed from medical charts.
Results: Six infants (3 males, 3 females) were included in this study. The median birth weight was 2,857 (588–3,722) g. The underlying diseases were ischemic colitis due to congenital heart disease in three patients, septic shock following intestinal perforation in two, and obstruction of bilateral common iliac arteries in one. The median duration from the onset of the underlying disease until the diagnosis of colonic stenosis or atresia was 77 (30–101) days. Single lesions were found in four patients and multiple lesions in two. The two patients who had sepsis as an underlying disease had multiple lesions. Five patients underwent surgery, and one was treated conservatively. Among the five surgically treated patients, three underwent laparotomy and the remaining two underwent single-incision laparoscopic surgery.
Conclusions: We concluded that infants with acquired colonic stenosis or colonic atresia due to intestinal ischemia should be treated carefully as multiple lesions may occur and may progress within three months of the onset of an underlying disease.
The surgical strategy for congenital portosystemic shunts depends on the anatomical type. We evaluated the effectiveness of the ligation of congenital portosystemic shunt (CPSS) type II for children and reviewed the literature on this rare entity. We conducted a retrospective chart review of four patients of CPSS type II treated by ligation of the shunt vessel between January 2013 and December 2017. There were two male patients and two female patients. The patients’ ages at diagnosis ranged from one to six months. Congenital heart disease was found in all the patients. Three patients underwent one-stage ligation of the shunt vessel, and one patient underwent two-stage ligation owing to high pressure of the portal vein. After the operation, blood ammonia levels decreased to normal in all the patients, and no early complication was detected. However, one patient showed pulmonary hypertension six months after surgery, and additional medical treatment was needed. In our series of patients, we effectively performed the ligation of CPSS type II. However, appropriate timing of ligation is important to minimize complications, such as pulmonary hypertension. Further study is needed to clarify the most appropriate timing of repair for CPSS and to improve the prognosis of CPSS patients.
A one-month-old male infant who was prenatally suspected of having meconium peritonitis was referred to our department, and we diagnosed him as having polycystic intralymphatic lymphangioma on examination. There were no problems in terms of the infant’s general condition or feeding at the time of admission, and there was also no abdominal distension; thus, the infant was allowed to return home and was followed up as an outpatient. At the age of 52 days, he was urgently admitted to the hospital with abdominal distension, fever, and poor feeding. Cystic puncture was performed as an emergency evacuation procedure because of respiratory distress. After his general condition improved, lymphangioma was resected at the age of 70 days. Lymphatic malformation was found to develop from the sigmoid colon and have progressed to the pelvic retroperitoneum; therefore, the involved sigmoid colon was also excised. Fetal detection of lymphatic malformation is relatively rare, and it is necessary to distinguish it from fecal peritonitis. However, after birth, it is important to identify the site of development and determine the timing of surgery, considering the risk of infection.
We report herein the case of a patient with rare jejuno-jejunal-type intussusception. A 12-year-old girl was admitted to our hospital because of bilious vomiting. She had abdominal pain and vomiting for three days prior to admission. A CT scan showed localized intestinal dilatation and ascites, indicative of strangulated obstruction due to an intestinal intussusception. An emergent laparotomy showed that the intestinal invagination of the lead point, which was found to be a jejunal polyp, extended 80 cm from the ligament of Treitz. She finally underwent extended resection of the necrotic intestine without performing enterostomy. For 18 months, the postoperative course was uneventful. A total of 17 cases of jejuno-jejunal-type intussusception secondary to an organic cause have been reported in Japan. We found that the intussusception frequently develops during school age, with the lead point being the pedunculated polyps (76%). Anemia is notably observed in five out of 15 patients without bloody stool. The length of the resected intestine is limited to less than 10 cm in five patients whose diagnosis was made less than 24 hours from the onset; however, extended resection of the intestine of more than 50 cm is inevitable in four patients whose diagnosis was delayed more than 24 hours (median, three days). Prompt recognition is paramount to make a correct diagnosis when one encounters abdominal pain and vomiting, even without bloody stool in school-age children.
We report the case of an 8-year-old girl with blind loop syndrome. She had a history of bowel resection in the neonatal period due to Type III jejunoileal atresia. At 7 days after the operation, the enteroenterostomy site leaked, which was conservatively treated. She grew normally afterwards. At 7 years of age, she really wanted ice and was diagnosed as having anemia. We suspected a small intestinal stenosis or a passage disturbance on the basis of the findings of computed tomography (CT) and radiological enteroclysis and she was then subjected to surgery. At 80 cm from the ileocecum, the oral-side small intestine adhered into a loop. The anal side was interrupted, and the oral and anal sides were under a condition wherein a fistula formed. After the resection of the blind loop intestinal tract, an end-to-end anastomosis was performed. With such a medical history, long-term follow-up of the patient for anemia should be carried out.
Classically, gastroschisis is a right-sided periumbilical abdominal wall defect; left-sided gastroschisis is rare. Case 1: A female infant was delivered at 35 gestational weeks by cesarean section. Her birth weight was 2,606 g. She had an abdominal wall defect on the left side of the umbilical cord, which was diagnosed as left-sided gastroschisis. She showed no merger malformations. We performed siloplasty at 0 days old and abdominal wall closure at 10 days old. Her postoperative course was uneventful. Case 2: A male infant was delivered at 36 gestational weeks by cesarean section. His birth weight was 2,014 g. He had an abdominal wall defect on the left side of the umbilical cord, which was diagnosed as left-sided gastroschisis. He showed no merged malformations. We performed siloplasty at 0 days old and abdominal wall closure at 6 days old. His postoperative course was uneventful. No significant complications other than umbilical hernia were present. Left-sided gastroschisis has been observed to be predominant in females and is typically associated with extraintestinal anomalies. Similarly to right-sided gastroschisis, the primary or staged closure is selected depending on the case; for left-sided gastroschisis, abdominal wall closure is selected. In general, left-sided gastroschisis has an equally good prognosis as right-sided gastroschisis, but it depends on the presence of merged malformations and complications. The knowledge of left-sided gastroschisis is clinically useful, because of the high incidence of extraintestinal congenital malformations. The cause of gastroschisis is controversial, and studies on left-sided gastroschisis will help clarify the cause.
The patient was a 13-year-old female who visited a local doctor with complaints of abdominal pain. Subsequently, she was referred to our hospital where an ovarian cyst was detected. However, the reported pain was located in the right upper abdomen, where an abdominal mass was also detected. Therefore, she underwent abdominal ultrasound and computed tomography examination. In the right upper abdomen, there was a multilocular cyst with a high echo (~90 mm) were detected. Moreover, a 115-mm-diameter single cyst was also found in the pelvis. In addition, the levels of inflammatory markers increased. We initiated antibiotic therapy for the right upper abdominal intracystic infection. The symptoms and inflammatory marker levels improved markedly, and the diameter of the right upper abdominal cyst was reduced to 40 mm. After three months, both cysts were removed by laparoscopic surgery. The preoperative diagnosis was omental cyst (upper right abdominal cyst) and ovarian cyst (pelvic cavity cyst). Upon surgery, the right upper abdominal cyst was found to be present in the omentum, and adhesion with surrounding tissues due to inflammation was observed. The pelvic cyst was an omental cyst with a twisted stem continuing from the omentum. In this case, we differentiated a pedunculated omental cyst from an ovarian cyst. There is room to consider pedunculated omental cysts as a means of differentiating pelvic cystic lesions.
A 15-year-old male patient with cerebral palsy, who underwent tracheal intubation for airway management due to pneumonia, developed granulation, and ventilation difficulties prevented his weaning from a respirator. Contrast-enhanced chest computed tomography (CT) showed that the brachiocephalic artery was pressing on the trachea, and that the granulation had narrowed the airway lumen. The patient was referred to our hospital owing to difficulty in extubation and the high risk of tracheo-brachiocephalic artery fistula. After confirmation of the presence of the Willis artery ring by head contrast-enhanced CT, the patient underwent brachiocephalic artery transection and tracheotomy. Although the clinical features of the patient’s condition improved postoperatively, the granulation severity gradually increased every 2 weeks after surgery and the granulation further narrowed the airway lumen. Laser ablation was performed 49 days after surgery and the granulation resolved. Brachiocephalic artery resection does not only reduce the risk of tracheo-brachiocephalic artery fistula but is also advantageous when performing laser ablation.
The case of a male fetus was referred to our hospital because a retroperitoneal tumor and polyhydramnios were shown by fetal ultrasonography at 32 weeks and 3 days of gestation. Because the mother complained of abdominal distension due to the polyhydramnios and presented signs of imminent premature birth, amniocentesis was performed. The signs of imminent preterm birth subsequently subsided, but the growth of the tumor may cause respiratory dysfunction. The infant was born by cesarean section at 36 weeks and 2 days of gestation. His birth weight was 2,638 g and his Apgar score was 2 points (1 min)/4 points (5 min). At the time of birth, he showed marked abdominal distention and no spontaneous breathing. He underwent cardiopulmonary resuscitation and he was immediately admitted to the neonatal intensive care unit (NICU). After his circulation stabilized, emergency surgery was performed on the first day of life because of progressive oxygenation and acidosis. A laparotomy revealed a huge tumor arising from the right kidney; thus, right nephrectomy was performed. The tumor was determined to be congenital mesoblastic nephroma by histopathological examination. When the pressure to the thorax due to the tumor was removed, the respiratory status and circulatory dynamics became stable. His postoperative course was uneventful. No recurrence or complications were observed 12 months after the surgery. Although the tumor has a relatively good prognosis, it should be noted that it may increase rapidly in size from the fetal period and cause an oncologic emergency.
We report two cases of patients with anorectal malformations and who carried carbapenemase-producing Enterobacteriaceae (CPE), with the focus on perioperative antibiotic prophylaxis. Case 1: A 16-month-old girl who carried CPE with persistent cloacae underwent anorecto-urethro-vaginoplasty. CPE was isolated during preoperative bacterial screening by a transverse colostomy swab. Gentamicin and cefmetazole were administered for three days, from one day before the operation. Case 2: A three-month-old boy who carried CPE had imperforate anus (rectovesical fistula), congenital urethral stricture, and prune belly syndrome. CPE was isolated from his urine at the age of 23 days and from a transverse colostomy sample at the age of 35 days. As refractory urinary tract infections developed repeatedly since CPE isolation, right nephrectomy was performed. The urinary tract infection that developed after nephrectomy was mainly caused by methicillin-resistant Staphylococcus aureus (MRSA); therefore, laparoscopy-assisted anorectoplasty was performed to separate the urinary tract from the colon at the age of 114 days. Fosfomycin and cefmetazole, in addition to linezolid for MRSA, were administered for five days, starting two days before the operation. In both cases, the patients were discharged without surgical site infection. Perioperative antibiotic prophylaxis for patients with CPE should be determined according to antibiotic sensitivity tests and the anatomical communication between the surgical and colonizing sites.
A 6-year-old boy who presented with abdominal pain was referred to our hospital. Enhanced abdominal CT revealed free gases in the abdominal cavity. We diagnosed him as having acute peritonitis owing to gastrointestinal perforation, but we were unable to identify the perforation site preoperatively. We performed emergency single-port laparoscopic-assisted surgery using a multichannel port (two 5-mm ports) with umbilical Benz incision. We identified the inflammatory ileum and pulled it out. A cystic lesion, with a hole at the base, was detected about 40 cm proximal to the end of the ileum. We partially resected the ileum. A histopathological examination revealed perforation of ileac duplication, which is rare and its preoperative diagnosis is difficult. We performed the single-port laparoscopic-assisted surgery without wound extension. The single-port laparoscopic-assisted surgery with the Benz incision is useful for the diagnosis and treatment of pediatric acute abdomen.