Pediatric Surgery

Distal ureteric stump empyema managed with doxycycline instillation Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): Kathryn M. O'Shea, Supul Hennayake

Wilms tumor of a horseshoe kidney in an 18 year old with an unusual metastasis Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): Allison Couillard, Erika B. Lindholm, Sean Ciullo Abstract Wilms tumor is the most common malignant renal tumor in the pediatric population. Children usually present with an abdominal swelling and are frequently diagnosed at Stage I or Stage II disease. The most common sites of metastasis are the lungs. The presence of metastatic disease and age at diagnosis has an important impact on prognosis. Less is known about Wilms tumor in adults, but the treatment is the same as it is for pediatric patients. Here, we present an 18-year-old male with a horseshoe kidney diagnosed with Wilms tumor and metastasis to the rectum.

Gastric perforation in a newborn Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): Euitae Kim Abstract Gastric perforation is a rare surgical emergency and a life-threatening disorder in a neonate. However, the exact mechanisms still remain unclear. Case presentation: A three-day-old male newborn was transferred our hospital with recurrent vomiting. The baby did not have any abnormal sign on prenatal examination. He was diagnosed with peritonitis after we performed an ultrasonogram and simple X-ray. We found a gastric perforation during an emergency laparotomy. The best way to saving neonatal gastric perforation patient is early diagnosis and performing the operation without delay.

Partial urorectal septum malformation sequence with prune belly syndrome and oesophageal atresia with a tracheoesophageal fistula Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): N.Z. Mashavave, D.S. Harrison, A.D. Grieve Abstract The concurrence of Urorectal Septum Malformation (URSM) Sequence and Prune Belly Syndrome are extremely uncommon, with increased rarity with the coexistence of an oesophageal atresia with tracheoesophageal fistula. The URSM is denoted by an absence of perineal/anal orifices together with ambiguous genitalia, urogenital, colorectal and lumbosacral anomalies. A persistent cloaca or a partial URSMS entails a single anal/perineal opening that drains the urethra, vagina and rectum. Prune belly syndrome (PBS) encompasses the triad of urological connective tissue anomalies, absence or weakened abdominal walls, and cryptorchidism. In patients that do not fulfil the complete criteria a term pseudo-prune belly syndrome (PPBS) is used. The Prune belly spectrum is associated with poor prognosis due to pulmonary and renal complications. We discuss a rare case of a neonate with pseudo-prune belly syndrome, partial urorectal septum malformation and oesophageal atresia with tracheoesophageal fistula.

Hydatid cyst of the parietal peritoneum Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): Ayad Ahmad Mohammed, Sardar Hassan Arif Abstract Introduction Hydatid disease is a type of zoonosis that is caused by Echinococcus granulosus which is transmitted by the fecal-oral route. The disease is endemic in certain areas like the Mediterranean region, South America, and some parts of the central Europe. It commonly affects the liver, the lungs and the brain. But all organs could be affected. Multiple organs could be affected simultaneously. The presentation depends on the site and the size of the cyst. It may cause pain or pressure effect. Emergency presentations occurs when the cyst rupture. The disease is usually diagnosed by CT scan or MRI. Medical treatment may be effective in the uni-vesicular cyst or used after surgery to decrease the recurrence rate. Surgery is still the main treatment option. Case presentation An 11-year-old boy presented with left lower quadrant abdominal pain for 4 months. The pain was dragging like pain that was aggravated by movement and standing position and relieved with rest and analgesics. There was no any associated symptom. Examination of the abdomen showed a palpable oval shaped mass in the left iliac fossa. The mass was about 10 cm by 5 cm and disappeared with abdominal wall contraction. The complete blood count was normal and the ultrasound examination showed a cystic lesion that arises from the abdominal wall, the position of the mass was constant by changing the position of the patient. During laparotomy there was a cystic lesion that arises from the parietal layer of the of the peritoneum behind the posterior rectus sheath on the left side. Complete excision of the cyst done. The cyst was a solitary hydatid cyst that affects this rare location. The patients discharged home after 4 days with good medical condition. Conclusion The presence of any cystic lesion in any organ in a patient from an endemic area for hydatid disease should raise the suspicion to this possibility. Treatment options should be chosen by a multidisciplinary team; certain group of patients may benefit from medical treatment. Surgery is still the main treatment modality.

Intussusception in preterm neonate Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): Mostafa Kotb, Mostafa Abdelatty, Omar Fawzy, Hayssam Rashwan Abstract Introduction While necrotizing enterocolitis (NEC) is more commonly encountered in premature infants in the neonatal intensive care unit, intussusception is extremely rare and usually forgotten in differential diagnosis. This is because both diseases share common clinical findings including abdominal distension, bilious gastric residuals and bloody stool. Presentation of case A 33-gestational week-male baby was referred on 23rd postnatal day with bleeding per rectum, intolerance to feed and absolute constipation 2 days earlier. He was misdiagnosed as necrotizing enterocolitis and received conservative treatment. Later, because of deterioration of general condition, he was explored and an intussusception was found. Resection and anastamosis were done and the child was discharged on the 11th day postoperative. Conclusion Although extremely rare, intussusception should be included in the differential diagnosis of neonatal intestinal obstruction, even in the preterms as delayed diagnosis will further result in gangrene and perforation as well as deterioration of the baby's general condition.

Traumatic buccal fat pad herniation in an infant Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): Giulia De Giorgi, Rossella Angotti, Giulia Fusi, Lorenzo Salerni, Mario Messina, Francesco Molinaro Abstract Traumatic herniation of buccal fat pad (BFP) is very rare, usually seen in young children, from 5 months to 12 years of age. A minor injury or perforation of the buccinator muscle and buccal mucosa can cause the extrusion of the buccal fat pad into the oral cavity. A differential diagnosis is very important but a history of trauma, an absence of masses before the accident, anatomical site and fatty appearance should suggest the correct diagnosis. The treatment options are usually excision or repositioning of the herniated fat. For the present case report, a 7 month-old boy, diagnosed with traumatic buccal fat pad herniation, was successfully treated with surgical excision.

Internal surgical drainage for bile lakes following hepatoportoenterostomy for biliary atresia Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): Edward C. Dee, Benjamin Zendejas, Rima Fawaz, Heung Bae Kim Abstract Bile lakes may be present at time of diagnosis or develop later following hepatoportoenterostomy (HPE) in patients with biliary atresia (BA). We report a patient with recurrent cholangitis following HPE who developed multiple large biliary cystic lesions. Percutaneous drainage resulted in resolution of jaundice and cholangitis but capping of drains resulted in recurrence of symptoms. Therefore, internal drainage of the bile lakes was accomplished using cystjejunostomy to the roux limb of the previous portoenterostomy. At 18 months of follow-up, the patient has remained jaundice free with only one recurrent cholangitis episode which occurred after stopping her antibiotic prophylaxis. Although this patient will likely require liver transplantation in the next few years, this case suggests that cystjejunostomy may be a viable surgical option to improve bile flow and prevent cholangitis in patients who develop bile lakes following HPE.

Cervical bronchogenic cyst diagnosed prenatally Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): Takuro Kazama, Masaki Nio, Motoshi Wada, Hideyuki Sasaki, Hiromu Tanaka, Hironori Kudo, Megumi Nakamura, Taichi Fukuzawa, Satoshi Yamaki Abstract Bronchogenic cysts are congenital malformations caused by abnormal lung buds. Almost all bronchogenic cysts are found in the thoracic cavity but rarely in the neck. We report a rare case of a cervical bronchogenic cyst diagnosed in the fetal stage. A male baby with a cervical cyst detected at 20 weeks of gestation was suspected of having a 4-cm cystic lymphatic malformation and was subsequently delivered via normal vaginal delivery at 37 weeks. At birth, no symptoms, apart from the palpable elastic tumor mass (3 cm in diameter) on the left side of the neck, were observed. He was followed-up for observation. The cyst contracted at 4 months of age. However, at one year and 4 months of age, the cyst started to grow again without symptomatic manifestations. Cystectomy was performed at 1 year and 11 months of age, and the cyst was diagnosed histologically as a bronchogenic cyst. The postoperative course was uneventful, except for transient recurrent nerve paralysis, which improved 4 months after surgery. No signs of cyst recurrence were observed at the 1-year follow-up. Our case shows that bronchogenic cysts should be considered as a differential diagnosis of cervical cystic disease found before birth.

Pathological fracture due to prolonged steroid use in a child with transverse myelitis Publication date: April 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 43 Author(s): Ahmad Jabir Rahyussalim, Ronald Henry Tendean, Rizky Priambodo Wisnubaroto, Tri Kurniawati Abstract Introduction Transverse myelitis (TM), a rare inflammatory disease of the spinal cord, is treated with corticosteroids that could result in other complications. Case report We present the case of a 4-year-old boy with a closed left femoral fracture after he hit the floor. He was diagnosed with TM 1 year ago and was treated with oral methylprednisolone for 8 months. Discussion In children, the prolonged use of corticosteroid enhances the osteoclast activity but reduces the osteoblast activity; this imbalance bone turnover causes osteoporosis that increases the fracture risk, which depends on the corticosteroid dose and treatment duration. Of note, the risk of fracture might last for years. Conclusion The increased risk of fracture because of the prolonged use of corticosteroids might not impede the corticosteroid treatment if indicated. Hence, bone health status and nutritional monitoring must be performed at the beginning of treatment in children who need corticosteroid therapy with a cumulative dose >1 g/year.