Pediatric Surgery

Immature gastric teratoma in a newborn Publication date: August 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 47 Author(s): Sandheeah Ramdeny, Katherine Broad, Prabhu Sekaran, Sara Harrison, Philip Connor, Mallinath Chakraborty Abstract We present a full-term male infant with a palpable abdominal mass who presented with severe haematemesis associated with cardiovascular compromise. Although an initial ultrasound imaging identified a left supra-renal calcified mass suggesting a neuroblastoma, further imaging suggested an atypical mass which was separate from the spleen and left kidney. An upper gastro-intestinal contrast study localised the mass to the stomach and a computed tomograph suggested the possibility of a gastric teratoma likely in combination with a raised serum Alpha-fetoprotein. The mass was completely surgically resected, and histology confirmed an immature gastric teratoma.We would like to draw the attention of clinicians of the possibility of a gastric teratoma in an infant who presents with an abdominal mass and haematemesis.

Splenic abscess with salmonella enteritidis following marsupialization of a splenic cyst Publication date: August 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 47 Author(s): Yolla Youssef, Lena Naffaa, Sarah Chamseddine, Ahmad Zaghal, Mohammad Khalife, Nadine Yazbeck, Ghassan Dbaibo, Rima Hanna-Wakim Abstract Splenic abscess in the setting of salmonella infection is a rare entity, which has been reported during the course of typhoid fever. We describe the presentation of a healthy 11 year-old boy who had abdominal pain, incidental finding of splenic cyst and who developed Salmonella enteritidis gastroenteritis and splenic abscess shortly following laparoscopic removal of the splenic cyst. We review 11 additional cases of nontyphoidal salmonellae splenic abscesses in pediatric patients.

Small intestinal obstruction by sunflower seed bezoar Publication date: July 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 46 Author(s): Tatiana de Warren, Melanie B. LaPlant, Daniel A. Saltzman, Donavon J. Hess Abstract Bezoars are rare mass formations in the gastrointestinal tract caused by consumption of indigestible materials such as plant fibers (Phytobezoars) or hair (Trichobezoars). We report a case of a 12-year-old boy who presented with abdominal pain, nausea and vomiting without any other clinical findings. Radiographic findings showed an area of obstruction in the small bowel, which we confirmed by performing an exploratory laparotomy. The treatment consisted of surgical removal of the obstructing bezoar from the distant ileum as well as excision of an incidentally identified Meckel's diverticulum. Postoperative discussions revealed, that the patient had ingested a large amount of unshelled sunflower seeds, which had caused a mass formation and obstruction of his small bowel. The patient did not suffer any complications during or after surgery and experienced a rapid recovery. Bezoars should be considered among adolescents presenting with intestinal obstruction, especially among baseball players.

Spontaneous perinatal gallbladder perforation Publication date: July 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 46 Author(s): Iran Tavakoli, David Bigam, Consolato Sergi, Bryan Dicken

Using silver poly (acrylate) matrix (Haemoblock) in children with lymphatic malformations Publication date: July 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 46 Author(s): D.A. Safin, D.V. Romanov Abstract Lymphatic malformations (LM) are a congenital malformation of lymphatic vessels. There exist large, small and mixed cystic LMs. Up to the present day, the causes of LM remain the subject of scientific research. Special sclerosing agents such as Doxycycline, Bleocyne, Picibanil (OK-432) and other drugs are used for sclerosing of LM. Due to the special characteristics of the impact of each drug on the endothelium, during the early post-surgical period there occur various undesirable effects (swelling, pain conditions, toxic effects, allergies, etc.), moreover, the effectiveness of the used sclerosing agents is not always sufficient to obtain a good clinical effect. The goal of our work is to evaluate the use of the Haemoblock™ sclerotherapy in children with various forms of lymphatic malformations. We carried out a retrospective analysis of the use of the silver poly (acrylate) matrix (Haemoblock™) for sclerotherapy (off-label protocol) of various forms of LM in children who underwent treatment at the Center for Vascular Pathology (Moscow) during the period from 2016 to 2018. After the conducted surgery - sclerotherapy with the Haemoblock™ in children with various LMs, we obtained the following results: excellent and good - in 6 cases, satisfactory - in 2 cases, no negative result was obtained. In the Center for Vascular Pathology (Moscow) in 2016–2018, there was conducted a treatment of 8 children with LM of various types and localization. During the early post-surgical stages (1–3 h after surgery), 4 children showed severe pain syndrome, which stopped on its own without prescription of drug-induced pain killers. 12–24 h after sclerotherapy, 6 children also showed an increase in swelling in the area of the surgery. The swelling persisted for 3–6 days, and stopped on its own. Considering the positive results of treatment, further multi center study of the use of the Haemoblock™ is needed for the purpose of the LM sclerotherapy in children.

Malignant sacro-coccygeal teratoma with growing teratoma syndrome Publication date: July 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 46 Author(s): Tamador Al-Shamaileh, Fatena Ajlouni, Rasha Deebajah, Iyad Sultan, Mohammad M. Saleem, Khalil Ghandour Abstract A 13-month-old female with sacro-coccygeal tumor type II by Altman, was proven by biopsy to be a malignant germ cell tumor. Serum tumor markers were normal. During neo-adjuvant chemotherapy visible tumor progression was confirmed radiologically and progressed despite changing chemotherapy. The external growing mass forced its way out of the skin. More importantly, CT showed resolution of the pelvic component. Complete tumor resection with coccygectomy was performed. Histopathology showed mature teratoma, immature cells in the coccyx and no malignant germ cells. Three months after ending her therapy she remains in remission. We report the first case of growing teratoma syndrome (GTS) in the coccygeal region.

Hybrid open and endovascular repair of a blunt traumatic thoracic aortic injury in a 7 year old boy Publication date: July 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 46 Author(s): Jennifer M. Brewer, Sarah Grout, Mohiuddin Cheema, Thomas Divinagracia, Carissa Webster-Lake, Douglas Moote, Nahum I. Kryzman, Edward Cortland, Brendan T. Campbell Abstract We describe a 7-year-old boy who sustained a blunt thoracic aortic injury following a rollover motor vehicle crash where the vehicle fell 200 feet down an embankment. The chest x-ray on arrival showed widening of the superior mediastinum, a left-sided hemothorax, and first rib fracture. The screening CTA of the chest revealed bilateral pulmonary contusions, a large left hemothorax, and evidence of aortic injury with active contrast extravasation. The patient was intubated due to respiratory distress and had a left chest tube placed. The patient became hypotensive with greater than 1.5 L of blood from the chest tube, so a resuscitative thoracotomy was performed. Bleeding was controlled with a sponge stick initially and definitively with a Satinsky vascular clamp. Next the patient was transported to the hybrid OR at the adjacent adult hospital with an open chest for endovascular graft placement. The patient was admitted to the PICU post-operatively, transferred to the floor on POD 4, and discharged home on POD 9. Aortic injury after blunt trauma in pre-adolescent children is uncommon and often fatal. Endovascular repair of traumatic thoracic aortic injury in adults is currently the standard of care, but there is a paucity of clinical data to guide management of these types of injuries in pediatric patients.

Melanotic neuroectodermal tumor of infancy Publication date: July 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 46 Author(s): Hao Tran Kiem, Kim Hoa Nguyen Thi, Phu Tran Xuan, Loi Nguyen Hong, Son Nguyen Huu, Duy Phan Canh, Carlos Rodriguez Galindo, McKay McKinnon Abstract Introduction Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, rapidly growing pigmented neoplasm of neural crest origin generally arising in infants during the first year of life. Case We report a 15-month old male who presented with a 2-month history of a rapidly growing mass in the anterior. A biopsy showed melanotic neuroectodermal tumor, and complete resection with negative margins was subsequently achieved. The patient is in remission at 11 months from surgery. Conclusion Due to its rapid growth potential and locally destructive behaviour, early diagnosis is extremely important to limit local expansion. The treatment of choice for melanotic neuroectodermal tumor of infancy (MNTI) is surgical excision.

Ureteral injury following vertebral body tethering for adolescent idiopathic scoliosis Publication date: July 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 46 Author(s): JuliAnne R. Rathbun, Daniel S. Hoernschemeyer, Mark R. Wakefield, Elizabeth A. Malm-Buatsi, Katie S. Murray, Venkataraman Ramachandran Abstract Adolescent idiopathic scoliosis (AIS) is a deformity of the spine of unknown etiology and no definitive cure. A novel technique for correction during growth known as vertebral body tethering (VBT) was introduced in 2005 in animal models, and then quickly adapted for human implementation [Courvoisier, 2015]. This method is in the early stages of growth and adaptation as well as evaluating risks to improve safety and feasibility. Some of the most common complications reported are atelectasis [Newton, 2018], proximal junctional kyphosis and reoperation for device breakage or addition [Hardesty, 2017]. There are no case reports describing ureteral injury following VBT. We present a case of primary ureteral injury following VBT with subsequent erosion and stricture formation requiring definitive ureteral reconstruction. We discuss the possible causes of this complication, its management, follow up, and short-term outcome.

Re-do Kasai procedure in a preterm infant Publication date: July 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 46 Author(s): Hiromu Tanaka, Hideyuki Sasaki, Masatoshi Hashimoto, Masaki Nio Abstract We report the case of a 10-day old boy with biliary atresia (BA) who was delivered by caesarean section at 33 weeks 4 days of gestation (birth weight, 2135 g). At birth, his direct bilirubin level was high, and stools were light yellow. Abdominal ultrasonography showed no triangular cord sign, and duodenal fluid examination showed no bile. We performed a Kasai procedure (KP) 27 days after birth. His liver biopsy showed intrahepatic bile duct reduction. No bile excretion occurred postoperatively. We performed a redo KP 83 days after birth. Postoperative bile excretion was good, and his jaundice promptly resolved. The patient's liver biopsy showed bile duct development. Jaundice recurred at 8 months of age, and brain-dead-donor liver transplantation was required. The patient died of liver failure at 23 months of age. Surgery for BA during the neonatal period is usually effective, and the results of re-operation in cases with poor postoperative biliary excretion are poor. Here, we present a novel case that illustrates the progression and timing of the pathological hepatic changes in BA and consider the indications for and timing of re-operation in preterm infants.