Multiple congenital colonic stenosis – A case report and review of literature Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Rujuta S. Shah, S. Soundharya, Sandesh V. Parelkar, Beejal V. Sanghvi, Rahul K. Gupta, Kedar P. Mudkhedkar, Deepa P. Makhija, Ashutosh K. Sharma, Pragati Sathe

Rapunzel syndrome with anal protusion of trichobezoar Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Gabriel Pinheiro Martins de Almeida e Souza, Matheus Eugênio de Sousa Lima, Aline Portela Muniz, José Albuquerque Landim, Augusto César Gadelha de Abreu Filho

Testicular torsion: The unexpected terrible twos, a unique case report Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Rachel Appelbaum, Sarah Azari, Michele Clement, Marybeth Browne Abstract Introduction Testicular torsion is a common pediatric urologic emergency that affects 3.8 per 100,000 males younger than 18 yrs annually. The age distribution of testicular torsion is bimodal, with one peak in the neonatal period and the second peak around puberty. Herein, we describe a case report involving testicular torsion in a rarely seen age group. Case presentation A 2 year old male with no past medical history presented to the Emergency Department with left testicular pain and swelling. His physical exam revealed a well-developed child in mild distress related to discomfort. The left testis appeared edematous and erythematous. It was firm and tender to palpation. The ultrasound with Doppler of the left testis revealed marked tunica thickening and hyperemia with overlying scrotal edema and hyperemia. The patient was taken emergently to the operating room for exploration. There was torsion of the left spermatic cord within the tunica vaginalis with a necrotic testis. A left orchiectomy and right orchiopexy were performed. Conclusion When dealing with acute scrotal etiologies one must consider a broad differential diagnosis including testicular torsion, incarcerated or strangulated inguinal hernia, trauma and epididymitis. This case report demonstrates a unique presentation of testicular torsion in an unexpected age group.

Saphenous venous cavernous angioma masquerading as an aneurysm Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Luai Zarour, Aaron J. Cunningham, Mubeen A. Jafri Abstract Cavernous angiomas are common in the upper body and viscera but saphenous vein cavernous angiomas have not been previously described in the literature. We present a case of a rare congenital vascular malformation of the lower extremity masquerading as an aneurysm in a 4-year-old girl who presented with an asymptomatic right lower leg mass. Ultrasound was concerning for saphenous venous aneurysm and MRI was confirmatory. Operative exploration identified a vascular mass without evidence of an aneurysm; cavernous angioma was confirmed on pathologic examination. Although infantile vascular lesions are common, imaging diagnosis of venous aneurysm – an unusual asymptomatic clinical entity – should raise concerns about possible rare entities or diagnostic alternatives.

Vaping is a risk factor for spontaneous pneumothorax: Two cases Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Nicholas J. Skertich, Gwyneth A. Sullivan, Mary Beth Madonna, Ami N. Shah Abstract Smoking is associated with an increased risk of spontaneous pneumothorax. Typically linked to tobacco smoking and cannabis use, to date there have been no reports of spontaneous pneumothorax associated with electronic cigarette use or “vaping.” Rates of vaping are rapidly rising amongst adolescents. We present two male patients age 15 and 16 who had a spontaneous pneumothorax after vaping and were initially treated with tube thoracostomy placement. Both patients had recurrences requiring surgical intervention and have been recurrence-free since. This is the first known report of vaping and its association with spontaneous pneumothorax. A comprehensive smoking history that includes vaping is important in patients presenting with suspected pneumothoraces as it can lead to earlier cessation interventions, help prevent recurrence, and raise suspicion for pneumothorax in patients presenting without severe symptoms. As more studies demonstrate vaping-associated lung injury, we advocate for stricter standards of quality control for electronic cigarettes and encourage legislators to do the same.

Cardiac nail gun injury Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Jonathan Stahl, Nitsana A. Spigland

Duplicate exstrophy presenting as an apparent urethral duplication Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Alexander Geoffrey Shaw Anderson, Tiernan Connor Middleton, Mark A. Rich, Hubert S. Swana Abstract Variants of the exstrophy-epispadias sequence are exceedingly rare. We report a case of a newborn with duplicate exstrophy of the bladder that mimicked a urethral duplication. We discuss the workup and review the embryology and treatment of exstrophy variants.

Bowel perforation secondary to local tissue injury from intentional iron overdose Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Kevin J. Goodwin, Jule Muegge, Daniel A. Saltzman, Robert D. Acton, Donavon J. Hess Abstract We report the case of a 16-year-old who presented after intentional ingestion of elemental iron (approximately 48 mg/kg). Iron levels at presentation were 4388 mcg/dl. The patient demonstrated symptoms of severe toxicity including hypotension, metabolic acidosis, and multiple organ failure. Fourteen days after ingestion, the patient suffered multiple punctate bowel perforations that were not related to ischemia and appeared to have been the result of local tissue injury from ingested iron. The bowel was successfully primarily repaired. However, the patient eventually succumbed due to the severity of multisystem organ failure and a systemic fungal infection. We report this case to highlight the risk of local tissue trauma from ingested iron, resulting in bowel perforation. This case highlights the need to eliminate ingested iron to limit systemic absorption and to prevent local tissue trauma and bowel perforation.

Retrograde gastroesophageal intussusception: Initial presenting feature of achalasia in a teenager Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Bryant S. Morocho, Paroma Bose, Britney L. Grayson, Joseph M. Croffie, Deborah F. Billmire Abstract A 16-year-old Caucasian male presented with acute vomiting and dysphagia. Imaging studies revealed retrograde gastroesophageal intussusception (RGEI), which reduced prior to diagnostic laparoscopy. No clear etiology for RGEI was identified at that time, so further surgical intervention was deferred. He returned several months later with persistent dysphagia. Imaging, endoscopy, and endoluminal function imaging probe then diagnosed achalasia. He underwent a second laparoscopy for Heller myotomy and Dor fundoplication. This is the first report of RGEI preceding a diagnosis of achalasia.

Single site laparoscopic repair of a Morgagni hernia in a pediatric patient Publication date: November 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 50 Author(s): Amanda Muñoz, Victoria Pepper, Faraz A. Khan, Andrei Radulescu Abstract Anterior diaphragmatic hernias through the foramen of Morgagni are rare accounting for about 3% of surgically treated diaphragmatic hernias. Current management of Morgagni type diaphragmatic hernias involves surgical intervention, which is traditionally done by open laparotomy, laparoscopy or thoracoscopic approach. Here we present the case of a two year old female with a Morgagni type congenital diaphragmatic hernia (CDH) found during work-up for an upper respiratory infection, repaired using a single site laparoscopic primary approach.