Sacrococcygeal teratoma with intraspinal extension Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): G. Frongia, M. Kessler, H. Bächli, J. Kunz, J.P. Schenk, M. Elsässer, B. Beedgen, A. Mehrabi, P. Günther Abstract We report a case series of two newborns with a sacrococcygeal teratoma (SCT) with intraspinal involvement. In one case, the SCT was detected prenatally and presented postnatally as a large mass of 8 × 10 × 10 cm. In the second case the prenatal ultrasound was unremarkable and the SCT presented postnatally as a rather flat one-sided gluteal mass. MRI diagnostics led to the diagnosis of extradural intraspinal involvement. In an interdisciplinary operation between pediatric surgeons and pediatric neurosurgeons a complete complications-free tumor resection was possible in both cases with a favorable postoperative course. Due to the complete resection and benign histology (Gonzales-Crussi grade 0 and 1 with exclusion of yolk sac tumor components), adjuvant measures such as chemotherapy were not necessary. At 4 months no morbidity or mortality occurred, micturition and defecation were unremarkable in both cases and neurological examinations were age appropriate.

Delayed presentation of preterm Hirschsprung's disease Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): Henry P. Miller, Jeremy M. Badach, Douglas Katz Abstract Hirschsprung's disease (HD) in a very low birth weight, preterm infant is a rare occurrence. We present a case of a baby born at 29 weeks gestation, who after stooling normally for several weeks, developed a large bowel obstruction on day of life (DOL) 34. The patient underwent surgical resection of an abnormal span of sigmoid colon and creation of a colostomy. The patient did well post-operatively, had early ostomy function on post operative day (POD) 2, and was discharged home. He returned for a laparoscopic-assisted completion proctectomy and Soave endorectal pull-through. He was discharged home on POD4. He continues to do well.

Hepatoblastoma associated with trisomy 18 Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): Naruhiko Murase, Kenitiro Kaneko, Asahito Hama, Nao Yoshida, Hirotoshi Sakaguchi, Kosuke Chiba, Makoto Oshiro Abstract There is currently no consensus regarding the treatment strategy for malignant tumors with trisomy 18 because of the high mortality rate of this genetic disorder. In this study, we reported five cases of hepatoblastoma associated with trisomy 18. With the exception of one patient with severe cardiac anomalies, the other four patients underwent hepatectomy, and two patients also underwent chemotherapy. There was no treatment-related deterioration of their general condition. Three of the four patients who underwent hepatectomy, including one with a high-risk hepatoblastoma, were still alive at a median follow-up of 43 months (range, 25–169 months) with no sign of recurrence. The combination of radical surgery and chemotherapy is a feasible and effective treatment for hepatoblastoma in carefully selected patients with trisomy 18. Risk adapted management might improve the prognosis and quality of life of these children, even in cases with high-risk hepatoblastoma.

Case report: 19M old boy with Morgagni Hernia associated with intestinal malrotation Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): A.G. Blood, Z.L. Whaley, A.V. Kadenhe-Chiweshe, N.A. Spigland

Subcutaneous bronchogenic cyst of the chest wall Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): Adil Ayub, Abdul Majeed Abid, Sifrance Tran, Kanika Bowen-Jallow Abstract Bronchogenic cysts are rare, congenital malformations of the foregut, most commonly located in the mediastinum. Subcutaneous bronchogenic cysts are exceedingly rare. We report an 11-month-old boy who presented with an asymptomatic chest wall mass. He underwent surgical excision and final histopathology was consistent with a bronchogenic cyst. To our knowledge, this is the first reported case of a chest wall subcutaneous bronchogenic cyst in a child.

Stump appendicitis in two adolescent boys: Rare presentations and alternative approaches in pediatrics Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): Sofia Ferreira de Lima, Joana Patena Forte, Mafalda de Castro, Sofia Morão, Rui Alves Abstract Stump appendicitis is a rare complication that results from reinflammation of the residual part of the appendix, after incomplete appendectomy. Factors that may contribute to inadequate identification of appendicular base are subserosal or retrocecal position, extensive inflammation or inadequate surgical exposure. The length of the appendiceal stump after ligation is likely a major predisposing factor. The presentation of stump appendicitis is similar to acute appendicitis, but this diagnosis is often dismissed because of the surgical history. Computed tomography and ultrasonography are the imaging modalities of choice. The usual recommended treatment for stump appendicitis is completion appendectomy. Stump appendicitis must be considered in the differential diagnosis of acute abdomen despite the patient's appendectomy history. A delayed diagnosis may lead to an increase in morbidity. We present two cases of stump appendicitis in adolescents after laparoscopic appendectomies, one being a case of recurrent stump appendicitis. We report two alternative therapeutic approaches: interval appendectomy and non-operative management. We conclude that these alternative approaches may be suitable for some patients with stump appendicitis. A review of the pertinent literature was done.

“Pushing the margin:” utilization of renal autotransplantation to achieve complete resection in vena caval leiomyosarcomas Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): Joseph Anderson, Vinayak Rohan, Helen Grey, Satish N. Nadig Abstract We report the case of a 19-year-old female who underwent resection of the sub- and infrahepatic inferior vena cava (IVC) with concomitant left kidney autotransplantation for leiomyosarcoma. Based on the available literature, this is the youngest patient reported undergoing IVC resection and reconstruction with concomitant renal autotransplant. We review the literature, presentation, and a unique treatment option for this infrequent pathology.

Meckel's diverticulum perforation by a wooden toothpick in a child: A case report Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): Abdulhafidh Kadhi, Stanley Crankson, Saud Al Jadaan Abstract Perforation of Meckel's diverticulum (MD) by ingested foreign body (FB) is an extremely uncommon cause of acute abdomen in children. We report on a 13-year-old boy who presented with right iliac fossa pain associated with anorexia, tenderness, guarding and rebound tenderness. Abdominal ultrasound showed findings of acute appendicitis. However, laparoscopy revealed a wooden toothpick perforating MD and a hyperemic appendix. The FB was removed and laparoscopic diverticulectomy and appendectomy performed. Perforation of MD by a FB is a diagnostic challenge and it should be included in the differential diagnosis of acute abdomen in children.

A simple technique for the management of refractory gastrostomy site complications a technical innovation in gastrostomy tube site revision Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): Rebecca M. Rentea, Wendy J. Svetanoff, Charlene Dekonenko, Courtney Pisano, Charles L. Snyder Abstract Introduction Longstanding gastrostomy sites are prone to leakage and excoriation secondary to protrusion of gastric mucosa into the tract, dilation of the site over time, and development of refractory granulation tissue. Surgical revision with creation of a new gastric and skin exit site can be difficult. We describe a technique to re-site a gastrostomy tube (GT) utilizing the existing GT site. Materials and methods For one patient with gastrostomy site refractory complications, we re-sited the GT using the existing site. A clamp was placed through the old GT site and was palpated through the abdominal wall. An incision over the tip was made and a silk tie was passed from this new site, exiting through the old site. A One-step™ device was then pulled from the old site out through the new site, and closure of the old gastrostomy was performed. Results The procedure took approximately 40 min to complete. Oral and GT intake was started within 3 hours. There were no intra- or post-operative complications. The patient was discharged home the same day. Conclusion This simple technique allows for revision of a gastrostomy tube without the use of laparoscopy and permits a cosmetically pleasing incision.

Continuous bilateral erector spinae plane analgesic block for an adolescent with Nuss repair of pectus excavatum Publication date: January 2020 Source: Journal of Pediatric Surgery Case Reports, Volume 52 Author(s): Ayòtúndé B. Fadayomi, Asmerom Adhanom, Patricia Amelin, Gustavo G. Angaramo Abstract Thoracic epidural analgesia has been proven to be an effective method for pain management following Pectus excavatum repair. However, because of the accompanying thoracic spinal deformities, thoracic epidural analgesia may not always be a feasible option in all cases. If ineffective, there could be increased opioid administration in order to adequately manage any post operative pain. Studies have shown that early exposure of adolescents to opioids is associated with increased risk of persistent opioid use. This is because adolescents have larger reward centers and underdeveloped prefrontal cortex, hence an immature inhibitory system. An alternative regional technique for post operative pain management in these patients is thus valuable. Erector spinae plane (ESP) block has been explored and found to be a useful alternative for pain management in this group of patients. Although there are a few case reports showing the effectiveness of ESP blocks in Ravitch repair, we present, for the first time, the effectiveness of ESP in Nuss repair.