Pediatric Surgery Case Reports

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.

Robot-assisted Heller myotomy for achalasia Publication date: June 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 45 Author(s): Giulia Fusi, Francesco Molinaro, Francesco Ferrara, Edoardo Bindi, Chiara Pellegrino, Chiara Calani, Mario Messina, Rossella Angotti Abstract Achalasia is a rare neuromuscular esophageal disorder in children. There are many surgical options to treatment including botulinum toxin (Botox) injections, oral pharmacologic therapies with nitrates and calcium channel blockers, pneumatic dilation (PD), and surgical myotomy (open surgery, endoscopy, laparoscopy and recently robotic approach). In pediatric age, usually, Heller's myotomy is the main choice. Laparoscopic approach is known and standardized. Few robotic have been published. We decided to report our first case to share our experience with scientific community.

Unexpected finding of an intra-peritoneal toothpick during laparoscopic appendectomy Publication date: June 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 45 Author(s): Mohamad El Mahmoud, Mohammad Al Onazi, Saad H. Aldosari, Sarah A. Hadi, Reema Alsadhan

Bilateral chest wall mesenchymal hamartomas treated with sclerotherapy and cryoablation Publication date: June 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 45 Author(s): Kristen A. Calabro, John McGrath, Elizabeth Bowdish Abstract Mesenchymal hamartoma of the chest wall is a rare disorder, traditionally treated with mutilating radical excision. We report a case of an infant with bilateral mesenchymal hamartomas (MH) complicated with aneurysmal bone cyst (ABC) features. We subsequently describe a novel technique combining sclerotherapy and cryoablation to achieve non-operative tumor burden reduction in an effort to minimize disfigurement making the MH amenable to less morbid resection. A 3.5-month-old male presented with bilateral, complex, mixed cystic and solid, chest wall masses consistent with a chest wall mesenchymal hamartoma. Under ultrasound and fluoroscopic guidance, the aneurysmal bone cyst components were aspirated and contrast studies performed to exclude venous drainage. Doxycycline sclerotherapy was performed using dwelling volumes approximately 50–60% of the estimated cyst cavity size. Repeat sclerotherapy was performed on days 85, 147, 229 and 267, with interval imaging guiding timing and location of therapy. The ABC components responded well to sclerotherapy with significant size decrease of the cystic components. Overall lesion size decreased significantly, with new bone formation noted in response to treatment. The first treatment of computer tomographic (CT)-guided cryoablation was then performed on day 329 to attempt further reduce the size of the solid components. Multiple cryoablation probes were advanced into the mass under CT fluoroscopy. Deep components were treated initially with a series of freeze/thaw cycles. Cryoprobes were then retracted to treat the more superficial portions of the lesion. CT guided cryoablation was repeated on day 601.

Urethral mucosa prolapse in a post-partum patient Publication date: June 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 45 Author(s): Godwin Turyasingura Abstract A 23 year old Ugandan, Black, Mukiga, mother of two presented to us one year after delivery with severe lower abdominal pain, failure to pass urine, slight vaginal bleeding and a mass protruding from her vagina. Vaginal examination revealed she had a prolapsed urethral mucosa which was undergoing ischemic necrosis. Her condition was successfully treated by surgical excision of the prolapsed mucosa. The patient had no urinary, genital or other symptoms at 6 weeks, 6 months and at one and half years follow up.

Pediatric pulmonary mucormycosis in a diabetic patient treated with extended pleurectomy and Clagett procedure Publication date: June 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 45 Author(s): Rebecca C. Gologorsky, Sora Ely, Kara A. Rothenberg, Carol Glaser, Jeffrey B. Velotta Abstract Mucor is a ubiquitous fungus that is non-pathogenic in healthy people. In immunocompromised hosts, nonfunctional or absent neutrophils and macrophages result in fungal invasion and infection [1]. Invasive mucor (mucormycosis) most commonly involves the sinuses, brain, or lungs. Pulmonary mucormycosis typically presents in patients with a history of organ transplantation or hematologic malignancy [2], and is rare in patients with diabetes alone. The epidemiology and management of pediatric pulmonary mucormycosis is poorly described. We report an unusual occurrence of this disease, complicated by segmental pulmonary artery thrombus in a 15-year-old with poorly controlled diabetes. His severe, medication-resistant infection was ultimately treated successfully with antifungal medication combined with aggressive surgical debridement. The pulmonary artery segmental thrombus resolved after treatment of the underlying infection without anticoagulation.

Segmental dilatation of colon detected on prenatal ultrasound Publication date: June 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 45 Author(s): Naoko Uga, Tatsuya Suzuki, Kouhei Sakurai, Tetsuya Tsukamoto, Tomonori Tsuchiya, Yasuhiro Kondo, Atsuki Naoe, Shunsuke Watanabe, Toshihiro Yasui, Fujio Hara Abstract Segmental dilatation of the colon is a rare condition in which there is an abrupt segment of dilated colon between regions of normal colon, without obstruction. The condition causes bilious vomiting and abdominal distention in the neonate, and causes constipation or anemia in infants and adults. We herein report a case of segmental dilatation of the descending colon detected on prenatal sonography. The patient was born at 39 weeks' gestation, weighing 3720 g. At 10 months, he developed constipation and enterocolitis. At 1 year of age, the patient underwent laparoscopic-assisted resection of dilated colon with end-to-end anastomosis. Resection of the dilated segment alone was not sufficient, according to frozen biopsy. Therefore, we resected an additional 3 cm both proximally and distally, where teniae coli were grossly evident. Histological examination of the dilated segment showed muscular layer hypertrophy with hyperplasia and widening of Auerbach's plexus. The patient's 7-month follow-up was unremarkable. With improved quality of prenatal sonography, more patients will be diagnosed with segmental dilatation of the intestine. This is the first report in the English literature of segmental dilatation of the colon detected on prenatal ultrasound.

Intrabronchial valves for persistent pulmonary air leaks in children Publication date: June 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 45 Author(s): Faisal G. Qureshi, Ahmed Abdelrahman, Mirza Zain Baig, Stephen Megison, Muhanned Abu-Hijleh Abstract Background Surgery to address parenchymal lung disease in children is rare. One of the complications of the surgery is a persistent air leak (PAL). Intrabronchial valves (IBV), which received FDA approval for treating PAL in recent years, limit or exclude the inflow of air towards the pleura and allow air and secretions to flow towards central airways. The valves have been effective in adults with PAL but little has been published on their use in children. Methods Retrospective chart review was performed after IRB approval on patients treated with IBV after surgical excision of lung parenchyma. A literature review was then performed. Results 2 pediatric patients are presented. Patient 1, a 10 year old girl underwent excision of a lung mass that developed persistent air leak. Traditional conservative methods did not seal the air leak for 23 days but an IBV sealed the leak in 24 h. Patient 2, a 6 year old boy underwent a pneumonectomy with post-operative bronhical leak. The bronchus was repaired but a leak persisted for 36 days. An IBV sealed the leak immediately. Conclusion Intrabronchial valves can be used for the management of persistent pulmonary air leaks. We propose a tentative algorithm for using the devices in children with PAL.

Urachal cyst and enteric duplication in a pediatric patient Publication date: June 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 45 Author(s): Allen K. Chen, Michael J. Allshouse Abstract Here we present an unusual case of a 3-year-old male with multiple congenital developmental abnormalities discovered during laparotomy: an urachal cyst and enteric duplication. This combination of anomalies has not been described before.

Sleeve lobectomy for an arteriovenous malformation in the bronchus intermedius in a child Publication date: June 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 45 Author(s): Aditya Sengupta, Othman Aljohani, Howaida El-Said, Aparna Rao, Matthew Brigger, Raghav Murthy Abstract Arteriovenous malformations within the tracheobronchial tree in pediatric patients uncommonly present as hemoptysis, and can usually be treated with percutaneous transcatheter embolization. When this fails, parenchymal-sparing operations are needed. While these have been popularized for the management of bronchial neoplasms in children and adults, such bronchoplastic techniques are not commonly performed in children with tracheobronchial vascular malformations and acute hemoptysis. Here, we present a patient with recurrent hemoptysis who was found to have an arteriovenous malformation in the bronchus intermedius, and had failed numerous attempts at coil embolization. Via a right thoracotomy approach, we successfully performed a right middle lobectomy and sleeve resection of the bronchus intermedius. The post-operative recovery was uneventful, and there were no further episodes of hemoptysis. Thus, by applying the principles of bronchoplastic resection, such parenchymal-preserving surgery can be successfully used to manage symptomatic bronchial arteriovenous malformations with hemoptysis.