Pediatric Surgery Case Reports

The rare case of a true rectovaginal fistula and its repair Publication date: September 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 48 Author(s): Carly R. Richards, Nicole R. Lafferriere, Sidney M. Johnson Abstract Background Within the spectrum of anorectal malformations, congenital rectovaginal fistulae are a rare but treatable entity. These less common variates can be treated much in the same fashion as other malformations such as imperforate anus or rectovestibular fistulae are repaired. Summary In the case presented here, diagnosis of a rectovaginal fistula was delayed despite repeated examinations until the patient reached a size where the fistula was easily identifiable. The patient had no other anorectal malformation and was otherwise in good health. Her repair was done as a same day surgery and the patient recovered without complication. Conclusion A rectovaginal fistula is a highly unusual clinical entity but one amenable to repair in the same fashion as other similar malformations.

Multicystic adenomatoid hamartoma of the pancreas Publication date: September 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 48 Author(s): Brian D. Hosfield, Britney L. Grayson, Attila Nakeeb, Eric A. Albright, Troy A. Markel Abstract Multicystic adenomatoid hamartoma is an extremely rare tumor of the pancreas, with only 4 other cases reported in the literature. We report a case of a 4-year old boy who presented with an 8 month history of abdominal pain, steatorrhea, and failure to thrive. Work-up showed severe pancreatic insufficiency and a large, multiseptated, cystic mass originating from the head of the pancreas and compressing the duodenum. The child underwent a classic pancreaticoduodenectomy with portal vein reconstruction. He tolerated the procedure well and has been seen in follow-up.

Superior mesenteric artery syndrome after severe head trauma Publication date: September 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 48 Author(s): Jurgita Gailiene, Ausra Lukosiute-Urboniene, Arturas Kilda, Vidmantas Barauskas Abstract Superior mesenteric artery syndrome (SMAS) is a very rare manifestation of duodenal obstruction with the incidence of 0.013–0.3% in adult population, but there are only few reports in the literature concerning children. SMAS can be related to a rapid loss of intraabdominal fat by severe, debilitating illnesses such as malignancy, burn, spinal cord injury, anorexia. As a result, compression of the third duodenal portion by the aorta and the overlying superior mesenteric artery occurs, when the angle formed by these two structures becomes smaller. We present a case of a 17-year-old boy who suffered a severe head trauma during a car accident. He had prolonged confinement in the supine position because of ongoing coma. The SMAS developed due to a progressive weight lost. Upper gastrointestinal Barium contrast study, fibroesophagogastroduodenoscopy (FEGDS), abdomen computed tomography scan (CT) were not specific and only, magnetic resonance imaging (MRI) findings suggested diagnosis of SMAS. As there was no response to the conservative treatment, surgical intervention of duodenojejunostomy was performed. The postoperative period was successful.

Small bowel obstruction secondary to Ascaris lumbricoides in the setting of prior exploratory laparotomy Publication date: August 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 47 Author(s): Cynthia Fata, Fouzia Naeem, Erik R. Barthel Abstract Ascaris lumbricoides is a parasitic roundworm that is transmitted via the fecal-oral route and is endemic in many areas around the world. At the end of its life cycle it resides in the small bowel, and while it can be asymptomatic, large masses of worms can result in intestinal obstruction, volvulus and perforation. While it is a common cause of mechanical obstruction in endemic areas, it is far less so in the developed world, where adhesions and other postoperative mechanical etiologies are more common. We present the case of a young man with a prior history of exploratory laparotomy for trauma, who had recently immigrated from the Philippines, where ascariasis is endemic, to the Central Valley of California in the United States. He presented with a small bowel obstruction, and at laparotomy was noted to have both a proximal Ascaris bezoar as well as a distal anastomotic stricture.

Displaced scapular body fracture treated with operative closed reduction Publication date: August 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 47 Author(s): Michael Ghassibi, Dhanunjay Sarma Boyalakuntla, Sheryl Handler-Matasar Abstract Case A majority of the pediatric scapula fractures sustained are scapular body fractures. There is a lack of literature concerning pediatric scapular body fractures and its management. We report the case of a scapular body fracture with significant angulation, our intraoperative closed reduction axillary fold approach under anesthesia, and the functional and radiologic outcomes post operatively. At 3 month and 2 year follow up, the patient was able to resume normal activities. Imaging demonstrated a completely healed, well aligned scapular body. Conclusions We suggest closed reduction as an option in significantly angulated isolated scapular body fractures.

Severe acquired tracheomalacia caused by a chronic esophageal foreign body Publication date: August 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 47 Author(s): Collin F. Mulcahy, Joseph C. Park, Eva I. Rubio, Allison L. Speer, Andrea Badillo, Maria Pena Abstract A 3-year-old otherwise healthy boy presented with new-onset progressive stridor that began 3 months prior. He was noted to have dyspnea on exertion, inspiratory stridor, and occasional regurgitation of undigested food. Direct laryngoscopy with bronchoscopy revealed tracheomalacia of the cervical trachea with marked compression extending down to 2 cm above the carina. Magnetic resonance imaging, computed tomography, and esophagram confirmed the presence of an esophageal foreign body with extensive inflammatory changes of the cervical and thoracic esophagus with mass effect causing compression on the trachea. Flexible esophagoscopy under sedation revealed a 2.9 cm × 2.5 cm hard plastic toy in the shape of rabbit ears, which was removed. The patient was extubated in the intensive care unit and was quickly advanced to a soft diet. He was asymptomatic at follow up 3 weeks after his procedure. Esophageal foreign bodies usually present with respiratory symptoms or feeding issues due to direct compression, and the presentation is typically acute. The finding of severe tracheomalacia has only been described in a few case reports. This is an unusual case of severe tracheomalacia secondary to a chronic esophageal foreign body.

Pneumatosis intestinalis and pneumoperitoneum secondary to Sapovirus colitis Publication date: August 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 47 Author(s): Thomas O. Xu, Daniel E. Levin Abstract Pneumatosis intestinalis (PI) with pneumoperitoneum are radiographic findings that may be associated with severe bowel compromise. Asymptomatic patients with benign pneumoperitoneum are well described and can typically be observed. Among symptomatic patients, these findings are more concerning and often mandate operative intervention. The common etiologies of PI with pneumoperitoneum in children can typically be determined by history, physical and imaging findings. Viral enteritis and colitis is an infrequent cause. Sapovirus is in the family Caliciviridae. It is similar to norovirus, a more common pathogen in acute gastroenteritis, but typically presents with less severe symptoms. Here, we describe the presentation of an 11 year old, immune competent boy with severe abdominal pain, PI and pneumoperitoneum. Diagnostic laparoscopy revealed viable bowel without the need for resection or diversion. Stool pathogen panel revealed Sapovirus infection. He made a complete recovery. To our knowledge, this is the first description of PI with pneumoperitoneum caused by Sapovirus infection.

Cautery versus laser excision of oral mucocele Publication date: August 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 47 Author(s): Parisa Foroughiasl Abstracts A mucous cyst is a benign cyst which is inside the thin capsule and it contains clear fluid. These masses appear from the disruption of minor salivary gland and it leaks to surrounding tissues. Most commonly it is localized on the lower lip. Mucoceles appear in a respond of traumatic injuries like sucking off the lip, biting lip, and trauma from orthodontic devices. The purpose of this study report is to describe two different methods of surgical excision to remove the mucoceles. In the first case, a standard electrocautery device and in the other case, l divide laser was used to excise the mucocele from the lower lip. Mucocele was removed from a 10-year-old patient with excision by scapale and the second case was 17-year-old patient with a carbon dioxide (CO2) laser. In both cases, excisions were applied after local infiltration with 1.8 ml 2% Lidocaine with 1:100,000 epinephrine. In the first case, the duration of healing was longer, and it affected the quality of life of patient post surgically. In the second case, the healing process was faster, no bleeding and the patient was comforted after a surgical procedure. In the final both cases, wounds healed well without relapse after 1 year.

Endovascular retrieval of difficult to remove port-a-caths Publication date: August 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 47 Author(s): Raghavendra Rao, Francis E. Marshalleck, Alan P. Ladd Abstract Long dwelling central venous lines develop intravenous adhesions or a calcified fibrous sheath causing difficulties in removal. Although such cases are rare, a few cases of endovascular retrieval have been reported in pediatric literature. We report our experience with 6 cases in children with port-a-caths. Transfemoral snare technique was effective in all but 1 patient. The mean age of the in dwelling port-a-caths was 5 years. One patient whose catheter could not be removed has developed no complications after a follow-up of 5 years. Review of literature suggests that while endovascular retrieval is not without risks, leaving a central line in situ has no major disadvantages. Heroic measures to remove such lines should be pursued only when absolutely necessary as in the case of an infected line.

Minimally invasive repair of the severe pectus excavatum in an infant Publication date: August 2019 Source: Journal of Pediatric Surgery Case Reports, Volume 47 Author(s): Muharrem Özkaya, Mehmet Bilgin Abstract Pectus excavatum is the most common congenital chest wall abnormality. Nuss et al., in 1998 described minimally invasive repair of pectus excavatum and this procedure is now the procedure of choice in many institutions for the surgical repair of pectus excavatum. However, since that time the optimal age and indications for surgical repair are still debate. Although there is no age limitation for the procedure, publications regarding the surgical management of infants with pectus deformities are few. We present a case of an 11-month-old girl with severe pectus excavatum who presented with a 3-day history of increasing dyspnea which was present since her birth. During her follow in pediatric intensive care unit she became apneic and underwent intubation. A chest tomography demonstrated pectus excavatum with right main stem bronchial compression and bilateral lower lobe pneumonia. She underwent minimally invasive repair of his pectus excavatum and was extubated on hospital day 10 and was discharged from the hospital on postoperative day 17.

Alexandros Sfakianakis
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alsfakia@gmail.com