European Journal of Pediatric Surgery Reports最新文献

Urethral stone impaction (USI) is an extremely rare cause of acute urinary retention (AUR) in pediatric urology. Few case reports are available, and no consensus guidelines currently exist for managing this condition. We describe our management of such a case and provide a review of the relevant literature. A 4-year-old boy with no prior urological history presented to our emergency department with abdominal pain lasting 8 days. An ultrasound performed 5 days earlier identified a 7-mm stone at the ureterovesical junction. Symptomatic treatment with paracetamol and non-steroidal anti-inflammatory drugs was initiated. However, dysuria, painful penile swelling, and AUR developed 7 days after the onset of pain. A CT scan revealed bilateral hydronephrosis, urinary retention, and a 9-mm stone (980 Hounsfield Units) that had migrated to the proximal anterior urethra. Under general anesthesia, a suprapubic puncture removed 400 mL of urine for analysis. A 7.5-Fr cystoscope was used to identify an impacted stone at the base of the penile urethra. In situ lithotripsy was performed using a holmium laser to fragment the stone in the urethra. The fragments were then pushed into the bladder for complete disintegration. Intravesical fragments were subsequently removed with a Dormia basket. No urethral wounds were observed, and a 10-Fr catheter was placed. Recovery was uneventful, with catheter removal and spontaneous voiding on postoperative day 1. At the 3-month follow-up, the patient exhibited normal voiding and uroflowmetry. AUR secondary to USI is rare and lacks standardized management protocols in pediatric urology. Management of USI should be tailored to the size and location of the calculus, as well as the presence of any associated urethral pathology, with a preference for minimally invasive endoscopic surgery whenever possible. If necessary, urethral in situ laser lithotripsy appears to be a safe and effective treatment option to consider.

We report the use of endoscopic cholecystoduodenostomy in a 6-year-old child to manage postanastomotic stricture of the common bile duct (CBD) secondary to an intraoperative injury sustained during the resection of an abdominal neuroblastoma (NB). The patient was diagnosed with stage M NB, characterized by dissemination to the bone marrow and vertebrae, and MYCN amplification. Following multiple cycles of chemotherapy and subsequent hematopoietic stem cell transplantation, the patient was scheduled for surgical resection. Preoperative imaging identified several image-defined risk factors, including infiltration of the porta hepatis and of the duodenopancreatic complex. During the dissection of the tumor, an incidental injury to the CBD occurred, which was subsequently repaired via end-to-end anastomosis. Seven months postoperatively, the patient presented with obstructive jaundice due to an anastomotic stricture, which was successfully managed through the placement of an endoscopic ultrasound-guided lumen-apposing metal stent (LAMS) between the dilated gallbladder and the duodenum. In our experience, endoscopic cholecystoduodenostomy constitutes a novel approach for addressing postoperative iatrogenic CBD strictures in pediatric patients. Further research is warranted to elucidate its benefits and risks as well as to evaluate its long-term efficacy and potential for broader application.

Pleuropericardial cysts are rare mediastinal tumors with variable, often severe, clinical presentations in children, occasionally requiring urgent intervention. We report the case of a previously healthy 14-year-old male who was admitted with signs of severe congestive heart failure and clinical evidence of cardiac tamponade. Transthoracic echocardiography and thoracic CT scan confirmed the presence of a compressive mediastinal cystic mass. The patient underwent emergency surgical resection via median sternotomy. Histopathological examination confirmed a benign pericardial cyst. Postoperative recovery was uneventful, and no recurrence was observed after 2 years of follow-up.

Background: Neuroblastoma, the most common extracranial solid tumor in children, requires meticulous surgical interventions due to its complex anatomical location and proximity to vital structures. Emerging technologies, such as virtual reality (VR) and indocyanine green (ICG) fluorescence-guided imaging, offer promising solutions to enhance surgical precision and outcomes. Despite their potential, their use in pediatric oncology remains underexplored. This case report highlights the integration of VR and ICG fluorescence imaging in the surgical treatment of neuroblastoma, emphasizing their benefits, limitations, and the need for further advancements.

Case description: A 12-month-old female with a prenatal diagnosis of cloacal malformation, Müllerian anomalies, and a horseshoe kidney was under care at our center for the management of her complex urogenital anomalies. During preoperative imaging to plan her reconstructive surgery, an abdominal MRI revealed a solid retroperitoneal mass, later confirmed as a right adrenal neuroblastoma. After six cycles of chemotherapy, metaiodobenzylguanidine (mIBG) scans indicated persistent uptake, suggesting the possible presence of tumor viability. Consequently, a definitive surgical resection was scheduled. The procedure incorporated VR for navigation and ICG fluorescence for real-time vascular mapping, facilitating precise dissection and preservation of critical structures. The patient's postoperative recovery was uneventful, and she was discharged in stable condition. Follow-up evaluations (i.e., MRI, mIBG) showed no evidence of residual macroscopic disease.

Conclusion: VR and ICG fluorescence imaging hold promise for enhancing surgical precision and safety in pediatric neuroblastoma. While current limitations include the lack of real-time image overlay and inadequate visualization of tumor margins, future advancements in navigation systems and targeted probes may overcome these barriers and significantly improve oncologic outcomes.

Mesenteric shear, injury due to sudden stretch of the mesentery, is a rare condition that remains poorly studied, especially in the pediatric population. Often resulting from trauma, its presentation can vary from nonspecific and vague abdominal symptoms to an acute abdomen and peritonitis requiring urgent surgical intervention. Unified management strategies are not yet in place. We describe the case of a 10-year-old boy who presented to the emergency department with diffuse abdominal pain of 1 day duration, 2 days after he sustained blunt abdominal trauma with an elbow during a soccer match. He was hemodynamically and clinically stable. Computed tomography scan revealed soft tissue thickening in the left upper quadrant at the root of the mesentery with mild surrounding inflammatory mesenteric fat stranding, suggesting mesenteric shearing. With stable vitals, a soft abdomen on physical exam, and no drop in hemoglobin, the decision was made to treat the patient conservatively. The patient was admitted for observation, and after frequent abdominal exams, stable laboratory results, and abdominal imaging, he was discharged home without any surgical intervention. Conservative management can be successful in the case of a stable patient without alarming physical, laboratory, or imaging findings. Observation and close monitoring remain essential to detect complicated cases that require surgical intervention.

We report the first documented pediatric case of the Deloyers procedure performed using robotic surgery to treat a female patient with long-segment Hirschsprung disease. A 9-month-old child was diagnosed with long-segment Hirschsprung disease. Despite rectal irrigations, the patient experienced refractory constipation and enterocolitis, necessitating exploratory surgery and ileostomy. A transition zone was identified at the proximal transverse colon, with mapping biopsies confirming aganglionosis up to the splenic flexure. At 16 months of age, the child underwent a robot-assisted endorectal pull-through with ileostomy closure. Four 8-mm trocars were placed in the epigastric, left subcostal, right subcostal, and right flank regions. Dissection and mobilization extended distally beyond the peritoneal reflection and proximally to the hepatic flexure, preserving the marginal vascular arcades. The middle and right colic arteries were ligated, while the ileocolic artery was preserved. Indocyanine green fluorescence imaging confirmed adequate vascularization of the hepatic flexure. A counterclockwise 180-degree rotation of the right colon was performed. In the perineal phase, a mucosal incision above the dentate line was followed by progressive mucosectomy to reach the isolated rectum. The colon was pulled through, and a tension-free coloanal anastomosis was performed. The postoperative period was uneventful at the 6-month follow-up. Robot-assisted laparoscopic endorectal pull-through with the Deloyers procedure is a feasible and safe technique for long-segment Hirschsprung disease. Larger case series are required to assess its long-term outcomes and potential advantages. An explanatory video of the surgery is available.

Concurrent rupture of hepatic hydatid cysts into the biliary tree and into the pleural cavity is a very rare complication in echinococcosis and can pose diagnostic and treatment challenges. We present the case of a 15-year-old female patient with recurrent abdominal pain, chest pain, fever, vomiting, jaundice, and cholangitis. Ultrasound, X-rays, computed tomography of the abdomen and thorax and cholangio-magnetic resonance imaging revealed a hepatic hydatid cyst with rupture into the main biliary duct causing obstruction, gallbladder microlithiasis, rupture of the right hemidiaphragm, and pleural hydatidosis. Echinococcus serology tests were positive. Endoscopic retrograde cholangiopancreatography (ERCP) could not resolve the obstructive jaundice. A laparotomy with choledochotomy, removal of hydatid structures, choledochal drainage with Kehr tube, cholecystectomy, Lagrot partial pericystectomy, partial pleural resection, suturing of the diaphragm, and triple drainage (right pleural cavity, cystic cavity, and Douglas pouch) was performed. Perioperative albendazole and antibiotic therapy was administered. The patient had an uneventful postoperative course. Follow-up at 1, 6, 12, and 24 months showed a favorable evolution without relapse of the hydatidosis. The very rare complications of cholangiohydatidosis and concomitant hepatothoracic transit lead to a severe condition, which needs adequate surgical treatment. Clinical presentation and laboratory findings are not specific and may simulate an obstructive jaundice and acute cholangitis of other etiology. ERCP with endoscopic papillotomy offers the advantage of a minimally invasive surgery, but it does not allow a definitive treatment of the whole problem and may be useful as a bridge procedure to drain the bile duct while awaiting definitive surgery.

A 12-year-old girl presented with inguinal swelling and recurrent groin pain since menarche. Ultrasound showed an inguinally located ovary with normal perfusion. Herniorrhaphy revealed an ectopic inguinal left ovary with fallopian tube and atretic hemiuterus and a closed internal inguinal ring. Laparoscopy revealed a right-sided hemiuterus and vaginally palpable cervix, leading to the diagnosis of ectopic OHVIRA syndrome type 1.2. The left hemiuterus was resected and the left ovary was pulled through the inguinal canal into the abdomen. During 12 months of follow-up, the left ovary showed normal perfusion and sonomorphologic appearance, menstrual periods were uneventful.

Cloacal exstrophy (CE) is a rare condition, and the preservation of a short hindgut is crucial for growth, fluid-electrolyte balance, and bowel management. Herein, we present the case of an infant with concurrent anomalies and the challenges faced during the preservation of both hindguts. A preterm male infant, born at 34 weeks weighing 2 kg, was diagnosed with CE. The first stage of CE repair was performed at 3 months of age, involving the separation and tubularization of the cecal plate and the joining of the two hemi-bladders. During the procedure, hindgut duplication was noted. Each hindgut had a short mesentery with far-separated, tiny blind ends (7 and 10 cm in length), each directed toward opposite sides of the pelvis and measuring 8 Fr in caliber. Due to the risk of compromising the blood supply during rotation and mobilization of one hindgut, the decision was made to exteriorize each hindgut as end stomas. Both stomas began functioning as expected. However, a colo-cutaneous fistula (connecting the cecum to the midline surgical wound) developed and was managed conservatively for 8 weeks. During this period, despite the functioning left stoma, the right stoma was stenosed, and the fistula persisted. The infant underwent a second laparotomy for fistula repair and reconstruction of both hindguts. This was successfully managed by creating a single-lumen end stoma, preserving the entire length of the hindguts with a wider caliber. In conclusion, complex cases of CE are uncommon, and unexpected operative findings should always be anticipated. Reconstructing both hindguts into a single lumen during the initial procedure can be challenging but is achievable with time and careful effort. Preservation of both hindgut ends should be prioritized. However, long-term outcomes remain uncertain due to the rarity of this presentation.

Arterio-ureteral fistula (AUF) is a rare condition affecting nearby adult-only patients. Patients usually present with hematuria, often starting as intermittent hematuria which frequently increases, and may lead to hemorrhagic shock. Without rapid diagnosis and prompt treatment, AUF can be lethal. Risk factors for developing an AUF include a history of pelvic surgery mainly due to cancer, a history of pelvic radiation, a history of vascular surgery, or chronic indwelling ureteral stents (CIUS). Imaging to confirm diagnosis includes angiography, computed tomography (CT) scan, or retrograde pyelography, although AUF may be missed. Therefore, even if imaging is negative, the presence of hematuria of unexplained origin in combination with mentioned risk factors is highly suspicious for AUF and must be excluded. We report the case of a 16-year-old male patient who presented with a new onset of intermittent hematuria to our emergency room. The patient's history included previous pelvic surgery for resection of ganglioneuroma 6 years ago with bilateral replacement of the iliac artery and postoperative acute kidney failure with reconstruction of both ureters and CIUS. After the initial uneventful postoperative follow-up over 5 years, another Double J (DJ) catheter had to be placed into the right ureter due to hydronephrosis. Six weeks later, the patient presented with intermittent hematuria. Despite negative imaging, we performed immediate surgical exploration confirming the diagnosis of AUF. To the best of our knowledge, this is the first case of AUF under the age of 18 years reported in the literature. In conclusion, in patients with macrohematuria and a history of the abovementioned risk factors, AUF has to be kept in mind and must be reliably excluded.