Journal of Pediatric Surgery Case Reports最新文献

Spontaneous enterocutaneous fistula in a neonate: A case report 新生儿自发性肠瘘：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-11-21 DOI: 10.1016/j.epsc.2024.102929

Yirgalem Teklebirhan Gebreziher , Yoseph Equar Assefa , Hadush Tesfay Negash , Fekrey berhe Gebru

Introduction

Spontaneous enterocutaneous fistulas (ECF) are extremely rare in children. To our knowledge, only two cases have been reported in the literature.

Case presentation

A male born vaginally at 34 weeks of gestation was referred to our hospital at 11 days of life due to a 4-day history of feculent discharge from a right upper quadrant wound. His birth weight was 1.6 kg, and his Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. He had a black blister in the right upper quadrant of the abdomen at birth, which started to ulcerate and increase in size in the following days. He was initially treated with intravenous antibiotics and wound care. On day of life 7, the wound began discharging feculent material. On arrival, his vital signs were within normal limits. A 4 × 4 cm ulcerated wound was noted in the right upper quadrant of the abdomen, with two separate fistula sites, consistent with ECF. The rest of the examination was unremarkable. Abdominal X-ray was normal. The patient was taken to the operating room for an abdominal exploration, which was done through a supraumbilical transverse laparotomy separate from the area of the ECF. We found a 0.5 × 0.5 cm perforation on the hepatic flexure of the colon and a large perforation in the ileum, 40 cm proximal to the ileocecal valve. The colonic perforation was primarily repaired, the perforated ileal segment was resected, and the intestinal continuity restored with an end-to-end anastomosis. The postoperative recovery was uneventful, and he was discharged on the sixth postoperative day. Histopathological examination of the resected bowel revealed normal bowel mucosa, with no evidence of ectopic gastric or pancreatic tissue.

Conclusion

Spontaneous ECF is an uncommon occurrence in neonates and children. Early surgical intervention is an effective management approach.

导言自发性肠瘘（ECF）在儿童中极为罕见。据我们所知，文献中仅报道过两例病例。病例介绍一名妊娠 34 周时经阴道出生的男婴，出生 11 天时因右上腹伤口排出脓性分泌物 4 天而被转诊至我院。他出生时体重为 1.6 千克，1 分钟和 5 分钟时的阿普加评分分别为 8 分和 9 分。出生时，他的右上腹有一个黑色水泡，随后几天开始溃烂并增大。最初，他接受了静脉注射抗生素和伤口护理治疗。出生后第 7 天，伤口开始排出粪便。到达医院时，他的生命体征在正常范围内。他的右上腹有一个 4 × 4 厘米的溃疡伤口，伤口上有两个独立的瘘管，与 ECF 一致。其他检查均无异常。腹部X光检查正常。患者被送入手术室进行腹部探查，探查是通过脐上横切口进行的，与ECF区域分开。我们发现结肠肝曲处有一个 0.5 × 0.5 厘米的穿孔，回肠也有一个大的穿孔，位于回盲瓣近端 40 厘米处。主要修复了结肠穿孔，切除了穿孔的回肠段，并通过端对端吻合术恢复了肠道的连续性。术后恢复顺利，他在术后第六天出院。切除肠道的组织病理学检查显示肠道粘膜正常，没有异位胃或胰腺组织的迹象。结论自发性 ECF 在新生儿和儿童中并不常见，早期手术干预是一种有效的治疗方法。

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引用次数: 0

Inflammatory myofibroblastic tumor of the sigmoid colon: A case report 乙状结肠炎性肌纤维母细胞瘤：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-11-16 DOI: 10.1016/j.epsc.2024.102927

Suleiman Ayalew , Michael A. Negussie , Messay Gebrekidan , Dinksira Bekele Deneke , Mulat Asrade Alemayehu , Mesfin Tesera Wassie

Introduction

Inflammatory myofibroblastic tumors (IMTs) are rare tumors primarily affecting children and young adults. IMT of the sigmoid colon is particularly rare, with very few cases reported in the literature.

Case presentation

A 2-year-old boy presented with a three-month history of painless, progressive abdominal swelling that began in the right lower abdomen and extended across to the left. He also experienced significant weight loss and reduced appetite, though there were no symptoms of nausea, vomiting, diarrhea, constipation, or rectal bleeding. On examination, a 10 cm firm, non-tender, and non-mobile mass was noted in the right lower quadrant and hypogastric region. No other abnormalities were detected. Laboratory results revealed severe anemia (hemoglobin: 6.1 g/dL) and elevated white blood cell (17,400/μL) and platelet (965,000/μL) counts. An abdominal ultrasound showed a large mass with associated lymphadenopathy, prompting further evaluation with contrast-enhanced CT. The scan revealed an avidly enhancing mesenteric mass near the superior mesenteric artery with minimal ascites and inguinal lymphadenopathy. The patient underwent laparotomy, during which a highly vascular mass originating from the sigmoid colon was resected, followed by colocolic anastomosis. Histopathological examination identified an intermediate-grade inflammatory myofibroblastic tumor with focal mucosal infiltration. Immunohistochemical staining confirmed the diagnosis, showing positivity for vimentin, smooth muscle actin, and focal desmin. Postoperatively, the patient recovered well, tolerated oral intake by day three, and was discharged on day six after a blood transfusion. At follow-up, he remained asymptomatic, with no recurrence on ultrasound and normalized hemoglobin levels.

Conclusion

IMT can occur in the gastrointestinal tract in children. Complete surgical resection is curative.

导言炎性肌纤维母细胞瘤（IMT）是一种罕见的肿瘤，主要影响儿童和年轻人。病例介绍一名两岁男孩因无痛性、进行性腹部肿胀就诊，病史长达三个月，肿胀从右下腹开始向左侧延伸。虽然没有恶心、呕吐、腹泻、便秘或直肠出血等症状，但他的体重明显下降，食欲减退。经检查，发现他的右下腹和下腹部有一个 10 厘米的肿块，质地坚硬，无触痛，不能移动。未发现其他异常。化验结果显示严重贫血（血红蛋白：6.1 g/dL），白细胞（17,400/μL）和血小板（965,000/μL）计数升高。腹部超声波检查显示有一个巨大的肿块，并伴有淋巴结肿大，因此需要进一步进行造影剂增强 CT 评估。扫描结果显示，肠系膜上动脉附近的肠系膜肿块呈阳性增强，腹水和腹股沟淋巴结病极少。患者接受了开腹手术，切除了源自乙状结肠的高血管性肿块，随后进行了结肠吻合术。组织病理学检查发现这是一个中级炎性肌纤维母细胞瘤，伴有局灶性粘膜浸润。免疫组化染色证实了这一诊断，显示波形蛋白、平滑肌肌动蛋白和局灶 desmin 呈阳性。术后，患者恢复良好，第三天就能进食，输血后于第六天出院。随访时，他仍无症状，超声检查无复发，血红蛋白水平恢复正常。结论IMT可发生在儿童的胃肠道，完全手术切除可治愈。

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引用次数: 0

3D-printed model for surgical planning in congenital porto-systemic shunt: A case report 用于先天性门-系统分流手术规划的 3D 打印模型：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-11-14 DOI: 10.1016/j.epsc.2024.102926

Sergio Assia-Zamora, Miriam Cortés-Cerisuelo, Athanasios Tyraskis, Nigel Heaton

Introduction

Hepatobiliary surgery can be challenging due to the complex nature of variations in liver anatomy, particularly in small children. Congenital portosystemic shunts (CPS – Abernethy syndrome) are increasingly recognized with a range of clinical presentations and associated complications and can present anatomical challenges for operative shunt closure. Three-dimensional printing (3DP) has gained popularity due to its ability to produce accurate models with the specific anatomical characteristics for the individual patient. We used a 3DP model from original image sources for planning of surgical shunt closure in a child with CPS and for educating the family and surgical team preoperatively.

Case presentation

A 5-year-old male with autism and hyperammonemia of 80 μmol/L and was found to have an intrahepatic CPS. No tumors were seen within the liver. Physical examination was unremarkable. After treatment with Rifaximin to lower blood ammonia levels, his ability to concentrate and achieve milestones improved. Angiography with shunt occlusion showed an intrahepatic shunt between the left portal and the middle hepatic vein into the IVC. Intrahepatic portal branches were demonstrated with the implication that a one stage closure could be performed. A 3DP model was printed from the cross sectional imaging which allowed for more detailed planning of shunt ligation and to explain the surgical details to the parents. Surgical closure was performed with no complications.

Conclusion

3DP models can be a useful tool for planning complex congenital porto-systemic shunt closure surgery.

导言由于肝脏解剖结构的复杂多变，肝胆外科手术具有挑战性，尤其是对小儿而言。先天性门静脉分流（CPS - Abernethy 综合征）的临床表现和相关并发症越来越多，给手术关闭分流带来了解剖学上的挑战。三维打印（3DP）能够根据患者的具体解剖特征制作精确的模型，因此越来越受欢迎。我们利用原始图像资源制作了一个 3DP 模型，用于规划一名 CPS 患儿的手术分流关闭，并对家属和手术团队进行术前教育。病例介绍一名 5 岁男性患者患有自闭症和 80 μmol/L 的高氨血症，被发现患有肝内 CPS。肝内未见肿瘤。体格检查无异常。在接受利福昔明治疗以降低血氨水平后，他集中注意力和达到里程碑的能力有所改善。分流闭塞的血管造影显示，左侧门静脉和肝中静脉之间有肝内分流进入 IVC。肝门静脉内分支也被显示出来，这意味着可以进行一期闭合。根据横截面成像打印出的 3DP 模型可以更详细地规划分流结扎手术，并向家长解释手术细节。结论 3DP 模型是规划复杂的先天性门-系统分流关闭手术的有用工具。

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引用次数: 0

Spigelian hernia diagnosed in a newborn: A case report 新生儿脊柱疝的诊断：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-11-13 DOI: 10.1016/j.epsc.2024.102922

Nicole Chicoine , Frederick Rescorla

Introduction

Spigelian hernias represent only 0.1–0.2 % of all abdominal wall hernias and are infrequently encountered in pediatric patients. Limited literature surrounding pediatric Spigelian hernias exists, and there is no uniform or optimal surgical repair technique.

Case presentation

A term female with unremarkable prenatal history presented a left-sided Spigelian hernia at birth that contained loops of bowel, by physical examination and ultrasound. The hernia was easily reducible, so she was discharged with a plan for an elective repair at a later point. At 8 months of age, she underwent an abdominal wall ultrasound that showed a defect of 6 cm in length. She underwent elective repair at 9 months of age due to parental preference in the setting of an enlarging defect size. The hernia repair was done through a combination of laparoscopic and open techniques. The laparoscopy part, which consisted in one port placed in the umbilicus for a camera, enabled visualization of the suspected hernia site, confirm the proper approximation of the lateral and medial borders of the hernia, and helped avoid any intra-abdominal injuries during the repair. The repair itself was completed in an open manner with interrupted sutures in a top to bottom approach, in a transverse orientation. The patient recovered well from the operation. At 1 year of follow up she has shown no signs of recurrence.

Conclusion

Congenital pediatric Spigelian hernias can be successfully repaired using a combination of laparoscopy and open approach. The addition of a laparoscopy allows proper visualization of the intra-abdominal side of the repair.

导言：斯皮盖尔疝仅占所有腹壁疝的 0.1%-0.2%，在小儿患者中很少见。有关小儿斯皮格脊柱疝的文献有限，也没有统一或最佳的手术修补技术。病例介绍一名足月女性，产前病史无异常，出生时通过体格检查和超声波检查发现左侧斯皮格脊柱疝，内含肠环。疝气很容易缩小，因此她在出院时计划日后进行选择性修补。8 个月大时，她接受了腹壁超声波检查，结果显示缺损长度为 6 厘米。由于缺损面积不断扩大，父母倾向于在她9个月大时进行选择性修补。疝气修补术通过腹腔镜和开腹技术相结合的方式进行。腹腔镜部分包括在脐部放置一个摄像头的孔，这样就能看到疑似疝气的部位，确认疝气的外侧和内侧边界是否合适，并有助于在修补过程中避免任何腹内损伤。修补术本身是以开放的方式完成的，采用从上到下的横向间断缝合。患者术后恢复良好。结论先天性小儿斯皮格疝可以通过腹腔镜和开腹手术相结合的方式成功修复。加用腹腔镜可使修复手术的腹腔内情况一览无余。

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引用次数: 0

Rapidly progressing necrotizing fasciitis with chickenpox infection: A case series 感染水痘后迅速恶化的坏死性筋膜炎：病例系列

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-11-13 DOI: 10.1016/j.epsc.2024.102925

Fereshteh Moshfegh , Zahra Hosseinzade , Seyed Hamid Salehi , Mohammad Javanbakht , Ali Manafi Anari , Behnam Sobouti

Introduction

Varicella usually resolves without complications. However, there is a risk of necrotizing soft tissue infections such as necrotizing fasciitis (NF) that can complicate the management.

Case series

Case 1 was a 5-year-old male who developed widespread vesicular lesions and fever, diagnosed as varicella. His condition worsened as he presented with abdominal distension and pain, leading to hospitalization for suspected toxic shock syndrome. Computed tomography (CT) of the chest and abdomen revealed features consistent with NF, prompting extensive debridement and subsequent vacuum-assisted closure (VAC) therapy. After several surgical revisions he underwent skin grafting and was eventually discharged home. Case 2 was a 4.5-year-old male with no significant medical history, who presented with generalized fever, neck pain, and rapidly spreading skin rashes. He subsequently developed severe acute idiopathic scrotal edema and extensive ecchymosis, requiring immediate hospitalization. Broad-spectrum antibiotics were started. He underwent emergent wide debridement of the ecchymotic areas. The pathology analysis confirmed necrotic tissue, and cultures were positive for bacteria and fungi. He underwent repeated debridement. The last debridement was followed by uncontrollable hemorrhage, and he passed away.

Conclusion

While varicella is generally a mild disease, life-threatening complications such as necrotizing fasciitis can occur.

导言：水痘通常不会引起并发症。病例系列病例 1 是一名 5 岁的男性，出现大面积水泡状皮损和发热，被诊断为水痘。他的病情恶化，出现腹胀和腹痛，疑似中毒性休克综合征而住院治疗。胸部和腹部的计算机断层扫描（CT）显示出与 NF 一致的特征，促使他进行了大面积清创，随后进行了真空辅助闭合（VAC）治疗。经过几次手术修整后，他接受了植皮手术，最终出院回家。病例 2 患儿是一名 4.5 岁的男性，无明显病史，因全身发热、颈部疼痛和皮疹迅速扩散而就诊。随后，他出现了严重的急性特发性阴囊水肿和大面积瘀斑，需要立即住院治疗。医生开始使用广谱抗生素。他接受了紧急的大面积瘀斑清创术。病理分析证实组织坏死，细菌和真菌培养呈阳性。他接受了反复清创。结论虽然水痘通常是一种轻微的疾病，但也可能出现危及生命的并发症，如坏死性筋膜炎。

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引用次数: 0

Recurrent spontaneous gastric perforations in a neonate with renal tubular dysgenesis: A case report 一名肾小管发育不良的新生儿反复发生自发性胃穿孔：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-11-08 DOI: 10.1016/j.epsc.2024.102923

Mashael AlSiddiqi , Safaa Najar , Sami Taha , Hassan Baghazal , Noora Alshahwani

Introduction

Neonatal gastric perforation (NGP) is a very rare, life-threatening condition. Management can be complicated in patients with co-morbidities. Recurrent gastric perforation is even more rare.

Case presentation

A 33 6/7 male was born by cesarean section and had a birth weight of 2300g. His mother was gravida 3/para 1, otherwise healthy. The parents were third-degree cousins. Prenatal ultrasounds showed severe oligohydramnios with bilateral hyperechogenic kidneys. On physical exam, he had subtle facial dysmorphism, rocker bottom feet, stiff joints, and long slender fingers. He developed respiratory distress shortly after birth, which required intubation and mechanical ventilation. He was made nil per os (NPO), and antibiotics were started. At 20 hours of life, he had a sudden deterioration with desaturations, hypotension, and severe abdominal distension. Abdominal X-ray showed free air in the peritoneal cavity. We placed a peritoneal drain. One day later he reaccumulated air. We suspected that he could have renal tubular dysgenesis (RTD) given that he had no urine output. One day later he was taken to the operating room for an exploratory laparotomy. We found a large perforation in the lesser curve of the stomach. We repaired the perforation and placed a peritoneal dialysis catheter. Four days later he was re-explored for pneumoperitoneum. We found a perforation in the anterior wall of the stomach and repaired it in 2 layers. There was no bowel obstruction distal to the stomach. Three days later, we re-explored him for pneumoperitoneum and found a perforation on the posterior wall. The two other repairs were intact. We closed the perforation and placed a gastrostomy. Thirteen days later he was re-explored for pneumoperitoneum, and we found a second perforation in the posterior wall. Feedings were slowly started. His renal function improved, and he was discharged home at 3 months of age.

Conclusion

The association of RTD and spontaneous gastric perforation has not been previously reported. We do not know if there is a causality between the two conditions but based on our case, we recommend that patients with RTD should be closely watched for signs of gastric perforation.

导言新生儿胃穿孔（NGP）是一种非常罕见的危及生命的疾病。对于合并有其他疾病的患者，处理起来可能比较复杂。病例介绍一名 33 6/7 的男婴经剖腹产出生，出生体重为 2300 克。他的母亲是孕 3/para 1，身体健康。父母是三代表亲。产前超声波检查显示他有严重的少尿症和双侧肾脏发育不全。体格检查时，他有细微的面部畸形、足底摇晃、关节僵硬、手指细长。出生后不久即出现呼吸困难，需要插管和机械通气。他在出生后不久就出现呼吸窘迫，需要插管和机械通气，并开始使用抗生素。出生 20 小时后，他的病情突然恶化，出现血饱和度下降、低血压和严重腹胀。腹部X光片显示腹腔内有游离空气。我们为他放置了腹腔引流管。一天后，他再次积气。鉴于他没有尿液排出，我们怀疑他可能患有肾小管发育不良（RTD）。一天后，他被送进手术室进行探查性开腹手术。我们发现胃小弯处有一个大穿孔。我们修补了穿孔，并放置了腹膜透析导管。四天后，他因腹腔积气再次接受检查。我们在胃前壁发现了一个穿孔，并分两层进行了修补。胃远端没有肠梗阻。三天后，我们再次对他进行腹腔积气检查，发现后壁有一处穿孔。其他两处修补完好无损。我们缝合了穿孔并进行了胃造口术。13 天后，我们再次对他进行腹腔积气检查，发现后壁有第二个穿孔。我们开始慢慢给他喂食。结论RTD与自发性胃穿孔的关系以前从未报道过。我们不知道这两种情况之间是否存在因果关系，但根据我们的病例，我们建议应密切观察 RTD 患者是否有胃穿孔的迹象。

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引用次数: 0

Ovarian dysgerminoma in a pre-pubertal girl: A case report 青春期前女孩卵巢发育不良瘤：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-11-08 DOI: 10.1016/j.epsc.2024.102920

Evance Salvatory Rwomurushaka , Patrick Amsi , Jay Lodhia

Introduction

Ovarian dysgerminoma is a rare malignant germ cell tumor that rarely occurs in pre-puberal girls.

Case presentation

An eight-year-old girl presented with a year-long history of progressive, painless abdominal distension and significant weight loss but without obstructive symptoms. Physical examination revealed peripheral subcentric lymphadenopathy and signs of cachexia. Her abdomen was globally distended with a large, irregular mass occupying most of the abdominal cavity. Imaging with CT of the chest and abdomen revealed a large intraperitoneal mass with regional lymphadenopathy and pulmonary metastases, initially raising suspicion for peritoneal Burkitt's lymphoma. However, an ultrasound-guided biopsy was inconclusive, prompting an exploratory laparotomy. During surgery, a large mass measuring 20 by 30 cm was excised, originating from the right ovary and fed by mesenteric vessels. The uterus, left ovary, and fallopian tube were intact and unaffected, and the peritoneum, liver, and omentum appeared smooth and without nodules.

The initial postoperative course was uneventful, and histopathology confirmed the mass as an ovarian dysgerminoma. Adjuvant chemotherapy with Etoposide, Carboplatin, and Bleomycin was initiated. Unfortunately, the patient succumbed nine weeks post-surgery, following two cycles of chemotherapy, likely due to complications from hospital-acquired pneumonia and pre-existing pulmonary metastases.

Conclusion

Ovarian dysgerminoma must be included in the differential diagnosis of pre-pubertal females who present with a pelvic mass.

导言卵巢生殖细胞瘤是一种罕见的恶性生殖细胞肿瘤，很少发生在青春期前的女孩身上。病例介绍一名八岁的女孩因进行性、无痛性腹胀和体重明显减轻，但无梗阻性症状而就诊，病史长达一年。体格检查发现她有外周中心下淋巴结肿大和恶病质体征。她的腹部整体胀大，一个巨大的不规则肿块占据了大部分腹腔。胸部和腹部 CT 扫描显示腹腔内有一个巨大肿块，伴有区域淋巴结病和肺转移，起初怀疑是腹膜伯基特淋巴瘤。然而，超声引导下的活组织检查并没有得出结论，因此需要进行剖腹探查手术。手术中，切除了一个 20×30 厘米的巨大肿块，肿块来自右侧卵巢，由肠系膜血管供血。子宫、左侧卵巢和输卵管完好无损，腹膜、肝脏和网膜光滑无结节。患者开始接受依托泊苷、卡铂和博来霉素的辅助化疗。不幸的是，患者在术后九周接受了两个周期的化疗后死亡，很可能是由于医院感染的肺炎和原有的肺转移引起的并发症。

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引用次数: 0

Multifocal hepatic adenoma in an adolescent female requiring right hepatic lobectomy: A case report 需要进行右肝叶切除术的青春期女性多灶性肝腺瘤：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-11-08 DOI: 10.1016/j.epsc.2024.102924

Prabhath Mannam , Patricia Repollet-Otero , Oluwadamilola Egbewole , Nicolle Burgwardt , Christine Finck

Introduction

Hepatic adenomas are benign tumors that are extremely rare in adolescents. Proper and early management is essential to prevent associated hemorrhage and potential malignant transformation.

Case presentation

We herein present a case of a 17-year-old female patient with obesity, precocious puberty, and oral contraceptive use that presented with abdominal pain, emesis, elevated liver enzymes, and leukocytosis. Magnetic resonance imaging identified two lesions within the right hepatic lobe: a 2.0× 6.8 × 2.0 cm T1-hyperintense semilunar component and a 5.9 x 7.2 × 7.2 cm T1-hypointense component suspicious for intralesional hemorrhage. A diagnosis of hepatic adenoma was made based on imaging characteristics and the patient's oral contraceptives were discontinued to prevent lesion expansion. The patient was discharged following improvements in her clinical presentation and was scheduled for follow up imaging. Three weeks later, the patient presented again with similar symptoms, suggestive of an acute exacerbation of her hepatic lesions. Repeat computed tomography imaging revealed free fluid in the pelvis and expansion of the larger lesion to 10.9 x 6.5 × 6.4 cm that was now bilobed with irregular borders. The lesions were unsuitable candidates for embolectomy and the patient ultimately underwent a right hepatic lobectomy and wedge biopsy of segment II for another lesion discovered intraoperatively. Pathological analysis identified three distinct masses in the right hepatic lobe and a single mass within segment II, all of which were consistent with a diagnosis of a benign multifocal hepatic adenoma. No residual tumor or recurrence was identified at 3-month follow-up imaging.

Conclusion

Despite being benign, hepatic adenomas can present with rapid growth and aggressive clinical deterioration that may require urgent surgical resection.

导言肝腺瘤是一种良性肿瘤，在青少年中极为罕见。我们在此介绍一例 17 岁女性患者，肥胖、性早熟、口服避孕药，表现为腹痛、呕吐、肝酶升高和白细胞增多。磁共振成像在右肝叶发现了两个病灶：一个是 2.0×6.8 × 2.0 厘米的 T1 高密度半月形成分，另一个是 5.9×7.2 × 7.2 厘米的 T1 高密度成分，怀疑为肝内出血。根据影像学特征诊断为肝腺瘤，为防止病灶扩大，患者停用了口服避孕药。患者的临床表现有所改善后出院，并被安排进行后续造影检查。三周后，患者再次出现类似症状，提示肝脏病变急性加重。复查计算机断层扫描成像显示，患者盆腔内有游离液体，较大的病灶扩大至 10.9 x 6.5 x 6.4 厘米，目前呈双叶状，边界不规则。这些病灶不适合进行栓子切除术，患者最终接受了右肝叶切除术，并对术中发现的另一个病灶进行了 II 段楔形活检。病理分析发现右肝叶有三个不同的肿块，II段有一个肿块，所有这些都符合良性多灶性肝腺瘤的诊断。结论：尽管肝腺瘤是良性的，但它可能生长迅速，临床症状急剧恶化，需要紧急手术切除。

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引用次数: 0

Uterine rupture due to pyometra and imperforate hymen in a 7-year-old girl: A case report 一名 7 岁女孩因子宫脓肿和处女膜穿孔导致子宫破裂：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-11-08 DOI: 10.1016/j.epsc.2024.102921

Umar Mahmood, Muhammad Usama Aziz, Maria Munawar, Laraib Amjad, Chaudhary Ehtsham Azmat, Sunaina Siddique

Introduction

Pyometra is a rare condition characterized by pus accumulation in the uterine cavity primarily affecting postmenopausal women, with only a few cases reported in the pediatric population.

Case presentation

A 7-year-old female with developmental delay was brought to the hospital in shock and having clinical signs of peritonitis. Her medical history included abdominal pain and pyuria for one week prior to presentation. The only other positive physical finding was that the hymen was imperforate. An erect abdominal X-ray revealed air under the diaphragm and an ultrasound (US) of the abdomen showed moderate ascites. She was taken to the operating room for an exploratory laparotomy. We found approximately 700 mL of purulent material. The examination of all abdominal organs revealed a perforation at the fundus of the uterus and extensive adhesions. We repaired the uterine wall and left a trans-abdominal drain in the uterine cavity. We also left a drain in the pelvis. We then closed the abdomen and did a hymenoplasty during which we drained 200 additional milliliters of purulent fluid. Cultures were positive for Acinetobacter species. She remained on tobramycin for 10 days. The drains were removed on the 2nd and 5th postoperative days. She was discharged home after an uneventful recovery and has been healthy on all postoperative visits.

Conclusion

Female children with imperforate hymen are at risk for pyometra and uterine perforation. A perineal exam should be included in the work up of premenarchal females who present with peritonitis.

导言子宫脓肿是一种罕见的疾病，其特点是宫腔积脓，主要影响绝经后妇女，仅有少数病例报告发生在儿童群体中。病例介绍一名发育迟缓的 7 岁女性因休克和腹膜炎的临床表现被送到医院。她的病史包括发病前一周的腹痛和脓尿。唯一的其他阳性体征是处女膜未穿孔。直立腹部 X 光检查显示膈下有空气，腹部超声波检查显示有中度腹水。她被送往手术室进行剖腹探查术。我们发现了大约 700 毫升的脓性物质。对所有腹部器官的检查显示，子宫底穿孔，并有广泛粘连。我们修补了子宫壁，并在子宫腔内留置了经腹引流管。我们还在骨盆中留置了引流管。然后，我们关闭了腹部，并进行了处女膜成形术，在此期间，我们又排出了 200 毫升脓性液体。阿奇霉素杆菌培养呈阳性。她继续服用妥布霉素 10 天。术后第 2 天和第 5 天拔除了引流管。结论处女膜未穿孔的女婴有患子宫脓肿和子宫穿孔的风险。对于出现腹膜炎的初产妇，应进行会阴部检查。

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引用次数: 0

Appendiceal hydatid cyst in a 5-year-old child: A case report 一名 5 岁儿童的阑尾水瘤囊肿：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-29 DOI: 10.1016/j.epsc.2024.102916

Mobina Taghva Nakhjiri, Jafar Soltani, Maryam Ghavami Adel, Hojatollah Raji

Introduction

Hydatidosis is the formation of cysts caused by the parasitic infection of Echinococcus granulosus. This disease predominantly affects the liver and lungs. The involvement of other organs is quite rare.

Case presentation

A 5-year-old Iranian boy presented with abdominal pain, anorexia, and hepatomegaly. The pain had been present for about 1 year. He had developed low-grade fever during the previous two months. On physical exam he had abdominal distention and a palpable mass on the right lower quadrant. Basic blood work revealed leukocytosis and eosinophilia. An abdominal ultrasound revealed a 5 × 6 × 8 cm cystic lesion in the pelvis, and two cystic lesions located in the right lobe of the liver. A computerized tomography (CT) scan of the abdomen confirmed the findings. CT of the chest and brain ruled out further cystic lesions. The patient had a positive Indirect hemagglutination assay (IHA), confirming the diagnosis of hydatidosis. A regimen of an albendazole was initiated. He was taken to the operating room for the resection of all cysts. The hepatic cysts were drained and re-filled with hypertonic saline solution, which was left in place for several minutes. Next, the hypertonic solution was drained and all hepatic cysts removed. We turned our attention to the pelvic cyst. It had a thick wall and was indistinguishable from the surrounding tissues. After dissecting it we found that it was arising from the wall of the appendix. We surrounded it with gauze embedded in hypertonic solution and resected the majority of it, leaving a small aspect of the external layer that was densely adherent to the bowel. He recovered well from the operation, remained on albendazole for 6 months, and has had no recurrences this far.

Conclusion

Appendiceal hydatid cysts should be included in the differential diagnosis of patients with hydatid disease and pelvic cysts.

导言棘球蚴病是由棘球蚴寄生感染引起的囊肿形成。这种疾病主要影响肝脏和肺部，其他器官受累的情况非常罕见。病例介绍一名 5 岁的伊朗男孩因腹痛、厌食和肝肿大就诊。疼痛已持续了约 1 年。此前两个月，他曾出现低烧。体格检查时，他腹部胀痛，右下腹可触及肿块。基础血液检查显示白细胞增多和嗜酸性粒细胞增多。腹部超声波检查显示，盆腔内有一个 5 × 6 × 8 厘米的囊性病变，肝脏右叶有两个囊性病变。腹部计算机断层扫描（CT）证实了这一结果。胸部和脑部CT排除了其他囊性病变。患者的间接血凝试验（IHA）呈阳性，确诊为包虫病。患者开始接受阿苯达唑治疗。他被送进手术室，切除了所有囊肿。肝囊肿被引流出来，重新注入高渗盐水，并在原位停留数分钟。然后，排出高渗溶液，切除所有肝囊肿。我们将注意力转向盆腔囊肿。该囊肿壁很厚，与周围组织无法区分。解剖后我们发现，它是从阑尾壁上长出来的。我们用浸泡在高渗溶液中的纱布将其包围，并切除了大部分，只留下一小部分与肠道紧密粘连的外层。结论阑尾包虫囊肿应纳入包虫病和盆腔囊肿患者的鉴别诊断中。

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引用次数: 0