Journal of Pediatric Surgery Case Reports最新文献

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

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

Laparoscopic repair of a sliding right inguinal hernia containing both fallopian tubes, both ovaries and the uterus in an infant: A case report 用腹腔镜修补包含双侧输卵管、双侧卵巢和子宫的婴儿右侧腹股沟滑动疝：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.2024.102914

Introduction

Sliding inguinal hernias containing the uterus, fallopian tubes, and adnexa are rare and can be challenging to repair, especially in infants.

Case presentation

A 4-month-old female infant, born prematurely from a triplet pregnancy, had been managed in the Neonatal Intensive Care Unit (NICU) for several months before discharge. She was referred to us with swelling in the right inguinal area. The other two triplets had inguinal hernias and had undergone surgical repair at the same hospital. On physical exam, the patient had a sizable, reducible hernia with no signs of obstruction or strangulation. She was taken to the operating room for a laparoscopic exploration, which was done with one 5-mm port for a camera and two 3-mm working ports. We found a sliding right inguinal hernia that contained both ovaries, both fallopian tubes, and part of the uterus in the hernial sac. The contents were carefully reduced, the hernial sac was carefully dissected, and the defect was repaired laparoscopically using a purse-string suture. No hernia was found on the left side. The postoperative course was uneventful. At six months of follow-up, she is doing well and has no signs of recurrence.

Conclusion

Sliding inguinal hernias containing bilateral ovaries, fallopian tubes, and the uterus are rare. Laparoscopy can help with the diagnosis, the reduction of the contents, and allows to assess the condition of the reduced organs.

导言：包含子宫、输卵管和附件的腹股沟滑动疝非常罕见，而且修复难度很大，尤其是在婴儿身上。病例介绍一名 4 个月大的女婴因三胎妊娠早产，出院前在新生儿重症监护室（NICU）接受了几个月的治疗。她因右侧腹股沟区肿胀而转诊到我们这里。另外两个三胞胎患有腹股沟疝，并在同一家医院接受了手术修复。经体格检查，患者的疝气很大，可以缩小，没有梗阻或绞窄的迹象。她被送往手术室进行腹腔镜探查，探查时使用了一个 5 毫米的摄像孔和两个 3 毫米的工作孔。我们发现右侧腹股沟滑动疝，疝囊内有两个卵巢、两个输卵管和部分子宫。我们小心地缩小了疝内容物，仔细解剖了疝囊，并用荷包线缝合腹腔镜修补了缺损。左侧未发现疝气。术后恢复顺利。结论包含双侧卵巢、输卵管和子宫的腹股沟滑动疝非常罕见。腹腔镜检查有助于诊断和缩小疝内容物，并能评估缩小器官的状况。

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引用次数: 0

Segmental absence of intestinal musculature increasingly recognized in premature infants with perforated viscus: A case series 在内脏穿孔的早产儿中，越来越多的人认识到肠道肌肉节段性缺失：病例系列

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-29 DOI: 10.1016/j.epsc.2024.102915

Introduction

Segmental absence of intestinal musculature (SAIM) is a pathological diagnosis, denoting focal absence of the muscularis propria in the presence of intact surrounding structures. This condition often presents as spontaneous intestinal perforation (SIP) and can be difficult to distinguish clinically from necrotizing enterocolitis (NEC).

Case presentations

We present 5 cases of premature babies with gestational age ranging from 24 + 3 weeks up to 32 + 1 weeks, who all presented with intestinal perforation before the 15th day of life. Three patients presented with a distended abdomen and discoloration and were subsequently found to have pneumoperitoneum on abdominal x-ray (AXR). The 2 other patients presented with clinical deterioration but without signs of intestinal perforation and were subsequently found to have pneumoperitoneum on AXR. All underwent bowel resection of perforated bowel with either ileostomy with mucous fistula or primary end-to-end anastomosis. Two patients required repeat exploratory laparotomies within a week of their initial surgery due to pneumoperitoneum in subsequent AXR caused by new perforations in other parts of the small bowel. One patient sustained an iatrogenic liver injury intra-operatively and passed away 1 day post-operatively. All patients were found to have SAIM on histopathological examination.

Conclusion

SAIM is a pathological diagnosis that can manifest as SIP and may denote a risk for recurrent peritonitis in premature infants who underwent bowel resection for perforated viscus without a clear etiology.

导言肠道肌肉组织节段性缺失（SAIM）是一种病理诊断，表示在周围结构完好的情况下，固有肌的局灶性缺失。这种情况通常表现为自发性肠穿孔（SIP），临床上很难将其与坏死性小肠结肠炎（NEC）区分开来。病例介绍我们介绍了 5 例早产儿，胎龄从 24+3 周到 32+1 周不等，他们都在出生后第 15 天前出现肠穿孔。其中 3 名患者出现腹部膨胀和变色，随后在腹部 X 光检查（AXR）中发现腹腔积气。另外两名患者临床症状恶化，但没有肠穿孔迹象，随后在腹部X光检查中发现腹腔积气。所有患者都接受了穿孔肠道切除术，并进行了回肠造口术和粘液瘘或原发性端端吻合术。两名患者在首次手术后一周内因小肠其他部位的新穿孔导致腹腔积气而需要再次进行剖腹探查手术。一名患者在术中出现先天性肝损伤，术后 1 天去世。结论 SAIM 是一种病理诊断，可表现为 SIP，可能意味着因内脏穿孔而接受肠切除术的早产儿在没有明确病因的情况下有复发腹膜炎的风险。

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引用次数: 0

Heteropagus (parasitic) twins and concomitant omphalocele: A case report 异卵（寄生）双胞胎并发脐膨出：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-25 DOI: 10.1016/j.epsc.2024.102909

Introduction

Heteropagus twins are extremely rare, occurring in one to two million live births. To date, fewer than 75 cases of epigastric heteropagus twins have been reported, and only a handful of these cases have involved heteropagus twins with a concomitant omphalocele.

Case presentation

We present a case of heteropagus twins in a 2-day-old neonate with a fully formed parasitic mass attached to the lower anterior chest wall and epigastrium. The parasitic twin was acephalic and acardiac, had bowel structures, pelvic bones, bilateral lower limbs, and a single upper limb. The blood supply of the parasitic twin primarily originated from the right internal mammary artery, and the venous return was via the right internal mammary vein to the superior vena cava. The parasitic twin's bowel loops overlapped the left lobe of the autosite's liver, which was partially contained in a midline omphalocele-like abdominal wall defect. The autosite also had a small patent foramen ovale and a patent ductus arteriosum with a left-to-right shunt. A successful dissection and excision of the parasitic twin was done to remove the rudimentary limbs, pelvis, and part of the parasitic trunk. The autosite's omphalocele was repaired at the same time. The patient had an uneventful postoperative recovery.

Conclusion

Early surgical separation of heteropagus twins is crucial to optimize the outcomes of the healthy twin.

导言异阴道双胞胎极为罕见，在一百万到两百万的活产婴儿中才会出现。迄今为止，有关上腹部异位肛门双胞胎的报道不足 75 例，其中只有极少数异位肛门双胞胎同时伴有脐膨出。寄生双胎为头位和心位，有肠道结构、盆骨、双下肢和单上肢。寄生双胞胎的血液供应主要来自右乳内动脉，静脉回流则通过右乳内静脉到达上腔静脉。寄生双胞胎的肠道襻与自体肝脏的左叶重叠，而自体肝脏的左叶部分包含在中线脐膨出样腹壁缺损中。这对寄生双胞胎还有一个小卵圆孔和一个带有左向右分流的动脉导管。对这对寄生双胞胎进行了成功的解剖和切除，移除了肢体、骨盆和部分寄生躯干。同时还修复了自体脐膨出。结论异卵双胎的早期手术分离对于优化健康双胎的预后至关重要。

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引用次数: 0

Granular cell tumor of the breast in a 17-year-old female: A case report 一名 17 岁女性的乳腺颗粒细胞瘤：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-25 DOI: 10.1016/j.epsc.2024.102913

Introduction

Granular Cell Tumors (GCTs) are rare soft tissue neoplasms originating from Schwann cells, often benign but mimicking breast carcinoma clinically and radiologically.

Case presentation

A 17-year-old female with a second-degree family history of breast cancer presented with a painful left breast mass (∼3 cm) persisting for three years. Initial evaluation with fine needle aspiration (FNA) suggested a benign lipoma, but imaging reported BIRADS IV mass. Mammography revealed an ovoid mass with irregular margins, Sono-mammogram reported heterogeneous slightly lobulated mass with excentric sonolucent of 3 x 2.4 × 1.8 cm, no increased vascularity on sono-doppler and core needle biopsy confirmed a GCT, positive for S-100 and CD68. The patient was taken to the operating room for surgical excision. A 4 cm curvilinear incision was made over the left breast mass, just lateral to the nipple at the 3 o'clock position. En-bloc excision of the mass was carried out with 1 cm margins. The specimen was removed and sent for frozen section analysis that confirmed the cytological diagnosis of a granular cell tumor with clear margins. The excised mass was sent for permanent section to pathology. Final histopathology confirmed a benign GCT with free margins. Due to the infiltrative nature of the tumor, a second excision in similar fashion was required to obtain wider margins, which was uneventful. Clear margins were pursued due to the tumor's infiltrative nature and patient's family history of breast cancer, despite the low risk of recurrence with positive margins. The patient remains clinically disease-free at three-year follow-up.

Conclusion

Granular cell tumors of the breast, though benign, are often mistaken for carcinoma due to their clinical similarity. Complete excision with clear margins, which may require re-excision due to their infiltrative nature, is crucial to prevent recurrence.

导读：粒细胞瘤（GCT）是一种罕见的软组织肿瘤，起源于许旺细胞，通常为良性，但在临床和影像学上可与乳腺癌相似。病例介绍一名 17 岁女性，家族二度罹患乳腺癌，因左侧乳房肿块（3 厘米）持续疼痛三年而就诊。细针穿刺术（FNA）的初步评估提示为良性脂肪瘤，但影像学检查报告为 BIRADS IV 级肿块。乳房 X 线造影显示为卵圆形肿块，边缘不规则，声像图显示为 3 x 2.4 x 1.8 厘米的异质轻微分叶状肿块，声像多普勒显示无血管增生，核心针活检证实为 GCT，S-100 和 CD68 阳性。患者被送往手术室进行手术切除。在左侧乳房肿块的乳头外侧 3 点钟位置做了一个 4 厘米的弧形切口。在 1 厘米的边缘对肿块进行了全切。切除的标本被送去进行冷冻切片分析，结果证实细胞学诊断为边缘清晰的颗粒细胞瘤。切除的肿块被送到病理科进行永久切片。最终组织病理学证实这是一个边缘游离的良性 GCT。由于肿瘤具有浸润性，需要以类似的方式进行第二次切除，以获得更宽的边缘，切除过程并不顺利。尽管边缘阳性复发风险较低，但考虑到肿瘤的浸润性和患者的乳腺癌家族史，还是选择了边缘清晰的手术。结论乳腺颗粒细胞瘤虽然是良性肿瘤，但由于临床表现相似，常常被误认为是癌症。完全切除并保留清晰的边缘（由于其浸润性，可能需要再次切除）对于预防复发至关重要。

{"title":"Granular cell tumor of the breast in a 17-year-old female: A case report","authors":"","doi":"10.1016/j.epsc.2024.102913","DOIUrl":"10.1016/j.epsc.2024.102913","url":null,"abstract":"<div><h3>Introduction</h3><div>Granular Cell Tumors (GCTs) are rare soft tissue neoplasms originating from Schwann cells, often benign but mimicking breast carcinoma clinically and radiologically.</div></div><div><h3>Case presentation</h3><div>A 17-year-old female with a second-degree family history of breast cancer presented with a painful left breast mass (∼3 cm) persisting for three years. Initial evaluation with fine needle aspiration (FNA) suggested a benign lipoma, but imaging reported BIRADS IV mass. Mammography revealed an ovoid mass with irregular margins, Sono-mammogram reported heterogeneous slightly lobulated mass with excentric sonolucent of 3 x 2.4 × 1.8 cm, no increased vascularity on sono-doppler and core needle biopsy confirmed a GCT, positive for S-100 and CD68. The patient was taken to the operating room for surgical excision. A 4 cm curvilinear incision was made over the left breast mass, just lateral to the nipple at the 3 o'clock position. En-bloc excision of the mass was carried out with 1 cm margins. The specimen was removed and sent for frozen section analysis that confirmed the cytological diagnosis of a granular cell tumor with clear margins. The excised mass was sent for permanent section to pathology. Final histopathology confirmed a benign GCT with free margins. Due to the infiltrative nature of the tumor, a second excision in similar fashion was required to obtain wider margins, which was uneventful. Clear margins were pursued due to the tumor's infiltrative nature and patient's family history of breast cancer, despite the low risk of recurrence with positive margins. The patient remains clinically disease-free at three-year follow-up.</div></div><div><h3>Conclusion</h3><div>Granular cell tumors of the breast, though benign, are often mistaken for carcinoma due to their clinical similarity. Complete excision with clear margins, which may require re-excision due to their infiltrative nature, is crucial to prevent recurrence.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":null,"pages":null},"PeriodicalIF":0.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Endovascular diagnosis and treatment of arterio-esophageal fistula after foreign body ingestion in children: A tale of two cases 儿童异物误食后动脉食管瘘的血管内诊断和治疗：两个病例的故事

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.epsc.2024.102912

Introduction

An arterio-esophageal fistula (AEF) is an abnormal communication between an artery and the esophagus. While a rare complication, patients are at risk of disastrous hemorrhage. The goal of this study is to highlight endovascular management options of AEF in children.

Case series

We present two cases of children with AEF. Both children were female, 3 years of age or younger, and had hematemesis upon presentation. For each patient, esophageal foreign body impaction was confirmed with radiography prompting emergent surgery. A multidisciplinary team was involved in the management of both patients, consisting of combinations of pediatric surgery, pediatric otolaryngology, pediatric cardiothoracic surgery and pediatric interventional radiology. Angiography successfully localized the AEF in both patients after several hours of unsuccessful open dissection and failed attempts at hemorrhage control. Further, angiographic embolization successfully controlled the hemorrhage in one patient. One of the two children experienced cardiac arrest intraoperatively due to hemorrhagic shock, which resulted in their death.

Conclusion

Our study highlights the importance of a multidisciplinary team to care for patients with AEF and the role of endovascular techniques in aiding rapid diagnosis and potential management of the fistula.

导言动脉食管瘘（AEF）是动脉与食管之间的异常沟通。虽然这是一种罕见的并发症，但患者面临着灾难性大出血的风险。本研究旨在强调儿童 AEF 的血管内治疗方案。两名患儿均为女性，年龄均在 3 岁或 3 岁以下，就诊时均有吐血症状。每名患者都通过放射线检查证实了食管异物嵌顿，并立即进行了手术。一个由小儿外科、小儿耳鼻喉科、小儿心胸外科和小儿介入放射科组成的多学科团队参与了这两名患者的治疗。在经过数小时的开放性剥离和控制出血尝试失败后，血管造影术成功定位了两名患者的 AEF。此外，血管造影栓塞术成功控制了一名患者的出血。结论：我们的研究强调了多学科团队护理 AEF 患者的重要性，以及血管内技术在帮助快速诊断和潜在处理瘘管方面的作用。

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引用次数: 0

Thoracoscopic closure of an H-type tracheoesophageal fistula: A case report 胸腔镜下 H 型气管食管瘘闭合术：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.epsc.2024.102910

Introduction

Isolated h-type tracheoesophageal fistula (H-TEF) without esophageal discontinuity is rare and poses challenges in selecting a surgical approach due to the height of the fistula within the thoracic cavity.

Case presentation

A female neonate was born prematurely at 31 weeks of gestation with a weight of 1200 g. She was intubated at birth due to respiratory distress. She was later diagnosed with CHARGE syndrome. Nasogastric tube feedings were initiated shortly after birth. Air bubbles could be seen coming out the nasogastric tube, which were suspicious for a tracheoesophageal fistula (TEF). A contrast esophagogram confirmed an h-type TEF at the level of the second thoracic vertebral body. When the patient was five months old and had a weight of 3 Kg, she was taken to the operating room for a thoracoscopic repair of the TEF. She was placed in complete left lateral position. Four 5-mm ports were placed in the right hemithorax. The right vagus nerve was identified. We first created a pleural flap with the mediastinal pleura. Blunt dissection of the esophagus and the trachea allowed clear identification of the TEF. A vessel loop was placed around the TEF. The TEF was divided. The esophageal end the tracheal sides of the TEF were closed with interrupted stitches. The pleural flap was interposed between the two stumps. The operation took 238 minutes. The postoperative period was uneventful, and she had no recurrence of the TEF. She underwent a tracheostomy one month later, and a laparoscopic fundoplication three months after that. She was discharged home at one year of age.

Conclusion

Thoracoscopy appears to be a suitable approach for the repair of high thoracic h-type TEF.

病例介绍一名女性新生儿在妊娠31周时早产，体重1200克。后来，她被诊断为 CHARGE 综合征。出生后不久即开始鼻胃管喂养。鼻胃管中有气泡冒出，怀疑是气管食管瘘（TEF）。对比食管造影证实，在第二胸椎体水平有一个 h 型 TEF。患者五个月大、体重 3 千克时，被送往手术室进行胸腔镜下 TEF 修复术。她被置于完全左侧卧位。在右侧胸腔放置了四个 5 毫米的孔。确定了右侧迷走神经。我们首先用纵隔胸膜制作了一个胸膜瓣。对食管和气管进行钝性剥离后，可以清楚地识别 TEF。在 TEF 周围放置一个血管环。分割 TEF。用间断缝合法缝合 TEF 的食管端和气管端。胸膜瓣被放置在两个残端之间。手术耗时 238 分钟。术后恢复顺利，TEF没有复发。一个月后，她接受了气管造口术，三个月后又接受了腹腔镜胃底折叠术。结论胸腔镜似乎是修复高位胸腔 h 型 TEF 的合适方法。

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引用次数: 0

Trans-anal prolapse of intussuscepted ileal Hartmann's pouch: A case report 经肛门的回肠哈特曼袋脱垂：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-24 DOI: 10.1016/j.epsc.2024.102911

Introduction

Postoperative complications of stomas in necrotizing enterocolitis (NEC) typically affect the proximal limb. Complications of the distal limb are rarely reported.

Case presentation

A 17-day-old newborn underwent an end ileostomy and an ileal Hartmann's pouch due to necrotizing enterocolitis (NEC). Eight weeks after the surgery, he passed bloody stool through the anus. No drop in his hemoglobin level was observed. He was made NPO, and no further bloody stool was seen after 24 hours. Ten weeks post-surgery he developed acute vomiting, and a 10-cm segment of bowel was seen prolapsed through the anus. The end of the prolapsed bowel was blind, raising the suspicion of a complete prolapse of the ileal Hartmann's pouch. He was taken to the operating room for an exploratory laparotomy. We found that the ileal Hartmann's pouch had intussuscepted into the ileocecal valve, progressed through the colon and the rectum, and prolapsed through the anus. We reduced the bowel manually. The involved ileum and colon were markedly swollen, and partially necrotic. The necrotic segments were resected, and the ileostomy was reversed. The patient was discharged one month later and had no adverse complications at two months of follow up.

Conclusion

Although rare, intussusception of an ileal Hartmann's pouch should be ruled out in patients that have a Hartmann's pouch and develop vomiting and bloody stool.

导言：坏死性小肠结肠炎（NEC）造口术后并发症通常影响近端肢体。病例介绍一名 17 天大的新生儿因坏死性小肠结肠炎（NEC）而接受了回肠造口术和回肠哈特曼袋。术后八周，他从肛门排出血便。他的血红蛋白水平没有下降。他接受了 NPO 治疗，24 小时后未再出现血便。手术后十周，他出现了急性呕吐，并看到一段 10 厘米长的肠子从肛门脱出。脱垂肠管的末端是盲肠，因此怀疑回肠哈特曼氏囊完全脱垂。他被送往手术室进行探查性开腹手术。我们发现，回肠哈特曼氏囊已侵入回盲瓣，穿过结肠和直肠，从肛门脱出。我们手动缩小了肠道。受累的回肠和结肠明显肿胀，部分坏死。我们切除了坏死的肠段，并反转了回肠造口术。结论回肠哈特曼氏囊肠套叠虽然罕见，但对于患有哈特曼氏囊并出现呕吐和血便的患者，应排除肠套叠的可能。

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引用次数: 0

Left-sided gallbladder in a 17-year-old male: A case report 一名 17 岁男性的左侧胆囊：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-23 DOI: 10.1016/j.epsc.2024.102908

Introduction

Left-sided gallbladder (LSG) is a rare anatomic variant in the pediatric population where the gallbladder lies to the left of the round ligament. The diagnosis of LSG is often made intraoperatively as preoperative imaging has poor sensitivity for detection. As LSG is also associated with biliary and vascular anatomic variation, lack of familiarity with these anatomic variants can lead to higher rates of bleeding and bile duct injury.

Case presentation

A 17-year-old previously healthy male with history of scoliosis and sickle cell trait was referred for surgical management of symptomatic cholelithiasis. The patient had presented with multiple transient episodes of severe epigastric pain and nausea with ultrasound findings of cholelithiasis. There was no comment on the ultrasound report of any anatomic variation or abnormal location of the gallbladder. However, review of the imaging demonstrated a gallbladder that was situated on the left side of the liver and medial to ligamentum teres hepatis (round ligament). During the laparoscopic cholecystectomy, we confirmed that the gallbladder was located to the left of the round ligament and inferior to segment III of the liver. A retrograde top-down approach was utilized to clearly delineate the cystic artery and duct. The cystic artery was identified by its entry point into the gallbladder crossing anterior to the common bile duct in a right-to-left fashion. The cystic duct was identified and noted to drain into the right-side of the common hepatic duct. Due to clear delineation of the gallbladder anatomy with this approach, intraoperative cholangiography or fluorescence cholangiography were not utilized. He was discharged on postoperative day one without any complications.

Conclusion

LSG is associated with biliary and vascular anomalies, which may lead to intraoperative complications. Therefore, the biliary anatomy should be clearly elucidated prior to proceeding with cholecystectomy in cases of LSG.

导言左侧胆囊（LSG）是一种罕见的小儿解剖变异，胆囊位于圆韧带左侧。由于术前影像学检查的灵敏度较低，LSG 通常在术中诊断。由于 LSG 还与胆道和血管解剖变异有关，如果对这些解剖变异缺乏了解，可能会导致出血率和胆管损伤率升高。病例介绍一名 17 岁的男性患者之前身体健康，有脊柱侧弯和镰状细胞遗传病史，因无症状性胆石症转诊接受手术治疗。患者曾多次出现一过性剧烈上腹痛和恶心症状，超声检查结果为胆石症。超声报告中没有任何关于胆囊解剖变异或位置异常的评论。然而，影像学检查显示胆囊位于肝脏左侧，在肝圆韧带（圆韧带）的内侧。在腹腔镜胆囊切除术中，我们确认胆囊位于圆韧带左侧，肝脏第三节的下方。我们采用了逆行自上而下的方法来清楚地划分胆囊动脉和胆囊管。通过胆囊动脉进入胆囊的入口，以从右到左的方式穿过胆总管前方，确定胆囊动脉。确定了胆囊管，并注意到其排入肝总管的右侧。由于采用这种方法可以清楚地划分胆囊解剖结构，因此没有采用术中胆管造影或荧光胆管造影。结论LSG与胆道和血管异常有关，可能导致术中并发症。因此，在对LSG病例进行胆囊切除术之前，应清楚地阐明胆道解剖结构。

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引用次数: 0

Laparoscopic repair of transurethral extrusion of a ventriculoperitoneal shunt: A case report 经尿道挤压脑室腹腔分流术的腹腔镜修复术：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-17 DOI: 10.1016/j.epsc.2024.102907

Introduction

Transurethral protrusion of ventriculoperitoneal shunt is a rare finding with few reported cases in the literature. As most presentations are treated with an open surgical approach, our case details successful management with laparoscopic intervention. Here we describe the presentation, diagnosis, and management of a pediatric patient with erosion and extrusion of a ventriculoperitoneal shunt through the urethra.

Case presentation

A 3-year-old girl with a history of congenital hydrocephalus treated with ventriculoperitoneal shunt presented to the Emergency Department after an incidental finding of the peritoneal end of the shunt protruding from the urethra draining cerebrospinal fluid (CSF). The patient was asymptomatic with vitals and laboratory values within normal limits. Urine and CSF cultures were negative. Preoperative x-ray showed distal midline protrusion of the shunt. Due to exposed hardware with risk of infection, a combined surgical effort between pediatric urology, neurosurgery, and general surgery was implemented. Laparoscopy was utilized to transect the shunt tubing with subsequent removal through the urethra, revealing a posterior cystotomy. The bladder defect was closed entirely with absorbable suture. The shunt hardware was removed in its entirety and an extraventricular drain (EVD) was placed. The patient subsequently underwent an endoscopic third ventriculostomy (ETV) and did not require shunt replacement. The postoperative course was uneventful with benign follow up imaging.

Conclusion

Minimally invasive surgical intervention can be utilized as a safe and effective alternative to open surgery for treatment of ventriculoperitoneal shunt migration. As cases may present asymptomatically, a high index of suspicion with detailed physical exam should be applied.

导言：脑室腹腔分流管经尿道突出是一种罕见病，文献中鲜有报道。由于大多数病例都采用开腹手术治疗，我们的病例详细介绍了腹腔镜介入治疗的成功案例。病例介绍一名患有先天性脑积水并接受过脑室腹腔分流术治疗的 3 岁女孩因意外发现分流管的腹膜端突出于引流脑脊液（CSF）的尿道口而到急诊科就诊。患者无症状，生命体征和实验室值均在正常范围内。尿液和脑脊液培养均为阴性。术前X光片显示分流管远端中线突出。由于硬件外露，存在感染风险，小儿泌尿科、神经外科和普通外科联合实施了手术。利用腹腔镜横切分流管，随后通过尿道将其取出，露出后方的膀胱切口。用可吸收缝线完全缝合了膀胱缺损。分流管硬件被全部移除，并放置了室外引流管（EVD）。患者随后接受了内镜下第三脑室造口术（ETV），无需更换分流器。结论微创手术干预可作为开腹手术的一种安全有效的替代方法，用于治疗脑室腹腔分流管移位。由于病例可能无症状，因此应高度怀疑并进行详细的体格检查。

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