Journal of Pediatric Surgery Case Reports最新文献_第10页

Vulvar abscess secondary to a congenital recto-vestibular fistula in a 2-month-old female: a case report 外阴脓肿继发于先天性直肠-前庭瘘1例2月大女性

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-28 DOI: 10.1016/j.epsc.2025.103098

Shanquell M. Dixon, Mike K. Chen

Introduction

Perineal canal is a rare anorectal malformation with a normal anus, most commonly seen in East Asian countries. Presentation of this disorder in Western countries often do not involve an inflammatory process and are incidentally found later in childhood.

Case presentation

A healthy, full term female infant presented to an outside hospital at 8 weeks old due to purulent, bloody discharge noted in her diaper. On exam she was noted to be febrile and found to have labial swelling. She was diagnosed with a left labial abscess and a urinary tract infection. Urology was consulted to evaluate the patient due to the urinary tract infection. Urology noted on physical exam that the patient produced stool from her anus and an orifice near the 4 o'clock position of the vaginal introitus simultaneously. Pediatric Surgery was consulted to evaluate the patient. The child completed an antibiotic course and was scheduled to follow up in surgery clinic. The child returned to the hospital prior to clinic follow up due to recurrent fevers, increased drainage from the fistula, and worsening irritation of her labia. An exam under anesthesia was performed of the rectum and the rectovestibular fistula was identified. She initially underwent excision of the rectovestibular fistula without diverting ostomy, but experienced wound breakdown requiring diversion. Her fistula repair has fully healed, and her ostomy is now reversed.

Conclusion

The presence of a labial abscess in a female infant should prompt a thorough physical exam to assess for a rectovestibular fistula.

会阴管是一种罕见的肛门直肠畸形，肛门正常，最常见于东亚国家。在西方国家，这种疾病的表现通常不涉及炎症过程，并且在儿童后期偶然发现。一例8周大的健康足月女婴因尿不湿出现脓性血性分泌物而被送到医院外就诊。检查发现她有发热和唇肿。她被诊断为左唇脓肿和尿路感染。咨询泌尿外科医生评估患者是否有尿路感染。泌尿科检查发现患者肛门和阴道开口4点钟位置附近的一个孔口同时有大便。我们咨询了儿科外科医生对患者进行评估。该儿童完成了抗生素疗程，并计划在外科诊所随访。由于反复发烧，瘘管引流增加，阴唇刺激加重，患儿在门诊随访前返回医院。在麻醉下对直肠进行检查，发现直肠前庭瘘。她最初接受了直肠前庭瘘管切除术，但没有转移造口术，但伤口破裂需要转移。她的瘘管修复术已经完全愈合，现在她的造口术已经逆转了。结论对出现唇脓肿的女婴应进行全面的体格检查，以确定是否有直肠前庭瘘管。

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引用次数: 0

Management of gastroschisis with biliary atresia: A case report 胃裂合并胆道闭锁1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-25 DOI: 10.1016/j.epsc.2025.103097

Rachel C. Bordelon , Joseph Pydyn , Henry W. Caplan , Essam M. Imseis , Allison L. Speer , Charles S. Cox (Jr)

Introduction

Gastroschisis and biliary atresia (BA) are both rare surgical disorders of neonates. While neither condition has a known etiology, there is currently no clear association between the two and the estimated odds of coincidence are 1 in 30, 000, 000 livebirths. Nonetheless, a few published reports have mentioned infants diagnosed with both gastroschisis and BA but usually in the setting of poor outcomes and incomplete descriptions of management decisions.

Case presentation

A 1960-g female with limited prenatal care was born at 35 weeks gestation and was found to have gastroschisis, which was managed with a hand-sewn silo and serial reductions until the abdomen was closed. At 25 days old, she developed acholic stools and rising direct hyperbilirubinemia. Workup was concerning for biliary atresia, which was confirmed with an intraoperative cholangiogram and she underwent Kasai portoenterostomy, which was challenging given intestinal malrotation from gastroschisis. Postoperatively, bilirubin levels normalized and pigmented stools returned. Her course was complicated by a small perforation of the ascending colon requiring exploration and creation of a diverting colostomy on post-operative day 7. However, since that time she has done well with normal liver function now over 9 months after portoenterostomy creation, and is pending colostomy takedown.

Conclusion

Prompt recognition and careful consideration of abnormal intestinal anatomy are necessary in the management of concurrent biliary atresia and gastroschisis, but this can be accomplished with favorable outcomes.

摘要星形裂和胆道闭锁都是新生儿罕见的外科疾病。虽然这两种情况都没有已知的病因，但目前两者之间没有明确的联系，估计巧合的几率为3000万分之一。尽管如此，一些已发表的报告提到了同时诊断为胃裂和BA的婴儿，但通常是在预后不佳和管理决策描述不完整的情况下。病例介绍：一名体重1960克的女性在妊娠35周出生时，产前护理有限，发现胃裂，用手工缝制的仓和连续复位治疗，直到腹部闭合。25天大时，她出现了胆汁性便和直接高胆红素血症。检查中发现胆道闭锁，术中胆道造影证实了这一点，她接受了Kasai门肠造口术，由于胃裂引起的肠道旋转不良，这是一个挑战。术后胆红素水平恢复正常，色素便恢复。术后第7天，她的病程因升结肠小穿孔而变得复杂，需要探查并建立转移结肠造口。然而，从那时起，她的肝功能正常，在造口9个多月后，正在等待结肠造口术的切除。结论在胆道闭锁并发胃裂的治疗中，及时识别并仔细考虑肠道异常解剖结构是必要的，但这是可以取得良好效果的。

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引用次数: 0

Giant simple biliary cyst in a 2-year-old child: a case report 2岁儿童巨大单纯性胆道囊肿1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-25 DOI: 10.1016/j.epsc.2025.103095

Ashagre Gebremichael Ganta , Wintana Tesfaye Desta

Introduction

Simple biliary cysts are exceptionally rare in pediatric patients and seldom manifest as giant hepatic masses. Their clinical and radiological overlap with malignant tumors poses diagnostic challenges, potentially leading to unnecessary aggressive interventions.

Case presentation

A 2-year-old female presented with progressive abdominal distension and recurrent pneumonias. Physical examination revealed a protuberant abdomen with visible venous collaterals. Liver span was 18 cm by percussion, with no splenomegaly. Laboratory findings included a hemoglobin level of 10.8 g/dL. Tumor markers (AFP and β-hCG) were within normal limits. X-ray studies demonstrated bilateral elevated hemidiaphragm and right basal consolidation. Abdominal ultrasound found a large anechoic lesion (18 × 15 × 12 cm) with internal septations and posterior acoustic enhancement, replacing the right hepatic lobe, with no Doppler flow, and compression of the inferior vena cava. Contrast-enhanced computerized tomography (CT) revealed a hypodense mass with peripheral rim enhancement and absence of centripetal filling, alongside right renal displacement, gastric compression, and diaphragmatic elevation. The patient was taken to the operating room for an exploratory laparotomy. Through a supraumbilical transverse incision extended on the midline below the umbilicus, the mass was entirely delivered. Anatomical resection of segments IV A and B was performed, including the mass, which weighted 6.5 kg. The postoperative course was uneventful apart from a self-limiting biliary leak managed conservatively. Histopathological analysis confirmed a simple biliary cyst with no evidence of malignancy. The patient had a complete resolution of respiratory symptoms and showed no recurrence at six months of follow-up.

Conclusion

Simple biliary cysts, although rare, must be considered in the differential diagnosis of giant hepatic cystic masses in children. Complete surgical excision is the treatment of choice.

单纯性胆道囊肿在儿科患者中极为罕见，很少表现为巨大的肝脏肿块。它们与恶性肿瘤的临床和放射学重叠构成诊断挑战，可能导致不必要的积极干预。病例表现：一名2岁女性，表现为进行性腹胀和复发性肺炎。体格检查显示腹部隆起，可见静脉侧支。肝跨18 cm，未见脾肿大。实验室检查结果包括血红蛋白水平10.8 g/dL。肿瘤标志物（AFP、β-hCG）均在正常范围内。x线检查显示双侧横膈膜升高和右侧基底实变。腹部超声示大无回声病灶（18 × 15 × 12 cm），内隔，后侧声增强，取代右肝叶，无多普勒血流，下腔静脉受压。计算机断层扫描（CT）显示低密度肿块，外周边缘增强，无向心充盈，伴右侧肾脏移位，胃受压，膈抬高。病人被带到手术室进行剖腹探查术。通过在脐下中线延伸的脐上横向切口，将肿块完全娩出。解剖切除IV节A节和B节，包括重6.5 kg的肿块。术后除了保守处理的自限性胆道泄漏外，一切顺利。组织病理学分析证实为单纯性胆道囊肿，无恶性肿瘤迹象。患者呼吸道症状完全消失，随访6个月无复发。结论单纯性胆道囊肿虽罕见，但在儿童巨大肝囊性肿物鉴别诊断中应予以重视。完全的手术切除是治疗的选择。

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引用次数: 0

Type IVA choledochal cyst with gallbladder duplication: a case report IVA型胆总管囊肿伴胆囊重复1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-25 DOI: 10.1016/j.epsc.2025.103096

Saalim Nazki , Saswati Behera , Akshat Sudhanshu

Background

Gallbladder duplication is a rare congenital anomaly, and its coexistence with choledochal cysts is exceptionally uncommon.

Case

A 7-year-old female presented with recurrent right upper quadrant abdominal pain over several months. Laboratory investigations revealed elevated serum AST (142 IU/L) (normal range 8–33 IU/L) and ALT (158 IU/L) (normal range 4–36 IU/L), with mildly raised alkaline phosphatase; bilirubin levels were within normal limits. Abdominal ultrasonography (USG) demonstrated common bile duct dilation, and Magnetic Resonance Cholangiopancreatography (MRCP) confirmed a Type IVA choledochal cyst. Laparoscopic excision of the cyst with hepaticoduodenostomy was planned. Intraoperatively, a V shaped duplicated intrahepatic bilobed gallbladder was discovered, with a single cystic artery and a single cystic duct (bifurcated high up distally to drain the duplicated lobes of gall bladder) draining into the common bile duct. Both gallbladders were excised, and a hepaticoduodenostomy was performed. Histopathology confirmed gallbladder duplication with chronic inflammatory changes and no dysplasia.

Conclusion

Gallbladder duplication is a rare congenital anomaly that may not be identified on preoperative imaging, particularly in the setting of complex biliary anomalies like choledochal cyst.

背景：胆囊复制是一种罕见的先天性异常，其与胆总管囊肿共存是非常罕见的。病例1:7岁女性，反复出现右上腹疼痛数月。实验室检查显示血清AST升高（142 IU/L）（正常范围8-33 IU/L）和ALT升高（158 IU/L）（正常范围4-36 IU/L），碱性磷酸酶轻度升高；胆红素水平在正常范围内。腹部超声（USG）显示胆总管扩张，磁共振胆管胰胆管造影（MRCP）证实IVA型胆总管囊肿。计划行腹腔镜囊肿切除并肝十二指肠切开术。术中发现一V型复制肝内双叶胆囊，单根囊性动脉和单根囊性导管（向上分叉以排出复制的胆囊叶）汇入总胆管。切除两个胆囊，并行肝十二指肠切开术。组织病理学证实胆囊复制伴慢性炎症改变，无发育不良。结论全膀胱重复是一种罕见的先天性异常，术前影像学检查难以发现，尤其是胆总管囊肿等复杂的胆道异常。

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引用次数: 0

Congenital intrapericardial diaphragmatic hernia associated with atrial septal defect in a 3-year-old child: a case report 先天性心包内膈疝合并房间隔缺损1例3岁儿童

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-25 DOI: 10.1016/j.epsc.2025.103094

Le Thanh Khanh Van , Hoang Ngoc Vi

Introduction

Congenital intrapericardial diaphragmatic hernia (CIPDH) is an extremely rare form of diaphragmatic hernia, in which abdominal contents herniate into the pericardial cavity. Due to its rarity and nonspecific clinical presentation, CIPDH is often misdiagnosed, particularly in settings with limited access to advanced imaging.

Case presentation

A 3-year-old boy, born at term without neonatal symptoms, was referred to us for an atrial septal defect (ASD) closure, which was detected after an episode of pneumonia. Chest x-ray revealed cardiomegaly and bowel loops in the mediastinum. Echocardiography showed a 14 mm ASD (Qp:Qs = 3.1:1) with trivial pericardial effusion. A Morgagni hernia was suspected. The patient was scheduled for an elective ASD closure and simultaneous repair of the Morgagni hernia. The operation was done through a median sternotomy. The anterior side of the diaphragm was intact, and no Morgagni hernia was found. Once the pericardium was opened, we found the transverse colon herniated into the pericardial space. There was a 3 × 5 cm pericardial/diaphragmatic defect. We reduced the colon easily and closed the defect primarily with interrupted stitches of non-reabsorbable material. We then closed the ASD on cardiopulmonary bypass. The patient recovered uneventfully and remains well at 3 months of follow-up.

Conclusion

Congenital intrapericardial diaphragmatic hernia should be considered in patients who have a preliminary diagnosis of an anterior (Morgagni) diaphragmatic hernia.

先天性心包内膈疝（CIPDH）是一种极为罕见的膈疝形式，其腹部内容物疝入心包腔。由于其罕见性和非特异性临床表现，CIPDH经常被误诊，特别是在无法获得高级影像学检查的情况下。一个3岁的男孩，足月出生，没有新生儿症状，被转介到我们房间隔缺损（ASD）关闭，这是在肺炎发作后发现的。胸片显示心脏肿大，纵隔肠袢。超声心动图示14 mm ASD （Qp:Qs = 3.1:1）伴少量心包积液。怀疑是莫加尼疝。患者计划择期行ASD闭合术，同时修复Morgagni疝。手术通过正中胸骨切开术完成。横膈膜前部完整，未发现Morgagni疝。一旦心包被打开，我们发现横结肠疝入心包间隙。心包/膈缺损3 × 5 cm。我们很容易地缩小了结肠，并主要用不可重新吸收的材料缝合。然后我们关闭了体外循环的ASD。患者恢复平稳，随访3个月。结论初步诊断为前膈疝的患者应考虑先天性心包内膈疝。

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引用次数: 0

Congenital segmental intestinal dilation in children: A case series 儿童先天性节段性肠扩张：一个病例系列

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-25 DOI: 10.1016/j.epsc.2025.103092

Samuel Gashu Adane , Tihitena Negussie , Fisseha Temesgen , Eden Yirdachew , Dagmawi Geremew

Introduction

Congenital segmental intestinal dilation (CSID) is a rare congenital anomaly of unknown origin that can present in neonates and older children with varying clinical manifestations. CSID can only be confirmed intraoperatively, and the treatment is simple resection and anastomosis.

Cases presentation

The first case was a 17-year-old ex-premature female who presented with a longstanding history of constipation, difficulty passing stool, abdominal distension, passage of hard, tarry stool, and symptoms of anemia. She underwent repeated blood transfusions and enemas, but her symptoms persisted. Abdominal computerized tomography (CT) was suspicious for CSID. She underwent an exploratory laparotomy during which we found a segmental dilatation of the sigmoid colon. The affected sigmoid colon was resected, followed by an end-to-end anastomosis. She recovered well ans was asymptomatic at 6 months of follow up. The pathology of the specimen revealed ganglionated bowel without obvious anomalies. The second case was a 6-year-old male child who had experienced recurring intermittent abdominal pain and vomiting since the age of three years. His physical examination, abdominal radiography, and abdominal ultrasound were all unremarkable. He eventually underwent an upper gastrointestinal contrast study as part of his work-up, which was suspicious for a gastric volvulus. We took him to the operating room for an exploratory laparotomy. We found no gastric volvulus but a segmental ileal dilatation. The affected ileum was resected, followed by an end-to-end anastomosis. His recovery was uneventful. Follow-up was discontinued after 7 months of regular outpatient visits. The pathology of the specimen revealed ganglionated bowel without obvious anomalies.

Conclusion

Congenital segmental dilation of the bowel is a rare anomaly but should be considered in children with symptom of chronic constipation and anemia.

先天性节段性肠扩张（CSID）是一种罕见的先天性异常，原因不明，可出现在新生儿和大龄儿童中，临床表现各异。CSID只能术中确诊，治疗方法为单纯切除吻合。第一例患者为17岁前早产女性，长期便秘、排便困难、腹胀、排便坚硬、含柏油，并有贫血症状。她接受了多次输血和灌肠，但症状持续存在。腹部电脑断层扫描（CT）怀疑为CSID。她接受了剖腹探查术，我们发现乙状结肠有节段性扩张。切除受影响的乙状结肠，然后进行端到端吻合。患者恢复良好，随访6个月无症状。标本病理显示肠神经节，无明显异常。第二例为一名6岁男童，自3岁起反复出现间歇性腹痛和呕吐。他的体格检查、腹部x光片和腹部超声检查均无明显异常。他最终接受了上胃肠造影检查，作为体检的一部分，怀疑是胃扭转。我们带他去手术室做剖腹探查术。我们没有发现胃扭转，但有节段性回肠扩张。切除受影响的回肠，然后进行端到端吻合。他的康复平安无事。随访在常规门诊就诊7个月后停止。标本病理显示肠神经节，无明显异常。结论先天性节段性肠扩张是一种罕见的异常，但在有慢性便秘和贫血症状的儿童中应予以考虑。

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引用次数: 0

Laparoscopic excision of giant omental cyst in a toddler: A case report 腹腔镜下切除幼童大网膜囊肿1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-25 DOI: 10.1016/j.epsc.2025.103093

M. Harshal, T.K. Jayakumar, K. Shubhangi, Nilesh Nagdeve

Background

Giant omental cysts are rare, benign intra-abdominal lesions that may mimic ascites in children. This often leads to delay in the diagnosis and complications such as anemia.

Case presentation

A 2-year-old girl presented with progressive gross abdominal distension and anemia. Physical examination revealed pallor and a distended abdomen with shifting dullness suggestive of ascites. Ultrasonography revealed a large, septated anechoic lesion with internal debris occupying the entire abdominal cavity, displacing all bowel loops. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis confirmed a well-encapsulated, non-enhancing, thin-walled cystic mass extending from the upper abdomen to the pelvis, displacing bowel loops to the left and compressing adjacent structures. We took her to the operating room for an exploratory laparoscopy. We first did a small supraumbilical incision and aspirated 500 cc of serosanguinous fluid from within the cyst. Once it was partially decompressed, we placed the ports and explored the abdomen. We found a large omental cyst with hemorrhagic fluid, which was the cause of the anemia. We proceeded to resect the cyst completely. The patient had an uneventful postoperative course and was discharged home on postoperative day two. Histopathology confirmed a lymphatic omental cyst. She remains asymptomatic at seven months of follow up.

Conclusion

Giant omental cysts should be included in the differential diagnoses of children who develop gradual abdomen distension and have pseudo-ascites on imaging studies.

背景：巨大的大网膜囊肿是一种罕见的腹腔内良性病变，可能与儿童腹水相似。这往往导致诊断延误和并发症，如贫血。病例表现：一名2岁女童表现为进行性腹胀和贫血。体格检查显示脸色苍白，腹部肿胀，伴有转移性麻木，提示腹水。超声检查显示一个大的，分隔的无回声病变，内部碎片占据整个腹腔，取代了所有肠袢。腹部和骨盆对比增强计算机断层扫描（CECT）证实一个包被良好，无增强，薄壁囊性肿块从上腹部延伸到骨盆，将肠袢移位到左侧并压迫邻近结构。我们带她去手术室做腹腔镜探查。我们首先做了一个小的脐上切口，从囊肿内抽吸500cc浆液。一旦部分减压，我们放置端口并探查腹部。我们发现了一个带有出血性液体的大网膜囊肿，这就是贫血的原因。我们开始彻底切除囊肿。患者术后过程顺利，术后第二天出院回家。组织病理学证实为淋巴网膜囊肿。随访7个月时，患者仍无症状。结论对逐渐腹胀、影像学表现为假性腹水的患儿，应将巨大网膜囊肿列入鉴别诊断。

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引用次数: 0

Congenital megacalycosis managed with observation only: A case report 仅观察治疗先天性巨核症1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-20 DOI: 10.1016/j.epsc.2025.103082

Kristy Alexandra Smith, Mohamed Sameh Shalaby

Introduction

Congenital megacalycosis (CM) is one of the rarest congenital renal anomalies. It typically presents with significant calyceal dilatation resembling severe pelvi-ureteric junction obstruction (PUJO) in a kidney with an intra-renal pelvis. Normal drainage on mercaptoacetyltriglycine (MAG3) renogram confirms the CM diagnosis.

Case presentation

A male infant presented antenatally with significant unilateral calyceal dilatation and presumed diagnosis of severe PUJO. Growth scans at 32, 36 and 39 weeks showed an increasingly dilated renal pelvis with normal liquor volume. He was delivered at 39 weeks by emergency caesarean due to fetal distress. Postnatal ultrasound (USS) was consistent with the antenatal scans with an anteroposterior diameter (APD) of 21mm but a MAG3 showed normal drainage and equal split function, confirming the diagnosis of megacalycosis rather than classic PUJO. The patient therefore avoided surgery and has been managed with active observation with 3 monthly USS. Repeat USS at 15 months shows improvement in dilatation (APD 13mm), and no deterioration of drainage or drop of function on repeat MAG3 at 12 months.

Conclusion

Congenital megacalycosis should be ruled out with MAG3 in children with suspected pelviureteric junction obstruction as the two conditions may have a similar USS appearance but have a significantly different management strategy.

摘要先天性巨alysis （CM）是一种罕见的先天性肾脏异常。典型表现为肾盏扩张，类似于肾盂-输尿管交界处严重梗阻（PUJO）。巯基乙酰甘油三酯（MAG3）肾图引流正常，证实CM诊断。一个男婴产前表现为明显单侧肾盏扩张，推测诊断为严重的PUJO。32、36和39周的生长扫描显示肾盂逐渐扩张，但尿量正常。由于胎儿窘迫，他在39周时通过紧急剖腹产分娩。产后超声（USS）与产前扫描一致，前后径（APD）为21mm，但MAG3显示引流正常，分裂功能均等，确认诊断为巨结石而不是典型的PUJO。因此，患者避免了手术，并进行了3个月的USS积极观察。重复号在15个月显示改善膨胀(adp 13毫米),也没有恶化的排水或删除功能重复MAG3在12个月。结论怀疑肾盂输尿管连接处梗阻的儿童，应排除先天性巨结石，因为这两种情况可能具有相似的USS外观，但处理策略有明显不同。

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引用次数: 0

Adenoid cystic carcinoma of the main stem bronchus in an 11-year-old child: A case report 11岁儿童支气管主干腺样囊性癌1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-18 DOI: 10.1016/j.epsc.2025.103091

Beatriz Manásia Schröter , Rafael Rodrigues Torres , Roberto Augusto Plaza Teixeira , Marcela Dias Borges , Alyne Condurú dos Santos Cunha , Ana Cristina Aoun Tannuri

Introduction

Airway tumors are infrequent in children. Adenoid cystic carcinomas (ACC) are the second most common histological type.

Case presentation

A previously healthy 11-year-old female presented with fever and cough for eight days. A chest x-ray revealed a large right lung opacity. Due to the opacity's extension, a contrast-enhanced chest computed tomography (CT) was done and revealed a vascularized lesion in the right main stem bronchus, with luminal narrowing and opacity suggesting pneumonia. Bronchoscopy with biopsy confirmed primary ACC. The pneumonia did not respond to ceftriaxone and was then treated with cefepime and vancomycin. The tumor was then approached via a right thoracotomy. We resected a two-centimeter segment of the right main stem bronchus and reconstructed it by an end-to-end anastomosis with a simple continuous suture on the posterior wall and simple interrupted sutures on the anterior wall. The patient left the operating room with a chest drain, having satisfactory pain control and no complications. On her sixth postoperative day on the she developed a pneumothorax due to displacement of the chest drain, which was managed by the placement of a new chest drain. On the thirteenth postoperative day she developed a pleural effusion and fever and was treated empirically with meropenem and vancomycin. The patient was discharged home with no chest drain twenty-six days after the operation. She had no further complications at the one-month follow-up.

Conclusion

ACC and other airway tumors should be considered in the differential diagnosis of children with lung consolidations that do not respond to antibiotics or have atypical presentations.

气道肿瘤在儿童中并不常见。腺样囊性癌（ACC）是第二常见的组织学类型。既往健康的11岁女性，出现发烧和咳嗽8天。胸部x光片显示右肺大影。由于混浊的延伸，造影增强胸部计算机断层扫描（CT）显示右支气管主干血管化病变，管腔狭窄和混浊提示肺炎。支气管镜活检证实原发性ACC。肺炎对头孢曲松没有反应，然后用头孢吡肟和万古霉素治疗。然后通过右开胸接近肿瘤。我们切除了一段2厘米长的右主干支气管，并通过后壁简单连续缝合和前壁简单间断缝合的端到端吻合重建。患者胸腔引流离开手术室，疼痛控制良好，无并发症。术后第6天，由于胸腔引流管移位，患者出现气胸，通过放置新的胸腔引流管进行处理。术后第13天，患者出现胸腔积液和发热，经美罗培南和万古霉素治疗。手术后26天，患者出院回家，没有胸腔引流。在一个月的随访中，她没有出现进一步的并发症。结论对于抗生素治疗无效或表现不典型的儿童肺实变，应考虑acc及其他气道肿瘤的鉴别诊断。

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引用次数: 0

Early-onset infantile hypertrophic pyloric stenosis: a case report 早发性婴儿肥厚性幽门狭窄1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-08-17 DOI: 10.1016/j.epsc.2025.103090

Eden Belay Tilahun , Tihitena Nigussie mamo , Werkneh Demissie Hailemariam , Gobena Mormata Dima , Nardos Mulu Admasu , Abraham Sisay Abie

Introduction

Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of non-bilious projectile vomiting in infants, typically presenting between 4 and 8 weeks of age. Early-onset cases, particularly those occurring within the first few days of life, are rare and often challenging to diagnose due to lack of standardized sonographic criteria for this age group.

Case presentation

A 12-day-old male neonate presented with persistent non-bilious projectile vomiting beginning on the first days of life. He was born at full term via spontaneous vaginal delivery to a 26-year-old primigravida mother after an uncomplicated pregnancy. Initial evaluation at a local health center led to conservative management for presumed gastroesophageal reflux. Persisting symptoms prompted referral after an initial ultrasound showed a pyloric muscle thickness of 3.6 mm and a length of 16 mm, suggestive of IHPS. However, due to the uncommon occurrence of IHPS at such an early age, a repeat ultrasound was done, which was interpreted as normal. An upper gastrointestinal contrast study was done to rule out intestinal malrotation and other sources of gastric outlet obstruction. Due to the persistence of symptoms, a third ultrasound was done on day of life 21, which showed a pyloric length of 16.6 mm and a thickness of 4.2 mm, conclusive for IHPS. The patient underwent an open Ramstedt pyloromyotomy without complications. The postoperative recovery was complicated by a hospital-acquired pneumonia, which was successfully treated. The patient was discharged on postoperative day 16 and remained asymptomatic at six months of follow-up, with normal growth and development.

Conclusion

Pyloric stenosis rarely occurs within the first few weeks of life but should be included in the differential diagnosis of newborns who develop persistent projectile non-bilious vomiting.

婴儿肥厚性幽门狭窄（IHPS）是婴儿非胆汁性抛射性呕吐的常见原因，通常出现在4至8周龄之间。早发病例，特别是那些发生在生命最初几天的病例，是罕见的，而且由于缺乏标准化的超声检查标准，往往难以诊断。病例介绍：一名12天大的男婴在出生的第一天就出现了持续的非胆汁性抛射性呕吐。他是一位26岁的初产妇在顺利怀孕后通过阴道自然分娩足月出生的。在当地卫生中心进行的初步评估导致了对疑似胃食管反流的保守治疗。最初的超声检查显示幽门肌厚度3.6 mm，长度16 mm，提示IHPS，持续症状促使转诊。然而，由于IHPS在这么小的年龄很少发生，因此再次做了超声检查，解释为正常。进行了上消化道对比研究，以排除肠道旋转不良和其他胃出口梗阻的来源。由于症状持续存在，在第21天进行了第三次超声检查，显示幽门长度为16.6 mm，厚度为4.2 mm，确定为IHPS。患者接受了开放式Ramstedt幽门肌切开术，无并发症。术后恢复因医院获得性肺炎而变得复杂，但已成功治疗。患者术后第16天出院，随访6个月无症状，生长发育正常。结论幽门狭窄很少发生在出生后几周内，但应列入新生儿持续性射性非胆汁性呕吐的鉴别诊断。

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