Journal of Pediatric Surgery Case Reports最新文献_第7页

Vascular lesion of the appendix causing torsion: A case report 阑尾血管病变导致扭转：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-30 DOI: 10.1016/j.epsc.2024.102858

Derek Marlor, Bayan Shalash, Vinay Prasad, Kathleen Nicol, Benjamin Kaumeyer, Dana Schwartz

Introduction

Laparoscopic appendectomy is a common procedure for pediatric surgeons, primarily employed for acute appendicitis. However, this case report presents a unique scenario of a 12-year-old male with symptoms suggestive of appendicitis, diagnosed with an appendiceal mass causing torsion, due to a vascular malformation or reactive vascular proliferation.

Case presentation

A 12-year-old male presented with three days of abdominal pain, diarrhea, and emesis. The clinical exam was concerning for appendicitis. Ultrasonography revealed a mildly dilated appendix terminating in a hypervascular, lobulated mass, suggestive of a large solid appendiceal neoplasm. Subsequent CT scan further characterized this lesion that encased the mildly dilated appendix, compressing it and causing reactive appendiceal wall thickening. All laboratory studies were within normal limits. Diagnostic laparoscopy revealed a torsed, hemorrhagic mass originating from the distal aspect of the appendix. He underwent laparoscopic appendectomy, and the entire specimen was removed intact. Pathology reported a non-malignant vascular malformation or reactive vascular proliferation. The patient had an uncomplicated postoperative course and was managed like a standard postoperative appendectomy. One year following this procedure, he was readmitted with a large abdominal mass found to be Burkitt's lymphoma and was started on treatment. Pathology from the original appendiceal resection was reviewed and confirmed to be unrelated.

Conclusion

Vascular malformation/proliferation of the appendix is rare and may present similarly to appendicitis. Any mass may serve as a lead point for appendiceal torsion. Simple appendectomy is likely sufficient for such vascular lesions, and many pediatric appendiceal neoplasms.

导言腹腔镜阑尾切除术是小儿外科医生的常用手术，主要用于治疗急性阑尾炎。然而，本病例报告介绍了一个独特的病例：一名 12 岁的男性出现阑尾炎症状，被诊断为阑尾肿块导致扭转，原因是血管畸形或反应性血管增生。临床检查显示他患有阑尾炎。超声波检查发现阑尾轻度扩张，末端有一个高血管性分叶状肿块，提示为阑尾大实变。随后的 CT 扫描进一步确定了这一病变的特征，它包裹着轻度扩张的阑尾，压迫阑尾并导致阑尾壁反应性增厚。所有实验室检查均在正常范围内。诊断性腹腔镜检查显示，阑尾远端有一个扭转的出血肿块。他接受了腹腔镜阑尾切除术，整个标本被完整切除。病理报告显示为非恶性血管畸形或反应性血管增生。患者的术后过程并不复杂，按照标准的阑尾切除术后处理。术后一年，他因腹部肿块再次入院，发现是伯基特淋巴瘤，并开始接受治疗。结论阑尾血管畸形/增生非常罕见，其表现可能与阑尾炎相似。任何肿块都可能成为阑尾扭转的导火索。对于此类血管病变和许多小儿阑尾肿瘤，简单的阑尾切除术就足够了。

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引用次数: 0

Spindle cell lipoma, a rare and benign adipocytic tumor: A case report 纺锤形细胞脂肪瘤，一种罕见的良性脂肪细胞肿瘤：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-29 DOI: 10.1016/j.epsc.2024.102863

Nitin Sajankila , Amanda Graveson , Veronica Ulici , John DiFiore

Introduction

Spindle cell lipomas are a rare, benign soft tissue mass that are easily treated with surgical excision. Although typically occurring in males and much later in life, in this case report, we present a case of a spindle cell lipoma occurring in a female teenager.

Case presentation

The patient is a healthy 16-year-old Female who presented with a soft, mobile, and poorly defined posterior flank mass on physical exam. As it was not well-visualized by ultrasound, a magnetic resonance image (MRI) was obtained, revealing a well-defined, T1 and T2 bright, ovoid lesion in the subcutaneous tissue. On MRI, the mass measured 7.4 x 4 × 4.5 cm and was consistent with a benign fatty mass. The mass was thought to be a lipoma and it was recommended that it be excised to confirm the diagnosis. However, the patient elected to defer due to concerns about undergoing surgery. Two years later she re-presented with a much larger mass in the same region and a surgical excision was then performed. On excision, the mass appeared smooth, glistening, and fatty, measuring 13.5 x 9.8 × 4.5 cm. Histology revealed encapsulated fibroadipose tissue containing both adipocytes and CD34-staining spindle cells, consistent with a diagnosis of spindle cell lipoma. The patient continues to do well 6 months later with no evidence of recurrence.

Conclusion

Spindle cell lipoma cannot be differentiated from lipomas pre-operatively.

导言纺锤形细胞脂肪瘤是一种罕见的良性软组织肿块，易于手术切除治疗。虽然纺锤形细胞脂肪瘤通常发生在男性身上，而且发病年龄较晚，但在本病例报告中，我们介绍了一例发生在女性青少年身上的纺锤形细胞脂肪瘤。病例介绍患者是一名健康的 16 岁女性，体检时发现其后侧有一个柔软、可移动、界限不清的肿块。由于超声检查显示不清，患者接受了磁共振成像（MRI）检查，结果显示皮下组织中有一个界限清楚、T1 和 T2 明亮的卵圆形病灶。核磁共振成像显示，肿块大小为 7.4 x 4 x 4.5 厘米，符合良性脂肪肿块的特征。该肿块被认为是脂肪瘤，建议将其切除以确诊。然而，由于担心接受手术，患者选择了推迟。两年后，她再次就诊，发现同一部位有一个更大的肿块，于是进行了手术切除。切除时，肿块看起来光滑、闪亮、脂肪较多，大小为 13.5 x 9.8 x 4.5 厘米。组织学检查显示，包裹的纤维脂肪组织含有脂肪细胞和 CD34 染色的纺锤形细胞，与纺锤形细胞脂肪瘤的诊断一致。结论纺锤形细胞脂肪瘤无法在术前与脂肪瘤区分开来。

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引用次数: 0

Ligamentum arteriosum calcification mimicking esophageal perforation: A case report 模仿食管穿孔的动脉韧带钙化病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-27 DOI: 10.1016/j.epsc.2024.102857

Abdulmalek Alzahrani, Mohammed Alsayed, Khalid Nassibi, Ali A. Alzahrani, Samira Alturkistany

Introduction

The ligamentum arteriosum is a structure that connects the pulmonary artery to the aorta in the developing fetus. After birth it usually undergoes fibrous degenerative changes and calcification. Ligamentum arteriosum calcification (LAC) can be mistaken for an esophageal perforation, especially in patients with suspected esophageal foreign bodies or suspected esophageal injuries.

Case presentation

A 16-month-old boy underwent elective surgery for congenital lipomyelomeningocele. The endotracheal intubation was technically difficult due to an anterior position of the larynx. Postoperatively he developed high fever and an elevated white blood cell count, which were concerning for an esophageal perforation. A computerized tomography (CT) scan with oral contrast with the patient in left latera decubitus due to recent lower back surgery was done and showed a hyperdense line near the aortopulmonary window, resembling an esophageal contrast leak. Knowing that LAC was in the differential, and before proceeding with any major interventions for a presumed esophageal injury we did a barium swallow study, which confirmed that there was no esophageal perforation. The patient recovered well.

Conclusion

LAC is an uncommon condition that is difficult to distinguish from a contrast leak secondary to an esophageal perforation. A lack of awareness of condition can lead to unnecessary intervention.

导言动脉韧带是连接发育中胎儿肺动脉和主动脉的结构。出生后，它通常会发生纤维变性和钙化。动脉韧带钙化（LAC）可能被误认为是食管穿孔，尤其是在怀疑有食管异物或怀疑食管损伤的患者中。由于喉头位置靠前，气管插管在技术上非常困难。术后他出现了高烧和白细胞计数升高，这与食道穿孔有关。计算机断层扫描（CT）显示主动脉肺窗附近有一条高密度线，类似食管造影剂泄漏。我们知道 LAC 属于鉴别诊断范围，在对假定的食管损伤采取任何重大干预措施之前，我们做了吞钡检查，结果证实没有食管穿孔。结论LAC是一种不常见的疾病，很难与食管穿孔继发的造影剂泄漏区分开来。对这种情况缺乏认识可能会导致不必要的干预。

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引用次数: 0

Hemorrhagic ulcerative gastric lymphangioma in an infant: A case report 婴儿出血性溃疡性胃淋巴管瘤：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-23 DOI: 10.1016/j.epsc.2024.102855

Mohammad Tareq Rahimi, Abdul Wahab Amanat, Haseeb Rahman, Soghra Khaliqi, Nawaz Sharif Kashaf, Roohullah Hares

Introduction

Lymphangiomas are congenital malformations of the lymphatic system, mostly presenting in the head and neck during early childhood. Its occurrence in the stomach is exceedingly rare with no reported cases in infants to date. Due to its asymptomatic nature and the limitations of imaging studies in providing a definitive diagnosis, gastric lymphangioma poses diagnostic and therapeutic challenges in children.

Case presentation

A 6-month-old female was brought to the emergency department with a three-day history of poor sucking, fever and feeding intolerance. In addition, she had been suffering from frequent non-bilious vomiting and hematemesis for two months. On physical exam, she appeared pale and drowsy. Her abdomen was soft, though slightly distended in the upper region with a small palpable mass in the epigastric area. An upper GI study revealed a dilated stomach and duodenum suggesting a duodenal obstruction. The only abnormal laboratory study was a hemoglobin level of 6 mg/dl. Laparotomy revealed an obstructive band between the duodenum and jejunum causing mild stenosis, which was released. A mass was found within the stomach. Through a gastrotomy we identified a cystic mass involving the body of the stomach and two-thirds of the antrum, with ulceration of its surface. The mass was completely excised and sent for histopathological examination. The stomach was then closed along the greater curvature as in a sleeve-gastrectomy fashion. The pathology report was consistent with an ulcerated lymphangioma. At 18 months of follow up she remains asymptomatic and has appropriate weight gain.

Conclusion

Gastric lymphangioma poses both diagnostic and surgical challenges in infants. Although rare in this population, it should be considered in patients presenting frequent vomiting and hematemesis.

导言淋巴管瘤是淋巴系统的先天性畸形，多发于幼儿期的头颈部。发生在胃部的淋巴管瘤极为罕见，迄今尚无婴儿病例的报道。由于胃淋巴管瘤无症状，且影像学检查在提供明确诊断方面存在局限性，因此给儿童的诊断和治疗带来了挑战。病例介绍一名 6 个月大的女性患者因吸吮不畅、发烧和喂养不耐受 3 天病史被送到急诊科。此外，两个月来她还经常出现非淤血性呕吐和吐血。体格检查时，她面色苍白，昏昏欲睡。她的腹部柔软，但上腹部略微胀大，上腹部可触及一个小肿块。上消化道检查发现胃和十二指肠扩张，提示有十二指肠梗阻。唯一异常的实验室检查结果是血红蛋白水平为 6 mg/dl。腹腔镜手术显示，十二指肠和空肠之间有一条阻塞带，造成轻度狭窄，该阻塞带已被释放。胃内发现一个肿块。通过胃切开术，我们发现了一个囊性肿块，涉及胃体和三分之二的胃窦，表面有溃疡。肿块被完全切除，并送去进行组织病理学检查。然后，按照袖状胃切除术的方式，沿胃大弯将胃关闭。病理报告与溃疡性淋巴管瘤一致。结论胃淋巴管瘤给婴儿的诊断和手术带来了挑战。虽然这种情况在婴幼儿中很少见，但如果患者经常呕吐和吐血，则应考虑到胃淋巴管瘤。

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引用次数: 0

Cloacal exstrophy variant in a female: A case report 一名女性的泄殖腔萎缩变异体：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-22 DOI: 10.1016/j.epsc.2024.102856

Shelley Warner , Luciana Lerendegui , Monica D. Chow , David Lasko , Miguel Castellan , Felipe Pedroso

Introduction

Cloacal exstrophy is a rare birth defect that affects both the genitourinary and gastrointestinal tract, with an estimated incidence between 1:200,000 and 1:400,000 live births. The exact mechanism that leads to this defect is still unknown. Our purpose is to report a case of omphalocele-exstrophy-imperforate anus-spinal defect (OEIS) complex with a rare variant to add to the literature.

Case presentation

A 28-year-old female with no known medical history had a monochorionic diamniotic twin pregnancy. At 20 weeks of gestation a prenatal ultrasound demonstrated multiple fetal anomalies on twin B, including omphalocele, absent right kidney, non-visualization of bladder, and single umbilical artery. She had a scheduled Cesarean section at 34 weeks and 5 days of gestation. Twin B had a large omphalocele with an intact sac. Below the omphalocele, there was a cecal plate with a prolapsed ileum and a second small orifice corresponding to the hindgut. Two hemivaginas and hemiclitorises were appreciated inferior to the cecal plate but superior to a bladder plate bridge joining both halves. Each of the hemivaginas was connected to a hemiuterus with its own fallopian tube and ovary. The bladder was on both sides of the cecal plate and connected in the midline adopting a crescent shape with the concave side facing cephalad. Genetic testing confirmed an XX karyotype. On day-of-life 5 the patient underwent omphalocele repair and closure of the abdominal wall, tubularization of the cecal plate, and an end colostomy. Additionally, the hemivaginas and hemiclitorises were relocated to an orthotopic position and the bladder plates were joined together and used to cover part of the abdominal wall defect. She was discharged on day of life 42 with a weight of 2.72 kg. She continues to follow up outpatient. Her second stage procedure is still pending.

Conclusion

The position of the genital tract superior to the bladder exstrophy observed in this case has not been described before and is not fully explained by the current theories on the development of OEIS.

导言泄殖腔萎缩是一种罕见的先天性缺陷，同时影响泌尿生殖道和胃肠道，估计发病率在1:200,000到1:400,000活产婴儿之间。导致这种缺陷的确切机制尚不清楚。我们的目的是报告一例脐膨出-肛门穿孔-脊柱缺损（OEIS）并伴有罕见变异的复杂病例，以补充相关文献。病例介绍一名 28 岁女性，无已知病史，单绒毛膜双羊膜妊娠。妊娠 20 周时，产前超声检查显示双胎 B 胎儿多处畸形，包括卵脐带畸形、右肾缺失、膀胱未显影和单脐动脉。她在妊娠 34 周零 5 天时按计划进行了剖宫产手术。双胎 B 有一个大的脐膨出，脐囊完好无损。在脐带下方有一块盲肠板，上面有一条脱垂的回肠和与后肠相对应的第二个小孔。在盲肠板的下部，可以看到两个半阴道和半阴道，但在连接两半盲肠的膀胱板桥的上部。每个半阴道都与半子宫相连，并有自己的输卵管和卵巢。膀胱位于盲肠板的两侧，在中线处相连，呈新月形，凹面朝向头侧。基因检测证实其核型为 XX。在出生后第 5 天，患者接受了脐膨出修补术和腹壁闭合术、盲板管化术和结肠末端造口术。此外，还将半阴道和半阴道移至正位，并将膀胱板连接在一起，用于覆盖部分腹壁缺损。她于第 42 天出院，体重为 2.72 千克。她继续在门诊接受随访。结论在本病例中观察到的生殖道位置高于膀胱外翻的情况以前从未描述过，目前的 OEIS 发展理论也不能完全解释这种情况。

{"title":"Cloacal exstrophy variant in a female: A case report","authors":"Shelley Warner , Luciana Lerendegui , Monica D. Chow , David Lasko , Miguel Castellan , Felipe Pedroso","doi":"10.1016/j.epsc.2024.102856","DOIUrl":"10.1016/j.epsc.2024.102856","url":null,"abstract":"<div><h3>Introduction</h3><p>Cloacal exstrophy is a rare birth defect that affects both the genitourinary and gastrointestinal tract, with an estimated incidence between 1:200,000 and 1:400,000 live births. The exact mechanism that leads to this defect is still unknown. Our purpose is to report a case of omphalocele-exstrophy-imperforate anus-spinal defect (OEIS) complex with a rare variant to add to the literature.</p></div><div><h3>Case presentation</h3><p>A 28-year-old female with no known medical history had a monochorionic diamniotic twin pregnancy. At 20 weeks of gestation a prenatal ultrasound demonstrated multiple fetal anomalies on twin B, including omphalocele, absent right kidney, non-visualization of bladder, and single umbilical artery. She had a scheduled Cesarean section at 34 weeks and 5 days of gestation. Twin B had a large omphalocele with an intact sac. Below the omphalocele, there was a cecal plate with a prolapsed ileum and a second small orifice corresponding to the hindgut. Two hemivaginas and hemiclitorises were appreciated inferior to the cecal plate but superior to a bladder plate bridge joining both halves. Each of the hemivaginas was connected to a hemiuterus with its own fallopian tube and ovary. The bladder was on both sides of the cecal plate and connected in the midline adopting a crescent shape with the concave side facing cephalad. Genetic testing confirmed an XX karyotype. On day-of-life 5 the patient underwent omphalocele repair and closure of the abdominal wall, tubularization of the cecal plate, and an end colostomy. Additionally, the hemivaginas and hemiclitorises were relocated to an orthotopic position and the bladder plates were joined together and used to cover part of the abdominal wall defect. She was discharged on day of life 42 with a weight of 2.72 kg. She continues to follow up outpatient. Her second stage procedure is still pending.</p></div><div><h3>Conclusion</h3><p>The position of the genital tract superior to the bladder exstrophy observed in this case has not been described before and is not fully explained by the current theories on the development of OEIS.</p></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"109 ","pages":"Article 102856"},"PeriodicalIF":0.2,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213576624000848/pdfft?md5=b53e9ec1d70b607c6eb43f08b9aa780c&pid=1-s2.0-S2213576624000848-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117719","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

Spontaneous pneumomediastinum in previously healthy pediatric patients: A case series 既往健康的儿科患者出现自发性气胸：病例系列

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-16 DOI: 10.1016/j.epsc.2024.102854

Isabel Cristina Brito Rojas , Mayra Angelica Hernandez Peñuela , Martin Alfonso La rotta , Vanessa Medina Gaviria

Introduction

Spontaneous pneumomediastinum is defined as the presence of air in the mediastinum not associated with trauma or iatrogenic causes. This pathology is rare in the pediatric population.

Cases presentation

Case 1: A previously healthy 15-year-old male was admitted with a 5-day history of sudden-onset chest pain associated with odynophagia. Upon admission, there were no signs of respiratory distress, but slight subcutaneous emphysema in the neck. A neck X-ray demonstrated extensive prevertebral and paracervical air. Chest x-ray showed increased transparency and delineation of the mediastinal contours as well as increased retrosternal space, all compatible with pneumomediastinum. Chest CT showed extensive emphysema of the supra- and infrahyoid anterior neck bilaterally. Neither the esophagram nor the upper endoscopy reveal an esophageal lesion. The patient remained stable without the need for supplemental oxygen, started a liquid diet 72 hours post admission with adequate tolerance, and was discharged home on the fourth day of hospitalization. Case 2: A previously healthy 10-year-old female was admitted to the emergency department with a clinical picture of odynophagia that prior to admission was associated with signs of respiratory distress and desaturation. Chest X-ray showed subcutaneous emphysema in the left cervical, thoracic, and axillary regions. Chest CT scan with oral contrast showed emphysema of the soft tissues of the left chest wall and neck and no extravasation. Upper endoscopy showed no lesions in the upper digestive tract. She resumed oral feedings 2 days post admission and was discharged home 6 days post admission.

Conclusion

Spontaneous pneumomediastinum is an infrequent benign clinical entity in children, especially in those with no history of lung disease, infections or substance abuse. Conservative treatment is successful in most cases. Rapid reinitiation of oral feedings does not increase complications and allows an early discharge.

导言自发性纵隔气胸是指纵隔内出现与外伤或先天性原因无关的空气。病例介绍病例 1：一名 15 岁的男性患者因突发胸痛伴有吞咽困难 5 天而入院。入院时无呼吸困难症状，但颈部有轻微皮下气肿。颈部 X 光片显示椎前和颈旁有大量积气。胸部X光片显示纵隔轮廓的透明度和清晰度增加，胸骨后间隙增大，这些都与纵隔积气相符。胸部CT显示双侧颈上和颈下有广泛的气肿。食管造影和上内镜检查均未发现食管病变。患者病情保持稳定，无需补充氧气，入院后 72 小时开始进食流质饮食，并有足够的耐受性，住院第四天出院回家。病例 2：一名原本健康的 10 岁女性因吞咽异物的临床表现被送入急诊科，入院前伴有呼吸困难和饱和度降低的症状。胸部 X 光片显示左侧颈部、胸部和腋窝区域出现皮下气肿。使用口服造影剂进行的胸部 CT 扫描显示，左胸壁和颈部软组织出现气肿，没有外渗。上部内窥镜检查显示上消化道没有病变。结论自发性气胸在儿童中是一种并不常见的良性临床症状，尤其是那些没有肺部疾病、感染或药物滥用史的儿童。保守治疗在大多数病例中都能取得成功。迅速恢复口腔喂养不会增加并发症，而且可以让患儿早日出院。

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引用次数: 0

Sacrococcygeal teratoma and jejunoileal atresia: A case report 骶尾部畸胎瘤和空肠闭锁：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-14 DOI: 10.1016/j.epsc.2024.102853

Jamie E. Anderson , Shinjiro Hirose , Amelia S. McLennan , Zahabiya H. Chithiwala , Payam Saadai

Introduction

Sacrococcygeal teratomas (SCTs) and jejunoileal atresias are both rare (1 in 35,000–40,000 births and 1 in 5000 births, respectively). We present a case of a concomitant diagnosis of a cystic sacrococcygeal teratoma and a jejunoileal atresia.

Case presentation

A twenty-week screening ultrasound identified a cystic pelvic mass (5.5 x 2.8 × 2.2 cm), dilated bowel, and mild polyhydramnios in an otherwise healthy G1P0 woman. Fetal magnetic resonance image showed a multiseptated presacral cystic mass suspicious for an internal sacrococcygeal teratoma and dilated bowel, thought to represent dilated ascending and transverse colon. Scheduled delivery at 39 weeks of gestation was uncomplicated. Postnatal ultrasound and MRI were consistent with prenatal findings. Given the rarity of both congenital anomalies and no known association between SCTs and jejunoileal atresia, the prenatal bowel dilation was thought to be due to partial obstruction secondary to the SCT. The baby thus underwent SCT resection on day-of-life 2. Ongoing obstruction after resection prompted a contrast enema which demonstrated a microcolon with reflux into the terminal ileum but no reflux into more dilated proximal loops concerning for intestinal atresia. On day-of-life 5, the baby underwent exploratory laparotomy which identified a type-2 ileal atresia, and a primary anastomosis was performed. The patient had an uneventful recovery and was discharged home on day-of-life 22.

Conclusion

Prenatal findings of dilated bowel should prompt providers to have a high index of suspicion for jejunoileal atresia, even if other diagnoses exist.

导言骶尾部畸胎瘤（SCTs）和空肠闭锁都很罕见（分别为每 35,000-40,000 名新生儿和每 5,000 名新生儿中各占 1 例）。病例介绍一位健康的 G1P0 孕妇在 20 周的超声筛查中发现盆腔囊性肿块（5.5 x 2.8 x 2.2 厘米）、肠管扩张和轻度多胎妊娠。胎儿磁共振图像显示，骶骨前多发囊性肿块疑似骶尾部畸胎瘤，肠管扩张，被认为是升结肠和横结肠扩张。孕妇在妊娠 39 周时顺利分娩。产后超声波和核磁共振成像与产前检查结果一致。鉴于这两种先天性畸形都很罕见，而且 SCT 与空肠闭锁之间也没有已知的关联，因此产前肠管扩张被认为是继发于 SCT 的部分梗阻所致。因此，婴儿在出生后第 2 天接受了 SCT 切除术。切除手术后，由于梗阻仍在继续，因此需要进行造影剂灌肠，结果显示有一个小肠结肠反流到回肠末端，但没有反流到更扩张的近端襻，这与肠闭锁有关。出生后第5天，婴儿接受了探查性开腹手术，确定为2型回肠闭锁，并进行了初级吻合术。结论产前发现肠管扩张应促使医疗人员高度怀疑空肠回肠闭锁，即使存在其他诊断。

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引用次数: 0

Cat scratch disease requiring incision and drainage: A case report 需要切开引流的猫抓病病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-13 DOI: 10.1016/j.epsc.2024.102851

Emile Jeunesse , Natalie Miller , Lisa Carroll , Mary Arbuthnot

Introduction

Cat Scratch Disease (CSD) is a relatively novel disease that often resolves on its own or with antibiotic therapy and rarely requires surgical intervention. We present a case of CSD with a variable presentation that required surgical incision and drainage for resolution.

Case presentation

This is a case of a 13-year-old African American male who presented with a 5cm × 8cm right-sided neck mass, with positive IgM titers for Bartonella henselae and parainfluenza virus following reported cat scratches. He was treated with a partial course of clindamycin before the diagnosis of CSD was made, then completed a five-day course of azithromycin. After three weeks with no resolution of systemic symptoms or reduction in mass size or pain, there was concern for malignancy. The mass was ultimately determined to be an enlarged lymph node and abscess via computed tomography and biopsy. It was surgically incised and drained, and a second five-day course of azithromycin was completed to prevent fistula formation. The surgery effectively treated the antibiotic resistant CSD, and resolution of systemic symptoms followed rapidly.

Conclusion

This case report highlights a variable presentation of antibiotic resistant CSD, and that biopsy may be indicated in lymphadenopathy to rule out malignancy. Surgery for CSD is rare, but incision and drainage may be required for abscess formation with CSD, especially with concern for mass effect, and we recommend early surgical referral for these situations regardless of diagnosis.

导言猫抓病（CSD）是一种相对较新的疾病，通常可自行消退或经抗生素治疗后消退，很少需要手术干预。本病例是一名 13 岁的非裔美国男性，因被猫抓伤而出现 5 厘米×8 厘米的右侧颈部肿块，并伴有鸡巴顿氏菌和副流感病毒 IgM 滴度阳性。在确诊为 CSD 之前，他接受了部分疗程的克林霉素治疗，然后完成了为期五天的阿奇霉素疗程。三周后，他的全身症状没有缓解，肿块的大小和疼痛也没有减轻，人们担心他患上了恶性肿瘤。通过计算机断层扫描和活检，最终确定肿块为肿大的淋巴结和脓肿。患者接受了手术切开和引流，并完成了第二个为期五天的阿奇霉素疗程，以防止瘘管形成。本病例报告强调了抗生素耐药 CSD 的多种表现形式，并指出淋巴结病可能需要进行活检以排除恶性肿瘤。CSD 的手术治疗很少见，但 CSD 脓肿形成时可能需要切开引流，尤其是考虑到肿块效应。

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引用次数: 0

Ciliated cyst of the liver: A case report 肝脏纤毛囊肿病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-12 DOI: 10.1016/j.epsc.2024.102852

Yassine Derouich , Kamal El Haissoufi , Abdelouhab Ammor , Houssain Benhaddou

Introduction

Ciliated cyst of the liver is rarely seen in the pediatric population and considered as a benign tumor often discovered incidentally.

Case presentation

We report the case of a 12-year-old child with a history of contact with dogs, admitted to our department of pediatric surgery because of an abdominal trauma. He had no significant medical history. All blood tests were within normal limits. A computed tomography scan was performed and revealed a 60-mm cystic lesion with dense contents in segment IV of the liver, suspicious for a biliary cyst or a hydatid cyst. Magnetic resonance imaging was in line with the diagnosis of a type I hydatid cyst of the liver according to the Gharbi classification. The patient underwent a laparoscopic resection of the cyst without spilling any content in the peritoneal cavity. The pathological examination of the specimen confirmed the presence of a cystic formation lined by ciliated pseudostratified epithelium without signs of infection or malignancy, confirming the diagnosis of a ciliated cyst of the liver. The postoperative course was uneventful. At 6 months of follow up he remains asymptomatic and has a normal abdominal ultrasound.

Conclusion

Ciliated cysts should be included in the differential diagnosis of cystic lesions of the liver. The therapeutic management is a subject of debate.

导言肝脏纤毛囊肿很少见于儿童群体，被认为是一种良性肿瘤，往往是偶然发现的。病例介绍我们报告了一例 12 岁儿童的病例，他有与狗接触史，因腹部外伤入住我们的小儿外科。该患儿无重大病史。所有血液检查均在正常范围内。计算机断层扫描显示，肝脏第四节有一个 60 毫米的囊性病变，内容物致密，怀疑是胆道囊肿或包虫囊肿。根据加尔比分类法，磁共振成像符合肝脏 I 型包虫囊肿的诊断。患者接受了腹腔镜囊肿切除术，腹腔内无任何内容物溢出。标本的病理检查证实，囊肿内有纤毛假上皮，无感染或恶变迹象，确诊为肝脏纤毛囊肿。术后恢复顺利。结论纤毛囊肿应列入肝脏囊性病变的鉴别诊断中。纤毛囊肿应列入肝脏囊性病变的鉴别诊断中，其治疗方法还存在争议。

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引用次数: 0

Association between visceral myopathy and Hirschsprung's disease: A case report 内脏肌病与赫氏病之间的关联：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-08-08 DOI: 10.1016/j.epsc.2024.102850

María Jesús Nally R , Isidora Lavado C , Rodrigo Maluje J , Miguel Guelfand C , Daniel Rojo V

Introduction

The coexistence of visceral myopathy (VM) and Hirschsprung's disease (HD) is exceptionally rare yet clinically significant. Both conditions necessitate full-thickness biopsy for precise diagnosis. Despite potential similarities in presentation, no documented cases have established an association between these two disorders.

Case presentation

We present a 3150-g, full-term male newborn, four days old, born without maternal pathologies or antenatal diagnoses. He was admitted to the emergency department with one day of fecal vomiting, lethargy, and decreased intake. On admission, he exhibited hypothermia, tachycardia, and his oxygen saturation was 94%. Physical examination revealed a septic, dehydrated, poorly perfused newborn with a distended abdomen and absent bowel sounds. Abdominal X-ray indicated pneumoperitoneum. Emergency laparotomy revealed colonic perforation necessitating resection and colonic anastomosis, with the abdomen left open and covered by a dressing, followed by a loop-ileostomy in the subsequent surgery. Surgical biopsies, including a later laparoscopic intestinal mapping, confirmed VM and HD. The patient progressed with complete oral feeding, normal bowel transit through the ileostomy, and no associated complications. Currently, the patient awaits resection of the aganglionic segment and rectal pull-through.

Conclusion

This case may suggest either an incidental finding or an undiscovered common etiology linking HD and VM in neonatal intestinal perforation. Comprehensive diagnostic approaches, personalized treatments, and further exploration of their genetic and developmental connections are crucial for improving patient outcomes.

导言：内脏肌病（VM）和赫斯普隆氏病（HD）同时存在的情况非常罕见，但临床意义重大。这两种疾病都需要进行全厚活检才能准确诊断。尽管这两种疾病在表现形式上可能存在相似之处，但目前还没有任何病例证明它们之间存在关联。病例介绍我们接诊的是一名体重 3150 克的足月男婴，出生四天，出生时母体无任何病变或产前诊断。他因一天的排泄物呕吐、嗜睡和摄入量减少而被送入急诊科。入院时，他体温过低、心动过速，血氧饱和度为 94%。体格检查显示，新生儿患有败血症、脱水、灌注不良，腹部膨胀，肠鸣音消失。腹部 X 光片显示腹腔积气。急诊开腹手术发现结肠穿孔，必须进行切除和结肠吻合术，腹部敞开并用敷料包扎，随后的手术中进行了环状回肠造口术。手术活检（包括后来的腹腔镜肠道造影）证实了 VM 和 HD。患者病情进展顺利，可以完全经口进食，通过回肠造口的肠道转运正常，没有出现相关并发症。结论：该病例可能是偶然发现，也可能是尚未发现的新生儿肠穿孔中 HD 和 VM 的共同病因。全面的诊断方法、个性化的治疗以及对其遗传和发育联系的进一步探索对于改善患者预后至关重要。

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引用次数: 0