Journal of Pediatric Surgery Case Reports最新文献_第8页

Unicornuate uterus and endometrial cyst of the ovary in a 15-year-old female: a case report 15岁女性独角状子宫和卵巢子宫内膜囊肿1例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-10-09 DOI: 10.1016/j.epsc.2025.103123

Justyna Kukulska, Magdalena Lewandowska

Introduction

Müllerian duct anomalies are congenital malformations of the female reproductive tract with diverse clinical presentations, ranging from asymptomatic cases to those associated with significant reproductive and gynecological complications. An unicornuate uterus with a rudimentary horn is a rare subtype of these anomalies.

Case presentation

A 15-year-old girl presented with acute abdominal pain. Ultrasound revealed a solid left ovarian tumor, initially suspected to be a teratoma. Laboratory findings showed elevated Ca-125 (60 U/ml; normal: <35 U/ml), while other tumor markers were normal. Pelvic magnetic resonance imaging (MRI) suggested uterus didelphys with a left ovarian mass. During laparoscopy, a unicornuate uterus with a non-communicating rudimentary horn and a left ovarian tumor was identified. The ovarian tumor was excised with preservation of residual ovarian tissue. Histopathological analysis revealed the diagnosis of an endometrial cyst. Six months later, during an elective laparoscopy, a non-communicating left rudimentary horn with the ipsilateral fallopian tube was excised using LigaSure® device. The postoperative course was uneventful. She recovered well and remains under gynecological follow-up, with regular menstrual cycles.

Conclusion

In pediatric and adolescent patients diagnosed with ovarian endometriotic cysts, a comprehensive evaluation of uterine anatomy is essential to exclude underlying obstructive Müllerian anomalies, as timely recognition and management may prevent progression of disease and preserve future reproductive potential.

摘要： lererian导管异常是女性生殖道的先天性畸形，临床表现多样，从无症状到伴有显著的生殖和妇科并发症。具有原始角的独角子宫是这些异常的一种罕见亚型。病例介绍一名15岁女孩，以急性腹痛为主诉。超声显示左侧卵巢实性肿瘤，最初怀疑为畸胎瘤。实验室结果显示Ca-125升高（60 U/ml；正常：35 U/ml），而其他肿瘤标志物正常。盆腔磁共振成像（MRI）提示子宫双缩伴左侧卵巢肿块。在腹腔镜检查中，发现了一个单角状子宫，有一个不相通的初级角和一个左侧卵巢肿瘤。切除卵巢肿瘤，保留卵巢残余组织。组织病理学分析显示诊断为子宫内膜囊肿。6个月后，在选择性腹腔镜检查中，使用LigaSure®设备切除与同侧输卵管不相通的左初级角。术后过程平淡无奇。患者恢复良好，仍在妇科随访，月经周期正常。结论在诊断为卵巢子宫内膜异位囊肿的儿童和青少年患者中，全面评估子宫解剖对排除潜在的梗阻性勒氏管异常至关重要，及时识别和处理可以预防疾病的发展，并保留未来的生殖潜力。

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引用次数: 0

Fetal inguinoscrotal hernia: A case series 胎儿腹股沟-阴囊疝：一个病例系列

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-10-09 DOI: 10.1016/j.epsc.2025.103122

Aliya Y. Ortaaslan , Françoise Rypens , Dickens Saint-Vil

Introduction

Inguinoscrotal hernias (ISH) are common in neonates but rarely seen in the fetal period, with only 21 reported cases to date. We present two cases of fetal ISH diagnosed antenatally, each initially misidentified.

Cases presentation

A 25-year-old woman (G6P3A2) was referred for a solid scrotal mass detected at 34 weeks of gestation and suspected to be teratoma. Repeat Ultrasound (US) at 35 weeks, diagnosed an isolated right-sided inguinoscrotal hernia containing peristaltic bowel loops and mesenteric vascularization without any other anomaly. Patient was born in a peripheral hospital before ultimately undergoing inguinal herniorrhaphy at 10 days of life.

In a 27-year-old woman (G1P0), US at 22 weeks revealed bilateral nephromegaly. Biweekly follow-up was performed. At 33 weeks, follow-up US detected a distended rectum containing heterogeneous material. Fetal MRI confirmed bilateral nephromegaly, normal rectal content, and diagnosed a right inguinoscrotal hernia with collapsed bowel loops in the scrotum and an associated left hydrocele. The infant was delivered by cesarean section at 36 weeks at our tertiary pediatric hospital. The infant underwent bilateral nephrectomy and simultaneous bilateral inguinoscrotal hernia repair at 2 months of age.

Conclusion

Fetal inguinoscrotal hernia is rare but should be considered in the differential for a fetal scrotal or perineal mass.

腹股沟阴囊疝（ISH）在新生儿中很常见，但在胎儿期很少见，迄今仅有21例报告。我们提出了两例胎儿ISH诊断产前，每个最初被误诊。病例介绍一名25岁的女性（G6P3A2）在妊娠34周时发现实心阴囊肿块，怀疑是畸胎瘤。35周时复查超声（US），诊断为孤立性右侧腹股沟阴囊疝，包含肠蠕动环和肠系膜血管，无其他异常。患者出生在外围医院，最终在出生后10天进行腹股沟疝修补术。27岁女性（G1P0）， 22周超声显示双侧肾肥大。每两周随访一次。在33周的随访中，超声检查发现直肠膨胀含有异质物质。胎儿MRI证实双侧肾肿大，直肠内容物正常，并诊断为右侧腹股沟阴囊疝伴阴囊肠袢塌陷，伴有左侧鞘膜积液。该婴儿于36周时在我院第三儿科医院剖宫产。婴儿于2月龄时行双侧肾切除术及双侧腹股沟阴囊疝修补术。结论胎儿腹股沟-阴囊疝是罕见的，但在鉴别胎儿阴囊或会阴肿块时应予以考虑。

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引用次数: 0

Neonatal appendicitis in a preterm male infant: A case report 早产男婴新生儿阑尾炎1例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-10-08 DOI: 10.1016/j.epsc.2025.103119

Keitumetse Teko, Ryan Lalbadoor, Leila Hartford

Introduction

Neonatal appendicitis (NA) is a rare condition with a reported incidence of 0.04–0.2 %, and a high mortality rate of approximately 28 %. Preoperative diagnosis of NA remains challenging due to its nonspecific and variable clinical presentation.

Case presentation

The patient was a 7-day-old preterm male born at 35 weeks of gestation with a birth weight of 1400g, and Apgar scores of 9,9,10 to a 16-year-old primigravid mother. The pregnancy was uneventful, with no maternal complications and no antenatal imaging. On day 4 of life he developed abdominal distension, with associated blood-stained nasogastric aspirates. On examination, he was tachycardic (198 bpm) and febrile (38.5 °C). The abdomen was distended, tender, and had no bowel sounds on auscultation. Abdominal radiography showed pneumoperitoneum. Laboratory results showed elevated c-reactive protein (65mg/L). An emergency exploratory laparotomy revealed a perforated appendix with right iliac fossa contamination, and grossly normal small bowel, colon and stomach. An appendicectomy was performed and the abdominal cavity irrigated with saline solution. Histopathology confirmed acute appendicitis. Postoperative rectal suction biopsy done day 3 post laparotomy excluded Hirschsprung's disease. The infant's recovery was uneventful. Full feedings were reached by day 5 post laparotomy, and he was discharged home on day 10 post laparotomy. He was seen in follow up at 1 month of age at the outpatient clinic and was growing well.

Conclusion

Although rare, perforated appendicitis should be included in the differential diagnosis of neonates who develop an acute abdomen and have a pneumoperitoneum.

新生儿阑尾炎（NA）是一种罕见的疾病，据报道发病率为0.04 - 0.2%，死亡率约为28%。由于其非特异性和多变的临床表现，NA的术前诊断仍然具有挑战性。病例介绍：该患者是一名出生7天的早产男性，出生时妊娠35周，出生体重为1400g， Apgar评分为9,9,10,16岁为初产妇。妊娠顺利，无产妇并发症，无产前影像学检查。出生第4天，患者出现腹胀，伴有鼻胃吸出血。检查时，他心动过速（198bpm）和发热（38.5°C）。腹部肿胀，触痛，听诊无肠音。腹部x线显示气腹。实验室结果显示c反应蛋白升高（65mg/L）。急诊剖腹探查发现阑尾穿孔伴右髂窝污染，小肠、结肠和胃大体正常。行阑尾切除术，并用生理盐水冲洗腹腔。组织病理学证实为急性阑尾炎。剖腹手术后第3天进行的术后直肠吸活检排除了先天性巨结肠病。婴儿的康复平安无事。剖腹手术后第5天达到完全喂养，并于剖腹手术后第10天出院。他在1个月大时在门诊随访，生长良好。结论穿孔性阑尾炎虽然罕见，但在新生儿急腹症合并气腹时应列入鉴别诊断。

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引用次数: 0

Combined endoscopic and laparoscopic surgery for staged repair of complex cloacal anomalies: A case series 内镜和腹腔镜联合手术分阶段修复复杂的肛管异常：一个病例系列

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-10-08 DOI: 10.1016/j.epsc.2025.103117

Erica M. Weidler , Matthew Ralls , Gwen Grimsby , Marcus Jarboe , Casey Calkins , Kathleen van Leeuwen

Introduction

The combined endoscopic and laparoscopic surgery (CELS) technique can be used during reconstruction for infants with complex congenital anomalies. In persistent cloacal malformations, this approach permits delineation of challenging anatomy and facilitates safer surgical separation of structures while minimizing tissue trauma for future procedures.

Cases presentation

Three patients with persistent cloacal malformations and complex upper tract reproductive anatomy underwent the CELS technique during their series of reconstructive procedures. The average age at first stage reconstruction, that included anorectoplasty, was 14 months (range 9–22). The average follow-up length from the time of reconstruction was 6.5 years (range 4–9 years). All patients have since undergone colostomy takedown. Two patients have undergone delayed vaginal pull-through and/or introitoplasty, and one patient has not yet undergone vaginoplasty.

Conclusion

The CELS technique may help reduce complications from open surgery, allows time for structural development, and minimizes tissue dissection and trauma at an early age. Staged repair for complex cloaca can be safely considered and allow for delay of vaginal reconstruction with minimal adverse short-term outcomes and impact on subsequent procedures.

内窥镜和腹腔镜联合手术（CELS）技术可用于复杂先天性畸形婴儿的重建。对于持续性的肛管畸形，这种方法可以描绘具有挑战性的解剖结构，并促进更安全的手术分离结构，同时最大限度地减少未来手术的组织创伤。病例介绍：3例持续性肛管畸形和复杂上生殖道解剖结构的患者在一系列的肛管重建手术中采用了CELS技术。一期重建（包括肛门直肠成形术）的平均年龄为14个月（范围9-22）。自重建时间起的平均随访时间为6.5年（4-9年）。所有患者都接受了结肠造口手术。2例患者接受了延迟阴道拉通和/或阴道成形术，1例患者尚未接受阴道成形术。结论CELS技术有助于减少开放性手术的并发症，为结构发育留出时间，并最大限度地减少早期组织剥离和创伤。复杂泄殖腔的分阶段修复可以安全考虑，并允许延迟阴道重建，以最小的不良短期结果和对后续手术的影响。

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引用次数: 0

Hybrid interventional radiological and surgical approach to treat biliary obstruction post Kasai portoenterostomy: A case report 开赛门静脉肠造口术后胆道梗阻的介入治疗：1例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-09-24 DOI: 10.1016/j.epsc.2025.103116

Anand Dhatt , Ravjot Dhatt , Erik D. Skarsgard , Manraj K.S. Heran

Introduction

Kasai procedure is used in the management of biliary atresia. Complications can include stricturing at anastomoses which can result in impeded bile flow and subsequently ascending cholangitis that requires management.

Case report

We present a case of a 4-year old with multiple episodes of ascending cholangitis in the context of prior Kasai portoenterostomy at day 56 of life for non-syndromic biliary atresia. After prolonged hospital admission, imaging in the form of US and MR-cholangiopancreatography showed an obliterated portoenterostomy. A combined surgical and Interventional Radiology approach was utilized in the form of the surgical creation of a loop jejunostomy within the Roux limb and then traversing of the portoenterostomy under fluoroscopy to dilate the stricture and place an internal-external biliary drain. Subsequently, the patient's hyperbilirubinemia resolved with no further episodes of ascending cholangitis in 3 years of follow-up.

Conclusion

A hybrid, percutaneous and surgical approach is a feasible option to restore bile flow in patients post-Kasai who develop delayed cholestasis due to obliteration of the portoenterostomy.

介绍kasai手术治疗胆道闭锁。并发症包括吻合口狭窄，可导致胆汁流动受阻，随后需要治疗的上升胆管炎。病例报告：我们报告了一例4岁儿童，在非综合征性胆道闭锁的第56天，在Kasai门肠造口术的背景下，多次发作上升胆管炎。住院时间延长后，超声和磁共振胆管造影显示门肠造口闭塞。采用外科和介入放射学相结合的方法，在Roux肢体内手术建立环形空肠造口，然后在透视下穿过门肠造口，扩大狭窄并放置内外胆道引流管。随后，患者的高胆红素血症得到解决，在3年的随访中没有再发生上升性胆管炎。结论经皮和手术混合入路是恢复kasai术后因门肠造口闭塞而发生迟发性胆汁淤积的患者胆汁流动的可行选择。

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引用次数: 0

Type III pleuropulmonary blastoma in a toddler: a case report 幼儿III型胸膜肺母细胞瘤1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-09-24 DOI: 10.1016/j.epsc.2025.103115

Binyam Mulatu Habte , Yoseph Mulatu Habte , Esimael Musema Abdu , Mintesnot Fitretu Zeberga , Abay Gosaye Wondimu , Yonas Girma Shumiye

Introduction

Pleuropulmonary blastoma (PPB) is an exceptionally rare and aggressive pediatric thoracic malignancy, accounting for less than 1 % of childhood lung tumors. Its nonspecific respiratory presentation often mimics common conditions, leading to delayed recognition, particularly in resource-limited settings.

Case presentation

A 2.5-year-old female with progressive respiratory distress since infancy managed as recurrent pneumonias without improvement was admitted to our hospital. She was tachypneic with absent air entry over the right hemithorax. Laboratory studies revealed leukocytosis and anemia. A contrast-enhanced chest computerized tomography (CT) showed a large heterogeneously enhancing right lower lobe mass with necrotic foci, encasement of hilar broncho-vascular structures, associated pleural and pericardial effusions, and mediastinal shift suspicious for a malignant process. Brain magnetic resonance (MRI) and abdominal CT were done to assess for metastasis and were normal. Given the child's critical condition, upfront surgical resection was undertaken without preoperative biopsy or neoadjuvant therapy. We did a right thoracotomy and found a large, encapsulated mass arising from the right lower lobe, which was excised via a lobectomy. Histopathology confirmed a type III pleuropulmonary blastoma, demonstrating sheets of undifferentiated mesenchymal cells with pleomorphism and necrosis. The patient had an uneventful postoperative recovery and was subsequently referred to a specialized oncology center for adjuvant chemotherapy.

Conclusion

Pleuropulmonary blastoma should be considered in the differential diagnosis of toddlers who present with recurrent or persistent respiratory symptoms that fail to improve with standard therapies.

胸膜肺母细胞瘤（pleuropulmonary blastoma， PPB）是一种极为罕见且侵袭性的儿童胸部恶性肿瘤，占儿童肺部肿瘤的不到1%。其非特异性呼吸表现通常模仿常见情况，导致识别延迟，特别是在资源有限的环境中。病例介绍：一名2.5岁女性，自婴儿期起出现进行性呼吸窘迫，被诊断为复发性肺炎，无好转。她呼吸急促，右半胸没有空气进入。实验室检查显示白细胞增多和贫血。增强胸部电脑断层扫描（CT）显示右下肺叶大肿块伴坏死灶，肺门支气管血管结构包裹，相关胸膜和心包积液，纵膈移位疑似恶性过程。脑磁共振（MRI）和腹部CT检查是否有转移，均未见异常。鉴于患儿病情危重，术前未行活检或新辅助治疗，先行手术切除。我们做了右开胸手术，发现右下叶有一个巨大的包裹性肿块，通过肺叶切除术切除了。组织病理学证实为III型胸膜肺母细胞瘤，表现为未分化的间充质细胞片，具有多形性和坏死。患者术后恢复顺利，随后转到专门的肿瘤中心进行辅助化疗。结论小儿胸膜肺母细胞瘤在鉴别诊断时应考虑到反复或持续性呼吸道症状，并通过标准治疗未能改善。

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引用次数: 0

Laparoscopic gastroduodenal anastomosis (Billroth I) for the management of type II pyloric atresia in Carmi syndrome: a case report 腹腔镜胃十二指肠吻合（Billroth I）治疗Carmi综合征II型幽门闭锁1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-09-23 DOI: 10.1016/j.epsc.2025.103113

Joel Cazares , Jorge Colín-Garnica , Eduardo de la Rosa-Bustamante , Rubi Beatriz Martínez-Carmona , Arturo Guillen-Cárdenas , Jorge Alberto Cantú-Reyes

Introduction

Pyloric atresia accounts for less than 1 % of all congenital intestinal obstructions, with an estimated incidence of 1:100,000 live births. Its association with epidermolysis bullosa, known as Carmi syndrome, is rare but well documented. Minimally invasive techniques can be employed in the surgical management of complex neonatal conditions.

Case report

A male neonate was delivered vaginally at 35 weeks of gestation to a 16-year-old mother, with reported consanguinity between the parents. At birth, he presented with widespread bullous skin lesions involving the extremities, thorax, and face, along with a positive Nikolsky sign, findings that raised strong suspicion for epidermolysis bullosa. Birth weight was 2000 g, and no resuscitative maneuvers were required.

Following the initiation of enteral feeding, the patient developed non-bilious vomiting. Abdominal radiography showed a single gastric bubble with absence of distal gas. A contrast study confirmed gastric outlet obstruction. Endoscopy on day three revealed complete pyloric occlusion and mucosal fragility. A laparoscopic procedure was performed, confirming type II pyloric atresia. A Laparoscopic gastroduodenostomy (Billroth I) was successfully carried out without intraoperative complications. Postoperative contrast imaging confirmed adequate anastomotic patency. Unfortunately, the patient developed sepsis due to extensive skin involvement and died on postoperative day three.

Conclusions

Minimally invasive gastroduodenal anastomosis (Billroth I) seems to be technically feasible in newborns with pyloric atresia.

幽门闭锁占所有先天性肠梗阻的不到1%，估计发病率为1:10万活产。它与大疱性表皮松解症有关，称为Carmi综合征，虽然罕见，但文献记载充分。微创技术可用于复杂新生儿疾病的外科治疗。病例报告一名男婴在妊娠35周时顺产给一名16岁的母亲，据报道父母之间有血缘关系。出生时，患者表现为广泛的大疱性皮肤病变，累及四肢、胸部和面部，同时伴有阳性的Nikolsky征，这些发现强烈怀疑为大疱性表皮松解症。出生体重2000克，不需要复苏操作。开始肠内喂养后，患者出现非胆汁性呕吐。腹部x线片显示单个胃泡，远端无气体。造影证实胃出口梗阻。第三天的内窥镜检查显示完全幽门阻塞和粘膜脆弱。行腹腔镜检查，确认II型幽门闭锁。腹腔镜胃十二指肠造口术（Billroth I）成功进行，无术中并发症。术后造影证实吻合口通畅。不幸的是，由于广泛的皮肤受累，患者发生败血症，并于术后第三天死亡。结论微创胃十二指肠吻合术（Billroth I）治疗新生儿幽门闭锁在技术上是可行的。

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引用次数: 0

Tracheal compression secondary to a bronchogenic cyst in an 18-year-old male: a case report 18岁男性支气管源性囊肿继发气管压迫1例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-09-22 DOI: 10.1016/j.epsc.2025.103112

Shruthi Srinivas , Nicholas A. Zumberge , Ashley L. Miller , Jennifer MacDonald , Jennifer H. Aldrink , Sara A. Mansfield

Introduction

Asthma is the most common pediatric respiratory disease; however, misdiagnosis is steadily increasing. Identification of surgically managed conditions with similar symptoms is essential to ensuring timely management.

Case presentation

An 18-year-old healthy male was diagnosed with asthma after visits to the pediatrician and Emergency Department for cough and shortness of breath. For several weeks, he was prescribed antibiotics, prednisone, albuterol, and fluticasone without improvement. He acutely worsened and presented with respiratory distress attributed to status asthmaticus. He required emergent intubation, which was difficult given resistance when advancing the endotracheal tube (ETT). Cross-sectional imaging with computed tomography demonstrated a large superior mediastinal cystic mass with tracheal compression distal to the ETT. After transfer to our facility, he acutely decompensated with worsening ventilatory needs and hypotension requiring vasopressors. After a multidisciplinary discussion, he was brought to the operating room for aspiration of the mass and rigid bronchoscopy. Ultrasound-guided percutaneous drainage of the mass was achieved with immediate improvement in his tidal volumes and evidence of alleviated obstruction on bronchoscopy. He was weaned from respiratory support and extubated postoperatively. A drain contrast study demonstrated no connection to the esophagus or trachea and showed tracheal compression with instillation of contrast into the cavity. Ultimately, he underwent definitive resection of the mass and has had excellent functional recovery. Pathology confirmed a congenital bronchogenic cyst.

Conclusion

Bronchogenic cysts can cause airway compression, which may present as new asthma-like symptoms. They can even cause acute airway obstruction. Bronchogenic cysts should be promptly ruled out in patients who develop new asthma-like symptoms but fail to respond to standard treatments.

哮喘是儿科最常见的呼吸系统疾病；然而，误诊率正在稳步上升。识别具有相似症状的手术治疗条件对于确保及时治疗至关重要。病例介绍一名18岁健康男性，因咳嗽和呼吸短促到儿科医生和急诊科就诊后被诊断为哮喘。几周后，他被开抗生素、强的松、沙丁胺醇和氟替卡松，但没有好转。他急性恶化，并表现出呼吸窘迫归因于状态哮喘。他需要紧急插管，在推进气管内插管（ETT）时遇到阻力，这很困难。计算机断层成像显示纵隔上有一个巨大的囊性肿块，气管压迫远端气管。转到我们的设施后，他急性代偿失调，呼吸需求恶化，低血压需要血管加压药物。在多学科讨论后，他被带到手术室进行肿块吸出和刚性支气管镜检查。超声引导下经皮引流肿物后，他的潮气量立即改善，支气管镜检查显示阻塞减轻。术后他已脱离呼吸支持并拔管。引流造影剂研究显示与食管或气管没有连接，并显示气管受压，向腔内注入造影剂。最终，他接受了肿瘤的彻底切除，功能恢复良好。病理证实为先天性支气管囊肿。结论支气管源性囊肿可引起气道受压，表现为新的哮喘样症状。它们甚至会引起急性气道阻塞。对于出现新的哮喘样症状但对标准治疗无效的患者，应及时排除支气管源性囊肿。

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引用次数: 0

Ileal arteriovenous malformation in an adolescent: A case report 青少年回肠动静脉畸形1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-09-22 DOI: 10.1016/j.epsc.2025.103114

Daniel Gulko , Ryan Thibodeau , Travis Bevington , Mary Christina Whyte

Introduction

Arteriovenous malformations (AVM) of the gastrointestinal tract are rare congenital vascular anomalies, particularly in the pediatric population.

Case presentation

A previously healthy 16-year-old male, with a past medical history of mild intermittent asthma and iron deficiency anemia presented with acute non-bilious vomiting and periumbilical abdominal pain without peritonitis. Initial abdominal radiography showed several grouped, round calcifications in the left lower quadrant. Computed tomography (CT) revealed a thickened loop of small bowel with calcifications. Focused ultrasonography demonstrated thickened loops of bowel that contained color Doppler flow, and several shadowing echogenic foci. His symptoms resolved spontaneously, and he was discharged home with a plan for potential elective surgery. He presented to the hospital 11 days later with abdominal pain and was taken to the operating room for an exploratory laparoscopy. We found a 13-cm vascular lesion in the ileum. We made a small periumbilical incision, eviscerated and resected the ileum containing the vascular lesion and did an end-to-end anastomosis. The postoperative course was uneventful, and he was discharged home on postoperative day two. The histology was consistent with an AVM, with dilated thick and thin-walled vessels and scattered calcifications.

Conclusion

AVM of the small bowel should be included in the differential diagnosis of children who develop abdominal pain and have localized abdominal calcifications and localized bowel wall thickening on imaging studies.

胃肠道动静脉畸形（AVM）是一种罕见的先天性血管异常，尤其在儿科人群中。既往健康16岁男性，既往有轻度间歇性哮喘和缺铁性贫血病史，表现为急性非胆汁性呕吐和脐周腹痛，无腹膜炎。最初的腹部x线片显示左下腹有几个成组的圆形钙化灶。计算机断层扫描（CT）显示增厚的小肠袢伴钙化。聚焦超声显示肠袢增厚，包含彩色多普勒血流，并有几个阴影回声灶。他的症状自然消失，出院回家时，他计划进行择期手术。11天后，他因腹痛来到医院，并被带到手术室进行腹腔镜探查。我们在回肠发现了一个13厘米的血管病变。我们做了一个小的脐周切口，取出并切除了含有血管病变的回肠，并做了端到端吻合。术后过程很顺利，术后第二天他出院回家。组织学与AVM一致，厚薄壁血管扩张，散在钙化。结论小肠avm应纳入腹痛患儿的鉴别诊断，影像学检查显示腹部局部钙化和肠壁局部增厚。

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引用次数: 0

Giant pubic keloid in a 6-year-old male: a case report 6岁男性巨大阴部瘢痕疙瘩1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2025-09-16 DOI: 10.1016/j.epsc.2025.103109

Tarek Abdelazeem Sabra , Eiman Yassir Musa Hussain , Nour Eldin Ali Thabet , Sarah Magdy Abdelmohsen

Introduction

Keloids are benign fibroproliferative scars resulting from abnormal wound healing. While frequently affecting the chest, shoulders, and earlobes, their occurrence in the suprapubic or genital region of children is exceedingly rare.

Case presentation

A 6-year-old male who developed a several-cm long and wide keloid extending from the suprapubic region to the base of the penis following a left inguinal hernia repair. The wound of the hernia repair had initially healed well. The keloid was initially noted within 2 months post-surgery and became larger and symptomatic during the following year. There were no signs of infection, ulceration, or urinary difficulty. The patient was taken electively to the operating room. We did a complete surgical excision with a closure in multiple layers. After the operation he underwent cutaneous injections of triamcinolone acetonide (40 mg/mL, 0.5 mL per session) monthly for three months. The postoperative recovery was uneventful, and no recurrence has been observed at 18 months of follow-up.

Conclusion

Surgical resection plus cutaneous steroid injection appears to be a safe and effective treatment for giant keloids that may develop after the repair of inguinal hernias.

瘢痕疙瘩是由伤口愈合异常引起的良性纤维增生性疤痕。虽然经常影响胸部、肩部和耳垂，但在儿童的耻骨上或生殖器区域发生极为罕见。病例介绍：一名6岁男性，左腹股沟疝修补术后出现从耻骨上延伸至阴茎底部数厘米长的宽瘢痕疙瘩。疝修补术的伤口初步愈合良好。瘢痕疙瘩最初在术后2个月内被发现，并在接下来的一年里变得更大和有症状。没有感染、溃疡或排尿困难的迹象。病人被选择性地送进手术室。我们做了一个完整的手术切除，关闭了多层。术后每月皮肤注射曲安奈德（40mg /mL，每次0.5 mL），连续3个月。术后恢复顺利，随访18个月未见复发。结论手术切除加皮肤类固醇注射治疗腹股沟疝修补后可能出现的巨大瘢痕疙瘩是一种安全有效的治疗方法。

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