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

Retroperitoneal Castleman's disease and ovarian torsion: A case report 腹膜后卡斯特曼病与卵巢扭转：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-10-05 DOI: 10.1016/j.epsc.2024.102897

Mingjun Jin , Tengfei Li , Qianhui Yang , Linsheng Zhao , Liang Dong , Jianghua Zhan

Introduction

Castleman's Disease (CD) is a rare lymphoproliferative disorder with diverse clinical manifestations. It is primarily characterized by painless lymph node enlargement, most commonly in the mediastinum, neck, retroperitoneum, axillary regions, and pelvis.

Case presentation

A 12-year-old female was admitted to our hospital with persistent abdominal pain and vomiting that were not alleviated by initial treatments. Physical examination revealed tenderness in the right lower abdomen. Pelvic ultrasound revealed a mass in the pelvic region. Due to persistent pain, she underwent a laparoscopic exploration during which it was discovered that the right ovary was twisted 360°, and it was adjacent to the pelvic mass. It appeared that the mass was pushing the ovary, and this phenomenon could have been the cause of the torsion. The nature of the mass could not be conclusively determined during the intraoperative assessment, but a biopsy with a fine needle was obtained. Pathological examination was suggestive of a tumor related to the lymphatic system. She underwent a pelvic MRI that confirmed a round, soft tissue mass on the right side of the pelvis measuring approximately 63 × 50 × 56 mm. We did a subsequent laparoscopy and completely resected the mass. The patient recovered well and was discharged without complications. At 2 years of follow up she is in good health. The final pathology diagnosis of the mass was CD.

Conclusion

CD is often asymptomatic, but symptoms can arise when the enlarged lymph nodes cause compression on surrounding organs.

导言卡斯特曼病（CD）是一种罕见的淋巴组织增生性疾病，临床表现多种多样。该病的主要特征是无痛性淋巴结肿大，最常见于纵隔、颈部、腹膜后、腋窝和盆腔。病例介绍一名 12 岁女性因持续腹痛和呕吐入院，经初步治疗无效。体格检查显示右下腹有触痛。盆腔超声检查显示盆腔区域有肿块。由于持续疼痛，她接受了腹腔镜探查，在探查过程中发现右侧卵巢扭转了360°，与盆腔肿块相邻。肿块似乎在挤压卵巢，这种现象可能是扭转的原因。术中评估无法确定肿块的性质，但还是用细针进行了活检。病理检查显示是与淋巴系统有关的肿瘤。她接受了盆腔磁共振成像检查，结果证实盆腔右侧有一个圆形软组织肿块，大小约为 63 × 50 × 56 毫米。我们随后进行了腹腔镜手术，完全切除了肿块。患者恢复良好，无并发症后出院。随访两年后，她的健康状况良好。该肿块的最终病理诊断为 CD。ConclusionCD 通常没有症状，但当肿大的淋巴结压迫周围器官时就会出现症状。

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引用次数: 0

A novel approach to pediatric chest wall reconstruction using a 3D-printed biodynamic prosthesis: A case report 使用 3D 打印生物动力假体重建小儿胸壁的新方法：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-30 DOI: 10.1016/j.epsc.2024.102896

Keerthi Burgi , Nikhil R. Shah , Tammy Stoll , James D. Geiger

Introduction

Chest wall reconstruction in children continues to be a challenging undertaking, aiming to restore both form and function. An optimal chest wall reconstruction material has not been identified that would provide dynamic chest function and would ideally avoid potential long-term sequelae.

Case presentation

A 15-year-old female with Li Fraumeni syndrome and a history of hepatic rhabdomyosarcoma presented with increasing left back and left scapular pain initially attributed to her known scoliosis. Computed tomography revealed a 12 x 6 × 7 cm mass encasing ribs 3–5 extending into the left chest wall and axilla. Image-guided biopsy confirmed a high-grade osteosarcoma without extra-thoracic metastatic disease. She underwent neoadjuvant chemotherapy after which a three-dimensional (3D) anatomic model of the tumor was printed using the post-therapy imaging reconstruction. The surgical team collaborated with Osteobionix (Osteobionics S.L., Santa Lucia de Tirajana, Spain) to create a patient-specific dynamic chest wall reconstruction implant, based on 3D modeling of the planned resection zone. The final implant was 3D printed with a titanium alloy using electron-beam manufacturing technology, sterilized prior to implantation. She underwent left thoracotomy and rib resection with prosthesis fixation to the T3, T4, and T5 vertebral bodies posteriorly and to the sternum anteriorly. More than2 years after the operation, she is doing well without evidence of recurrent disease. She has an excellent cosmetic result, there has been no progression of her scoliosis, and she has returned to competitive sports.

Conclusion

Our titanium-based 3D-printed, patient-specific implant seems to be a valuable option for the reconstruction of the chest wall in children who require an extensive chest wall resection.

导言儿童胸壁重建仍然是一项具有挑战性的工作，其目的是同时恢复外形和功能。病例介绍一位患有李-弗劳米尼综合征并有肝横纹肌肉瘤病史的 15 岁女性因左背部和左肩胛骨疼痛加剧而就诊，最初的原因是她已知的脊柱侧弯。计算机断层扫描显示，一个 12 x 6 x 7 厘米的肿块包裹着 3-5 根肋骨，并向左胸壁和腋窝延伸。图像引导下的活组织检查证实这是一个高级别骨肉瘤，没有胸腔外转移性疾病。她接受了新辅助化疗，之后利用治疗后的成像重建打印了肿瘤的三维（3D）解剖模型。手术团队与 Osteobionix 公司（Osteobionics S.L.，西班牙圣卢西亚德蒂拉亚纳）合作，根据计划切除区域的三维建模，制作了患者专用的动态胸壁重建植入物。最终植入物采用电子束制造技术用钛合金进行三维打印，并在植入前进行消毒。她接受了左侧开胸手术和肋骨切除术，假体后部固定在T3、T4和T5椎体上，前部固定在胸骨上。术后两年多，她的情况良好，没有复发的迹象。结论我们基于钛的三维打印患者特异性植入物似乎是需要大面积胸壁切除的儿童重建胸壁的重要选择。

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引用次数: 0

Intraductal papilloma presenting as a breast mass in an 8-month-Old male infant: A case report 8 个月大男婴乳房肿块中出现的导管内乳头状瘤：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-28 DOI: 10.1016/j.epsc.2024.102894

Maen Kamal , Nesma Ghanim , Raima Hashmi , Zachary Patterson , Qazi Azher , Antonio J. Williams Sr

Introduction

Intraductal papilloma is an exceptionally rare condition in the pediatric population, particularly among males in infancy and early childhood, typically most prevalent among women aged between 35 and 55 years presenting as sanguineous or serosanguineous nipple discharge and a discrete breast mass. Despite its historical classification as benign, emerging research indicates a potential for malignant transformation, prompting a reevaluation of its clinical significance.

Case presentation

We present the case of a healthy 8-month-old male infant with a right subareolar breast swelling that appeared non tender, well-circumscribed, smooth, mobile, rubbery, without any associated nipple discharge or regional lymphadenopathy, clinically measuring 10 × 10 mm in diameter, and exhibited a bluish green hue with no associated changes in overlying skin. Ultrasound confirmed presence of a right retro areolar breast mass, characterized as a multiseptated complex cyst-like structure with tubular anechoic formations within, measuring 21 x 20 × 6 mm. The findings were suggestive of possible duct ectasia classified as Bi-Rads Category 3 with a benign probability. Due to parental concern for increase in size over 2 months, the mass was resected under general anesthesia through a subareolar incision. Microscopic analysis confirmed dilated cystic ducts and an intraductal papilloma with calcifications. The patient recovered well from the operation, and follow-up at nine months, he has experienced no recurrences.

Conclusion

Although rare, this case underscores the importance of including intraductal papilloma in the differential diagnosis of breast nodules in male infants.

导言导管乳头状瘤在儿科人群中是一种极为罕见的疾病，尤其是在婴幼儿期的男性中，通常在 35 至 55 岁的女性中最为常见，表现为血色或血清样乳头溢液和离散性乳房肿块。本病例中，一名 8 个月大的健康男婴右侧乳晕下乳房肿胀，无触痛，边界清楚，光滑，可移动，呈橡胶样，无任何相关的乳头溢液或区域淋巴结病，临床上直径为 10 × 10 毫米，呈蓝绿色，上覆皮肤无相关变化。超声波检查证实了右侧乳晕后肿块的存在，其特征为多隔复合囊肿样结构，内有管状无回声形成，大小为 21 × 20 × 6 毫米。检查结果提示可能存在导管异位，被归为 Bi-Rads 3 类，良性可能性大。由于父母担心肿块会在两个月内增大，因此在全身麻醉下通过乳晕下切口切除了肿块。显微镜分析证实，囊性导管扩张，导管内乳头状瘤伴有钙化。患者术后恢复良好，9 个月后随访，未见复发。结论虽然罕见，但该病例强调了将导管内乳头状瘤纳入男婴乳腺结节鉴别诊断的重要性。

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引用次数: 0

Traumatic rupture of a yolk sac tumor: A case report 卵黄囊肿瘤的外伤性破裂：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-27 DOI: 10.1016/j.epsc.2024.102893

Hannah Z. Weiss , Michael Dedwylder , Faris Azar , Thomas Bolton , Melanie Altizer , Anne Fischer

Introduction

Yolk sac tumors are rare neoplasms with a risk of rupture due to their rapid growth and vascularity. There is only one reported case of a ruptured yolk sac tumor in the literature.

Case presentation

A nine-year-old girl presented to an outside hospital with worsening bilateral lower quadrant abdominal pain following a handlebar injury. The patient was tachycardic and tachypneic with a hemoglobin of 7.4 g per deciliter, lactic acid of 7.7 mmol/L, and white blood cell count of 45,000 per μL. A Computed Tomography (CT) scan revealed a large, hypodense 19.1 × 11.4 cm abdominal mass and free fluid concerning for a hematoma with possible peritoneal carcinomatosis. The patient was transfused with one unit of packed red blood cells (PBRCs) given her tachycardia. After transfer from the outside hospital, the patient continued to be tachycardic (143 beats per minute) and tachypneic (36 breaths per minute). A repeat CT was performed, revealing a 6 × 5.5 cm right subhepatic mass and a 16 × 12 cm pelvic mass. In the OR (operating room), a large, multi-cystic hemorrhagic tumor measuring 16.8 cm was discovered in the left pelvis. A second mass was found in the subhepatic space that was a large tumor nodule. The patient underwent left oophorectomy and salpingectomy for tumor resection. An omentectomy was performed due to omental carcinomatosis, with tumor nodules reaching up to 9.5 cm in length. A smaller tumor nodule was resected from the left round ligament. During the operation, the patient received a transfusion of five units of PBRCs, four units of fresh frozen plasma, one unit of platelets, and 2.5 units of crystalloids. Labs taken at the time of surgery revealed an alpha fetal protein (AFP) level of 17,523 ng/mL. The patient was staged as a stage IIIC mixed germ cell tumor with 99% yolk sac and 1% mature teratoma cells. Post-operatively, the patient was treated with BEP chemotherapy, achieving normalization of AFP levels by the end of the fourth cycle.

Conclusion

The aggressive growth pattern of yolk sac tumors places patients at risk of tumor rupture, potentially leading to an acute abdomen. These patients require prompt surgical intervention followed by chemotherapy.

导言卵黄囊肿瘤是一种罕见的肿瘤，因其生长迅速、血管丰富而有破裂的风险。文献中仅报道过一例卵黄囊肿瘤破裂的病例。病例介绍一名 9 岁女孩因手把受伤后双下腹痛加剧而到外院就诊。患者心动过速、呼吸急促，血红蛋白为 7.4 克/分升，乳酸为 7.7 毫摩尔/升，白细胞计数为 45,000 个/微升。计算机断层扫描（CT）显示，患者腹部有一个 19.1 × 11.4 厘米的巨大低密度肿块，腹腔内有游离液体，可能是腹膜癌变的血肿。由于患者心动过速，医生为其输注了一个单位的包装红细胞（PBRCs）。从外院转院后，患者仍然心动过速（每分钟 143 次），呼吸急促（每分钟 36 次）。再次进行CT检查，发现一个6 × 5.5厘米的右肝下肿块和一个16 × 12厘米的盆腔肿块。在手术室，发现左侧盆腔有一个 16.8 厘米大的多囊出血性肿瘤。在肝下腔发现了第二个肿块，是一个大肿瘤结节。患者接受了左侧输卵管切除术和输卵管切除术以切除肿瘤。由于网膜癌变，患者接受了网膜切除术，肿瘤结节长达 9.5 厘米。从左侧圆韧带切除了一个较小的肿瘤结节。手术期间，患者接受了 5 个单位的 PBRCs、4 个单位的新鲜冰冻血浆、1 个单位的血小板和 2.5 个单位的晶体液输注。手术时的化验结果显示，α胎儿蛋白（AFP）水平为 17,523 纳克/毫升。患者被分期为IIIC期混合生殖细胞瘤，卵黄囊细胞占99%，成熟畸胎瘤细胞占1%。结论卵黄囊肿瘤的侵袭性生长模式使患者面临肿瘤破裂的风险，可能导致急腹症。这些患者需要及时进行手术治疗，然后进行化疗。

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引用次数: 0

Sigmoid perforation after endoscopic clip placement in an infant: A case report 婴儿内镜夹置入术后发生乙状结肠穿孔：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-26 DOI: 10.1016/j.epsc.2024.102892

Lucia Fein, Gabriela Carro, Bernardo Berazategui

Introduction

Intestinal perforation following endoscopic clip placement is an uncommon complication that has been reported in adult patients but, as far as we now, not in pediatric patients.

Case presentation

An 8-month-old female infant with a history of metabolic encephalopathy was admitted with a convulsive disorder requiring mechanical ventilation. On the seventh day of hospitalization in the intensive care unit, the patient experienced three bowel movements with dark blood clots. Despite being hemodynamically stable upon physical examination, her hemoglobin level decreased to 8.6 g/dL. Upper endoscopy findings were normal, and exploratory laparoscopy ruled out Meckel's diverticulum or other visible parietal causes of bleeding. Lower gastrointestinal endoscopy revealed ulcers in the rectum, sigmoid, and terminal ileum, where hemostatic clips were placed. No repeated bleeding events occurred. However, 20 days later she presented with fever, abdominal pain, and distension. Abdominal radiography revealed pneumoperitoneum, leading to an emergency exploratory laparotomy. A perforation of the sigmoid colon from one of the clips was found. We resected the short segment of sigmoid colon that contained the perforation and did an end-to-end anastomosis. She recovered well and had no complications.

Conclusion

Hemostatic clips placed endoscopically in the colon can lead to perforation even several weeks after placement.

导言：内窥镜夹置入术后发生肠穿孔是一种不常见的并发症，在成人患者中已有报道，但就目前而言，在儿童患者中还没有报道。在重症监护室住院的第七天，患者出现了三次大便，并伴有深色血块。尽管体格检查时血流动力学稳定，但她的血红蛋白水平降至 8.6 g/dL。上消化道内镜检查结果正常，探查性腹腔镜检查排除了梅克尔憩室或其他可见的顶叶出血原因。下消化道内窥镜检查发现直肠、乙状结肠和回肠末端有溃疡，在这些部位放置了止血夹。没有再发生出血事件。然而，20 天后，她出现了发烧、腹痛和腹胀。腹部放射线检查发现腹腔积气，于是紧急进行了剖腹探查术。发现其中一个夹子导致乙状结肠穿孔。我们切除了包含穿孔的一段乙状结肠，并进行了端对端吻合术。结论内镜下放置在结肠中的止血夹即使在放置数周后也可能导致穿孔。

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引用次数: 0

Rectosigmoid intussusception presenting as rectal prolapse in a premature baby: A case report 早产儿直肠乙状结肠肠套叠表现为直肠脱垂：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-24 DOI: 10.1016/j.epsc.2024.102890

Cesar Kattini , Meagan E. Wiebe , Marc-Olivier Deguise , Brigitte Lemyre , Ahmed Nasr

Introduction

Rectosigmoid intussusception in premature infants is a rare condition. We present a case of rectosigmoid intussusception initially presenting as rectal prolapse.

Case presentation

A premature male baby born at 24 weeks gestation was transferred to our center at two months of age due to recurrent rectal prolapse with minimal straining, despite repeated reductions. The etiology of the prolapse was unclear. An abdominal X-ray showed bowel dilation with air-fluid levels. The gas pattern in the abdomen indicated a mid to distal bowel obstruction. An abdominal ultrasound revealed an intussusception behind the bladder, measuring 3.8 cm in cranio-caudal dimension, appearing to be in the rectum or distal sigmoid colon. The patient underwent a diagnostic laparoscopy. We found a rectosigmoid intussusception, which we reduced laparoscopically. After the laparoscopy we did a flexible sigmoidoscopy and saw that the bowel wall appeared edematous and bruised but was not compromised. There were no polyps or any other intraluminal lesions. We concluded that the recurrent prolapse was the intussusception protruding through the anus (likely originating from mesenteric lymph nodes) rather than a rectal prolapse. There were no perioperative or postoperative complications, the patient tolerated the procedure well and had an uneventful recovery.

Conclusion

Rectosigmoid intussusception can resemble rectal prolapse and should be ruled out if prolapse recurs immediately after reduction.

导言早产儿直肠乙状结肠肠套叠是一种罕见病。病例介绍一名妊娠 24 周时出生的早产男婴在两个月大时因反复出现直肠脱垂而转入本中心，尽管反复进行了减压，但脱垂仍很小。脱肛的病因尚不清楚。腹部 X 光片显示肠道扩张，并伴有气液水平。腹腔内的气体形态显示中远端肠梗阻。腹部超声波检查显示，膀胱后方有一个肠套叠，头尾尺寸为 3.8 厘米，似乎位于直肠或乙状结肠远端。患者接受了腹腔镜诊断。我们发现了直肠乙状结肠肠套叠，并在腹腔镜下将其缩小。腹腔镜检查后，我们进行了柔性乙状结肠镜检查，发现肠壁出现水肿和淤血，但没有受损。没有息肉或其他任何腔内病变。我们的结论是，复发性脱垂是肠套叠通过肛门突出（可能源自肠系膜淋巴结），而不是直肠脱垂。没有围手术期或术后并发症，患者对手术的耐受性良好，术后恢复顺利。

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引用次数: 0

Late presentation of type-I jejunal atresia in an infant: A case report 婴儿I型空肠闭锁的晚期表现：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-24 DOI: 10.1016/j.epsc.2024.102891

Sunnie Wong , Rachel Landisch , Rachel Ruiz , Sumit Datta , Julie Fuchs

Introduction

Intestinal atresia is an uncommon cause of intestinal obstruction. In the vast majority of the cases, signs and symptoms develop early in the neonatal period. Presentations beyond the neonatal period are rare.

Case presentation

A former premature female infant who was otherwise healthy developed recurrent, non-bilious vomiting associated with feedings at the age of 8 months. Up until that time her weight gain had been appropriate, and she had regular bowel movements. Over the course of the following weeks, the vomiting became more frequent. A few days after her 9-month well-child visit during which she still appeared to be in good health, her vomiting turned bilious and was not related to feedings. Her parents brought her to the emergency room. She was admitted to the hospital and underwent imaging studies to investigate the source of what seemed to be an intestinal obstruction. The upper gastrointestinal series (UGI) showed delayed passage of contrast, and a caliber change in the proximal small bowel. The computerized tomography (CT) confirmed the findings, which were suggestive of a partial proximal intestinal obstruction. She underwent a laparotomy. We identified an area of caliber change 15 cm distal to the ligament of Treitz. We opened the proximal side and identified a jejunal membrane that had a pinhole opening in the center. We resected a 4-cm segment of jejunum that included the caliber transition and the membrane and did an end-to-end anastomosis. She tolerated the operation well and was discharged home 12 days later. At the age of 1 year, she is thriving well.

Conclusion

Although type-I jejunal atresia typically presents in the neonatal period, it should be included in the differential diagnosis of infants with recurrent vomiting and signs of a partial bowel obstruction.

导言：肠闭锁是导致肠梗阻的一种不常见原因。在绝大多数病例中，症状和体征出现在新生儿早期。病例介绍一名曾是早产儿的女婴原本身体健康，但在8个月大时出现反复、非淤积性呕吐，并伴有喂食困难。在此之前，她的体重增长一直很正常，排便也很规律。在接下来的几周里，呕吐变得越来越频繁。在她 9 个月大时进行的健康检查中，她看起来仍然健康状况良好，但几天后，她的呕吐变成了胆汁性呕吐，而且与喂食无关。她的父母带她来到急诊室。她被送进了医院，并接受了影像学检查，以确定似乎是肠梗阻的原因。上消化道造影（UGI）显示，造影剂通过延迟，近端小肠口径发生变化。计算机断层扫描（CT）证实了这一结果，提示部分近端肠梗阻。她接受了开腹手术。我们在特雷兹韧带远端 15 厘米处发现了一个口径改变的区域。我们打开近端，发现空肠膜中央有一个针孔开口。我们切除了一段 4 厘米长的空肠，其中包括口径变化区和空肠膜，并进行了端对端吻合术。她对手术的耐受性很好，12 天后就出院回家了。结论虽然I型空肠闭锁通常发生在新生儿期，但对于反复呕吐并伴有部分肠梗阻症状的婴儿，应将其纳入鉴别诊断。

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引用次数: 0

Preoperative percutaneous catheter drainage for symptomatic macrocystic congenital pulmonary airway malformation: A case report 症状性大囊状先天性肺气道畸形的术前经皮导管引流术：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-23 DOI: 10.1016/j.epsc.2024.102889

Ilaria Acquaviva , Edoardo Bindi , Giovanni Cobellis

Introduction

Infants with congenital pulmonary airway malformation (CPAM) are generally asymptomatic and the surgical treatment can be planned using a thoracoscopic technique. We report the case of a newborn with a large type 1 CPAM who presented with severe respiratory distress and was treated with percutaneous transthoracic drainage before open surgery.

Case report

A full-term male patient was born via vaginal delivery. Antenatal imaging had raised suspicion of type 1 CPAM in the right lung. At birth, he was admitted to the neonatal intensive care unit (NICU) due to ventilatory insufficiency and oxygen dependence. A chest X-ray confirmed the antenatal diagnosis of a large type 1 CPAM. On the first days of life (DOL), we inserted a percutaneous transthoracic chest tube to drain the large cyst and initiated high-frequency oscillatory ventilation (HFOV). Although the patient initially showed clinical improvement, his condition subsequently deteriorated. Suspecting tube dislocation, on the seventh DOL a second drainage was placed in the cyst. On the tenth DOL, given the persistent clinical severity, a right upper lobectomy was performed. Postoperatively, the patient was supported by conventional ventilation with a reduced oxygen requirement. On the thirteenth DOL, the infant was successfully extubated. Histological analysis confirmed the diagnosis of type 1 CPAM. After nearly a month, the infant was transferred to the pediatric surgery ward and later discharged. During multidisciplinary follow-up, the patient maintained good general health with no signs of recurrence.

Conclusion

In newborns with large, symptomatic type-1 CPAMs a percutaneous catheter drainage can be used as a temporizing measure before the definitive surgical resection.

导言：患有先天性肺气道畸形（CPAM）的婴儿通常没有症状，可以计划使用胸腔镜技术进行手术治疗。我们报告了一例患有巨大 1 型 CPAM 的新生儿，该患儿出现严重呼吸困难，经皮经胸腔引流术治疗后进行了开胸手术。产前造影检查怀疑右肺存在 1 型 CPAM。出生时，由于通气不足和氧气依赖，他被送入新生儿重症监护室（NICU）。胸部 X 光检查证实了大面积 1 型 CPAM 的产前诊断。在患者出生后的第一天（DOL），我们为其插入了经皮经胸腔穿刺胸管以引流大囊肿，并启动了高频振荡通气（HFOV）。虽然患者最初的临床症状有所改善，但随后病情恶化。由于怀疑插管脱位，在第七个 DOL 日，在囊肿中放置了第二个引流管。第 10 个 DOL 日，鉴于临床症状持续严重，医生对患者进行了右上肺叶切除术。术后，患者接受常规通气支持，氧气需求量减少。DOL 第 13 天，婴儿成功拔管。组织学分析证实了 1 型 CPAM 的诊断。近一个月后，婴儿被转到小儿外科病房，随后出院。在多学科随访期间，患者保持良好的一般健康状况，没有复发迹象。

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引用次数: 0

Unusual variant of esophageal atresia and tracheo-esophageal fistula: A case report 食管闭锁和气管食管瘘的异常变异：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-17 DOI: 10.1016/j.epsc.2024.102886

Rachael Stottlemyre , David M. Notrica , Mark McOmber , Erin Garvey

Introduction

Esophageal atresia (EA) is the most common congenital anomaly affecting the esophagus. We describe an unusual variant of EA, which shares similarities with Type A but features a mid-esophageal segment attached to the trachea.

Case presentation

A 38-week gestational age baby girl had prenatal diagnoses of EA and congenital cardiac anomalies. Postnatal attempts to advance an orogastric tube were unsuccessful, and EA was confirmed by chest X-ray showing the tube at the T2/T3 level without distal bowel air. Further workup included bronchoscopy, which identified a posterior tracheal outpouching without an apparent connection to the esophagus, and Cardiac CT, which revealed a mid-esophageal segment with a tracheo-esophageal fistula. Workup was consistent with complex esophageal anatomy with distinct proximal and distal pouches and a mid-esophageal segment attached to the trachea. A gastrostomy tube was placed for decompression and enteral feeds. Surgical intervention included closure and excision of the mid-esophageal fistula. The gap between the proximal and distal pouches was impressive, requiring cervical esophageal mobilization and two esophageal myotomies to add length, and concluded in a primary esophago-esophagostomy. Postoperative complications included a contained leak at the anastomosis, which was managed conservatively with placement of a feeding tube past the anastomotic site and resolved after 4 weeks. The patient required multiple esophageal dilations during the first two years of life and achieved successful closure of the gastrostomy at 25 months of age without further complications.

Conclusion

Awareness of rare subtypes of EA enables surgeons to anticipate and address unique challenges that may arise during surgical intervention.

导言食道闭锁（EA）是影响食道的最常见先天性畸形。我们描述了一种不同寻常的食管闭锁变异型，它与A型食管闭锁相似，但食管中段与气管相连。病例介绍一名妊娠38周的女婴产前被诊断为食管闭锁和先天性心脏畸形。产后尝试推进口胃管未成功，胸部 X 光片显示插管位于 T2/T3 水平，且远端肠道无空气，证实为 EA。进一步检查包括支气管镜检查和心脏 CT，前者发现气管后部有一个气管外口，但没有明显的食管连接；后者发现食管中段有一个气管食管瘘。检查结果显示食管解剖结构复杂，近端和远端有明显的小囊，食管中段与气管相连。为减压和肠道进食放置了胃造瘘管。手术治疗包括关闭和切除食管中段瘘管。近端和远端瘘袋之间的间隙非常大，需要进行颈部食管移动和两次食管肌切开术来增加长度，最后进行了食管-食管造口术。术后并发症包括吻合口处的渗漏，当时采取了保守治疗，在吻合口处放置了一根喂食管，4周后渗漏消失。该患者在出生后的头两年需要进行多次食管扩张，在 25 个月大时成功关闭了胃造口，没有再出现并发症。

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引用次数: 0

Totally implantable venous access device (TIVAD) migration into the pleural space: A case report 全植入式静脉通路装置 (TIVAD) 移入胸膜腔：病例报告

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports

Pub Date : 2024-09-16 DOI: 10.1016/j.epsc.2024.102887

Fatemeh Shahrahmani , Reza Shojaeian

Introduction

Totally implantable venous access devices (TIVADs) offer significant advantages for long-term intravenous therapy, but their use is not without potential complications. Catheter migration is one of them.

Case presentation

An 11-year-old boy with a primitive neuro-ectodermal tumor (PNET) undergoing chemotherapy was a candidate for a TIVAD placement. A TIVAD was implanted through the right internal jugular vein and secured to the pectoralis major in a right thoracic subcutaneous pouch without complications. Approximately six months later, port malfunction was noticed. Physical examination revealed that the port was no longer palpable, and a chest X-ray confirmed that the port was displaced. Subsequent chest X-rays showed different locations of the port and the catheter. With the hypothesis that the port had entered the pleural space and was moving freely, we did an exploratory thoracoscopy. We confirmed the intrapleural position of the port and catheter and removed both without complications. The patient was discharged four days later.

Conclusion

Although rare, TIVADs can migrate from the chest wall into the pleural cavity. Frequent evaluation of their function and position is critical for the early detection of complications.

导言完全植入式静脉通路装置（TIVAD）为长期静脉治疗提供了显著优势，但其使用并非没有潜在并发症。病例介绍一名患有原始神经外胚层肿瘤（PNET）并正在接受化疗的 11 岁男孩是 TIVAD 植入的候选者。通过右侧颈内静脉植入了 TIVAD，并将其固定在右胸皮下袋的胸大肌上，未出现并发症。大约六个月后，发现端口出现故障。体格检查发现已无法触及端口，胸部 X 光检查证实端口移位。随后的胸部 X 光片显示端口和导管的位置不同。我们假设移植口已进入胸膜腔并可自由移动，于是进行了探查性胸腔镜检查。我们确认了接口和导管在胸膜内的位置，并在没有并发症的情况下将两者移除。结论尽管罕见，但 TIVAD 仍有可能从胸壁移入胸膜腔。经常评估其功能和位置对于早期发现并发症至关重要。

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