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Fetal volvulus presenting with In utero bilious emesis: A case report 胎儿腹腔积液伴有宫内胆汁淤积症:病例报告
IF 0.4 Q4 Medicine Pub Date : 2024-04-27 DOI: 10.1016/j.epsc.2024.102818
Felix Richter , Vanessa Eddy-Abrams , Harsha K. Garg , Peter S. Midulla , Veniamin Ratner

Introduction

We report a case of fetal volvulus presenting with meconium-stained amniotic fluid, illustrating how meconium can mask in utero bilious emesis.

Case presentation

The male neonate was born at 37 + 1 weeks gestation via c-section for maternal indications and admitted to the Neonatal Intensive Care Unit for respiratory distress presumably due to meconium aspiration. However, an initial x-ray was not consistent with meconium aspiration syndrome. Overnight, the orogastric tube drained 173 mL of dark green-tinged fluid and the bilirubin was elevated at 8.2 (threshold 7.4), prompting phototherapy. Orogastric feeds were attempted but unsuccessful. The orogastric output was originally attributed to swallowed meconium. However, the large volume, bilious color, persistent output, unexplained respiratory distress, and elevated bilirubin prompted an upper GI series (UGIS). The UGIS was consistent with a proximal obstruction that was likely present from birth. The patient underwent exploratory laparotomy which revealed a volvulus from malrotation that was repaired with detorsion and Ladd procedure. Despite a dusky bowel suggestive of ischemic changes, the bowel was fully pink after untwisting and no bowel needed to be resected. After untwisting, Ladd's bands were lysed, patency was demonstrated, and an appendectomy was performed. The baby was discharged on day-of-life 16 with full oral feeds and no complications.

Conclusion

Persistent bilious gastric output in the setting of extensive meconium-stained amniotic fluid is an uncommon presenting sign of fetal volvulus from malrotation. Prompt recognition is important to prevent bowel necrosis.

导言我们报告了一例胎儿排气伴有胎粪染色羊水的病例,说明了胎粪是如何掩盖子宫内胆汁淤积性呕吐的。病例介绍这名男新生儿在妊娠 37+1 周时因母体原因剖腹产出生,因呼吸窘迫被送入新生儿重症监护室,推测原因是胎粪吸入。然而,最初的 X 光检查并不符合胎粪吸入综合征。一夜之间,口胃管排出 173 毫升深绿色液体,胆红素升高至 8.2(阈值 7.4),需要进行光疗。曾尝试口胃喂养,但未成功。口胃分泌物最初被认为是吞入的胎粪。然而,巨大的胃容量、胆汁颜色、持续的胃液排出、不明原因的呼吸困难和胆红素升高促使他接受了上消化道系列检查(UGIS)。上消化道穿刺检查结果显示,患者的近端梗阻很可能在出生时就已存在。患者接受了探查性开腹手术,结果发现肠旋转不良导致的肠管卷曲,并通过分离和拉德术进行了修复。尽管肠道呈暗色,提示有缺血性病变,但松开后肠道完全呈粉红色,无需切除肠道。松绑后,Ladd 带被溶解,显示出通畅,并进行了阑尾切除术。结论:在胎粪染色羊水广泛的情况下出现持续的胆汁性胃排出,是胎儿旋转不良引起胎儿肠旋转的一个不常见的表现。及时识别对防止肠坏死非常重要。
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引用次数: 0
Transverse vaginal septum in a teenager with a history of imperforate hymen: A case report 一名有处女膜穿孔病史的少女的阴道横隔:病例报告
IF 0.4 Q4 Medicine Pub Date : 2024-04-18 DOI: 10.1016/j.epsc.2024.102812
Lifa Lee, Mariko Matsuno, Sachino Kira, Sotaro Hayashi, Satoshi Nishiyama, Hiroshi Tsujioka

Introduction

Imperforate hymen and transverse vaginal septum are conditions characterized by obstructive defects, typically leading to hematometrocolpos detected around the time of puberty. We encountered a patient who had undergone hymenotomy in infancy to treat pyocolpos due to an imperforate hymen and later developed hematometrocolpos in puberty due to a transverse vaginal septum.

Case presentation

A 13-year-old female presented with hypomenorrhea and hematometrocolpos-induced dysmenorrhea. She had a history of pyocolpos with a urinary tract infection at 3 months of age. At that time, no vaginal opening was found on perineal examination, and imperforate hymen was diagnosed. When hymenotomy was performed, the external cervical os was not detected by intravaginal bronchoscopic examination. However, this abnormal finding was not fully investigated. The postoperative course after hymenotomy was free of complications, and the patient remained asymptomatic until menarche. When she presented 3 months after menarche, genital examination revealed a bulging transverse septum inside the vagina, 5 cm from the hymen. Ultrasound and magnetic resonance imaging revealed a distended uterus, distended upper vagina, and collapsed lower vagina. Transverse vaginal septum was considered, and vaginoscopy was performed to exclude vaginal reclosure or adhesion caused by the previous surgery. A diagnosis of transverse vaginal septum was confirmed, and total excision of the septum was performed. The patient underwent regular postoperative follow-ups for stenosis prevention.

Conclusion

Considering the rarity of these concurrent conditions, clinicians must always consider the possibility of several complex anomalies. Vaginoscopy using a hysteroscope may be useful for definitive diagnosis and determining appropriate treatments.

导言:无孔处女膜和阴道横隔是以阻塞性缺陷为特征的疾病,通常会导致在青春期前后发现血精。我们遇到过这样一位患者,她在婴儿时期接受了处女膜切开术,以治疗因处女膜无孔而导致的脓性阴道炎,后来在青春期因阴道横隔而出现血精。她在 3 个月大时曾患过脓性结肠炎和尿路感染。当时,会阴部检查未发现阴道口,诊断为处女膜未穿孔。在进行处女膜切开术时,阴道内支气管镜检查没有发现宫颈外口。然而,这一异常发现并未得到充分调查。处女膜切开术后无并发症,患者直到月经初潮前一直没有症状。月经初潮后 3 个月,生殖器检查发现阴道内有一个凸起的横隔膜,距离处女膜 5 厘米。超声波和磁共振成像显示子宫膨胀,上阴道膨胀,下阴道塌陷。考虑为阴道横隔,患者接受了阴道镜检查,以排除阴道闭锁或之前手术造成的粘连。阴道横隔的诊断得到了证实,并对阴道横隔进行了全切。结论考虑到这些并发症的罕见性,临床医生必须始终考虑多种复杂异常的可能性。使用宫腔镜进行阴道镜检查可能有助于明确诊断和确定适当的治疗方法。
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引用次数: 0
Abdominal compartment syndrome requiring urgent decompression in infants with severe respiratory syncytial virus infection: A case series 严重呼吸道合胞病毒感染婴儿需要紧急减压的腹腔隔室综合征:病例系列
IF 0.4 Q4 Medicine Pub Date : 2024-04-18 DOI: 10.1016/j.epsc.2024.102813
Nitin Sajankila, Brian Tang, Katherine C. Montelione, Jason O. Robertson, Miguel Guelfand

Introduction

Although extrapulmonary complications can occur in cases of severe Respiratory Syncytial Virus (RSV) infections, abdominal compartment syndrome (ACS) has not previously been described in the context of RSV. In this case series we describe two infants who presented with severe RSV and subsequently developed ACS.

Case presentations

Case 1: A 7-week-old term infant with severe RSV requiring intubation and care in the ICU. Shortly after admission, she became septic with abdominal distention and erythema, concerning for an intra-abdominal source. In addition, she had increased peak airway and bladder pressures suggestive of ACS. An abdominal ultrasound revealed significant ascites and dilated loops of bowel, but no suitable window for drainage. Given the possibility of intra-abdominal sepsis and ACS, an exploratory and decompressive laparotomy was performed revealing colitis and tense ascites. After relief of ACS, she quickly recovered with successful closure of her abdomen and eventual resolution of her ascites.

Case 2: A 6-month-old preterm infant who presented similarly to Case 1 with symptoms of severe RSV. A few days after ICU admission, she developed abdominal distention with hemodynamic instability, acute kidney injury, and rising bladder pressures, suggestive of ACS. She then urgently underwent a decompressive laparotomy with similar findings of tense ascites and colitis. Despite surgical decompression, however, her sepsis worsened post-operatively with evidence of multisystem organ failure, including hemodynamic instability, anasarca, and coagulopathy. Ultimately, she succumbed to her illness.

Conclusion

Our case series shows that infants with severe RSV are at risk for ACS, which can be deadly despite surgical intervention.

导言虽然严重的呼吸道合胞病毒(RSV)感染病例可能会出现肺外并发症,但以前还没有人描述过 RSV 引起的腹腔隔室综合征(ACS)。在本病例系列中,我们描述了两名患重症 RSV 并随后发展为 ACS 的婴儿。病例 1:一名 7 周大的足月婴儿,患有重症 RSV,需要插管并在重症监护室接受治疗。入院后不久,她就出现了腹胀和红斑的脓毒症,考虑是腹内感染所致。此外,她的气道和膀胱压力峰值增高,提示有急性呼吸道综合征。腹部超声波检查发现腹水明显,肠管扩张,但没有合适的引流窗口。考虑到腹腔内脓毒症和 ACS 的可能性,医生对她进行了剖腹探查和减压手术,发现了结肠炎和紧张性腹水。病例 2:一名 6 个月大的早产儿,其症状与病例 1 相似,都是严重的 RSV。入住重症监护室几天后,她出现腹胀、血流动力学不稳定、急性肾损伤和膀胱压力升高,提示为急性肾功能衰竭。随后,她紧急接受了腹腔减压术,发现了类似的紧张性腹水和结肠炎。尽管进行了手术减压,但术后脓毒症恶化,出现多系统器官衰竭,包括血流动力学不稳定、贫血和凝血功能障碍。结论:我们的系列病例表明,患有严重 RSV 的婴儿有发生 ACS 的风险,尽管进行了手术干预,ACS 仍可能致命。
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引用次数: 0
Innominate artery compression of the trachea in a 9-month-old previously healthy male: A case report 一名 9 个月大的健康男性气管受腹内动脉压迫:病例报告
IF 0.4 Q4 Medicine Pub Date : 2024-04-10 DOI: 10.1016/j.epsc.2024.102811
Jessica Carullo, Anayansi Lasso-Pirot, Nidhi Kotwal

Introduction

Innominate Artery Compression of the Trachea (IACT) is rare but can cause stridor in infancy. IACT involves anterior compression of the trachea as the innominate (brachiocephalic) artery originates later along the transverse portion of the aortic arch. We present a case of IACT in a previously healthy 9-month-old male that failed to respond to medical therapy. This case demonstrates an unusual, delayed presentation of IACT.

Case presentation

Our patient is a 9-month-old previously healthy male presenting to the outpatient pulmonology clinic with a one-month history of stridor. Patient initially presented to outside providers and prescribed systemic steroid courses, which failed to improve the stridor. On exam, patient demonstrated respiratory distress and biphasic stridor that worsened when feeding from a bottle. Patient was admitted from clinic for further evaluation by ENT. Initial chest radiographs showed findings consistent with viral lower respiratory infection versus reactive airway disease and no radiopaque foreign body. Bedside scope was performed by ENT, which did not show obstruction or foreign body above the level of the glottis. Computed tomography (CT) without contrast was performed per ENT recommendations, which showed focal tracheal narrowing but significant movement artifact. To provide further clarification on the tracheal narrowing, a direct bronchoscopy was performed by ENT, which showed tracheal compression at the level of the thoracic inlet. Computed Tomographic Angiography (CTA) of the chest confirmed the diagnosis of IACT. Patient underwent arterial relocation and reimplantation, and the tracheal compression was markedly improved on repeat bronchoscopy. Patient recovered from the procedure well with improvement in stridor and respiratory distress. Patient was discharged on POD3 and followed up in pulmonology clinic with resolution of stridor and no residual respiratory symptoms.

Conclusion

This case particularly highlights the importance of continued investigation into persistent stridor that is refractory to medications, with special consideration for congenital causes.

导言:气管贲门动脉压迫症(IACT)非常罕见,但在婴儿期可导致呼吸困难。IACT 涉及气管前部受压,因为贲门(肱)动脉发源于主动脉弓的横向部分。我们介绍了一例 IACT 病例,患者是一名 9 个月大的男性,之前身体健康,但对药物治疗无效。本病例展示了一种不寻常的延迟性 IACT。病例介绍我们的患者是一名 9 个月大的男性,之前身体健康,因有一个月的呼吸困难病史而到肺科门诊就诊。患者最初在外部医疗机构就诊,医生为其开具了全身类固醇处方,但未能改善呼吸困难。检查时,患者表现出呼吸困难和双相性喘鸣,用奶瓶喂食时喘鸣加剧。患者被从诊所转入耳鼻喉科接受进一步评估。初步胸片检查结果显示,患者为病毒性下呼吸道感染,而非反应性气道疾病,且无放射性异物。耳鼻喉科医生进行了床边检查,未发现声门上方有阻塞或异物。根据耳鼻喉科的建议,进行了无造影剂计算机断层扫描(CT),结果显示气管局灶性狭窄,但运动伪影明显。为了进一步明确气管狭窄的情况,耳鼻喉科医生为患者进行了直接支气管镜检查,结果显示气管在胸腔入口处受压。胸部计算机断层扫描(CTA)证实了 IACT 的诊断。患者接受了动脉移位和再植手术,再次接受支气管镜检查时,气管受压情况明显好转。患者术后恢复良好,喘鸣和呼吸困难有所改善。患者于 POD3 出院,并在肺科门诊进行了随访,呼吸困难症状得到缓解,无呼吸道症状残留。 结论:该病例特别强调了对药物治疗无效的持续性呼吸困难进行持续调查的重要性,并特别考虑了先天性原因。
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引用次数: 0
Feasibility, outcomes and technique of symptomatic aberrant right subclavian artery reimplantation via a right collar incision in children: A case series 通过右衣领切口对儿童进行无症状反常右锁骨下动脉再植的可行性、效果和技术:病例系列
IF 0.4 Q4 Medicine Pub Date : 2024-04-10 DOI: 10.1016/j.epsc.2024.102810
Nicole H. Chicoine , Hannah C. Cockrell , Eustina G. Kwon , Sarah L.M. Greenberg , Liya Savochka , Matthew B. Dellinger , John H.T. Waldhausen

Introduction

Symptomatic incomplete vascular rings resulting from aberrant right subclavian arteries (ARSA) are usually repaired with a subclavian to carotid transposition via a right thoracotomy or median sternotomy approach. We describe the successful use and long-term outcomes of a less invasive approach via a right collar incision for ARSA repair in a pediatric case series.

Case presentations

Between January 2020 and December 2022, four pediatric patients with symptomatic ARSAs underwent operative repair using a right collar incision on the pediatric general and thoracic surgery service at a quaternary pediatric medical center. Demographic information, clinical characteristics and intra-operative complications were obtained from retrospective review of the medical record. Structured telephone interviews using a survey tool adapted from the Self Evaluation of Breathing Questionnaire and the PEDI-EAT 10 collected data on long-term symptomatic improvement.

Two patients were male, and two were female. Age at time of operation ranged from 9 to 38 months. In all patients, the operative indication was dysphagia in the setting of an ARSA with no additional symptom etiology of symptoms identified. No patients required postoperative intensive care unit admission. Hospital length of stay was 2 days for all patients. There were no intra-operative complications. All patients experienced long-term symptomatic improvement following their operation with 100 % reporting symptomatic improvement and none reporting symptom recurrence.

Conclusion

A right collar incision is a feasible and effective approach for subclavian to carotid transposition of ARSA in pediatric patients and should be considered for operative intervention of symptomatic aberrant right subclavian arteries.

导言由于右锁骨下动脉(ARSA)畸形导致的无症状不完全血管环通常通过右侧胸廓切开术或胸骨正中切开术进行锁骨下至颈动脉转位修复。病例介绍在 2020 年 1 月至 2022 年 12 月期间,一家四级儿科医疗中心的儿科普外科和胸外科采用右衣领切口对四名有症状的 ARSA 儿科患者进行了手术修复。通过回顾性审查病历获得了患者的人口统计学信息、临床特征和术中并发症。使用改编自呼吸自我评估问卷(Self Evaluation of Breathing Questionnaire)和PEDI-EAT 10的调查工具进行的结构化电话访谈收集了有关长期症状改善情况的数据。两名患者为男性,两名患者为女性,手术时的年龄从9个月到38个月不等。所有患者的手术指征均为ARSA导致的吞咽困难,且未发现其他症状病因。没有患者需要在术后入住重症监护室。所有患者的住院时间均为 2 天。术中未出现并发症。所有患者术后症状均得到长期改善,100%患者症状得到改善,无一例患者症状复发。 结论:右衣领切口是对儿童患者进行锁骨下到颈动脉转位的ARSA手术的一种可行且有效的方法,在对症状异常的右锁骨下动脉进行手术干预时应加以考虑。
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引用次数: 0
Bilateral phyllodes tumor: Case report 双侧 Phyllodes 肿瘤:病例报告
IF 0.4 Q4 Medicine Pub Date : 2024-04-09 DOI: 10.1016/j.epsc.2024.102803
Isabel Mayorga-Pérez , Patricia Mulero-Soto , Kerwin Cruz-De La Rosa , Viviana Negrón-González , Jonathan Hernandez-Rosa , Jose Feneque-Gonzalez , Maria Correa-Rivas , Anwar Abdul-Hadi

Introduction

Phyllodes tumors are rare fibroepithelial neoplasms. They represent less than 0.5–1% of all primary breast tumors and their presentation is even rarer in children.

Case description

A 15-year-old female with Autism Spectrum Disorder (ASD) was seen in the outpatient surgery clinic due to bilateral breast masses. She underwent core-needle aspiration. biopsy of both masses and the results were suspicious of fibroadenomas. Two days later the patient presented to the emergency room with ulceration and bleeding from the left breast mass. She was scheduled for an urgent nipple-sparing mastectomy, which was uneventful. The pathology revealed a multifocal, aggressive type tumor with moderate stromal cellularity, moderate stromal atypia and high mitotic index, corresponding to a borderline phyllodes tumor. Based on this result, she underwent an elective right nipple-sparing mastectomy. The pathology of the right breast mass was similar to the left breast mass.

Conclusion

Core-needle aspiration biopsy is not reliable for the diagnosis of phyllodes tumor. If a phyllodes tumor is diagnoses in one breast, a contralateral breast mass should be considered a phyllodes tumor until proven otherwise.

导言Phyllodes肿瘤是一种罕见的纤维上皮肿瘤。病例描述:一名患有自闭症谱系障碍(ASD)的 15 岁女性因双侧乳房肿块在外科门诊就诊。她接受了双侧肿块的核芯针穿刺活检,结果怀疑是纤维腺瘤。两天后,患者因左侧乳房肿块溃烂和出血到急诊室就诊。她被紧急安排接受乳头保留乳房切除术,手术顺利。病理结果显示,这是一个多灶、侵袭性肿瘤,基质细胞度中等,基质不典型性中等,有丝分裂指数较高,与边缘性鳞状细胞瘤相符。根据这一结果,她接受了选择性右侧乳头保留乳房切除术。右侧乳房肿块的病理结果与左侧乳房肿块相似。如果在一侧乳房确诊为植物瘤,则对侧乳房肿块应被视为植物瘤,除非另有证明。
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引用次数: 0
Duodenum inversum as a cause of bilious emesis in a teenager: A case report 十二指肠逆位是一名青少年胆汁性呕吐的病因:病例报告
IF 0.4 Q4 Medicine Pub Date : 2024-04-07 DOI: 10.1016/j.epsc.2024.102808
Shachi Srivatsa , Qican Weng , Karen A. Diefenbach , Benedict C. Nwomeh

Introduction

Duodenum inversum is a rare congenital anatomical variant and presents a myriad of clinical challenges. This case presentation highlights a unique case of symptomatic duodenum inversum diagnosed in the second decade of life requiring operative intervention.

Case presentation

We present the case of a thirteen-year-old male who presented with one year of intermittent abdominal pain with associated bilious emesis. Diagnostic work-up included multiple abdominal ultrasounds and abdominal radiographs which only revealed constipation. Despite adequate bowel regimen, patient's symptoms persisted. Duodenum inversum was diagnosed on a fluoroscopic upper gastrointestinal study and the patient was subsequently taken to the operating room to evaluate for concurrent midgut volvulus and malrotation. A diagnostic laparoscopy revealed fibrotic adhesive bands contributing to partial duodenal obstruction. Surgical resection of these bands alleviated the obstruction and resolved the patient's symptoms with no recurrence noted on post-operative follow-up.

Conclusion

In cases of duodenum inversum, recognition through diagnostic tools like fluoroscopic upper gastrointestinal studies is critical. While initial medical management may suffice for mild cases, surgical intervention remains the cornerstone for severe cases, particularly when obstruction is evident, emphasizing the necessity of tailored approaches based on clinical severity.

导言十二指肠倒置是一种罕见的先天性解剖变异,给临床带来了无数挑战。本病例重点介绍了一例独特的症状性十二指肠倒置病例,该病例在患者生命的第二个十年被诊断出,需要进行手术干预。病例介绍 我们介绍了一名 13 岁男性的病例,该患者出现间歇性腹痛一年,伴有胆汁性呕吐。诊断性检查包括多次腹部超声波检查和腹部 X 射线检查,但仅发现便秘。尽管采取了适当的排便疗法,但患者的症状依然存在。上消化道透视检查确诊为十二指肠嵌顿,随后患者被送入手术室,以评估是否同时存在中肠翻卷和旋转不良。诊断性腹腔镜检查发现,纤维粘连带导致部分十二指肠梗阻。结论在十二指肠倒置病例中,通过透视上消化道检查等诊断工具进行识别至关重要。对于轻度病例,最初的药物治疗可能就足够了,但对于重度病例,特别是阻塞明显的病例,手术干预仍然是治疗的基石,这就强调了根据临床严重程度采取针对性治疗方法的必要性。
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引用次数: 0
Thoracoscopic posterior approach for an S6 left lower lobe segmentectomy in a patient with an incomplete fissure: A case report 胸腔镜后入路为一名不完全裂隙患者实施 S6 左下叶分段切除术:病例报告
IF 0.4 Q4 Medicine Pub Date : 2024-04-07 DOI: 10.1016/j.epsc.2024.102809
Yusuke Matsui , Hiroyuki Oizumi , Hikaru Watanabe , Akihiro Takeshi , Megumi Nakamura , Satoshi Shiono

Introduction

Thoracoscopic superior-segment (S6) segmentectomy is a simple procedure. However, it is applicable only when an interlobar fissure approach is applied, which can sometimes be challenging in cases with a fused interlobar fissure. Herein, we discuss our experience in performing thoracoscopic left S6 segmentectomy in a pediatric patient with congenital pulmonary airway malformation (CPAM) involving a fused interlobar fissure.

Case presentation

A 5-year-old girl was prenatally diagnosed with a cystic mass in her left thorax and suspected to have a congenital pulmonary airway malformation. No postnatal respiratory symptoms were observed; elective surgery was performed after reaching the age when differential lung ventilation became feasible. Multiportal complete thoracoscopic surgery was performed under general anesthesia. A large cyst was identified in S6, and the interlobar fissure was fused; thus, we performed a fissure-last S6 segmentectomy using a posterior approach. We first manipulated the vein by retracting the lower lobe anteriorly thus enabling us to identify the segmental veins (V6), and subsequently divide V6a and V6c. We divided segmental arterial branches and separated the intersegmental plane between the S6 and basal segment along V6b using staplers. Lastly, the fused interlobar fissure was divided using a stapler. No postoperative leakage was observed, and the chest tube was removed on the evening of the day of surgery. Pathological examination revealed CPAM type 1 with no malignant findings. The patient survived and is living without any complications 16 months postoperatively.

Conclusion

The fissure-last method may be an alternative treatment for patients with incomplete interlobar fissures.

简介:胸腔镜上段(S6)切除术是一种简单的手术。然而,它只有在采用叶间裂方法时才适用,而在叶间裂融合的病例中,这种方法有时具有挑战性。在此,我们讨论了我们为一名患有先天性肺气道畸形(CPAM)并伴有叶间裂融合的儿童患者实施胸腔镜下左侧 S6 段切除术的经验。病例介绍一名 5 岁女孩在产前诊断出左侧胸部有囊性肿块,并怀疑患有先天性肺气道畸形。出生后未发现任何呼吸道症状;在达到可以进行肺部差速通气的年龄后,她接受了择期手术。多孔胸腔镜手术在全身麻醉下进行。在 S6 段发现了一个大囊肿,叶间裂融合;因此,我们采用后入路进行了裂隙-最后 S6 段切除术。我们首先通过向前方牵开下叶来操作静脉,这样就能识别节段静脉(V6),随后分割 V6a 和 V6c。我们分割了节段动脉分支,并使用订书机沿 V6b 分离了 S6 和基底节段之间的节段间平面。最后,我们使用订书机分割了融合的叶间裂。术后未发现渗漏,胸管已于手术当天晚上拔除。病理检查显示为 CPAM 1 型,无恶性病变。结论对于不完全叶间裂患者来说,裂隙终末法可能是一种替代治疗方法。
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引用次数: 0
Giant immature sacrococcygeal teratoma with early recurrence and lung metastases: A case report 伴有早期复发和肺转移的巨大未成熟骶尾部畸胎瘤:病例报告
IF 0.4 Q4 Medicine Pub Date : 2024-04-06 DOI: 10.1016/j.epsc.2024.102807
Kyoko Matsuki , Kenji Santo , Takashi Sasaki , Hiroyuki Fujisaki , Akihiro Yoneda

Introduction

Neonatal sacrococcygeal teratoma (SCT) results in poor outcomes if it is associated with preterm delivery and an immature histology. Furthermore, some patients experience recurrence, generally one to two years later. We herein present a preterm infant case of an immature SCT with metastatic recurrence within two months of the initial resection.

Case presentation

A neonate with prenatally diagnosed SCT was born at 28 weeks’ gestation with a birth weight of 2337 g. The tumor measured 18 × 9 × 8 cm in diameter, and it was predominantly solid and hypervascular. Postnatally, the patient presented with anemia and coagulopathy requiring a massive transfusion presumably due to intratumoral hemorrhage. Surgical resection was performed at 12 days of age. The tumor was histologically diagnosed to be an immature teratoma. The alpha-fetoprotein (AFP) levels decreased but increased thereafter on postoperative day 68. Computed tomography revealed both local recurrence and bilateral lung metastases. During chemotherapy, all secondary lesions were enlarged. We resected the lesion in the right lung, which was histologically diagnosed as mature teratoma. Even after switching chemotherapy protocols, the residual lesions were progressive. We resected the lesion from the left lung. Following another course of chemotherapy, we resected the presacral recurrent tumor, which was histologically confirmed as a mature teratoma. The patient has not shown any signs of a re-recurrence for 6 years.

Conclusion

This case highlights the fact that immature sacrococcygeal teratomas can recur and metastasize as early as two months after the initial resection.

导言:新生儿骶尾部畸胎瘤(SCT)如果与早产和组织学不成熟有关,则会导致不良后果。此外,有些患者还会复发,一般是在一到两年后。我们在此介绍一例早产儿未成熟 SCT 病例,该病例在首次切除后两个月内出现转移性复发。病例介绍一名早产儿在妊娠 28 周时出生,出生体重为 2337 克。出生后,患者出现贫血和凝血功能障碍,可能是由于瘤内出血,需要大量输血。手术切除是在患者出生12天时进行的。肿瘤经组织学诊断为未成熟畸胎瘤。甲胎蛋白(AFP)水平有所下降,但在术后第68天又有所上升。计算机断层扫描发现了局部复发和双侧肺转移。化疗期间,所有继发病灶均增大。我们切除了右肺的病灶,组织学诊断为成熟畸胎瘤。即使更换了化疗方案,残留病灶仍在进展。我们切除了左肺的病灶。经过另一个疗程的化疗,我们切除了骶骨前复发的肿瘤,经组织学确诊为成熟畸胎瘤。结论:本病例突出表明,未成熟骶尾部畸胎瘤最早可在初次切除后两个月复发和转移。
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引用次数: 0
Superior mesenteric artery syndrome in a neonate: A case report 新生儿肠系膜上动脉综合征:病例报告
IF 0.4 Q4 Medicine Pub Date : 2024-04-06 DOI: 10.1016/j.epsc.2024.102806
Takuma Kawawaki , Sachiko Sakai , Yoshihiro Kubota , Masaji Tani

Introduction

Superior mesenteric artery syndrome (SMAS) is a complete or incomplete obstruction of the third portion of the duodenum caused by compression between the aorta and the superior mesenteric artery (SMA). Some diagnostic strategies and treatments exist for adults; however, in neonates, these are controversial because the condition is uncommon.

Case presentation

A 4-day-old male infant with a birth weight of 2630 g was referred to our hospital with a 2-day history of bilious vomiting. Ultrasonography and contrast enema revealed no malrotation or midgut volvulus. On day 7 of life, an upper gastrointestinal series with contrast revealed obstruction of passage in the third portion of the duodenum. Congenital duodenal stenosis was suspected, and exploratory laparotomy was performed on day 9 of life. The SMA compressed and narrowed the third portion of the duodenum. The duodenum was mobilized and the ligament of Treitz was divided using the technique described by Strong, which released the duodenal compression. A feeding tube was successfully inserted through the duodenum. No duodenal web was observed and SMAS was suspected. The patient's postoperative course was uneventful and SMAS was diagnosed. Complete oral intake was achieved on postoperative day 20, and the patient was discharged on postoperative day 30.

Conclusions

Neonatal SMAS is a rare but possible cause of duodenal obstruction. The procedure reported by Strong is useful in neonatal cases.

导言肠系膜上动脉综合征(SMAS)是由主动脉和肠系膜上动脉(SMA)之间的压迫引起的十二指肠第三部分完全或不完全阻塞。对于成人,已有一些诊断策略和治疗方法;但对于新生儿,由于这种病症并不常见,因此还存在争议。病例介绍一名出生 4 天、体重 2630 克的男婴因两天前出现胆汁性呕吐而被转诊至我院。超声波检查和造影剂灌肠检查均未发现肠旋转不良或中肠翻卷。出生后第 7 天,造影剂上消化道检查发现十二指肠第三部分通道阻塞。怀疑是先天性十二指肠狭窄,于是在出生后第9天进行了剖腹探查手术。SMA 压迫并缩小了十二指肠的第三部分。使用 Strong 所描述的技术移动了十二指肠并分割了特雷兹韧带,从而解除了对十二指肠的压迫。喂食管成功地从十二指肠插入。未观察到十二指肠蹼,因此怀疑是 SMAS。患者术后恢复顺利,并确诊为 SMAS。结论新生儿 SMAS 是十二指肠梗阻的一个罕见但可能的原因。Strong报告的手术对新生儿病例很有用。
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引用次数: 0
期刊
Journal of Pediatric Surgery Case Reports
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