Mesenteric venous thrombosis as a complication of appendicitis in an adolescent: A case report and literature review

RATIONALE: Mesenteric venous thrombosis is an uncommon but potentially fatal condition that can cause bowel ischemia. It results from a systemic hypercoagulable state or abdominal infection draining into the portal venous system. Several cases regarding portomesenteric venous thrombosis as a complication of appendicitis were reported in adults, but there are far fewer reports in pediatric patients. The mortality rate of the condition is high if untreated, especially in children, reaching up to 50%. PATIENT CONCERNS: A healthy 15-year-old male with no significant past medical history presented with right lower quadrant pain, lethargy, and fever. The computed tomography scan showed a focal thrombosis at the superior mesenteric vein branch and an inflamed appendix. DIAGNOSES: Mesenteric venous thrombosis complicating acute appendicitis. INTERVENTIONS: Intravenous antibiotics along with anticoagulants and laparoscopic appendectomy OUTCOMES:: After 1 month, a follow-up ultrasonography revealed full resolution of the thrombosis. LESSONS: Appendicitis is one of the most frequently encountered causes of pediatric surgical emergencies; therefore, physicians should be conscious of mesenteric venous thrombosis as a possible complication of acute appendicitis, irrespective of whether patients have thrombophilic conditions or not.ope

Pediatric Adenocarcinoma in Korea: A Multicenter Study

Purpose Adenocarcinoma is an extremely rare malignancy in the pediatric population. Research regarding pediatric adenocarcinoma is very rare in Korea. This study aimed to investigate the clinical features of pediatric adenocarcinomas of various primary organ sites in Korea. Materials and Methods Pediatric patients under 18 years, diagnosed with adenocarcinoma of various sites between January 1995 and December 2016, were included. We retrospectively reviewed patient and tumor characteristics and calculated survival estimates, reported as 5-year survival rate and 95% confidence interval. Results Of 80 patients (median age, 15 years; range, 10 to 17 years), 37 (46.3%) were men, and 24 (30%) had a family history of cancer or underlying disease relevant to malignancy. The cancer locations were the colon and rectum (n=32), ovaries (n=18), stomach (n=15), lung (n=4), small bowel (n=1), and other sites (n=10). Totally, 54.8% patients (42/77) had stage 3 or 4 disease. The median follow-up period was 2.0 years (range, 0 to 20.4). The 5-year overall survival estimate for all patients, and for those with stomach, colorectal, ovarian, and other cancer sites were 57.9%+/- 11.5%, 58.2%+/- 25.7%, 41.5%+/- 18.2%, 87.5%+/- 16.2%, and 64.0%+/- 34.4%, respectively. The 5-year survival rate differed significantly between categories of adenocarcinomas into gastrointestinal (GI) (44.7%) and non-GI adenocarcinomas (78.8%) (p=0.007). The 5-year survival rate also differed significantly according to carcinoembryonic antigen level (69.3% in 3 ng/mL; p < 0.001). Conclusion In pediatric patients, adenocarcinomas arise from various organs and are often diagnosed at advanced stages. Large, prospective studies for their accurate clinical characteristics and prognostic factors are needed.ope

Outcomes of Pediatric Airway Surgeries Performed by a Single Pediatric Surgeon

Purpose To report the clinical progress and findings seen in pediatric airway surgeries performed by a single pediatric surgeon. Methods We retrospectively reviewed 32 pediatric patients with various airway diseases who underwent surgical correction performed by a single pediatric surgeon between January 2005 and March 2021. Surgical indications depended on the presence and severity of respiratory symptoms. Surgical results were considered good if symptoms improved and normal respiration was possible without dependence on a ventilator or tracheostomy, without postoperative complications, at the last postoperative follow-up. Results A total of 32 patients who underwent airway surgery were diagnosed with 3 types of surgical airway diseases: tracheomalacia (n=19), subglottic stenosis (n=10), and tracheal stenosis (n=3). In the treatment for tracheomalacia, surgical efficacy was 88.2% for aortopexy and 100.0% for tracheopexy. The postoperative mortality rate of slide thyrocricotracheoplasty for subglottic stenosis and slide tracheoplasty for tracheal stenosis was 20.0%. The age at the time of all airway surgeries ranged from 1.0 to 127.6 months (median, 4.8 months). The postoperative follow-up period ranged from 1.2 months to 16.6 years (median, 4.5 years). Conclusion Severe pediatric airway diseases with obstructive symptoms are life-threatening and require surgical treatment. Pediatric airway surgery performed in this study by a single pediatric surgeon had similar or better outcomes than in previous studies. However, more accurate diagnostic methods and improved surgical procedures for pediatric airway diseases require development.ope

Comparison of Surgical Outcomes of Laparoscopic Glue and Laparoscopic Suture Hernioplasty in Pediatric Female Inguinal Hernia

This study aimed to report the surgical outcomes of laparoscopic glue hernioplasty (LGH) compared with conventional laparoscopic suture hernioplasty (LSH) in pediatric female inguinal hernia repair. We retrospectively analyzed 465 female pediatric patients who underwent laparoscopic inguinal hernia repair between January 2013 and December 2020. LGH and LSH were performed in 95 and 370 cases, respectively. Surgical outcomes (length of hospital stay, operative time, complications, and recurrences) were compared between the LGH and LSH groups. We found that the operation times for bilateral hernia repair were shorter in the LGH group (LGH: 35.5 ± 8.2 min, LSH: 45.2 ± 11.6 min; p < 0.001). No significant differences in complications or recurrences were observed between the two groups during the follow-up period. Our findings suggest that LGH is a feasible and easily applied surgical technique for the treatment of pediatric female inguinal hernia.ope

Bile Duct Stricture and Intrahepatic Cystic Formation after Abdominal Injury due to Child Abuse: A Case Report

A 6-year-old male who lived with a mother in a single-parent family was referred to the emergency room with multiple traumas. There was no specific finding on CT scan of the other hospital performed 55 days before admission. However, CT scan at the time of admission showed common bile duct (CBD) stenosis, proximal biliary dilatation and bile lake formation at the segment II and III. Endoscopic retrograde biliary drainage was performed, but the tube had slipped off spontaneously 36 days later, and follow-up CT scan showed aggravated proximal biliary dilatation above the stricture site. He underwent excision of the CBD including the stricture site, and the bile duct was reconstructed with Roux-en-Y hepaticojejunostomy. Pathologic report of the resected specimen revealed that the evidence of trauma as a cause of bile duct stricture. While non-iatrogenic extrahepatic biliary trauma is uncommon, a level of suspicion is necessary to identify injuries to the extrahepatic bile duct. The role of the physicians who treat the abused children should encompass being suspicious for potential abdominal injury as well as identifying visible injuries.ope

Santulli Enterostomy: A Considerable Method for Patients Who Require Proximal Enterostomy

Purpose : Santulli enterostomy has been used for various surgical abdominal conditions that require temporary diversion of bowel during a neonatal period. The aim of this study was to report clinical outcomes of Santulli enterostomy and to evaluate its usefulness. Methods : Between January 2000 and December 2016, 40 neonates who underwent Santulli enterostomy were enrolled; Santulli enterostomies were performed for 25 patients without previous laparotomy (primary Santulli group) and 15 patients with previous laparotomy (secondary Santulli group). Results : Small bowel atresia is the first common indication of Santulli enterostomy (22/40, 55.0%), and luminal discrepancy between proximal and distal bowel was the most common determinant factor of Santulli enterostomy (17/40, 42.5%). The median age at surgery and mean birth weight were 2 days and 2,480 g respectively in the primary group, and 71 days, 2,340 g respectively in the secondary group. Operation time was significantly longer in the secondary group than the primary group (156±48 minutes vs. 224±95 minutes, p=0.019), and there was no difference in the time taken to initiation of oral feeding between the two groups. Santulli enterostomy closure was performed at median 65 days after Santulli enterostomy for primary group and 70 days for secondary group. Six complications (15.0%) were found after Santulli enterostomy, and nine complications (24.3%) after Santulli enterostomy closure (p=0.302). The incidence of complications was significantly higher in secondary group than in primary group (4.5% vs. 53.3%, p=0.001), and the reoperation rate was also significantly higher in the secondary group (4.5% vs. 46.7%, p=0.004). Conclusion : Santulli enterostomy could be applied as a temporary enterostomy in neonatal patients with various surgical abdominal diseases. Considering the high complication rate after secondary Santulli enterostomy closure, decision making on the timing of enterostomy closure should be done with caution.ope

Nissen Fundoplication for the Treatment of Gastroesophageal Reflux After Repair of Esophageal Atresia

Purpose Gastroesophageal reflux disease (GERD) frequently affects patients with esophageal atresia (EA). GERD is often resistant to medical therapy, and anti-reflux surgery in the form of fundoplication is required. However, there are no generally accepted indications for fundoplication in EA patients with significant gastroesophageal reflux (GER). This study aimed to report the outcomes and review the clinical characteristics and treatment of GERD with Nissen fundoplication among EA patients. Methods The medical records of patients with EA repair who underwent Nissen fundoplication for GERD treatment from January 2005 to December 2018 were retrospectively reviewed. Twenty patients were included in this study. Results In total, 166 patients with EA underwent treatment during the study period. Among these, 20 (12%) patients underwent Nissen fundoplication. The median age at the time of fundoplication was 5.3 (range, 1.6–49.4) months, and the mean body weight was 6.3±2.4 kg. The indications for Nissen fundoplication were hiatal hernia in 18 (90%) patients, feeding intolerance in 17 (85%), recurrent aspiration pneumonia in 13 (65%), GER-related refractory anastomosis stenosis in seven (35%), and reflux-related acute life-threatening events in five (25%). The median follow-up duration after Nissen fundoplication was 5.7 (range, 2.4–10.7) years; two (10%) patients experienced surgery-related complications, 11 (55%) had recurrent hiatal hernia, and three (15%) required re-operation. Feeding intolerance improved (p<0.001), and the number of esophageal dilatations decreased following Nissen fundoplication (p=0.038). There was no mortality during the follow-up period. Conclusion Nissen fundoplication was required in patients with more complicated EA and was performed at a young age. Nissen fundoplication was relatively effective in controlling EA-associated GERD. However, Nissen fundoplication in patients with EA may be associated with a high rate of recurrent hiatal hernia. A careful follow-up is necessary because poor long-term outcomes are common for such patients.ope

Clinical Characteristics and Treatment of Currarino Syndrome: A Single Institutional Experience

Purpose Currarino syndrome is a rare disease, and understanding its clinical characteristics is important because it involves complex anomalies and it requires a multidisciplinary approach for treatment. However, the accumulation of treatment experiences is challenging, and studies on this disease remain insufficient. Our study aimed to review the clinical characteristics and treatment of Currarino syndrome at our institution. Methods The medical records of patients diagnosed as Currarino triad or Currarino syndrome at the authors institution from 1997 to 2018 were retrospectively reviewed. Thirteen patients were included in this study. Results No significant difference in disease prevalence was observed in terms of sex (male:female, 7:6), and the median age at diagnosis was 7 months (1 day to 35 years). Currarino syndrome was diagnosed during the neonatal period in only one patient, whereas its diagnosis was delayed in the other patients. The most common initial symptom or diagnosis was anorectal malformation (ARM) followed by constipation and sacrococcygeal mass. All patients underwent simple abdominal X-ray and magnetic resonance imaging for the diagnosis of this disease. The most common sacral anomaly was partial sacral agenesis (type III, 62%) followed by hemisacrum (type IV, 38%). The most common presacral mass was mature teratoma. No pathologic malignant features were observed. In ARM, nine patients had anal stenosis, and posterior sagittal anorectoplasty was the most common operative method for ARM. Twelve patients were followed up beyond the age of three, and the median follow-up age was 8.1 years (range: 3.1–30.0 years). Among the 12 patients, 4 patients did not show symptoms of functional abnormality, whereas 8 patients showed constipation, fecal incontinence, urinary dysfunction, or gait disturbance. Conclusion The diagnosis of Currarino syndrome could be delayed when sacral bony anomaly and anorectal stenosis are not given attention. A careful follow up is essential because poor long-term functional outcomes are common.ope

Development of a Multidisciplinary Aerodigestive Program: An Institutional Experience

We share our experience on the implementation of a multidisciplinary aerodigestive program comprising an aerodigestive team (ADT) so as to evaluate its feasibility. We performed a retrospective chart review of the patients discussed at the monthly ADT meetings and analyzed the data. A total of 98 children were referred to the ADT during the study period. The number of cases increased steadily from 3.5 cases per month in 2019 to 8.5 cases per month in 2020. The median age of patients was 34.5 months, and 55% were male. Among the chronic comorbidities, neurologic disease was the most common (85%), followed by respiratory (36%) and cardiac (13%) disorders. The common reasons for consultation were suspected aspiration (56%), respiratory difficulty (44%), drooling/stertor (30%), regurgitation/vomiting (18%), and feeding/swallowing difficulty (17%). Following discussions, 58 patients received active interventions, including fundoplication, gastrostomy, laryngomicrosurgery, tracheostomy, and primary dilatation of the airway. According to the questionnaire of the caregiver, the majority agreed that the main symptoms and quality of life of patients had improved (88%), reducing the burden on caregivers (77%). Aerodigestive programs may provide comprehensive and multidisciplinary management for children with complex airway and digestive tract disorders.ope

Multidisciplinary aerodigestive program at a children's hospital: A protocol for a prospective observational study

Background: Children with complex chronic multisystemic diseases frequently require care from multiple pediatric subspecialists. The aerodigestive program is a multidisciplinary program that diagnoses and treats pediatric patients with complex multi-systematic problems affecting airway, breathing, feeding, swallowing, or growth. The aim of this study is to present the protocol of the aerodigestive program of a children's hospital. Methods and design: This study is a prospective study to evaluate and compare the overall improvement of patients' objective and subjective conditions before and after the AeroDigestive Team (ADT) program. Among children from 1 month to 18 years of age, patients with complex problems of the airway, breathing, feeding, swallowing, or growth meeting at least two parameters of the inclusion criteria were enrolled. The overall process included referral based on the inclusion criteria, enrollment of ADT program with informed consents, interview and questionnaire for assessing patients' medical condition, prescheduling appointment, multi-specialists' evaluation, monthly team meetings, wrap-up discussion with the patients and family, therapeutic intervention, and follow-up at 6 months with the assessment of outcome measures. The outcome was evaluated objectively and subjectively. The objective outcome measure was divided into surgical or medical intervention, assessment of changes in medical condition, and follow-up study. Both caregiver interviews and questionnaires using a scoring system were used as subjective outcome measures before and after the ADT program. Children were scheduled to be followed-up at 6 months after the interventions or ADT meeting. Discussion: The aerodigestive program is expected to provide comprehensive and multidisciplinary management of children with complex airway and digestive tract disorders.ope