Esophageal granular cell tumor colliding with intramucosal adenocarcinoma: a case report

We report a case of a granular cell tumor colliding with intramucosal adenocarcinoma of the esophagus. A 58-year-old white was found to have a 5 mm nodule in the distal esophagus detected by upper gastrointestinal endoscopy performed as part of the workup of long standing reflux. Endoscopic biopsies revealed intramucosal adenocarcinoma arising in the setting of Barrett’s esophagus. The adenocarcinoma infiltrated a granular cell tumor also present at the nodular site. Endoscopic mucosal resection using Duette band ligation and hot snare electrocautery was performed. Margins were negative for both tumors, and endoscopic surveillance for recurrence is planned

Acute acalculous cholecystitis (AAC) in the pediatric population associated with Epstein–Barr Virus (EBV) infection. Case report and review of the literature

BACKGROUND: Epstein Barr Virus (EBV) is a ubiquitous herpes virus that persists lifelong in normal humans by colonizing memory B cells. Infection during childhood is usually asymptomatic. Isolated gallbladder wall thickening or hydrops have been reported in patients with EBV infectious mononucleosis. However, acute acalculous cholecystitis is an atypical clinical presentation of primary EBV infection. We present a teenager with acute cholecystitis associated with EBV acute infection. Acute acalculous cholecystitis accounts for 2–15% of all cases of acute cholecystitis. Few cases of acute cholecystitis have been reported during the course of primary EBV infection. PRESENTATION OF CASE: A 15-year-old female who came to the JDCH ER complaining of 3 days history of mild diffuse abdominal pain associated with two episodes of emesis. She also reports headache as well as a mild cough and low grade subjective fever. Blood test results showed mild leukocytosis with significant elevation in the lymphocytes (59%), High alkaline phosphatase (221 U/I), AST (191 U/I), ALT(221 U/I) and bilirubin (Total 1.8 and direct 1.5). Abdominal US showed a contracted gallbladder with wall thickness and pericholecystic fluid. During hospital stay number 2–3 laboratory work up show a trending up in the bilirubin levels. MRCP was ordered and no abdnormalities were found. At this point Hospital stay number 3 EBV acute infection was suspected. Serum serological studies were subsequently diagnostic for this viral disease. Management was conservative and the patient was discharged asymptomatic on hospital day number six

Laparoscopic single stage procedure for perforated choledochal cyst

Spontaneous perforation of choledochal cyst is a rare presentation. Complicated choledochal cysts are routinely managed by staged open surgical procedures for excision and reconstruction [1, 2]. Complex laparoscopic surgery in infants is an evolving field but no reports have been published describing a minimal invasive approach to the management of spontaneous perforation of choledochal cyst. We report a case of perforated choledochal cyst in a 12 week old, female which was managed by single stage laparoscopic resection of the cyst with biliary reconstruction. She presented with fever and bilious vomiting for 4 days. She had chemical pancreatitis and further work up showed her to have a perforated choledochal cyst. After conservative treatment of her pancreatitis, she underwent laparoscopic resection of the choledochal cyst with reconstruction. She had an uneventful postoperative recovery. This is the first ever reported case of laparoscopic management of a perforated choledochal cyst in infants which was managed by single stage laparoscopic surgery with immediate reconstruction

Surgical intervention for Kasaback-Merritt Syndrome: A case report

Kasabach-Merritt Syndrome (KMS) is an uncommon phenomenon characterized by the presence of a vascular tumor in association with thrombocytopenia, consumption coagulopathy and hemodynamic instability. Typically presents in infancy and involve the skin and deep soft tissues of the arms and legs. Treatment options vary with clinical presentation, and ranges from medical management to immediate surgical intervention. We present an unusual case of a newborn with KMS and fatal hemodynamic collapse imminent, which was successfully treated with surgical resection at our institution

Do Racial/Ethnic and Economic Factors Affect the Rate of Complicated Appendicitis in Children?

Introduction. Appendicitis continues to be one of the most common surgical conditions in the pediatric population. We set out to determine demographic and practice variations among children admitted with appendicitis and highlight the racial/ethnic and healthcare access role in relation to the rate of complicated appendicitis using the 2012 Kids’ Inpatient Database (KID). Methodology. A retrospective cross-sectional database study was performed using the 2012 KID. All children (age 1 months to 20 years) with appendicitis were identified using the ICD-9 diagnosis codes. Children with a diagnosis of appendicitis were compared with all other discharges. Among children with appendicitis, demographic and practice variations and the rate of complicated appendicitis were evaluated. Univariate and multivariate analyses were done to analyze the data. Sample weighing was done to present national estimates. Results. In 2012, a total of 89, 935 out of 2.7 million pediatric hospital discharges (3.3%) had a diagnosis of appendicitis. The incidence of appendicitis was higher in males (4.7%), 6–15-year age group (7.43%), Hispanics (5.2%), and in the Western region (5.2%) and was lower in infants (0.02%) and African American children (1.2%) (p<0.0001). The proportion of children with peritonitis or abscess was higher in children’s hospitals (48.2% vs. 29.0%; OR 2.3, 95% CI: 2.2–2.4). The risk of complicated appendicitis was inversely related to age, while racial and ethnic minority status, bottom quartile of the income group, and government insurance increased the risk. Laparoscopic appendectomy was performed more frequently at children’s hospitals (84.8% vs. 74.3%; p<0.0001). Conclusions. Appendicitis is more common in Hispanics, males, older children, and in the Western region. Complicated appendicitis is more common in younger children, minority groups, low-income group, and children with government insurance. Children’s hospitals manage more children with complicated appendicitis and are more likely to perform laparoscopic appendectomy

Prospective Comparison of Nonnarcotic versus Narcotic Outpatient Oral Analgesic Use after Laparoscopic Appendectomy and Early Discharge

Purpose. To compare narcotic versus nonnarcotic outpatient oral pain management after pediatric laparoscopic appendectomy. Methods. In a prospective study from July 1, 2010, to March 30, 2011, children undergoing laparoscopic appendectomy on a rapid discharge protocol were treated with either nonnarcotic or narcotic postoperative oral analgesia. Two surgeons in a four-person faculty group employed the nonnarcotic regimen, while the other two used narcotics. Days of medication use, time needed for return to normal activity, and satisfaction rate with the pain control method were collected. Student’s t-test was used for statistical analysis. Results. A total of 207 consecutive children underwent appendectomy for acute, nonperforated appendicitis or planned interval appendectomy. The age and time to discharge were equivalent between the nonnarcotic (n=104) and narcotic (n=103) groups. Both had an equivalent number of medication days and similar times of return to normal activity. Ninety-seven percent of the parents of children in the nonnarcotic group stated that the pain was controlled by the prescribed medication, compared to 90 percent in the narcotic group (P=0.049). Conclusion. This study indicates that after non-complicated pediatric laparoscopic appendectomy, nonnarcotic is equivalent to narcoticbased therapy for outpatient oral analgesia, with higher parental satisfaction