A right colonic volvulus requiring extensive colectomy in an infant with trisomy 13

AbstractColonic volvulus is a rare surgical emergency condition in children. Only approximately 40 children with cecal volvulus have been reported in English literature in the past 50 years. Among these, a right colonic volvulus involving the long segment from the ileal end to the transverse colon, as in our case, is limited to a few reports. Neurodevelopmental delay and a history of chronic constipation have been reported as common associated disorders. This is the first report about a case of right colonic volvulus in an infant with trisomy 13 who required extensive colectomy during an emergency laparotomy

Intrahepatic biliary cyst after a Kasai procedure

A 30-day-old female infant presented with a cystic lesion at the porta hepatis. The cyst was first detected on a prenatal ultrasound at 16 weeks of gestation and diagnosed as congenital biliary dilatation. The size of the cyst did not change over the course of gestation and the infant's liver function was stable after birth, although she had a persisting yellowish stool. Surgical cholangiography was performed at 30 days, and a complete obstruction of the hepatic hilum was identified as a type IIId cyst. However, cholangitis recurred at 10 months post-surgery, with marked dilation of the right and left hepatic ducts. Right cyst-intestinal anastomosis and left cyst-gastric anastomosis were performed. Cyst recurrence is sometimes a complication in patients with type III biliary atresia who undergo the Kasai procedure. The mechanisms of cyst formation are still unknown, and there is no consensus regarding the treatment. Our case suggests that cysto-enterstomy is a feasible treatment for recurrent cysts

Deterioration of autoimmune condition associated with repeated injection of dextranomer/hyaluronic acid copolymer: A case report

A 6-year-old girl underwent ureterocystoneostomy (UCN) because of left flank pain due to delayed onset of ureteral stenosis one and a half years after endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for the treatment of vesicoureteral reflux (VUR). Histopathological examination indicated chronic inflammation with abundant eosinophils characteristic of a reaction to Deflux. Several autoimmune diseases developed during the treatment for ureteral stenosis. First, 2 weeks prior to the onset of left flank pain, she was diagnosed as having systemic lupus erythematosus. Finally, she died of pulmonary hemorrhage due to thrombotic thrombocytopenic purpura 4 months after UCN. The fatal outcome in this case was suspected to be caused by autoimmune syndrome induced by adjuvants, which in this case was the hyaluronic acid polymer injected into the ureteric orifice for the treatment of VUR

Laryngo fiberscopy-guided suspension procedure for an ectopic lingual thyroid obstructing airway

Abstract Background Currently, there is no consensus regarding the optimal therapeutic strategy for the management of an ectopic lingual thyroid. A surgical approach is suggested when airway obstructive symptoms cannot be tolerated at all, or when bleeding or malignancy occurs. However, for patients in whom ectopic thyroid is the only functioning thyroid tissue, complete surgical excision needs to be followed by lifelong hormone replacement therapy. We report the case of an infant with ectopic lingual thyroid obstructing the airway that was treated using our novel surgical procedure. Case presentation A 10-day-old male infant presented with symptoms of airway obstruction and subclinical hypothyroidism. Imaging tests revealed an ectopic lingual thyroid and the absence of a normal pretracheal thyroid gland. We administered oral levothyroxine to lower his thyroid stimulating hormone (TSH) level and reduce the volume of the lingual mass; however, his airway symptoms did not improve. Subsequently, we performed a surgical intervention when he was 2 months old. We split the hyoid bone, and then suspended the lingual thyroid by suturing it to the hyoid bone to elevate the epiglottis. We confirmed the degree of suspension using intraoperative laryngo fiberscopy. After the surgery, the symptoms of airway obstruction were resolved and the patient was clinically euthyroid on low-dose oral levothyroxine. Conclusions Our laryngo fiberscopy-guided suspension procedure can be an effective surgical procedure for the treatment of ectopic thyroid. This relatively simple surgical procedure could completely preserve the patient’s thyroid tissue and resolve airway obstruction