Laparoscopic fundoplication for neurologically impaired adolescents with severe scoliosis

AbstractLaparoscopic antireflux procedure for patients with severe scoliosis is often challenging, as the esophageal hiatus lies in an extremely deep position and is frequently rotated. Reports regarding the clinical results of laparoscopic fundoplication are scarce, especially in patients with severe scoliosis. In this study, laparoscopic Nissen fundoplication was applied to seven adolescent patients aged between 19 and 29 years with neurological impairment and gastroesophageal reflux disease (GERD). The scoliosis among them was considerably severe with a median Cobb angle of 131°. Follow-up was conducted with a median period of 7.8 years. There was no intraoperative complication or recurrence of GERD. Two patients required tracheostomy, and one died due to recurrent pneumonia after fundoplication. Our experience suggested the feasibility of laparoscopic Nissen fundoplication with an arrangement of port layout even in neurologically impaired adolescents with severe scoliosis. As recurrent aspiration pneumonia can persist after fundoplication in some patients, an anti-aspiration procedure may be considered to achieve a higher quality of life

Laparoscopic Findings of Rare Pediatric Inguinal Hernias

Pediatric inguinal hernias are caused to the patency of the processus vaginalis (PPV). The principle for the repair of indirect inguinal hernias in children consists of complete ligation of the PPV. Laparoscopic percutaneous extraperitoneal closure (LPEC) has spread rapidly since it was reported by some groups from around 1998, and the number of institutions adopting this method as a standard procedure for pediatric inguinal hernia is increasing in Japan. Since the closure of PPV by laparoscopic surgery is popular, rare hernias in children can be observed from the abdominal cavity. We present the laparoscopic findings of rare pediatric inguinal hernias and report their experience

Primary great saphenous vein aneurysm in a five-year-old boy

AbstractPrimary venous aneurysm is a very rare disease, especially in pediatric patients. A case of primary great saphenous vein aneurysm in a five-year-old boy is reported. He was initially suspected of suffering from inguinal hernia because the soft mass was detected at the inguinal region when the patient was in the standing position. However, ultrasonography revealed the swelling to be a great saphenous vein aneurysm. The lesion was restricted to the thigh area and was surgically excised

A female infant with an inguinal hernia containing the uterus and bilateral ovaries

Indirect inguinal hernia is one of the most common congenital abnormality in children. In approximately 15–20% of female patients, the hernia sac contains an ipsilateral ovary, but a few cases have been reported in which the uterus and both ovaries are within the hernia sac. Ultrasonography is a very effective tool to detect prolapsed organs in inguinal hernia; however, detection may be difficult in infants. The present study describes a rare case of inguinal hernia containing the uterus and both ovaries. The hernia was sliding hernia and Bevan's technique was adopted for radical herniorrhaphy. The clinical features of the disease are discussed

Tailgut cyst in a female infant with a skin dimple at the coccygeal region

A tailgut cyst is a congenital cystic lesion that is situated at the presacral and postrectal area and is considered to be a remnant of the tailgut that develops in early fetal life and usually regresses later. Approximately 20 pediatric cases of tailgut cyst have been reported. We report an infantile case of tailgut cyst that was complicated with a skin dimple at the coccygeal region. The cyst was completely resected and the pathological diagnosis was mature teratoma. We finally diagnosed it as a tailgut cyst by several clinical findings including the site of the cyst, MRI image, the fact that it was complicated with a skin dimple, and the pathological findings

Acute pancreatitis caused by a duodenal duplication cyst covering the ampulla of Vater

Duodenal duplication cyst is not a common congenital anomaly and the pathophysiology may become very complicated if the cyst is situated at the ampulla of Vater. Here we report a very rare female case of duodenal duplication cyst at the ampulla of Vater, which caused acute pancreatitis due to massive protein plaques in the pancreatic duct. She had a past history of double duodenal atresia and underwent surgery as a neonate. The correct diagnosis could not be determined before the second operation at four years of age and the exact pathophysiology finally became apparent during the operation with a contrast medium study and duodenotomy. We discuss the complicated clinical features and diagnostic and treatment procedures before and during the operation