Strangulated right paraduodenal hernia successfully treated with single-incision transumbilical surgery

Right paraduodenal hernia (RPH) has been recently reported to be treated with laparoscopic surgery. We report a case of strangulated ileus that occurred as a result of RPH treated via a small umbilical incision. An 11-year-old boy presented to our hospital with complaints of sudden upper abdominal pain associated with bilious vomiting and bloody stool. We preoperatively diagnosed the case to be strangulated ileus caused by an internal hernia and thus performed emergency surgery. After the entire small intestine was carefully exteriorized via a small umbilical incision, a strangulated ileus as a result of the internal hernia was observed. A large hernia sac with its orifice on the right side of the jejunal origin was found behind the right mesocolon, on the basis of which the diagnosis of RPH was made. After releasing the strangulation, the ischemic intestine was reperfused. The hernia orifice was closed. All the abovementioned procedures were transumbilically performed. The patient's postoperative course was uneventful. An umbilical approach is useful for treating RPH because of its favorable cosmetic outcome. In addition, manual delivery of the herniated or incarcerated intestine provides a sense of safety compared with operation using forceps during laparoscopic surgery

A case of superior mesenteric artery syndrome developed after pancreatic teratoma resection

A mature teratoma of the pancreas has rarely been reported, and postoperative superior mesenteric artery syndrome (SMAS) is extremely rare in pediatric pancreatic surgery. A 12-year-old girl underwent an enucleation of the large mature teratoma located at the pancreas uncus. Although her postoperative recovery was fair, the bile-stained gastric juice continued draining at a rate of>1.5 l per day for 2 weeks. An upper gastrointestinal series revealed an abrupt disruption with to-and-fro peristalsis at the third portion of the duodenum. Endoscopy revealed an extrinsic pulsatile compression of this third portion. The aortomesenteric angle measured 12° on ultrasonography, which met the criteria for SMAS. The patient underwent a modified transposition procedure, “switching jejunojejunostomy,” on postoperative day 18. The gastrointestinal passage gradually improved, and complete oral intake was established 1 month after the first surgery. It was considered that the clinical symptoms of SMAS were caused by an anatomical deformation after the pancreatic tumor resection. Switching jejunojejunostomy was found to be an acceptable therapeutic option for this condition

Congenital Treves' field transmesenteric hernia in children: A case series and literature review

Transmesenteric hernia is abdominal visceral herniation through a congenital or acquired mesenteric defect. Treves' field is the area of terminal ileal mesentery circumscribed by the ileocolic artery and its last ileal branch. It is very susceptible to congenital defects. To clarify the clinical course of congenital Treves' field transmesenteric hernia (cTFTH), we retrospectively reviewed pediatric cases and conducted a literature review. Five consecutive pediatric cTFTH cases (one male, four females) underwent emergency laparotomy at our institutions from April 2009 and December 2014. We analyzed their demographics, preoperative findings, surgical procedures, and outcomes, along with a literature review. Abdominal plain X-ray showed displaced intestinal gas with gas paucity in the center of the abdomen in two cases and diffusely increased intestinal gas in two others. Abdominal computed tomography (CT) in four cases showed intestinal loop clusters, mesenteric vessel changes, small-bowel obstruction, and ascites. All cases underwent emergency laparotomy for ileal resection with ileocecal valve preservation. Simultaneous anastomoses were performed in four cases; the remaining case underwent ileostomy because of prematurity. Although one case needed reoperation for postoperative bowel obstruction, all patients survived. Literature review of pediatric cTFTH showed a high frequency of necrosis (70.5%) and mortality (26.5%). Among pediatric cTFTH cases, 67.6% were aged <5 years. Mesenteric defect was <5 cm in 70% cases. We should be aware of the clinical importance and radiological features of pediatric cTFTH. Abdominal CT may provide useful information

Aldehyde Dehydrogenase 1 (ALDH1) Is a Potential Marker for Cancer Stem Cells in Embryonal Rhabdomyosarcoma.

Cancer stem cells (CSCs) are defined as a small population of cancer cells with the properties of high self-renewal, differentiation, and tumor-initiating functions. Recent studies have demonstrated that aldehyde dehydrogenase 1 (ALDH1) is a marker for CSCs in adult cancers. Although CSCs have been identified in some different types of pediatric solid tumors, there have been no studies regarding the efficacy of ALDH1 as a marker for CSCs. Therefore, in order to elucidate whether ALDH1 can be used as a marker for CSCs of pediatric sarcoma, we examined the characteristics of a population of cells with a high ALDH1 activity (ALDH1high cells) in rhabdomyosarcoma (RMS), the most common soft tissue sarcoma in children. We used the human embryonal RMS (eRMS) cell lines RD and KYM-1, and sorted the cells into two subpopulations of ALDH1high cells and cells with a low ALDH1 activity (ALDH1low cells). Consequently, we found that the ALDH1high cells comprised 3.9% and 8.2% of the total cell population, respectively, and showed a higher capacity for self-renewal and tumor formation than the ALDH1low cells. With regard to chemoresistance, the survival rate of the ALDH1high cells was found to be higher than that of the ALDH1low cells following treatment with chemotherapeutic agents for RMS. Furthermore, the ALDH1high cells exhibited a higher degree of pluripotency and gene expression of Sox2, which is one of the stem cell markers. Taken together, the ALDH1high cells possessed characteristics of CSCs, including colony formation, chemoresistance, differentiation and tumor initiation abilities. These results suggest that ALDH1 is a potentially useful marker of CSCs in eRMS

Upregulated mRNA in the ALDH1^high cells.

<p>A quantitative real-time PCR analysis was performed to evaluate the expression levels of ALDH1 (A), stemness markers (B) and ABC transporters (C). The mean ± SE was calculated from triplicate wells of a representative experiment, and the data for one of three independent experiments are shown in the figure. The expression of ALDH1A3, ALDH1B1, ALDH1L2, Sox2 and ABC transporters was significantly higher in the ALDH1^<b>high</b> cells than in the ALDH1^<b>low</b> cells (p<0.01).</p

List of primers used for quantitative real-time PCR.

<p>List of primers used for quantitative real-time PCR.</p

ALDH1^high cells show enhanced chemoresistance.

<p>The ALDH1^<b>high</b> and ALDH1^<b>low</b> cells of RD (A) and KYM-1 cells (B) were treated with 100 nM-10 μM vincristine, 5 mM-15 mM cyclophosphamide and 10 μM-100 μM etoposide and the cell viability was measured after 72 hours using a WST-8 assay. The viability of the “no treatment” cells was also measured as a control. The mean ± SD was calculated from triplicate wells of a representative experiment, and the data for three independent experiments are shown in the figure. The viability of the ALDH1^<b>high</b> cells was significantly higher than that of the ALDH1^<b>low</b> cells.</p

The number of mice that formed RD tumors two months after inoculation.

<p>*p<0.05</p><p>**p<0.01 (Fisher’s exact test)</p><p>The number of mice that formed RD tumors two months after inoculation.</p