Appendiceal polyp as a lead point for an appendico-colic intussusception requiring operative reduction

Intussusception of the appendix is a rare condition. When intussusception occurs in the pediatric age group, the intussusceptum usually involves the ileum, cecum or colon. The majority of cases of pediatric intussusception are idiopathic, without a pathologic lead point, and polyps are an uncommon focus of invagination. In this case report, we describe a three year-old female with known Juvenile Polyposis Syndrome (JPS) who presented to our Emergency Department with an appendico-colic intussusception in the right lower quadrant, extending to the right upper quadrant of the abdomen. The patient underwent a surgical reduction of the intussusception and an appendiceal polyp was noted to be the pathologic lead point. The case highlights a highly unusual presentation of intussusception and the surgical management utilized

Pediatric paraduodenal dermoid cyst: Clinical presentation, minimally invasive management and literature review

AbstractDermoid cysts (mature cystic teratomas) are congenital masses composed of all three germ cell layers: commonly occurring in the head, neck, and gonads and rarely in the abdomen. We present the first documented case of a paraduodenal dermoid cyst in a child, and describe the minimally invasive surgical approach utilized for resection. The patient was an asymptomatic five-month old female diagnosed with a cystic lesion in the posterior mid-abdomen on a prenatal ultrasound, followed up by MRI at three months of age. We proceeded with a laparoscopic resection for both diagnosis and definitive management. Intraoperatively, the lesion was noted to be separate of the pancreas and the stomach, located between the superior mesenteric vessels and splenic vein. It was dissected out with histopathology confirming the diagnosis of a dermoid cyst. We believe that the use of a laparoscopic technique allowed for better post-operative pain control, less overall morbidity and a shorter hospital stay compared to an open approach. Given the significant recurrence rate and possibility of malignant degeneration with incomplete resection, it is imperative to perform a complete resection if this lesion is suspected

Tracheal injury during extraction of an esophageal foreign body: Repair utilizing venovenous ECMO

Extracorporeal membrane oxygenation (ECMO) is a form of life support with an ever-expanding range of indications. Veno-venous (VV) ECMO is often utilized to support children with respiratory compromise, and has been employed successfully in the acute setting of traumatic tracheobronchial injury as well as during elective tracheal surgery. We present a successful case of VV ECMO used in the perioperative management of a tracheal repair for a traumatic laceration caused by attempts to retrieve an esophageal foreign body. While this mechanism of injury appears to be rare, we believe that VV-ECMO allowed for the optimal management of this child and should be considered for other extensive tracheal injuries in children

Continuous double volume exchange transfusion is a safe treatment for ECMO-induced hemolysis

Extracorporeal membrane oxygenation (ECMO)-related hemolysis is a recognized complication and remains a source of significant morbidity and mortality in the neonatal population. This is the first description of continuous double-volume exchange transfusion (ET) performed for profound hemolysis that developed in a neonate with congenital heart disease on VA ECMO for sepsis. The aim of this report is to demonstrate the safety and efficacy of performing ET on a physiologically frail patient on ECMO support. Keywords: Veno-arterial extracorporeal membrane oxygenation, Hemolysis, Exchange transfusio