Pediatric anterior thoracic wall reconstruction: a successful case of extensive resection and repair

Abstract Background Thoracic tumors are a challenge for pediatric surgeons. They comprise a heterogeneous group of neoplasms classified based on histological variety, location, presentation, biological behavior, treatment response, and prognosis. Primary tumors of the thoracic wall in children and adolescents are sporadic, accounting for only 1–2% of all pediatric thoracic neoplasms, with two-thirds of them being malignant. Case presentation We present the case of a 16-year-old male patient with osteoblastic osteosarcoma localized in the right anterior rib cage. The patient underwent extensive tumor resection using titanium bars. Conclusion Thoracic reconstruction following extensive resection in pediatric cancer patients has been underexplored and poorly described. Nevertheless, it has been demonstrated to be feasible, particularly considering the 5-year survival rate of 60% following tumor resection. This approach helps prevent anatomical and physiological complications that may arise without reconstruction. We report a successful single-stage resection and thoracic reconstruction case in a pediatric patient. This case underscores the importance of considering reconstruction in patients with thoracic tumors, as it can contribute to improving prognosis and preventing associated complications

Outcomes of meso-Rex bypass for prehepatic portal hypertension in pediatric patients

Portal hypertension in pediatric patients is often associated with prehepatic portal hypertension (PHPH), frequently linked to thrombosis and cavernomatous degeneration of the portal vein (CDVP). This study evaluates the efficacy of the MesoRexBypass (MRB) in managing PHPH and associated thrombosis. Methods: A retrospective prognostic cohort design was employed to analyze the clinical outcomes of nine pediatric patients who underwent MRB between 2020 and 2022. Clinical and surgical variables were examined, including graft type, surgical time, and complications. Postoperative follow-up confirmed MRB functionality. Results: The MRB proved highly successful, with improved clinical parameters observed in all patients. Significant reductions in gastrointestinal bleeding, esophageal varices, and hypertensive gastropathy were observed postoperatively. Thrombocytopenia and liver enzyme levels showed substantial improvement, indicating enhanced liver function and amelioration of hypersplenism. The MRB's adaptability was demonstrated using autologous grafts and various graft sources.One patient experienced shunt thrombosis, another experienced minor gastrointestinal bleeding, and another died. The MRB exhibited a high success rate and few complications. Conclusion: The MRB is an effective and versatile surgical technique for managing PHPH in pediatric patients. This study emphasizes its promising outcomes and suggests its potential for enhancing treatment approaches and quality of life in this patient population. Further research with larger cohorts is needed to strengthen the evidence presented. The MRB holds promise as a valuable addition to the management of PHPH in children. Level of Evidence IV

Insights from a retrospective study: an understanding of pediatric colorectal carcinoma

Abstract Pediatric colorectal cancer, comprising just 1% of childhood cancers, has surged among young individuals, underscoring its significant health impact. Diagnostic challenges arise from atypical presentation and nonspecific symptoms in 90% of cases, leading to delayed detection in 19%. Methods A 2-year retrospective study of pediatric colorectal carcinoma cases was conducted across a specialized surgical pediatric center. Data were gathered, including age, symptoms, diagnostics, treatments, and outcomes. Results Six colorectal carcinoma cases (median age, 16) were documented, mainly in males (66%). Predominant histological types included mucinous adenocarcinoma and signet ring cell carcinoma. Metastasis was present in all cases, with symptoms including hematochezia (83%), abdominal pain (100%), weight loss (66%), and anemia (100%). Diagnosis often faced misidentification, fostering disease progression and metastasis. Various diagnostic and treatment modalities were employed, including surgery and neo-adjuvant or adjuvant chemotherapy. Conclusion Swift detection and intervention for pediatric colorectal carcinoma are pivotal. Efficient diagnostics and heightened awareness among medical professionals and the public are imperative. Early surgical intervention remains a cornerstone, especially for patients with pertinent family histories and characteristic symptoms. Tailored guidelines for pediatric patients are needed to enhance outcomes and survival