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

Congenital diaphragmatic hernia and complete tracheal rings: The value of peri-operative ECMO

A full-term male prenatally diagnosed with left congenital diaphragmatic hernia (CDH) was intubated at birth and scheduled for elective repair. The pre-operative chest radiograph incidentally demonstrated tracheal narrowing and an intraoperative flexible bronchoscopy was performed, suggestive of impending airway occlusion secondary to complete tracheal rings. Given these findings, he was electively cannulated post-operatively to venoarterial extracorporeal membrane oxygenation (ECMO) for stabilization and tracheal repair. Post-operative day one, he underwent further characterization by computed tomography and was taken for slide tracheoplasty on ECMO support. Immediately following tracheal repair, he was decannulated from ECMO and was extubated to nasal CPAP two days after the slide tracheoplasty. This case highlights the rare association of tracheal anomalies associated with CDH and options for perioperative management, including the role of ECMO. Keywords: Congenital diaphragmatic hernia, CDH, Extracorporeal membrane oxygenation, ECMO, Complete tracheal rings, Tracheal stenosis, Tracheoplast