Daniel J. Ledbetter

Thyroid surgery in children

Although surgical conditions of the thyroid gland are uncommon in children, the increased incidence of thyroid cancer, combined with the fact that childrens hospitals are increasingly treating older adolescents, means that it is important that all pediatric surgeons have a knowledge of these conditions. Abnormalities of the thyroid can be associated with abnormalities of thyroid function (hyperthyroidism or hypothyroidism) and/or can be associated with symmetrical or asymmetrical enlargement of the gland.

Laparoscopic Splenopexy for the Wandering Spleen Syndrome

Purpose: Wandering spleen syndrome is an uncommon condition characterized by the absence of the normal suspensory ligaments of the spleen. The wandering spleen is highly mobile, suspended only by its vascular pedicle, and may cause significant morbidity, including hypersplenism, splenic torsion and infarction, pancreatitis, intestinal obstruction, and bleeding from gastric varices. Splenectomy has been the traditional method of treatment; however, splenopexy has recently been advocated to avoid the risk for post-splenectomy sepsis. We present a novel, minimally invasive method of splenopexy for the treatment of a wandering spleen and associated hypersplenism in a pediatric patient. Methods: A 15-year-old girl presented with a 3-week history of intermittent severe lower abdominal pain and was found to have anemia, thrombocytopenia, and a palpable lower abdominal mass. Ultrasonography demonstrated an enlarged wandering spleen and cholelithiasis. Laparoscopic splenopexy and cholecystectomy were performed wit...