Makoto Honzumi

An intestinal fistula in a 3-year-old child caused by the ingestion of magnets: Report of a case

We describe herein the case of a 3-year-old child in whom a jejunoileal fistula was caused by the ingestion of magnets. This case report demonstrates that if more than one magnet is found as a foreign body in the intestine, they should not be left untreated even if there are no sharp edges and, it seems they could be evacuated spontaneously. This recommendation is made because the magnets will attract each other and hold the intestinal walls between them, causing necrosis and resulting in intestinal perforation or a fistula.

Surgical Resection for Pyriform Sinus Fistula

There has been no established operative procedure for pyriform sinus fistula because of its rarity. Recurrence may occur even after neck exploration. We successfully managed six pediatric cases with this disease without any complications or recurrences. Our experience indicates that exposing the inferior cornu of thyroid cartilage with its covering muscles facilitates resection of the proximal portion of this fistula.

Metachronous bilateral adrenal neuroblastoma

A boy with bilateral adrenal neuroblastoma was presented. The left adrenal neuroblastoma was found when he was at 5 years of age and was curatively excised. The right adrenal neuroblastoma was found when he was at 13 years of age and also was totally excised. The authors consider that the case presented is an extremely rare, metachronous primary bilateral adrenal neuroblastoma, reflecting the multicentric origin of neuroblastoma.

A case of metastatic ovarian non-gestational choriocarcinoma: successful treatment with conservative type surgery and myeloablative chemotherapy.

origin. In contrast, non-gestational choriocarcinoma of the ovary (NGCO) is an exceedingly rare germ cell neoplasm.1–3 Non-gestational choriocarcinoma has a worse prognosis than gestational neoplasms and only occasional survivals have been reported in advanced cases.1,2,4 We report a case of metastatic NGCO successfully treated with combined highdose chemotherapy and autologous bone marrow stem cell transplantation with preservation of the reproductive system.

Duodenal motility after tapering duodenoplasty for high jejunal and multiple intestinal atresia

Duodenal motility after tapering duodenoplasty was investogated by radiography and video-fluoroscopy. Two patients underwent tapering duodenoplasty, one at the time of duodenojejunostomy for double high jejunal atresias and another 6.5 months after the restoration of intestinal continuity for multiple intestinal atresias. Both patients showed a satisfactory postoperative course and were doing well. Radiographic and video-fluoroscopic studies demonstrated that the tapered portion of the duodenum had restored active peristalsis and excellent passage of contrast material, while the proximal, non-tapered portion remained dilated and dismotile soon after the operation. Tapering duodenoplasty proved to be a valuable procedure for restoring duodenal motility.

Fecal incontinence successfully managed by antegrade continence enema in children: A report of two cases

Two children with intractable fecal incontinence after correction of high anorectal malformations were successfully managed by the daily administration of a glycerin enema into the cecum via an appendicocecostomy or tubularized cecostomy, according to the method of Malones antegrade continence enema (ACE). Fluoroscopic defecography performed during this procedure in each patient disclosed that the glycerin enema promptly evoked cecal peristalsis, which was transmitted to the distal colon and rectum, and squeezed out almost all the fecal matter, evacuating it from the anus. However, two enemas within a short interval were required to achieve a complete washout of feces. Although this report describes only two patients, our experience confirmed that the ACE was very effective and that adding the word “continence” to antegrade enema was justifiable. Moreover, fluoroscopic defecography was proven to play a significant role in determining the appropriate regimens of this technique to achieve complete washout of the feces.

Hepatoblastoma in neonates: Report of a case and review of the Japanese literature

A female infant who presented with abdominal distention and jaundice at the age of 2 days underwent resection of a large hepatoblastoma at the age of 8 days by a right trisegmentectomy. Although postoperative adjuvant chemotherapy was not given, the patient is now alive without disease 10 months after surgery. We were able to find only 10 other cases of hepatoblastoma occurring in the newborn period in the Japanese literature. Resection of the tumor was performed in seven of these patients, of whom there were five survivors, one operative death and one death due to tumor recurrence. However, none of the three patients treated conservatively survived. Thus, we suggest that in newborns with hepatoblastoma, resection of the tumor should be performed, if feasible, but believe that postoperative chemotherapy is not necessary for patients whose tumor has been completely resected.

Rectoanal pressures and rectal compliance in children with rectal prolapse

The results of anorectal manometry in 11 children with complete rectal prolapse were evaluated. Abnormalities of sphincter control or bowel movements occurred in 8 out of these 11 patients. Anal canal pressure of the patients was lower than in the controls, but there was no significant difference of resting pressure profiles of the anorectum between the patients and the controls. Rectoanal reflex was present in all the patients and in the controls. Rectal compliance was significantly lower in the patients, but there was no correlation between rectal compliance and sphincter control of the patients.

Abdominal malignant lymphoma in a child after successful portoenterostomy for biliary atresia

Malignant disorders in long-term survivors of biliary atresia have rarely been reported. We report a case of abdominal malignant lymphoma in a 5-year-old boy who underwent a successful portoenterostomy for biliary atresia at the age of 45 days.

Portal circulation and the function of hepatocytes during ex vivo perfusion of the rat liver preserved for six hours after core cooling

Portal circulation and the function of hepatocytes during isolated organ perfusion were compared between the rat liver perfused immediately after extirpation and the liver perfused after core cooling and six hours of preservation. Nine rat livers were extirpated after core cooling, preserved for six hours in University of Winsconsin (UW) solution at 4°C and then were connected to a perfusion chamber (hypothermic preservation group: 6-hr HP group). Six rat livers were immediately connected to the perfusion chamber after extirpation (control group). During 60 minutes of isolated liver perfusion, both portal circulation and the function of hepatocytes were determined every 10 minutes. Portal vein resistance increased and portal blood flow decreased during the first 20 minutes of perfusion and then stabilized in both groups. Portal vein resistance was significantly higher and portal blood flow was significantly lower for the first 10 minutes of perfusion in the 6-hr HP group, compared to the control group. The function of hepatocytes, determined by the rate of elimination of ammonia, oxygen consumption, and glucose availability were depressed in the 6-hr HP group, compared to the control groups during isolated liver perfusion. However, there was no statistically significant difference of portal perfusion and the function of hepatocytes between the two groups at the end of perfusion. The results of the present study indicate that the rat liver can be preserved in a satisfactory condition for six hours by the use of hypothermic preservation, coupled with core cooling.