Takeo Yonekura

Handlebar hernia: case report and review of pediatric cases

Abstract The authors describe a rare case of handlebar hernia in a 9-year-old-boy. All layers of his abdominal wall were disrupted by a fall on a bicycle; however, his skin and intra-abdominal organs were completely intact. Computed tomography demonstrated subcutaneous intestinal loops protruding through the rent. Surgical repair was performed, and his postoperative course was uneventful.

Effect of electrolyzed strong acid water on peritoneal irrigation of experimental perforated peritonitis

PurposeElectrolyzed strong acid water (ESAW) is generated by the electrolysis of a weak sodium chloride solution. Although ESAW is known to have a strong bactericidal activity and to be harmless to the living body, its effectiveness and safety in the treatment of perforated peritonitis has not been well established.MethodsMale Wistar rats were used for the study. Three hours after cecal ligation and puncture, the cecum was resected and the peritoneal cavity was irrigated with 50 ml of saline (Group S, n=12) or ESAW (Group E, n=14). The 5-day survival rate was compared between the two groups. In another pair of animals (n=10 each), bacteria in the ascitic fluid were counted at 6 and 18 h after irrigation.ResultsNo adverse effects of ESAW were observed in the experimental group. The 5-day survival rate was 25% (3/12) and 85.7% (12/14) in Groups S and E, respectively (P < 0.01). The bacterial count at 18 h after the irrigation in Groups S and E was (5.0 ± 2.5) × 105/ml and (2.2 ± 2.0) × 104/ml, respectively (P < 0.0001).ConclusionPeritoneal lavage with ESAW had no adverse effect, and achieved more effective decontamination than saline for perforated peritonitis. Therefore, the results of this study are considered to warrant and support the clinical application of ESAW.

Idiopathic gastric rupture in a 3‐month‐old girl

This case reports on idiopathic gastric rupture in a 3‐mo‐old girl who had frequent episodes of vomiting and abdominal distension the day before admission to the clinic. Metabolic acidosis was detected and rotavirus antigen was identified in the stools. Abdominal X‐rays and CT scans revealed free air and fluid in the abdominal cavity, leading to a diagnosis of gastrointestinal perforation. During surgery, idiopathic gastric rupture was detected and treated. The postoperative course was uneventful.

Clinical application of indocyanine green (ICG) fluorescent imaging of hepatoblastoma

BACKGROUND/PURPOSE Although the usefulness of intraoperative indocyanine green (ICG) fluorescent imaging for the resection of hepatocellular carcinoma has been reported, its usefulness for the resection of hepatoblastoma remains unclear. This study clarifies the feasibility of intraoperative ICG fluorescent imaging for the resection of hepatoblastoma. METHODS In three hepatoblastoma patients, a primary tumor, recurrent tumor, and lung metastatic lesions were intraoperatively examined using a near-infrared fluorescence imaging system after the preoperative administration of ICG. RESULTS ICG fluorescent imaging was useful for the surgical navigation in hepatoblastoma patients. In the first case, the primary hepatoblastoma exhibited intense fluorescence during right hepatectomy, but no fluorescence was detected in the residual liver. In the second case, a recurrent tumor exhibited fluorescence between the residual liver and diaphragm. A complete resection of the residual liver, with a partial resection of the diaphragm, followed by liver transplantation was performed. In the third case with multiple lung metastases, each metastatic lesion showed positive fluorescence, and all were completely resected. These fluorescence-positive lesions were pathologically proven to be viable hepatoblastoma cells. CONCLUSION Intraoperative ICG fluorescence imaging for patients with hepatoblastoma was feasible and useful for identifying small viable lesions and confirming that no remnant tumor remained after resection.

Laparoscopic treatment of gallbladder volvulus: a pediatric case report and literature review.

Volvulus of the gallbladder has been reported mostly in elderly women and is rarely reported in children. In this paper, we report a recent case of successful detorsion and removal of the gallbladder via minimal access surgery, which was diagnosed as gallbladder volvulus preoperatively by means of magnetic resonance imaging (MRI). An 11-year-old boy presented with an acute abdomen, and acute cholecystitis was suspected, based on the findings of ultrasound and computed tomography. However, a diagnosis of gallbladder volvulus was established through MRI, and emergency laparoscopic surgery was subsequently performed. Laparoscopy revealed a hemorrhagic, gangrenous gallbladder that floated anteriorly. The gallbladder was rotated twice around its pedicle in a counterclockwise direction. It was untwisted through laparoscopy, and a cholecystectomy was performed without difficulty. To achieve an early, prompt preoperative diagnosis, MRI could be an effective alternative to conventional imaging modalities. The advent of laparoscopic detorsion and cholecystectomy as a treatment for gallbladder volvulus allows less invasive treatment, a shorter hospital stay, and better cosmesis, which are highly desirable in children.

Late onset of right Bochdalek's hernia with strangulation of the omentum

We report a case of bloody pleural effusion and infarction of the greater omentum caused by a non‐traumatic diaphragmatic hernia with a late presentation. A 15‐y‐old boy with Downs syndrome developed abdominal pain and vomiting, as well as an elevated serum level of C‐reactive protein. Chest roentgenograms showed a right‐sided pleural effusion and computed tomography revealed a right diaphragmatic hernia. Barium enema confirmed the diagnosis. An operation revealed a right Bochdaleks hernia with strangulation of the greater omentum in the right pleural cavity.

An unusual presentation of congenital infantile myofibromatosis arising from the interspinous ligament

Abstract The authors describe an extremely rare presentation of congenital infantile myofibromatosis. A full-term newborn boy presented with a thumb-sized subcutaneous mass on the mid-spinal line between the 2nd and 3rd lumbar spinous processes. A solid tumor arising from the interspinous ligament was resected. Microscopic and immunohistochemical studies revealed myofibromatosis.

High therapeutic effectiveness of postoperative irinotecan chemotherapy in a typical case of radiographically and pathologically diagnosed pleuropulmonary blastoma.

A 2-year 9-month-old girl with a large mass in the right chest underwent middle and inferior lobectomy, after which the mass was pathologically diagnosed as a pleuropulmonary blastoma (PPB). The clinical, radiographic, and pathologic findings were typical. Three courses of postoperative chemotherapy with 2 different regimens were ineffective in preventing multiple metastases of the lung. We then instituted a protocol with irinotecan (CPT-11) and vincristine. After the third course of this protocol the metastases disappeared and there were no recurrences. PPB is a rare pediatric malignant tumor, and no adequate therapy has been defined. This is the only case reported to have been treated with vincristine/irinotecan therapy for the treatment of PPB.

Congenital esophageal atresia with tracheoesophageal fistula occurring in both members of dizygotic twins

Abstract The authors present a pair of dizygotic twins with congenital esophageal atresia with tracheoesophageal fistula who underwent successful single-stage surgical repair. To our knowledge, this is the second set of dizygotic twins with this congenital anomaly in the literature.

Late-onset hemothorax after the Nuss procedure for funnel chest.

A 4-year-and-3-month-old boy with funnel chest underwent the Nuss procedure. He had an uneventful intraoperative and postoperative course, and was discharged on the tenth day of hospitalization. He developed chest pain while playing on the 29th day after surgery, and was diagnosed with right hemothorax. He was followed conservatively and the hemothorax disappeared.