Pediatric & Adolescent Surgery - CRSLS

Minilaparoscopic Resection of Mesenteric Cystic Lymphangioma in an Infant

SLS — Thu, 10 Dec 2015 14:00:36 +0000

Arpit Amin, MD, Nishank Nooli, MD , Samir Pandya, MD

Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York (all authors).

ABSTRACT

Introduction: Abdominal mesenteric cystic lymphangiomas are congenital lymphatic malformations found most commonly within the small bowel mesentery, omentum, and mesocolon. These lesions may be detected incidentally on imaging studies or may present with bowel obstruction. Treatment of choice is surgical enucleation with possible segmental intestinal resection.

Case Description: This report describes the use of minilaparoscopy in the treatment of abdominal mesenteric cystic lymphangioma (MCL) in a child, along with a review of the current literature on laparoscopic treatment. Our patient, who had a prenatal diagnosis of an intra-abdominal mass, had developed postprandial emesis. Imaging work-up with ultrasonography and CT scan revealed an intra-abdominal mass suspicious for lipomatous tumor. The patient underwent minilaparoscopy-assisted resection of the intra-abdominal mass, along with the resection of small bowel that was adherent to the tumor. The final pathology showed that the mass was an MCL.

Discussion: The traditional treatment for MCL has been open surgical resection. Recently, laparoscopic surgical excision of mesenteric cysts in children has been reported in the literature.

Key Words: Abdominal mesenteric cystic lymphangioma, Minilaparoscopy

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Laparoscopic Approach to a Unilateral Adrenal Cyst in a Pediatric Patient

SLS — Thu, 04 Dec 2014 20:20:09 +0000

Christoph Castellani, MD, Georg Singer, MD, Manfred Ratschek, MD, Erich Sorantin, MD, Florian Friedmacher, MD, Holger Till, MD

Department of Pediatric and Adolescent Surgery (Drs Castellani, Singer, Friedmacher, Till), Department of Pathology (Dr Ratschek), Department of Radiology (Dr Sorantin), Medical University Graz, Graz, Austria.

ABSTRACT

Introduction: Adrenal cysts are rare findings, with an age peak between the third and fifth decades of life. In adults, laparoscopic and retroperitoneoscopic approaches to these cysts have been described. In pediatric patients, however, reports of this pathology and its management are limited to a small number of case reports.

Case Report: A cystic mass was discovered in the left upper abdominal quadrant of a 12-year-old female patient during the diagnostic workup because of chronic back pain. Blood chemistry, parasitology, and tumor markers were negative, and the patient was scheduled for laparoscopy. Intraoperatively, the cyst was found to originate from the left adrenal gland. Firm attachments between the cyst and the adrenal gland required partial adrenalectomy. The operation and the postoperative course were uneventful, and the patient was discharged on the sixth postoperative day. The histologic workup revealed a true endothelial cyst of the adrenal gland.

Discussion: In the described case, laparoscopy was found to be a safe and feasible approach allowing definitive localization of the pathology and therapy within the same session.

Key Words: Laparoscopy, Adrenal cyst, Children, Abdominal cyst

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Laparoscopic Treatment of Giant Abdominal Lymphangioma in a Child

SLS — Sun, 16 Nov 2014 21:13:33 +0000

Giulia Giannotti, MD, Giovanni Boroni, MD, Luca Giacomo Tonegatti, MD, Susanna Milianti, MD, Fabio Torri, MD, Marco Schiavo Lena, MD, Daniele Alberti, MDDepartment of Pediatric Surgery, University of Brescia, Italy (Drs. Giannotti, Boroni, Tonegatti, Milianti, Torri, Lena, Alberti).

Department of Pathological Anatomy, University of Brescia, Italy (Dr. Marco).

ABSTRACT

Giant cystic lymphangioma (GCL) is a rare benign cystic tumor. The gold standard treatment of abdominal GCL is surgical excision. Only few series of pediatric patients managed with mini-invasive surgery are reported. We describe a case of a 2-year-old girl with a GCL who was treated with laparoscopic excision with a good outcome. She was admitted to our hospital because of acute abdominal pain associated with high temperature. At physical examination, the abdomen was distended and tender. An x-ray film and ultrasonography with Doppler of the abdomen shows the presence of large amount of corpusculated fluid into the peritoneal cavity. Computed tomography showed a very large, septated, cystic abdominopelvic lesion, with the small bowel and colon displaced in the central abdomen. At laparoscopy, GCL arising from the great omentum was identified and completely removed. Histological examination confirmed the diagnosis. At 2-year follow-up, the child is doing well.

Key Words: Laparoscopy, Lymphangioma, Pediatric age.

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Polymer Surgical Clip Migration Into the Trachea of an Infant

SLS — Sun, 16 Nov 2014 20:05:11 +0000

Thomas M. Hagopian, BA, Paula J. Harmon, MD, Matthew S. Clifton, MD

Emory University School of Medicine, Atlanta, GA, USA (Hagopian). Division of Pediatric Otolaryngology, Emory University School of Medicine, Atlanta, GA, USA (Dr. Harmon). Division of Pediatric Surgery, Emory University School of Medicine, Atlanta, GA, USA (Dr. Clifton).

ABSTRACT

Introduction: Newborns with congenital esophageal atresia and a distal tracheoesophageal fistula undergo repair by several different approaches, the newest of which is thoracoscopic. The fistula is frequently occluded using a small polymer or titanium clip at the point of insertion into the trachea.

Case Description: We report the case of a 1-day-old male newborn with proximal esophageal atresia and a distal tracheoesophageal fistula who underwent thoracoscopic repair and who then presented with respiratory distress 10 weeks later. The polymer Hem-o-lok clip (Weck Surgical Instruments [Teleflex Medical], Durham, North Carolina) used to ligate the tracheoesophageal fistula eroded through the membranous trachea, causing partial airway obstruction.

Discussion: This case represents a previously unreported complication of the use of polymer clips in esophageal atresia repair. The possibility of airway obstruction after thoracoscopic repair of esophageal atresia with a tracheoesophageal fistula should raise concern among pediatric surgeons and prompt further study into the use of plastic clips for this type of procedure.

Key Words: Tracheoesophageal fistula repair, Hem-o-lok clip, Thoracoscopic repair, Clip migration

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Laparoscopic Diagnosis and Excision of a Giant Sigmoid Cystic Duplication

SLS — Sat, 15 Nov 2014 19:43:27 +0000

Mirko Bertozzi, MD, and Antonino Appignani, MD, PhDS.C. di Clinica Chirurgica Pediatrica, Universita` degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy (all authors).

ABSTRACTThe authors report a very rare case of giant duplication of sigmoid colon in a 4-year-old girl successfully diagnosed and treated with a laparoscopy-assisted technique. This case shows that laparoscopy is useful in definitive diagnosis of giant cystic masses with a preoperative undiagnosed origin. Laparoscopy-assisted treatment of these benign masses may be realized, even in difficult cases such as the one described.

Key Words: Enteric duplications, Abdominal cyst, Sigmoid colon, Pediatric age.

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Laparoscopic Ovarian Cystectomy in a Very Low–Birth Weight Preterm Newborn

SLS — Wed, 12 Nov 2014 18:41:36 +0000

Valentina Pastore, MD, Angela Basile, MD, Raffaella Cocomazzi, MD, Fabio Bartoli, MD

Pediatric Surgery Unit, University of Foggia, Foggia, Italy (all authors).

ABSTRACT

Introduction: Minimally invasive surgery is normally used in children but is not so common in newborns, especially those with very low birth weight, as a consequence of an immature cardiopulmonary system and technical difficulties.

Case Description: A preterm female with very low birth weight (1.4 kg), born in the 32nd week of gestation with a prenatal diagnosis of abdominal cyst, presented with distension of the abdomen and a palpable tension mass in the right iliac and hypochondriac region on the first day of postnatal life. Clinical investigation findings indicated a suspected simple right-side ovarian cyst measuring 5.4 8.55 8.72 cm occupying most of the abdomen. The patient’s clinical condition deteriorated quickly with respiratory distress due to the mass’s effect. The cyst was surgically aspirated, isolated, and removed by a completely laparoscopic approach. The operating time was 30 minutes, the respiratory distress resolved immediately, and the patient’s recovery was uneventful.

Discussion: Ovarian cysts are the most common ovarian lesions in newborns; they are usually simple and benign but can be complicated and symptomatic. Minimally invasive surgery is nowadays the gold standard for newborns and children with ovarian cysts, even when complications occur. Furthermore, we have shown that laparoscopy also can be used safely in distressed preterm very low–birth weight newborns without cardiorespiratory consequences, anesthetic incidents, or hypothermia.

Key Words: Ovarian cyst, VLBW, Laparoscopy.

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Laparoscopic Resection of a Colonic Venous Malformation in an Infant

SLS — Wed, 12 Nov 2014 17:30:03 +0000

Thomas Lehnert, MD, Roland Boehm, MD, Steffi Mayer, MD, Ina Sorge, MD, Thomas Richter, MD, PhD, Holger Till, MD, PhD

Department of Pediatric Surgery, University Hospital of Leipzig, Leipzig, Germany (Drs. Lehnert, Boehm, Mayer, Till). Department of Pediatric Radiology, University Hospital of Leipzig, Leipzig, Germany (Dr. Sorge). Department of Pediatrics, Hospital St. Georg, Leipzig, Germany (Dr. Richter). Department of Pediatric and Adolescent Surgery, Medical University of Graz, Austria (Dr. Till).

ABSTRACT

Introduction: Venous malformations in the bowel are extremely rare in children. A few case reports recommend the laparoscopic assisted mobilization of the lesion and conversion to an external resection and anastomosis. However, in infants with large tumors of the descending and sigmoid colon, this strategy would require a laparotomy.

Case Description/Technique Description: A 2-year-old girl presented with painless rectal bleeding and anemia. Ultrasonography and magnetic resonance imaging (MRI) revealed a 5 3 3-cm angiodysplastic lesion of the distal bowel. Colonoscopy verified a vascular malformation of the sigmoid with exophytic growth. Performing a 4-port laparoscopy (3–5 mm), we identified the lesion along with grossly distended blood vessels in the sigmoid colon. After hitching it to the anterior abdominal wall, we carefully mobilized the lesion. To avoid a laparotomy of equivalent size or significant bleeding during externalization, the mass was resected laparoscopically using the LigaSure device (Covidien, Mansfield, Massachusetts). Finally an all-in laparoscopic anastomosis was fashioned (4–0 Vicryl, interrupted stitches; Ethicon, Somerville, New Jersey). The inspection of both remaining colonic margins showed no macroscopic evidence of the disease. The specimen was placed in a bag and morcellated with forceps through one slightly extended port site until it could be extracted. Operative time was 269 minutes. Histology described a venous malformation. The postoperative course was uneventful, and after a follow-up of more than 1.5 years, the girl remains free of symptoms.

Conclusion: An all-in laparoscopic resection of a vascular malformation of the colon can be performed successfully and with excellent cosmetic results in children and even infants.

Key Words: Laparoscopy, colonic resection, venous malformation, infant, child.

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