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

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/12/2014.00236.pdf”]

The post Laparoscopic Approach to a Unilateral Adrenal Cyst in a Pediatric Patient first appeared on JSLS.

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.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00057-.pdf”]

The post Laparoscopic Resection of a Colonic Venous Malformation in an Infant first appeared on JSLS.