Cecal volvulus associated with mobile cecum in Cornelia de Lange syndrome: Report of a case

We report a case of cecal volvulus in an 11-year-old girl who had been diagnosed with Cornelia de Lange syndrome. She had undergone operative fundoplication several years earlier and was referred to our institute for treatment of intestinal obstruction. A severely dilated colon was detected on abdominal roentgenogram, and abdominal CT and colonic enema strongly suggested cecal volvulus. Emergency operation was performed and cecal volvulus with mobile cecum was ascertained;the volvulus was corrected and the mobile cecum was fixed to the peritoneum on the right side. Neurologically handicapped patients sometimes suffer from cecal volvulus, and patients with Cornelia de Lange syndrome are at especially high risk. Moreover, operative fundoplication promotes intestinal dilatation and it may be another risk factor for cecal volvulus.

Cases of pediatric intra-abdominal solid organ injury induced by blunt trauma experienced over a 15-year period at two centers in Japan

Objective The present study attempts to clarify the clinical features of pediatric intra-abdominal solid organ injury at two institutions.Methods The injured organ,patient age,sex,injury grade,imaging findings,intervention,length of hospital stay,and complications were retrospectively reviewed using medical records at two centers from 2007 to 2021.Results There were 25 cases of liver injury,9 of splenic injury,8 of pancreatic injury,and 5 of renal injury.The mean age of all patients was 8.6±3.8 years old,with no difference between organ injury types.Radiological intervention was performed in four cases of liver injury(16.0%)and one case of splenic injury(11.1%),and surgery was performed in two cases of liver injury(8.0%)and three cases of pancreatic injury(37.5%).All other cases were treated conservatively.Complications included adhesive ileus in one case of liver injury(4.0%),splenic atrophy in one case of splenic injury(11.1%),pseudocysts in three cases of pancreatic injury(37.5%),atrophy of the pancreatic parenchyma in one case of pancreatic injury(12.5%),and urinoma in one case of renal injury(20.0%).No mortalities were observed.Conclusion Pediatric patients with blunt trauma had favorable outcomes at two pediatric trauma centers covering a broad medical area,including remote islands.

Analysis of the risk of ovarian torsion in 49 consecutive pediatric patients treated at a single institution

Purpose An early diagnosis of ovarian torsion is sometimes difficult due to variable clinical symptoms and non-specific imaging findings.We retrospectively reviewed patients with pediatric ovarian masses manifesting torsion.Methods Fifty-eight ovarian masses(55 episodes)in 49 non-neonatal patients treated from April 1984 to March 2017 were retrospectively analyzed.The Mann-Whitney U test and Fisher’s exact test were used for the statistical analysis.results The median age of these 55 episodes was 10.5 years old(range 1.0-23.0).Thirty-three patients presented with abdominal pain.Forty-five tumors and 13 cystic masses were resected and diagnosed pathologically(50 benign and 8 malignant).Torsion was identified in 15 cases(25.9%)at operation.The torsion masses were all benign,and 8 ovaries(53.3%)were successfully preserved.Comparing the torsion cases with the non-torsion cases,only the white cell count was significantly higher in the torsion cases(p=0.0133)and in the patients presented with abdominal pain(p=0.0068).The duration of abdominal pain was significantly shorter in ovary preserved cases than in oophorectomy cases.Conclusion The white blood cell may be a helpful indicator of the presence of torsion as well as the need for surgery.