Pediatric Surgery International最新文献

{"title":"Prospective microvessel density profiling across severity of hypospadias: understanding preputial tissue angiogenic deficit and the impact of preoperative testosterone stimulation.","authors":"Vikesh Agrawal, Ramesh Babu, Leena Dennis Joseph, Pawan Agarwal, P S Muthu Subramanian, Neeta Bhatiya, Rohit Harchandani","doi":"10.1007/s00383-026-06638-6","DOIUrl":"10.1007/s00383-026-06638-6","url":null,"abstract":"<p><strong>Background: </strong>Vascular adequacy of preputial tissue is a critical determinant of successful hypospadias repair. Previous studies have suggested reduced microvessel density (MVD) in hypospadias, but evidence is limited by heterogeneity and lack of standardized prospective data. This study aimed to evaluate MVD across hypospadias severity and assess the impact of preoperative testosterone stimulation.</p><p><strong>Methods: </strong>A prospective observational study was conducted including children with distal and proximal hypospadias along with controls. Standardized dorsal preputial biopsies were analyzed using CD34 immunohistochemistry. MVD was quantified as vessels per high-power field (HPF). Proximal cases were analyzed separately based on testosterone exposure. Non-parametric statistical comparisons were performed between groups.</p><p><strong>Results: </strong>MVD demonstrated a stepwise decline from control (45.4 ± 4.3 vessels/HPF) to distal (33.1 ± 7.4) and proximal hypospadias without testosterone (12.5 ± 3.7) (p < 0.0001). Testosterone significantly increased MVD in proximal cases (45.7 ± 10.8), restoring values to near-control levels (p = 0.48). Skin necrosis occurred in 6 cases and was associated with significantly lower MVD (12.2 ± 2.3 vs. 27.1 ± 3.2, p < 0.05). Three such cases progressed to urethrocutaneous fistula.</p><p><strong>Conclusion: </strong>Hypospadias is associated with a severity-dependent angiogenic deficit, most pronounced in proximal cases. Preoperative testosterone significantly enhances MVD, suggesting a modifiable microvascular component. Reduced MVD correlates with adverse outcomes, supporting its potential role as a predictive biomarker to reduce morbidity. Further longitudinal studies correlating MVD with surgical outcomes are warranted.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of peritoneal fluid culture findings on postoperative outcomes in pediatric patients with complicated appendicitis.","authors":"Wataru Kudo, Tetsuya Mitsunaga, Shugo Komatsu, Satoru Oita, Yunosuke Kawaguchi, Katsuhiro Nishimura, Genta Ozeki, Tomoro Hishiki","doi":"10.1007/s00383-026-06624-y","DOIUrl":"10.1007/s00383-026-06624-y","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative peritoneal cultures for pediatric complicated appendicitis (CA) are important for informing postoperative antibiotic strategies. However, the specific impact of individual bacterial species remains unclear. In this study, we aimed to elucidate the association between peritoneal fluid culture findings and postoperative length of stay.</p><p><strong>Methods: </strong>We reviewed the cases of 63 pediatric patients with CA, treated with appendectomy between 2018 and 2025, with peritoneal fluid samples submitted for bacterial culture. We extracted clinical data from medical records retrospectively and performed regression analyses to identify postoperative hospitalization-associated factors.</p><p><strong>Results: </strong>Among the 63 patients, bacterial growth was observed in 46 (73.0%). Univariable analysis revealed significant associations between postoperative stay and C-reactive protein levels, perforation, and the number of detected bacteria. Specifically, Prevotella nigrescens, Escherichia coli, Parvimonas micra, and Streptococcus anginosus were associated with prolonged hospitalization. Among these, only P. nigrescens was not significantly associated with C-reactive protein levels, perforation, or number of detected bacteria, whereas the other 3 bacteria exhibited significant associations across certain parameters.</p><p><strong>Conclusion: </strong>Peritoneal fluid culture findings are associated with postoperative hospitalization in pediatric CA. Specific bacterial species may be associated with variations in postoperative outcomes.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The surgical outcomes and educational value of three laparoscopic approaches for pediatric appendectomy performed by surgical residents rotating through pediatric surgery and pediatric surgery fellow training programs: a two-institution retrospective study.","authors":"Lynne Takada, Toshio Harumatsu, Koshiro Sugita, Ayaka Nagano, Yumiko Tabata, Yumiko Iwamoto, Masato Ogata, Nanako Nishida, Chihiro Kedoin, Yudai Tsuruno, Masakazu Murakami, Keisuke Yano, Shun Onishi, Koji Yamada, Waka Yamada, Takafumi Kawano, Motofumi Torikai, Satoshi Ieiri","doi":"10.1007/s00383-026-06643-9","DOIUrl":"10.1007/s00383-026-06643-9","url":null,"abstract":"<p><strong>Purpose: </strong>Laparoscopic appendectomy (LA) is the ideal initial laparoscopic procedure for surgical residents, but the comparative educational value of conventional three-port LA (CTPLA), transumbilical laparoscopy-assisted appendectomy (TULAA), and two-site LA (TSLA) remains unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed 372 pediatric patients who underwent LA at two institutions between 2016 and 2024. The cases were stratified by technique and appendicitis severity (simple, n = 217; complicated, n = 155). The physicians were classified into the junior residents/surgical residents' group (JR/SR group; n = 55) or the pediatric surgery fellow group (PSF group; n = 317).</p><p><strong>Results: </strong>In simple appendicitis, TULAA demonstrated a shorter operative time (62.0 min) than TSLA (85.0 min; p < 0.001) and a shorter pneumoperitoneum time than both other approaches (p < 0.001). Similar advantages were observed in patients with complicated appendicitis. The postoperative hospital stay was shorter with TULAA and CTPLA than with TSLA in simple appendicitis (4.0 vs. 5.0days; p < 0.001). The perioperative complication rates were comparable. TULAA operative time was significantly influenced by surgeon experience (JR/SR group: 94.0 vs. PSF group: 59.5 min; p = 0.005), whereas TSLA was experience-independent (p = 0.983).</p><p><strong>Conclusion: </strong>TULAA offers optimal operative efficiency for early resident training. The sequential progression from TULAA to CTPLA to TSLA provides a data-driven framework for structured laparoscopic training in pediatric surgery.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biotube/Biosheet as a collagen-based scaffold for vaginal reconstruction: evaluation in a rat model.","authors":"Takaaki Sakai, Yasuhide Nakayama, Kyoko Matsuki, Satoshi Umeda, Yuko Tazuke, Takaharu Oue","doi":"10.1007/s00383-026-06617-x","DOIUrl":"10.1007/s00383-026-06617-x","url":null,"abstract":"<p><strong>Purpose: </strong>Biotube/Biosheet, collagenous tissue membranes generated by in-body tissue architecture, have been used as scaffolds in various tissue engineering applications. However, their use in vaginal reconstruction has not been reported. This study aimed to evaluate the biocompatibility and potential utility of Biotube/Biosheet as scaffolds for vaginal reconstruction in a rat model.</p><p><strong>Methods: </strong>A cylindrical mold was implanted subcutaneously on the backs of rats to generate Biotube/Biosheet. Two models were established: a partial defect of the posterior vaginal wall and a complete circumferential implantation. In each model, trimmed Biotube/Biosheet was sutured into place. Rats were euthanized 4 to 14 days after surgery for macroscopic and histological evaluation.</p><p><strong>Results: </strong>An epithelial extension from the residual vagina along the luminal surface of the Biotube/Biosheet was observed and eventually reached the vaginal orifice, resulting in complete mucosal coverage. The Biotube/Biosheet was gradually infiltrated and replaced by granulation tissue, and muscular tissue extended toward the vaginal orifice. No neutrophil or lymphocyte infiltration suggestive of acute rejection was detected.</p><p><strong>Conclusion: </strong>Biotube/Biosheet shows promise as a scaffold for vaginal reconstruction. Long-term follow-up studies are needed to determine whether it is fully replaced by normal vaginal tissue and whether the reconstructed vagina can support pregnancy and childbirth.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of atelocollagen implant therapy for a rabbit model of acquired tracheomalacia following tracheostomy.","authors":"Juma Obayashi, Junki Koike, Kanji Otsubo, Koji Kojima, Shigeyuki Furuta","doi":"10.1007/s00383-026-06618-w","DOIUrl":"10.1007/s00383-026-06618-w","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated whether local atelocollagen gel administration prevented airway collapse in a rabbit model of acquired tracheomalacia after tracheostomy.</p><p><strong>Methods: </strong>Japanese white rabbits (≥ 20 weeks) underwent anterior resection of the second-fourth tracheal rings with mucosal preservation. Group A received 1 mL of 3% atelocollagen around the trachea, whereas Group B was untreated. Bronchoscopy was performed preoperatively (Term 1), immediately postoperatively (Term 2), and 3-4 months postoperatively (Term 3). The tracheal lumen area was measured using negative-pressure suction.</p><p><strong>Results: </strong>Six of seven rabbits in Group A and five of six rabbits in Group B survived. At 30 cmHg, lumen area (%) in Group A was 90.1 ± 19.9 (Term 1), 48.0 ± 40.4 (Term 2), and 69.0 ± 50.3 (Term 3), versus 99.4 ± 7.8, 53.4 ± 20.0, and 15.0 ± 18.8 in Group B. No differences were observed at Terms 1 or 2. At Term 3, lumen area decreased with increasing suction in Group B but was relatively preserved in Group A. Lumen area ≥ 50% at 30 cmHg was observed in 4/6 (66.7%) in Group A and 0/5 (0%) in Group B.</p><p><strong>Conclusion: </strong>Local atelocollagen administration may attenuate airway collapse in tracheomalacia at 3-4 months.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A study of the learning curve for laparoscopic Nissen fundoplication procedure, focusing on operative times using cumulative sum (CUSUM) method and multiple regression analysis for patients with neuromuscular disease.","authors":"Kazuo Oshima, Kazuki Yokota, Shuichi Tanaka, Junko Mouri, Jumpei Shibata, Norihiro Niimi","doi":"10.1007/s00383-026-06628-8","DOIUrl":"10.1007/s00383-026-06628-8","url":null,"abstract":"<p><strong>Purpose: </strong>The number of cases necessary to achieve proficiency in laparoscopic Nissen fundoplication (Lap-Nissen) remains unclear. We analyzed operative times using the cumulative sum (CUSUM) method to construct learning curves and estimate the required case volume.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent Lap-Nissen at our institution beginning in October 2008. Learning curves for each surgeon were constructed using CUSUM analysis and divided into three phases (I-III) by piecewise linear regression.</p><p><strong>Results: </strong>A total of 109 cases were analyzed. For surgeon A (n = 46), the mean operative time decreased across phases I (cases 1-8, 299.4 min), II (9-32, 217.7 min), and III (33-46, 179.6 min). Similar trends were observed for surgeon B (n = 42): I (1-5, 328.2 min), II (6-30, 204.4 min), and III (31-42, 179.5 min). Surgeon C (n = 14) delivered no clear learning curve, and surgeons D-F were excluded due to low case numbers. Multiple regression analysis identified the surgeons' experience as the strongest factor associated with operative time (β = - 0.53, p < 0.001).</p><p><strong>Conclusion: </strong>Phase I comprised approximately five cases, while phase II included more than 30 cases. Larger multicenter prospective studies are warranted.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric peripheral vascular surgical interventions: a 13-year single-center experience.","authors":"Kenan Öztürker, Fatih Tomrukçu, Abdullah Arif Yılmaz, Babürhan Özbek, Eylem Tunçer","doi":"10.1007/s00383-026-06637-7","DOIUrl":"10.1007/s00383-026-06637-7","url":null,"abstract":"<p><strong>Background: </strong>Pediatric peripheral vascular surgical pathology is uncommon, and published experience remains limited to small institutional series or trauma-focused cohorts. We aimed to evaluate the indications, anatomic distribution, operative strategies, and 30-day outcomes of pediatric peripheral vascular surgical interventions performed at our center over a 13-year period.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included all consecutive patients younger than 18 years who underwent peripheral vascular surgical intervention between January 2012 and December 2024 at a tertiary pediatric cardiovascular referral center. Demographic characteristics, etiology, anatomic site, type of vascular involvement, operative techniques, and early outcomes were analyzed. Patients were stratified into 3 age groups: infants (0-2 years), children (3-12 years), and adolescents (> 12 to < 18 years).</p><p><strong>Results: </strong>A total of 60 patients were included: 14 infants (23.3%), 16 children (26.7%), and 30 adolescents (50.0%). Trauma was the most common etiology overall (36/60, 60.0%), followed by iatrogenic lesions (18/60, 30.0%) and congenital vascular lesions (6/60, 10.0%). Marked age-related differences were observed: infants were predominantly affected by iatrogenic lesions (12/14, 85.7%), whereas trauma predominated in adolescents (27/30, 90.0%). The upper extremity was the most frequently involved anatomic region overall (37/60, 61.7%), followed by the lower extremity (21/60, 35.0%) and cervical vessels (2/60, 3.3%). Arterial lesions were most common (40/60, 66.7%). The most frequently performed procedures were primary repair or end-to-end anastomosis (23/60, 38.3%), embolectomy (12/60, 20.0%), ligation (10/60, 16.7%), and autologous saphenous vein interposition grafting (8/60, 13.3%). All patients completed the 30-day clinical and Doppler ultrasonographic assessment. There was no 30-day mortality, major amputation, vascular reintervention, or clinically evident ischemic complication.</p><p><strong>Conclusions: </strong>In this surgically selected cohort, favorable 30-day outcomes were observed following pediatric peripheral vascular surgical interventions, with no mortality, major amputation, or clinically evident ischemic complication. Etiologic patterns differed descriptively across age groups: trauma predominated overall and among adolescents, whereas iatrogenic lesions were most frequent among patients aged 0-2 years. These findings may support age-specific clinical awareness, individualized decision-making, and timely referral to specialized multidisciplinary centers. Multicenter studies with standardized long-term follow-up are needed to assess late vascular patency, growth-related changes in vascular reconstructions, and functional outcomes.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative predictors for endoscopic Deflux injection therapy for vesicoureteral reflux: a single-center experience during 10 years.","authors":"Michiaki Ikegami, Nana Nakazawa-Tanaka, Shuko Nojiri, Risa Masuda, Takafumi Mikami, Junya Ishii, Ryo Sueyoshi, Go Miyano, Tadaharu Okazaki","doi":"10.1007/s00383-026-06629-7","DOIUrl":"10.1007/s00383-026-06629-7","url":null,"abstract":"<p><strong>Purpose: </strong>We conducted an analysis to identify preoperative predictors of vesicoureteral reflux (VUR) correction following endoscopic Deflux injection (EDI).</p><p><strong>Methods: </strong>We retrospectively reviewed 109 patients with primary VUR (173 renal units) aged < 16 years who underwent EDI between 2016 and 2025. If grade II-V VUR persisted on postoperative voiding cystoureterography, injections were repeated up to two additional times. Preoperative variables included constipation, renal scarring, and VUR grade.</p><p><strong>Results: </strong>VUR was corrected in 86 units (49.7%) after the first injection and in 152 (87.9%) after up to three injections. Univariable analysis showed that high-grade VUR, renal scarring, and constipation were associated with failure after the first injection, whereas only constipation was associated with failure after up to three injections. Multivariable analysis identified high-grade VUR, renal scarring and constipation as independent risk factors for failure of the first injection. These associations persisted even after exclusion of clinically evident bladder and bowel dysfunction (BBD).</p><p><strong>Conclusions: </strong>Constipation was an independent risk factor for failure after the first injection and remained associated with failure after repeated injections, even after exclusion of clinically evident BBD. It may serve as a clinically relevant and easily assessable predictor, particularly in young children in whom bladder function is difficult to assess.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of vascular proximity metrics on preoperative CT imaging in pediatric retroperitoneal teratoma.","authors":"Masahiro Fukuhara, Naonori Kawakubo, Amane Kamouchi, Yoshiki Yamaguchi, Kenta Ishimoto, Yuko Hino, Junnosuke Maniwa, Yukihiro Toriigahara, Yoshiaki Takahashi, Atsuhisa Fukuta, Koichiro Yoshimaru, Kouji Nagata, Junko Miyata, Toshiharu Matsuura, Tatsuro Tajiri","doi":"10.1007/s00383-026-06623-z","DOIUrl":"10.1007/s00383-026-06623-z","url":null,"abstract":"<p><strong>Purpose: </strong>We identified quantitative cutoff values for CT-based vascular proximity metrics and evaluated their associations with intraoperative complications and extent of resection.</p><p><strong>Methods: </strong>We reviewed the records of 20 children who underwent retroperitoneal teratoma resection between 2005 and 2025. Using contrast-enhanced CT, we measured tumor-vessel contact length, counted the number of contacted major vessels, and assigned a vascular deformation score from 0 to 2.</p><p><strong>Results: </strong>Intraoperative complications occurred in seven patients (35%). The contacted vessel count was significantly higher in patients with complications (p = 0.015), and contact length showed a similar trend (p = 0.056). Receiver operating characteristic analysis demonstrated good discrimination for contacted vessel count (AUC 0.838; cutoff 3) and contact length (AUC 0.769; cutoff 58.8 mm). Complication rates were highest when the contacted vessel count was ≥ 3 and contact length was ≥ 60 mm. Complete resection was achieved in 15 patients (75%), and subtotal resection was associated with a higher vascular deformation score (p = 0.029).</p><p><strong>Conclusion: </strong>Preoperative CT-based vascular proximity assessment helped estimate surgical difficulty in pediatric retroperitoneal teratoma. A contacted vessel count ≥ 3 and contact length ≥ 60 mm indicated higher complication risk, whereas a higher vascular deformation score was associated with subtotal resection.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of diagnostic indicators using normalized CT attenuation values of the ovarian wall in contrast-enhanced CT for pediatric ovarian tumor torsion.","authors":"Michiko Ueda, Naonori Kawakubo, Junnosuke Maniwa, Yukihiro Toriigahara, Takuya Kondo, Yoshiaki Takahashi, Atsuhisa Fukuta, Koichiro Yoshimaru, Kouji Nagata, Junko Miyata, Toshiharu Matsuura, Tatsuro Tajiri","doi":"10.1007/s00383-026-06619-9","DOIUrl":"10.1007/s00383-026-06619-9","url":null,"abstract":"<p><strong>Purpose: </strong>Pediatric ovarian tumor torsion often presents with nonspecific symptoms, and delayed diagnosis can lead to ovarian necrosis. Although contrast-enhanced CT is frequently used, objective quantitative indicators have not been established. This study evaluated normalized ovarian wall CT attenuation (n-OWA) and a combined index incorporating white blood cell count (WBC).</p><p><strong>Methods: </strong>Among 82 patients with surgically-treated ovarian tumor, 52 who underwent contrast-enhanced CT (15 with torsion and 37 without torsion) were analyzed. The n-OWA was calculated as the ovarian wall CT attenuation divided by the inferior vena cava attenuation. The WBC/n-OWA ratio was also evaluated. Group comparisons were performed using the Wilcoxon test, and diagnostic performance was evaluated by an ROC analysis.</p><p><strong>Results: </strong>The n-OWA was significantly lower in the torsion group (0.25 vs. 0.31, p = 0.02), with an AUC of 0.71. The WBC/n-OWA ratio was significantly higher in the torsion group (44.8 vs. 19.9, p < 0.01) and showed improved diagnostic performance with an AUC of 0.86. At a cutoff of 25.4, the sensitivity and specificity were 1.00 and 0.70, respectively.</p><p><strong>Conclusions: </strong>The n-OWA is an objective imaging biomarker for pediatric ovarian torsion. The WBC/n-OWA ratio may further improve diagnostic accuracy, particularly for excluding ovarian torsion.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}