Journal of Pediatric Surgery Case Reports最新文献

{"title":"Trans-umbilical management of OHVIRA syndrome by a thoracic trocar technique: A case report","authors":"Husam Ibrahimoglu,&nbsp;Ibrahim Uygun","doi":"10.1016/j.epsc.2024.102933","DOIUrl":"10.1016/j.epsc.2024.102933","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical atresia in cases of obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is rare. To prevent complications that may occur due to the association of cervical atresia with OHVIRA syndrome, a left hemihysterectomy and salpingectomy is occasionally needed.</div></div><div><h3>Case presentation</h3><div>A 14-year-old female was referred to us due to abdominal pain. She had never experienced menstrual pain until three periods preceding her presentation. Abdominal ultrasound (US) showed that the left horn of the uterus was hypoplastic and compatible with hematosalpinx. Computerized tomography (CT) of the abdomen showed a 3-cm left endometrial cavity, and an 8-cm septated lesion in the left adnexa. The left ovary could not be visualized. Magnetic resonance (MR) revealed uterus didelphys and a 6–8 cm septated lesion in the left adnexa. The left kidney was not present. The left cervix was absent. Based on these findings, OHVIRA syndrome was diagnosed. She was taken to the operating room for a hysteroscopy, which showed a single cervix, normal uterine mucosa, and a single tubal ostium. No septum was seen in the vagina. She then underwent a laparoscopy, which revealed uterus didelphys, widespread endometriosis, a large left hematosalpinx, left tubal torsion, no left ovary, and a normal right ovary. We proceeded with a left hemihysterectomy and salpingectomy using a transumbilical single-incision approach. The foci of endometriosis were suctioned and the specimen retrieved through the umbilical incision. She recovered well from the operation and was discharged home 5 days later.</div></div><div><h3>Conclusion</h3><div>OHVIRA syndrome should be suspected in patients with renal agenesis and an ipsilateral adnexal mass. Patients with OHVIRA and cervical atresia may need a left hemihysterectomy and salpingectomy, which can be done through a transumbilical single-incision approach.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102933"},"PeriodicalIF":0.2,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common bile duct cysts in neonates, not always a choledochal cyst: A case report","authors":"Josephine Issenman ,&nbsp;Kathryn Martin","doi":"10.1016/j.epsc.2024.102928","DOIUrl":"10.1016/j.epsc.2024.102928","url":null,"abstract":"<div><h3>Introduction</h3><div>Obstructive jaundice in neonates results from disruption of bile drainage from the liver, which may be related to several conditions. Differentiating between these conditions and intervening rapidly is critical, as the success of treatment for biliary atresia decreases as the infant ages.</div></div><div><h3>Case presentation</h3><div>A 10-week-old term female born at 39 weeks of gestation was brought to the gastroenterology service to assess persistent jaundice. The jaundice was first noted by the patient's mother and pediatrician at 2 weeks of age and was thought to be physiologic. The stool during this period was reported to be normal in color. Laboratory investigations revealed obstructive jaundice (total bilirubin of 9.6 mg/dL; direct bilirubin of 5.6 mg/dL). Imaging demonstrated a cystic dilation of the common bile duct, concurrent dilation of the right hepatic duct, and no visible gallbladder. Given the ultrasound findings and parental report of normally colored stools, the diagnosis of an obstructed choledochal cyst was favored. However, due to the absence of a gallbladder, we obtained a magnetic cholangiography. The findings were similar, and with a presumed diagnosis of a type IV choledochal cyst the patient was taken to the operating room at the age of 91 days. A cystic dilatation of the common bile duct was found, with no distal duct. The structure identified as the right hepatic duct on imaging was found to be an atretic gallbladder. An intraoperative cholangiogram confirmed the diagnosis of cystic biliary atresia, and a Kasai portoenterostomy with Roux-en-Y reconstruction was performed. Postoperatively the hyperbilirubinemia resolved, but her liver function has gradually deteriorated, and she has been referred for a liver transplant.</div></div><div><h3>Conclusion</h3><div>Biliary atresia can present with symptoms and imaging findings that mimic choledochal cysts. Given that the treatment and prognosis of these conditions vary, persistent neonatal jaundice must be worked up expeditiously, and a high index of suspicion for biliary atresia must be maintained.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102928"},"PeriodicalIF":0.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous enterocutaneous fistula in a neonate: A case report","authors":"Yirgalem Teklebirhan Gebreziher ,&nbsp;Yoseph Equar Assefa ,&nbsp;Hadush Tesfay Negash ,&nbsp;Fekrey berhe Gebru","doi":"10.1016/j.epsc.2024.102929","DOIUrl":"10.1016/j.epsc.2024.102929","url":null,"abstract":"<div><h3>Introduction</h3><div>Spontaneous enterocutaneous fistulas (ECF) are extremely rare in children. To our knowledge, only two cases have been reported in the literature.</div></div><div><h3>Case presentation</h3><div>A male born vaginally at 34 weeks of gestation was referred to our hospital at 11 days of life due to a 4-day history of feculent discharge from a right upper quadrant wound. His birth weight was 1.6 kg, and his Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. He had a black blister in the right upper quadrant of the abdomen at birth, which started to ulcerate and increase in size in the following days. He was initially treated with intravenous antibiotics and wound care. On day of life 7, the wound began discharging feculent material. On arrival, his vital signs were within normal limits. A 4 × 4 cm ulcerated wound was noted in the right upper quadrant of the abdomen, with two separate fistula sites, consistent with ECF. The rest of the examination was unremarkable. Abdominal X-ray was normal. The patient was taken to the operating room for an abdominal exploration, which was done through a supraumbilical transverse laparotomy separate from the area of the ECF. We found a 0.5 × 0.5 cm perforation on the hepatic flexure of the colon and a large perforation in the ileum, 40 cm proximal to the ileocecal valve. The colonic perforation was primarily repaired, the perforated ileal segment was resected, and the intestinal continuity restored with an end-to-end anastomosis. The postoperative recovery was uneventful, and he was discharged on the sixth postoperative day. Histopathological examination of the resected bowel revealed normal bowel mucosa, with no evidence of ectopic gastric or pancreatic tissue.</div></div><div><h3>Conclusion</h3><div>Spontaneous ECF is an uncommon occurrence in neonates and children. Early surgical intervention is an effective management approach.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102929"},"PeriodicalIF":0.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory myofibroblastic tumor of the sigmoid colon: A case report","authors":"Suleiman Ayalew ,&nbsp;Michael A. Negussie ,&nbsp;Messay Gebrekidan ,&nbsp;Dinksira Bekele Deneke ,&nbsp;Mulat Asrade Alemayehu ,&nbsp;Mesfin Tesera Wassie","doi":"10.1016/j.epsc.2024.102927","DOIUrl":"10.1016/j.epsc.2024.102927","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammatory myofibroblastic tumors (IMTs) are rare tumors primarily affecting children and young adults. IMT of the sigmoid colon is particularly rare, with very few cases reported in the literature.</div></div><div><h3>Case presentation</h3><div>A 2-year-old boy presented with a three-month history of painless, progressive abdominal swelling that began in the right lower abdomen and extended across to the left. He also experienced significant weight loss and reduced appetite, though there were no symptoms of nausea, vomiting, diarrhea, constipation, or rectal bleeding. On examination, a 10 cm firm, non-tender, and non-mobile mass was noted in the right lower quadrant and hypogastric region. No other abnormalities were detected. Laboratory results revealed severe anemia (hemoglobin: 6.1 g/dL) and elevated white blood cell (17,400/μL) and platelet (965,000/μL) counts. An abdominal ultrasound showed a large mass with associated lymphadenopathy, prompting further evaluation with contrast-enhanced CT. The scan revealed an avidly enhancing mesenteric mass near the superior mesenteric artery with minimal ascites and inguinal lymphadenopathy. The patient underwent laparotomy, during which a highly vascular mass originating from the sigmoid colon was resected, followed by colocolic anastomosis. Histopathological examination identified an intermediate-grade inflammatory myofibroblastic tumor with focal mucosal infiltration. Immunohistochemical staining confirmed the diagnosis, showing positivity for vimentin, smooth muscle actin, and focal desmin. Postoperatively, the patient recovered well, tolerated oral intake by day three, and was discharged on day six after a blood transfusion. At follow-up, he remained asymptomatic, with no recurrence on ultrasound and normalized hemoglobin levels.</div></div><div><h3>Conclusion</h3><div>IMT can occur in the gastrointestinal tract in children. Complete surgical resection is curative.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102927"},"PeriodicalIF":0.2,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D-printed model for surgical planning in congenital porto-systemic shunt: A case report","authors":"Sergio Assia-Zamora,&nbsp;Miriam Cortés-Cerisuelo,&nbsp;Athanasios Tyraskis,&nbsp;Nigel Heaton","doi":"10.1016/j.epsc.2024.102926","DOIUrl":"10.1016/j.epsc.2024.102926","url":null,"abstract":"<div><h3>Introduction</h3><div>Hepatobiliary surgery can be challenging due to the complex nature of variations in liver anatomy, particularly in small children. Congenital portosystemic shunts (CPS – Abernethy syndrome) are increasingly recognized with a range of clinical presentations and associated complications and can present anatomical challenges for operative shunt closure. Three-dimensional printing (3DP) has gained popularity due to its ability to produce accurate models with the specific anatomical characteristics for the individual patient. We used a 3DP model from original image sources for planning of surgical shunt closure in a child with CPS and for educating the family and surgical team preoperatively.</div></div><div><h3>Case presentation</h3><div>A 5-year-old male with autism and hyperammonemia of 80 μmol/L and was found to have an intrahepatic CPS. No tumors were seen within the liver. Physical examination was unremarkable. After treatment with Rifaximin to lower blood ammonia levels, his ability to concentrate and achieve milestones improved. Angiography with shunt occlusion showed an intrahepatic shunt between the left portal and the middle hepatic vein into the IVC<em>.</em> Intrahepatic portal branches were demonstrated with the implication that a one stage closure could be performed. A 3DP model was printed from the cross sectional imaging which allowed for more detailed planning of shunt ligation and to explain the surgical details to the parents<em>.</em> Surgical closure was performed with no complications.</div></div><div><h3>Conclusion</h3><div>3DP models can be a useful tool for planning complex congenital porto-systemic shunt closure surgery.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102926"},"PeriodicalIF":0.2,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spigelian hernia diagnosed in a newborn: A case report","authors":"Nicole Chicoine ,&nbsp;Frederick Rescorla","doi":"10.1016/j.epsc.2024.102922","DOIUrl":"10.1016/j.epsc.2024.102922","url":null,"abstract":"<div><h3>Introduction</h3><div>Spigelian hernias represent only 0.1–0.2 % of all abdominal wall hernias and are infrequently encountered in pediatric patients. Limited literature surrounding pediatric Spigelian hernias exists, and there is no uniform or optimal surgical repair technique.</div></div><div><h3>Case presentation</h3><div>A term female with unremarkable prenatal history presented a left-sided Spigelian hernia at birth that contained loops of bowel, by physical examination and ultrasound. The hernia was easily reducible, so she was discharged with a plan for an elective repair at a later point. At 8 months of age, she underwent an abdominal wall ultrasound that showed a defect of 6 cm in length. She underwent elective repair at 9 months of age due to parental preference in the setting of an enlarging defect size. The hernia repair was done through a combination of laparoscopic and open techniques. The laparoscopy part, which consisted in one port placed in the umbilicus for a camera, enabled visualization of the suspected hernia site, confirm the proper approximation of the lateral and medial borders of the hernia, and helped avoid any intra-abdominal injuries during the repair. The repair itself was completed in an open manner with interrupted sutures in a top to bottom approach, in a transverse orientation. The patient recovered well from the operation. At 1 year of follow up she has shown no signs of recurrence.</div></div><div><h3>Conclusion</h3><div>Congenital pediatric Spigelian hernias can be successfully repaired using a combination of laparoscopy and open approach. The addition of a laparoscopy allows proper visualization of the intra-abdominal side of the repair.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102922"},"PeriodicalIF":0.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142705153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapidly progressing necrotizing fasciitis with chickenpox infection: A case series","authors":"Fereshteh Moshfegh ,&nbsp;Zahra Hosseinzade ,&nbsp;Seyed Hamid Salehi ,&nbsp;Mohammad Javanbakht ,&nbsp;Ali Manafi Anari ,&nbsp;Behnam Sobouti","doi":"10.1016/j.epsc.2024.102925","DOIUrl":"10.1016/j.epsc.2024.102925","url":null,"abstract":"<div><h3>Introduction</h3><div>Varicella usually resolves without complications. However, there is a risk of necrotizing soft tissue infections such as necrotizing fasciitis (NF) that can complicate the management.</div></div><div><h3>Case series</h3><div>Case 1 was a 5-year-old male who developed widespread vesicular lesions and fever, diagnosed as varicella. His condition worsened as he presented with abdominal distension and pain, leading to hospitalization for suspected toxic shock syndrome. Computed tomography (CT) of the chest and abdomen revealed features consistent with NF, prompting extensive debridement and subsequent vacuum-assisted closure (VAC) therapy. After several surgical revisions he underwent skin grafting and was eventually discharged home. Case 2 was a 4.5-year-old male with no significant medical history, who presented with generalized fever, neck pain, and rapidly spreading skin rashes. He subsequently developed severe acute idiopathic scrotal edema and extensive ecchymosis, requiring immediate hospitalization. Broad-spectrum antibiotics were started. He underwent emergent wide debridement of the ecchymotic areas. The pathology analysis confirmed necrotic tissue, and cultures were positive for bacteria and fungi. He underwent repeated debridement. The last debridement was followed by uncontrollable hemorrhage, and he passed away.</div></div><div><h3>Conclusion</h3><div>While varicella is generally a mild disease, life-threatening complications such as necrotizing fasciitis can occur.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102925"},"PeriodicalIF":0.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent spontaneous gastric perforations in a neonate with renal tubular dysgenesis: A case report","authors":"Mashael AlSiddiqi ,&nbsp;Safaa Najar ,&nbsp;Sami Taha ,&nbsp;Hassan Baghazal ,&nbsp;Noora Alshahwani","doi":"10.1016/j.epsc.2024.102923","DOIUrl":"10.1016/j.epsc.2024.102923","url":null,"abstract":"<div><h3>Introduction</h3><div>Neonatal gastric perforation (NGP) is a very rare, life-threatening condition. Management can be complicated in patients with co-morbidities. Recurrent gastric perforation is even more rare.</div></div><div><h3>Case presentation</h3><div>A 33 6/7 male was born by cesarean section and had a birth weight of 2300g. His mother was gravida 3/para 1, otherwise healthy. The parents were third-degree cousins. Prenatal ultrasounds showed severe oligohydramnios with bilateral hyperechogenic kidneys. On physical exam, he had subtle facial dysmorphism, rocker bottom feet, stiff joints, and long slender fingers. He developed respiratory distress shortly after birth, which required intubation and mechanical ventilation. He was made nil per os (NPO), and antibiotics were started. At 20 hours of life, he had a sudden deterioration with desaturations, hypotension, and severe abdominal distension. Abdominal X-ray showed free air in the peritoneal cavity. We placed a peritoneal drain. One day later he reaccumulated air. We suspected that he could have renal tubular dysgenesis (RTD) given that he had no urine output. One day later he was taken to the operating room for an exploratory laparotomy. We found a large perforation in the lesser curve of the stomach. We repaired the perforation and placed a peritoneal dialysis catheter. Four days later he was re-explored for pneumoperitoneum. We found a perforation in the anterior wall of the stomach and repaired it in 2 layers. There was no bowel obstruction distal to the stomach. Three days later, we re-explored him for pneumoperitoneum and found a perforation on the posterior wall. The two other repairs were intact. We closed the perforation and placed a gastrostomy. Thirteen days later he was re-explored for pneumoperitoneum, and we found a second perforation in the posterior wall. Feedings were slowly started. His renal function improved, and he was discharged home at 3 months of age.</div></div><div><h3>Conclusion</h3><div>The association of RTD and spontaneous gastric perforation has not been previously reported. We do not know if there is a causality between the two conditions but based on our case, we recommend that patients with RTD should be closely watched for signs of gastric perforation.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102923"},"PeriodicalIF":0.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian dysgerminoma in a pre-pubertal girl: A case report","authors":"Evance Salvatory Rwomurushaka ,&nbsp;Patrick Amsi ,&nbsp;Jay Lodhia","doi":"10.1016/j.epsc.2024.102920","DOIUrl":"10.1016/j.epsc.2024.102920","url":null,"abstract":"<div><h3>Introduction</h3><div>Ovarian dysgerminoma is a rare malignant germ cell tumor that rarely occurs in pre-puberal girls.</div></div><div><h3>Case presentation</h3><div>An eight-year-old girl presented with a year-long history of progressive, painless abdominal distension and significant weight loss but without obstructive symptoms. Physical examination revealed peripheral subcentric lymphadenopathy and signs of cachexia. Her abdomen was globally distended with a large, irregular mass occupying most of the abdominal cavity. Imaging with CT of the chest and abdomen revealed a large intraperitoneal mass with regional lymphadenopathy and pulmonary metastases, initially raising suspicion for peritoneal Burkitt's lymphoma. However, an ultrasound-guided biopsy was inconclusive, prompting an exploratory laparotomy. During surgery, a large mass measuring 20 by 30 cm was excised, originating from the right ovary and fed by mesenteric vessels. The uterus, left ovary, and fallopian tube were intact and unaffected, and the peritoneum, liver, and omentum appeared smooth and without nodules.</div><div>The initial postoperative course was uneventful, and histopathology confirmed the mass as an ovarian dysgerminoma. Adjuvant chemotherapy with Etoposide, Carboplatin, and Bleomycin was initiated. Unfortunately, the patient succumbed nine weeks post-surgery, following two cycles of chemotherapy, likely due to complications from hospital-acquired pneumonia and pre-existing pulmonary metastases.</div></div><div><h3>Conclusion</h3><div>Ovarian dysgerminoma must be included in the differential diagnosis of pre-pubertal females who present with a pelvic mass.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102920"},"PeriodicalIF":0.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifocal hepatic adenoma in an adolescent female requiring right hepatic lobectomy: A case report","authors":"Prabhath Mannam ,&nbsp;Patricia Repollet-Otero ,&nbsp;Oluwadamilola Egbewole ,&nbsp;Nicolle Burgwardt ,&nbsp;Christine Finck","doi":"10.1016/j.epsc.2024.102924","DOIUrl":"10.1016/j.epsc.2024.102924","url":null,"abstract":"<div><h3>Introduction</h3><div>Hepatic adenomas are benign tumors that are extremely rare in adolescents. Proper and early management is essential to prevent associated hemorrhage and potential malignant transformation.</div></div><div><h3>Case presentation</h3><div>We herein present a case of a 17-year-old female patient with obesity, precocious puberty, and oral contraceptive use that presented with abdominal pain, emesis, elevated liver enzymes, and leukocytosis. Magnetic resonance imaging identified two lesions within the right hepatic lobe: a 2.0× 6.8 × 2.0 cm T1-hyperintense semilunar component and a 5.9 x 7.2 × 7.2 cm T1-hypointense component suspicious for intralesional hemorrhage. A diagnosis of hepatic adenoma was made based on imaging characteristics and the patient's oral contraceptives were discontinued to prevent lesion expansion. The patient was discharged following improvements in her clinical presentation and was scheduled for follow up imaging. Three weeks later, the patient presented again with similar symptoms, suggestive of an acute exacerbation of her hepatic lesions. Repeat computed tomography imaging revealed free fluid in the pelvis and expansion of the larger lesion to 10.9 x 6.5 × 6.4 cm that was now bilobed with irregular borders. The lesions were unsuitable candidates for embolectomy and the patient ultimately underwent a right hepatic lobectomy and wedge biopsy of segment II for another lesion discovered intraoperatively. Pathological analysis identified three distinct masses in the right hepatic lobe and a single mass within segment II, all of which were consistent with a diagnosis of a benign multifocal hepatic adenoma. No residual tumor or recurrence was identified at 3-month follow-up imaging.</div></div><div><h3>Conclusion</h3><div>Despite being benign, hepatic adenomas can present with rapid growth and aggressive clinical deterioration that may require urgent surgical resection.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102924"},"PeriodicalIF":0.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}