Journal of Pediatric Surgery Case Reports最新文献

{"title":"Uterine rupture due to pyometra and imperforate hymen in a 7-year-old girl: A case report","authors":"Umar Mahmood,&nbsp;Muhammad Usama Aziz,&nbsp;Maria Munawar,&nbsp;Laraib Amjad,&nbsp;Chaudhary Ehtsham Azmat,&nbsp;Sunaina Siddique","doi":"10.1016/j.epsc.2024.102921","DOIUrl":"10.1016/j.epsc.2024.102921","url":null,"abstract":"<div><h3>Introduction</h3><div>Pyometra is a rare condition characterized by pus accumulation in the uterine cavity primarily affecting postmenopausal women, with only a few cases reported in the pediatric population.</div></div><div><h3>Case presentation</h3><div>A 7-year-old female with developmental delay was brought to the hospital in shock and having clinical signs of peritonitis. Her medical history included abdominal pain and pyuria for one week prior to presentation. The only other positive physical finding was that the hymen was imperforate. An erect abdominal X-ray revealed air under the diaphragm and an ultrasound (US) of the abdomen showed moderate ascites. She was taken to the operating room for an exploratory laparotomy. We found approximately 700 mL of purulent material. The examination of all abdominal organs revealed a perforation at the fundus of the uterus and extensive adhesions. We repaired the uterine wall and left a trans-abdominal drain in the uterine cavity. We also left a drain in the pelvis. We then closed the abdomen and did a hymenoplasty during which we drained 200 additional milliliters of purulent fluid. Cultures were positive for Acinetobacter species. She remained on tobramycin for 10 days. The drains were removed on the 2nd and 5th postoperative days. She was discharged home after an uneventful recovery and has been healthy on all postoperative visits.</div></div><div><h3>Conclusion</h3><div>Female children with imperforate hymen are at risk for pyometra and uterine perforation. A perineal exam should be included in the work up of premenarchal females who present with peritonitis.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102921"},"PeriodicalIF":0.2,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658585","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":"Appendiceal hydatid cyst in a 5-year-old child: A case report","authors":"Mobina Taghva Nakhjiri,&nbsp;Jafar Soltani,&nbsp;Maryam Ghavami Adel,&nbsp;Hojatollah Raji","doi":"10.1016/j.epsc.2024.102916","DOIUrl":"10.1016/j.epsc.2024.102916","url":null,"abstract":"<div><h3>Introduction</h3><div>Hydatidosis is the formation of cysts caused by the parasitic infection of Echinococcus granulosus. This disease predominantly affects the liver and lungs. The involvement of other organs is quite rare.</div></div><div><h3>Case presentation</h3><div>A 5-year-old Iranian boy presented with abdominal pain, anorexia, and hepatomegaly. The pain had been present for about 1 year. He had developed low-grade fever during the previous two months. On physical exam he had abdominal distention and a palpable mass on the right lower quadrant. Basic blood work revealed leukocytosis and eosinophilia. An abdominal ultrasound revealed a 5 × 6 × 8 cm cystic lesion in the pelvis, and two cystic lesions located in the right lobe of the liver. A computerized tomography (CT) scan of the abdomen confirmed the findings. CT of the chest and brain ruled out further cystic lesions. The patient had a positive Indirect hemagglutination assay (IHA), confirming the diagnosis of hydatidosis. A regimen of an albendazole was initiated. He was taken to the operating room for the resection of all cysts. The hepatic cysts were drained and re-filled with hypertonic saline solution, which was left in place for several minutes. Next, the hypertonic solution was drained and all hepatic cysts removed. We turned our attention to the pelvic cyst. It had a thick wall and was indistinguishable from the surrounding tissues. After dissecting it we found that it was arising from the wall of the appendix. We surrounded it with gauze embedded in hypertonic solution and resected the majority of it, leaving a small aspect of the external layer that was densely adherent to the bowel. He recovered well from the operation, remained on albendazole for 6 months, and has had no recurrences this far.</div></div><div><h3>Conclusion</h3><div>Appendiceal hydatid cysts should be included in the differential diagnosis of patients with hydatid disease and pelvic cysts.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102916"},"PeriodicalIF":0.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552036","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":"Laparoscopic repair of a sliding right inguinal hernia containing both fallopian tubes, both ovaries and the uterus in an infant: A case report","authors":"Humaid Alzaabi,&nbsp;Maithah Alkaabi,&nbsp;Hiba Ahmad,&nbsp;Iftikhar Jan","doi":"10.1016/j.epsc.2024.102914","DOIUrl":"10.1016/j.epsc.2024.102914","url":null,"abstract":"<div><h3>Introduction</h3><div>Sliding inguinal hernias containing the uterus, fallopian tubes, and adnexa are rare and can be challenging to repair, especially in infants.</div></div><div><h3>Case presentation</h3><div>A 4-month-old female infant, born prematurely from a triplet pregnancy, had been managed in the Neonatal Intensive Care Unit (NICU) for several months before discharge. She was referred to us with swelling in the right inguinal area. The other two triplets had inguinal hernias and had undergone surgical repair at the same hospital. On physical exam, the patient had a sizable, reducible hernia with no signs of obstruction or strangulation. She was taken to the operating room for a laparoscopic exploration, which was done with one 5-mm port for a camera and two 3-mm working ports. We found a sliding right inguinal hernia that contained both ovaries, both fallopian tubes, and part of the uterus in the hernial sac. The contents were carefully reduced, the hernial sac was carefully dissected, and the defect was repaired laparoscopically using a purse-string suture. No hernia was found on the left side. The postoperative course was uneventful. At six months of follow-up, she is doing well and has no signs of recurrence.</div></div><div><h3>Conclusion</h3><div>Sliding inguinal hernias containing bilateral ovaries, fallopian tubes, and the uterus are rare. Laparoscopy can help with the diagnosis, the reduction of the contents, and allows to assess the condition of the reduced organs.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102914"},"PeriodicalIF":0.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571442","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":"Segmental absence of intestinal musculature increasingly recognized in premature infants with perforated viscus: A case series","authors":"Carolina Pinzon-Guzman ,&nbsp;Alexander Kevorkov ,&nbsp;Karl Grenier ,&nbsp;Maeve O'Neill Trudeau ,&nbsp;Pramod Puligandla ,&nbsp;Etienne St-Louis","doi":"10.1016/j.epsc.2024.102915","DOIUrl":"10.1016/j.epsc.2024.102915","url":null,"abstract":"<div><h3>Introduction</h3><div>Segmental absence of intestinal musculature (SAIM) is a pathological diagnosis, denoting focal absence of the muscularis propria in the presence of intact surrounding structures. This condition often presents as spontaneous intestinal perforation (SIP) and can be difficult to distinguish clinically from necrotizing enterocolitis (NEC).</div></div><div><h3>Case presentations</h3><div>We present 5 cases of premature babies with gestational age ranging from 24 + 3 weeks up to 32 + 1 weeks, who all presented with intestinal perforation before the 15th day of life. Three patients presented with a distended abdomen and discoloration and were subsequently found to have pneumoperitoneum on abdominal x-ray (AXR). The 2 other patients presented with clinical deterioration but without signs of intestinal perforation and were subsequently found to have pneumoperitoneum on AXR. All underwent bowel resection of perforated bowel with either ileostomy with mucous fistula or primary end-to-end anastomosis. Two patients required repeat exploratory laparotomies within a week of their initial surgery due to pneumoperitoneum in subsequent AXR caused by new perforations in other parts of the small bowel. One patient sustained an iatrogenic liver injury intra-operatively and passed away 1 day post-operatively. All patients were found to have SAIM on histopathological examination.</div></div><div><h3>Conclusion</h3><div>SAIM is a pathological diagnosis that can manifest as SIP and may denote a risk for recurrent peritonitis in premature infants who underwent bowel resection for perforated viscus without a clear etiology.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102915"},"PeriodicalIF":0.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571443","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":"Heteropagus (parasitic) twins and concomitant omphalocele: A case report","authors":"Samuel Gashu ,&nbsp;Belachew Dejene ,&nbsp;Yidnekachew Getachew ,&nbsp;Gobena Mormata ,&nbsp;Mihret solomon Tesfaye","doi":"10.1016/j.epsc.2024.102909","DOIUrl":"10.1016/j.epsc.2024.102909","url":null,"abstract":"<div><h3>Introduction</h3><div>Heteropagus twins are extremely rare, occurring in one to two million live births. To date, fewer than 75 cases of epigastric heteropagus twins have been reported, and only a handful of these cases have involved heteropagus twins with a concomitant omphalocele.</div></div><div><h3>Case presentation</h3><div>We present a case of heteropagus twins in a 2-day-old neonate with a fully formed parasitic mass attached to the lower anterior chest wall and epigastrium. The parasitic twin was acephalic and acardiac, had bowel structures, pelvic bones, bilateral lower limbs, and a single upper limb. The blood supply of the parasitic twin primarily originated from the right internal mammary artery, and the venous return was via the right internal mammary vein to the superior vena cava. The parasitic twin's bowel loops overlapped the left lobe of the autosite's liver, which was partially contained in a midline omphalocele-like abdominal wall defect. The autosite also had a small patent foramen ovale and a patent ductus arteriosum with a left-to-right shunt. A successful dissection and excision of the parasitic twin was done to remove the rudimentary limbs, pelvis, and part of the parasitic trunk. The autosite's omphalocele was repaired at the same time. The patient had an uneventful postoperative recovery.</div></div><div><h3>Conclusion</h3><div>Early surgical separation of heteropagus twins is crucial to optimize the outcomes of the healthy twin.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102909"},"PeriodicalIF":0.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533017","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":"Granular cell tumor of the breast in a 17-year-old female: A case report","authors":"Juan R. Medina-Morell ,&nbsp;Jorge I. Cheverez-Ocasio ,&nbsp;Viviana Negron-Gonzalez ,&nbsp;Gloria Ramos-Rivera","doi":"10.1016/j.epsc.2024.102913","DOIUrl":"10.1016/j.epsc.2024.102913","url":null,"abstract":"<div><h3>Introduction</h3><div>Granular Cell Tumors (GCTs) are rare soft tissue neoplasms originating from Schwann cells, often benign but mimicking breast carcinoma clinically and radiologically.</div></div><div><h3>Case presentation</h3><div>A 17-year-old female with a second-degree family history of breast cancer presented with a painful left breast mass (∼3 cm) persisting for three years. Initial evaluation with fine needle aspiration (FNA) suggested a benign lipoma, but imaging reported BIRADS IV mass. Mammography revealed an ovoid mass with irregular margins, Sono-mammogram reported heterogeneous slightly lobulated mass with excentric sonolucent of 3 x 2.4 × 1.8 cm, no increased vascularity on sono-doppler and core needle biopsy confirmed a GCT, positive for S-100 and CD68. The patient was taken to the operating room for surgical excision. A 4 cm curvilinear incision was made over the left breast mass, just lateral to the nipple at the 3 o'clock position. En-bloc excision of the mass was carried out with 1 cm margins. The specimen was removed and sent for frozen section analysis that confirmed the cytological diagnosis of a granular cell tumor with clear margins. The excised mass was sent for permanent section to pathology. Final histopathology confirmed a benign GCT with free margins. Due to the infiltrative nature of the tumor, a second excision in similar fashion was required to obtain wider margins, which was uneventful. Clear margins were pursued due to the tumor's infiltrative nature and patient's family history of breast cancer, despite the low risk of recurrence with positive margins. The patient remains clinically disease-free at three-year follow-up.</div></div><div><h3>Conclusion</h3><div>Granular cell tumors of the breast, though benign, are often mistaken for carcinoma due to their clinical similarity. Complete excision with clear margins, which may require re-excision due to their infiltrative nature, is crucial to prevent recurrence.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102913"},"PeriodicalIF":0.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533018","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":"Endovascular diagnosis and treatment of arterio-esophageal fistula after foreign body ingestion in children: A tale of two cases","authors":"Claire E. White-Dzuro ,&nbsp;Bryan D. Steitz ,&nbsp;Eunice Y. Huang ,&nbsp;Christopher M. Baron ,&nbsp;Lyndy Wilcox ,&nbsp;Jamie R. Robinson","doi":"10.1016/j.epsc.2024.102912","DOIUrl":"10.1016/j.epsc.2024.102912","url":null,"abstract":"<div><h3>Introduction</h3><div>An arterio-esophageal fistula (AEF) is an abnormal communication between an artery and the esophagus. While a rare complication, patients are at risk of disastrous hemorrhage. The goal of this study is to highlight endovascular management options of AEF in children.</div></div><div><h3>Case series</h3><div>We present two cases of children with AEF. Both children were female, 3 years of age or younger, and had hematemesis upon presentation. For each patient, esophageal foreign body impaction was confirmed with radiography prompting emergent surgery. A multidisciplinary team was involved in the management of both patients, consisting of combinations of pediatric surgery, pediatric otolaryngology, pediatric cardiothoracic surgery and pediatric interventional radiology. Angiography successfully localized the AEF in both patients after several hours of unsuccessful open dissection and failed attempts at hemorrhage control. Further, angiographic embolization successfully controlled the hemorrhage in one patient. One of the two children experienced cardiac arrest intraoperatively due to hemorrhagic shock, which resulted in their death.</div></div><div><h3>Conclusion</h3><div>Our study highlights the importance of a multidisciplinary team to care for patients with AEF and the role of endovascular techniques in aiding rapid diagnosis and potential management of the fistula.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102912"},"PeriodicalIF":0.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533016","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":"Thoracoscopic closure of an H-type tracheoesophageal fistula: A case report","authors":"Kazuo Oshima ,&nbsp;Yujiro Tanaka ,&nbsp;Keisuke Suzuki ,&nbsp;Chizuka Seki ,&nbsp;Mina Yoshida ,&nbsp;Hiroaki Komuro","doi":"10.1016/j.epsc.2024.102910","DOIUrl":"10.1016/j.epsc.2024.102910","url":null,"abstract":"<div><h3>Introduction</h3><div>Isolated h-type tracheoesophageal fistula (H-TEF) without esophageal discontinuity is rare and poses challenges in selecting a surgical approach due to the height of the fistula within the thoracic cavity.</div></div><div><h3>Case presentation</h3><div>A female neonate was born prematurely at 31 weeks of gestation with a weight of 1200 g. She was intubated at birth due to respiratory distress. She was later diagnosed with CHARGE syndrome. Nasogastric tube feedings were initiated shortly after birth. Air bubbles could be seen coming out the nasogastric tube, which were suspicious for a tracheoesophageal fistula (TEF). A contrast esophagogram confirmed an h-type TEF at the level of the second thoracic vertebral body. When the patient was five months old and had a weight of 3 Kg, she was taken to the operating room for a thoracoscopic repair of the TEF. She was placed in complete left lateral position. Four 5-mm ports were placed in the right hemithorax. The right vagus nerve was identified. We first created a pleural flap with the mediastinal pleura. Blunt dissection of the esophagus and the trachea allowed clear identification of the TEF. A vessel loop was placed around the TEF. The TEF was divided. The esophageal end the tracheal sides of the TEF were closed with interrupted stitches. The pleural flap was interposed between the two stumps. The operation took 238 minutes. The postoperative period was uneventful, and she had no recurrence of the TEF. She underwent a tracheostomy one month later, and a laparoscopic fundoplication three months after that. She was discharged home at one year of age.</div></div><div><h3>Conclusion</h3><div>Thoracoscopy appears to be a suitable approach for the repair of high thoracic h-type TEF.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102910"},"PeriodicalIF":0.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142551536","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":"Trans-anal prolapse of intussuscepted ileal Hartmann's pouch: A case report","authors":"Yu Liu,&nbsp;Youcheng Zhang,&nbsp;Ting Wang","doi":"10.1016/j.epsc.2024.102911","DOIUrl":"10.1016/j.epsc.2024.102911","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative complications of stomas in necrotizing enterocolitis (NEC) typically affect the proximal limb. Complications of the distal limb are rarely reported.</div></div><div><h3>Case presentation</h3><div>A 17-day-old newborn underwent an end ileostomy and an ileal Hartmann's pouch due to necrotizing enterocolitis (NEC). Eight weeks after the surgery, he passed bloody stool through the anus. No drop in his hemoglobin level was observed. He was made NPO, and no further bloody stool was seen after 24 hours. Ten weeks post-surgery he developed acute vomiting, and a 10-cm segment of bowel was seen prolapsed through the anus. The end of the prolapsed bowel was blind, raising the suspicion of a complete prolapse of the ileal Hartmann's pouch. He was taken to the operating room for an exploratory laparotomy. We found that the ileal Hartmann's pouch had intussuscepted into the ileocecal valve, progressed through the colon and the rectum, and prolapsed through the anus. We reduced the bowel manually. The involved ileum and colon were markedly swollen, and partially necrotic. The necrotic segments were resected, and the ileostomy was reversed. The patient was discharged one month later and had no adverse complications at two months of follow up.</div></div><div><h3>Conclusion</h3><div>Although rare, intussusception of an ileal Hartmann's pouch should be ruled out in patients that have a Hartmann's pouch and develop vomiting and bloody stool.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102911"},"PeriodicalIF":0.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593118","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":"Left-sided gallbladder in a 17-year-old male: A case report","authors":"William G. Lee ,&nbsp;Shannon T. Wong-Michalak ,&nbsp;Eveline H. Shue ,&nbsp;Eugene S. Kim ,&nbsp;Christopher T. Watterson ,&nbsp;Juan Carlos Pelayo","doi":"10.1016/j.epsc.2024.102908","DOIUrl":"10.1016/j.epsc.2024.102908","url":null,"abstract":"<div><h3>Introduction</h3><div>Left-sided gallbladder (LSG) is a rare anatomic variant in the pediatric population where the gallbladder lies to the left of the round ligament. The diagnosis of LSG is often made intraoperatively as preoperative imaging has poor sensitivity for detection. As LSG is also associated with biliary and vascular anatomic variation, lack of familiarity with these anatomic variants can lead to higher rates of bleeding and bile duct injury.</div></div><div><h3>Case presentation</h3><div>A 17-year-old previously healthy male with history of scoliosis and sickle cell trait was referred for surgical management of symptomatic cholelithiasis. The patient had presented with multiple transient episodes of severe epigastric pain and nausea with ultrasound findings of cholelithiasis. There was no comment on the ultrasound report of any anatomic variation or abnormal location of the gallbladder. However, review of the imaging demonstrated a gallbladder that was situated on the left side of the liver and medial to ligamentum teres hepatis (round ligament). During the laparoscopic cholecystectomy, we confirmed that the gallbladder was located to the left of the round ligament and inferior to segment III of the liver. A retrograde top-down approach was utilized to clearly delineate the cystic artery and duct. The cystic artery was identified by its entry point into the gallbladder crossing anterior to the common bile duct in a right-to-left fashion. The cystic duct was identified and noted to drain into the right-side of the common hepatic duct. Due to clear delineation of the gallbladder anatomy with this approach, intraoperative cholangiography or fluorescence cholangiography were not utilized. He was discharged on postoperative day one without any complications.</div></div><div><h3>Conclusion</h3><div>LSG is associated with biliary and vascular anomalies, which may lead to intraoperative complications. Therefore, the biliary anatomy should be clearly elucidated prior to proceeding with cholecystectomy in cases of LSG.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102908"},"PeriodicalIF":0.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533019","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}