Journal of Pediatric Surgery Case Reports最新文献

{"title":"Congenital intrapericardial diaphragmatic hernia associated with atrial septal defect in a 3-year-old child: a case report","authors":"Le Thanh Khanh Van ,&nbsp;Hoang Ngoc Vi","doi":"10.1016/j.epsc.2025.103094","DOIUrl":"10.1016/j.epsc.2025.103094","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital intrapericardial diaphragmatic hernia (CIPDH) is an extremely rare form of diaphragmatic hernia, in which abdominal contents herniate into the pericardial cavity. Due to its rarity and nonspecific clinical presentation, CIPDH is often misdiagnosed, particularly in settings with limited access to advanced imaging.</div></div><div><h3>Case presentation</h3><div>A 3-year-old boy, born at term without neonatal symptoms, was referred to us for an atrial septal defect (ASD) closure, which was detected after an episode of pneumonia. Chest x-ray revealed cardiomegaly and bowel loops in the mediastinum. Echocardiography showed a 14 mm ASD (Qp:Qs = 3.1:1) with trivial pericardial effusion. A Morgagni hernia was suspected. The patient was scheduled for an elective ASD closure and simultaneous repair of the Morgagni hernia. The operation was done through a median sternotomy. The anterior side of the diaphragm was intact, and no Morgagni hernia was found. Once the pericardium was opened, we found the transverse colon herniated into the pericardial space. There was a 3 × 5 cm pericardial/diaphragmatic defect. We reduced the colon easily and closed the defect primarily with interrupted stitches of non-reabsorbable material. We then closed the ASD on cardiopulmonary bypass. The patient recovered uneventfully and remains well at 3 months of follow-up.</div></div><div><h3>Conclusion</h3><div>Congenital intrapericardial diaphragmatic hernia should be considered in patients who have a preliminary diagnosis of an anterior (Morgagni) diaphragmatic hernia.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103094"},"PeriodicalIF":0.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital segmental intestinal dilation in children: A case series","authors":"Samuel Gashu Adane ,&nbsp;Tihitena Negussie ,&nbsp;Fisseha Temesgen ,&nbsp;Eden Yirdachew ,&nbsp;Dagmawi Geremew","doi":"10.1016/j.epsc.2025.103092","DOIUrl":"10.1016/j.epsc.2025.103092","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital segmental intestinal dilation (CSID) is a rare congenital anomaly of unknown origin that can present in neonates and older children with varying clinical manifestations. CSID can only be confirmed intraoperatively, and the treatment is simple resection and anastomosis.</div></div><div><h3>Cases presentation</h3><div>The first case was a 17-year-old ex-premature female who presented with a longstanding history of constipation, difficulty passing stool, abdominal distension, passage of hard, tarry stool, and symptoms of anemia. She underwent repeated blood transfusions and enemas, but her symptoms persisted. Abdominal computerized tomography (CT) was suspicious for CSID. She underwent an exploratory laparotomy during which we found a segmental dilatation of the sigmoid colon. The affected sigmoid colon was resected, followed by an end-to-end anastomosis. She recovered well ans was asymptomatic at 6 months of follow up. The pathology of the specimen revealed ganglionated bowel without obvious anomalies. The second case was a 6-year-old male child who had experienced recurring intermittent abdominal pain and vomiting since the age of three years. His physical examination, abdominal radiography, and abdominal ultrasound were all unremarkable. He eventually underwent an upper gastrointestinal contrast study as part of his work-up, which was suspicious for a gastric volvulus. We took him to the operating room for an exploratory laparotomy. We found no gastric volvulus but a segmental ileal dilatation. The affected ileum was resected, followed by an end-to-end anastomosis. His recovery was uneventful. Follow-up was discontinued after 7 months of regular outpatient visits. The pathology of the specimen revealed ganglionated bowel without obvious anomalies.</div></div><div><h3>Conclusion</h3><div>Congenital segmental dilation of the bowel is a rare anomaly but should be considered in children with symptom of chronic constipation and anemia.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103092"},"PeriodicalIF":0.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic excision of giant omental cyst in a toddler: A case report","authors":"M. Harshal,&nbsp;T.K. Jayakumar,&nbsp;K. Shubhangi,&nbsp;Nilesh Nagdeve","doi":"10.1016/j.epsc.2025.103093","DOIUrl":"10.1016/j.epsc.2025.103093","url":null,"abstract":"<div><h3>Background</h3><div>Giant omental cysts are rare, benign intra-abdominal lesions that may mimic ascites in children. This often leads to delay in the diagnosis and complications such as anemia.</div></div><div><h3>Case presentation</h3><div>A 2-year-old girl presented with progressive gross abdominal distension and anemia. Physical examination revealed pallor and a distended abdomen with shifting dullness suggestive of ascites. Ultrasonography revealed a large, septated anechoic lesion with internal debris occupying the entire abdominal cavity, displacing all bowel loops. Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis confirmed a well-encapsulated, non-enhancing, thin-walled cystic mass extending from the upper abdomen to the pelvis, displacing bowel loops to the left and compressing adjacent structures. We took her to the operating room for an exploratory laparoscopy. We first did a small supraumbilical incision and aspirated 500 cc of serosanguinous fluid from within the cyst. Once it was partially decompressed, we placed the ports and explored the abdomen. We found a large omental cyst with hemorrhagic fluid, which was the cause of the anemia. We proceeded to resect the cyst completely. The patient had an uneventful postoperative course and was discharged home on postoperative day two. Histopathology confirmed a lymphatic omental cyst. She remains asymptomatic at seven months of follow up.</div></div><div><h3>Conclusion</h3><div>Giant omental cysts should be included in the differential diagnoses of children who develop gradual abdomen distension and have pseudo-ascites on imaging studies.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103093"},"PeriodicalIF":0.2,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital megacalycosis managed with observation only: A case report","authors":"Kristy Alexandra Smith,&nbsp;Mohamed Sameh Shalaby","doi":"10.1016/j.epsc.2025.103082","DOIUrl":"10.1016/j.epsc.2025.103082","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital megacalycosis (CM) is one of the rarest congenital renal anomalies. It typically presents with significant calyceal dilatation resembling severe pelvi-ureteric junction obstruction (PUJO) in a kidney with an intra-renal pelvis. Normal drainage on mercaptoacetyltriglycine (MAG3) renogram confirms the CM diagnosis.</div></div><div><h3>Case presentation</h3><div>A male infant presented antenatally with significant unilateral calyceal dilatation and presumed diagnosis of severe PUJO. Growth scans at 32, 36 and 39 weeks showed an increasingly dilated renal pelvis with normal liquor volume. He was delivered at 39 weeks by emergency caesarean due to fetal distress. Postnatal ultrasound (USS) was consistent with the antenatal scans with an anteroposterior diameter (APD) of 21mm but a MAG3 showed normal drainage and equal split function, confirming the diagnosis of megacalycosis rather than classic PUJO. The patient therefore avoided surgery and has been managed with active observation with 3 monthly USS. Repeat USS at 15 months shows improvement in dilatation (APD 13mm), and no deterioration of drainage or drop of function on repeat MAG3 at 12 months.</div></div><div><h3>Conclusion</h3><div>Congenital megacalycosis should be ruled out with MAG3 in children with suspected pelviureteric junction obstruction as the two conditions may have a similar USS appearance but have a significantly different management strategy.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103082"},"PeriodicalIF":0.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenoid cystic carcinoma of the main stem bronchus in an 11-year-old child: A case report","authors":"Beatriz Manásia Schröter ,&nbsp;Rafael Rodrigues Torres ,&nbsp;Roberto Augusto Plaza Teixeira ,&nbsp;Marcela Dias Borges ,&nbsp;Alyne Condurú dos Santos Cunha ,&nbsp;Ana Cristina Aoun Tannuri","doi":"10.1016/j.epsc.2025.103091","DOIUrl":"10.1016/j.epsc.2025.103091","url":null,"abstract":"<div><h3>Introduction</h3><div>Airway tumors are infrequent in children. Adenoid cystic carcinomas (ACC) are the second most common histological type.</div></div><div><h3>Case presentation</h3><div>A previously healthy 11-year-old female presented with fever and cough for eight days. A chest x-ray revealed a large right lung opacity. Due to the opacity's extension, a contrast-enhanced chest computed tomography (CT) was done and revealed a vascularized lesion in the right main stem bronchus, with luminal narrowing and opacity suggesting pneumonia. Bronchoscopy with biopsy confirmed primary ACC. The pneumonia did not respond to ceftriaxone and was then treated with cefepime and vancomycin. The tumor was then approached via a right thoracotomy. We resected a two-centimeter segment of the right main stem bronchus and reconstructed it by an end-to-end anastomosis with a simple continuous suture on the posterior wall and simple interrupted sutures on the anterior wall. The patient left the operating room with a chest drain, having satisfactory pain control and no complications. On her sixth postoperative day on the she developed a pneumothorax due to displacement of the chest drain, which was managed by the placement of a new chest drain. On the thirteenth postoperative day she developed a pleural effusion and fever and was treated empirically with meropenem and vancomycin. The patient was discharged home with no chest drain twenty-six days after the operation. She had no further complications at the one-month follow-up.</div></div><div><h3>Conclusion</h3><div>ACC and other airway tumors should be considered in the differential diagnosis of children with lung consolidations that do not respond to antibiotics or have atypical presentations.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103091"},"PeriodicalIF":0.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-onset infantile hypertrophic pyloric stenosis: a case report","authors":"Eden Belay Tilahun ,&nbsp;Tihitena Nigussie mamo ,&nbsp;Werkneh Demissie Hailemariam ,&nbsp;Gobena Mormata Dima ,&nbsp;Nardos Mulu Admasu ,&nbsp;Abraham Sisay Abie","doi":"10.1016/j.epsc.2025.103090","DOIUrl":"10.1016/j.epsc.2025.103090","url":null,"abstract":"<div><h3>Introduction</h3><div>Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of non-bilious projectile vomiting in infants, typically presenting between 4 and 8 weeks of age. Early-onset cases, particularly those occurring within the first few days of life, are rare and often challenging to diagnose due to lack of standardized sonographic criteria for this age group.</div></div><div><h3>Case presentation</h3><div>A 12-day-old male neonate presented with persistent non-bilious projectile vomiting beginning on the first days of life. He was born at full term via spontaneous vaginal delivery to a 26-year-old primigravida mother after an uncomplicated pregnancy. Initial evaluation at a local health center led to conservative management for presumed gastroesophageal reflux. Persisting symptoms prompted referral after an initial ultrasound showed a pyloric muscle thickness of 3.6 mm and a length of 16 mm, suggestive of IHPS. However, due to the uncommon occurrence of IHPS at such an early age, a repeat ultrasound was done, which was interpreted as normal. An upper gastrointestinal contrast study was done to rule out intestinal malrotation and other sources of gastric outlet obstruction. Due to the persistence of symptoms, a third ultrasound was done on day of life 21, which showed a pyloric length of 16.6 mm and a thickness of 4.2 mm, conclusive for IHPS. The patient underwent an open Ramstedt pyloromyotomy without complications. The postoperative recovery was complicated by a hospital-acquired pneumonia, which was successfully treated. The patient was discharged on postoperative day 16 and remained asymptomatic at six months of follow-up, with normal growth and development.</div></div><div><h3>Conclusion</h3><div>Pyloric stenosis rarely occurs within the first few weeks of life but should be included in the differential diagnosis of newborns who develop persistent projectile non-bilious vomiting.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103090"},"PeriodicalIF":0.2,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital myofibromatosis of the porta hepatis: a case report","authors":"Kiyokazu Kim,&nbsp;Masafumi Iguchi,&nbsp;Maho Inoue,&nbsp;Shohei Takayama,&nbsp;Shigehisa Fumino,&nbsp;Shigeru Ono","doi":"10.1016/j.epsc.2025.103088","DOIUrl":"10.1016/j.epsc.2025.103088","url":null,"abstract":"<div><h3>Introduction</h3><div>Infantile myofibromatosis (IM) of the hepatic hilum is an extremely rare condition. Although IM is expected to undergo spontaneous tumor regression, surgical management of hilar IM presenting with obstructive jaundice can be challenging.</div></div><div><h3>Case presentation</h3><div>A male infant was born at 38 weeks of gestation with a birth weight of 2628 g. A tumor in the porta hepatis had been detected prenatally at 32 weeks of gestation. Postnatal MRI and contrast-enhanced CT revealed a large hilar mass extending into the right hepatic lobe, encasing the hepatic artery, portal vein, and common bile duct, with marked bile duct stenosis. At 19 days of age, the patient developed cholangitis, hepatic dysfunction, and worsening jaundice. Following antibiotic treatment, an open biopsy and hepatic duct drainage were performed on day 26 under intraoperative ultrasound guidance, with a tube placed in the bile duct. Bile was reinfused into the gastrointestinal tract via a nasoduodenal tube. Pathological examination showed minimal cellular proliferation, raising suspicion for IM or infantile fibrosarcoma. Genetic testing confirmed IM by detecting a PDGFRB tandem duplication. While awaiting spontaneous tumor regression, complications such as drain dislodgement and infection necessitated repeated interventions. Therefore, on day 241, a side-to-side hepaticojejunostomy was performed without tumor resection. Two years postoperatively, the child remains well without major complications, and imaging shows significant tumor regression.</div></div><div><h3>Conclusion</h3><div>Temporary external biliary drainage followed by bilio-enteric reconstruction should be considered in infants who have myofibromatosis of the hepatic hilum causing cholestasis.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103088"},"PeriodicalIF":0.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transperineal approach for the repair of a low H-type rectovestibular fistula: a case report","authors":"Marko Mesić ,&nbsp;Mateja Majnarić ,&nbsp;Marla A. Sacks ,&nbsp;Melissa Grageda ,&nbsp;Mario Mašić ,&nbsp;Francisca T. Velček","doi":"10.1016/j.epsc.2025.103087","DOIUrl":"10.1016/j.epsc.2025.103087","url":null,"abstract":"<div><h3>Introduction</h3><div>H–type rectovestibular fistula with a normal anus is a rare entity in the spectrum of anorectal malformations. There have been only a few reports describing a very low positioned H-type fistula with several operative techniques described.</div></div><div><h3>Case presentation</h3><div>A female patient that was followed since birth due to passing stool through the introitus. On physical exam the anal and urethral openings appeared normal. She had a small opening at the vestibule of the vagina suspicious for an H-type recto-vestibular fistula. At the age of 1 month, she was taken to the operating room for a diverting colostomy. The presence of an H-type fistula was confirmed by demonstration of bubbles emanating from the anal canal after instillation of hydrogen peroxide through the vestibular fistula opening. A small umbilical catheter was inserted through the fistula for better visualization. At 4 months of age, the definitive surgical repair was done via a transperineal approach, using the perineal sphincter muscle and fat tissue as an interposition flap that served as a barrier between the vaginal and rectal walls. The technique provided excellent visualization of the dissection plane between the rectum and vagina. The patient recovered uneventfully. The colostomy was closed at the age of 7 months. She has had no recurrence at two years of follow-up.</div></div><div><h3>Conclusion</h3><div>The transperineal approach with addition of fatty tissue interposition seems to be an effective option for the management of low H-type rectovestibular fistulas.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103087"},"PeriodicalIF":0.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144863572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infantile inflammatory myofibroblastic tumor of the small bowel: a case report","authors":"Moaied A. Hassan ,&nbsp;Halah Raheem Mohammed","doi":"10.1016/j.epsc.2025.103089","DOIUrl":"10.1016/j.epsc.2025.103089","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammatory myofibroblastic tumors are rare, solid, intermediate-grade mesenchymal neoplasms that predominantly affect children and adolescents. Infantile cases are exceedingly rare.</div></div><div><h3>Case presentation</h3><div>A 6-month-old female infant was referred to our institution with a history of abdominal pain, repeated non-bilious vomiting and pallor, with an abdominal ultrasound that revealed the presence of a large (120✕76 mm) left sided abdominal mass. Apart from recurrent attacks of vague abdominal pain, there were no features of small bowel obstruction. Peripheral blood smear revealed normochromic anemia with moderate thrombocytosis. Other investigations, including random blood sugar, renal and liver function tests, serum electrolytes, and coagulation profile, were all within normal limits. Abdominal computed tomography confirmed the presence of a large (10✕10✕9 cm), solid heterogeneously enhanced mass in the left suprarenal region, crossing the midline, with the suggestion of neuroblastoma. Exploratory laparotomy revealed a large lobulated mass at the antimesenteric border of the mid-ileum. Complete surgical resection was performed with free intestinal margins. Histopathological examination revealed myofibroblastic spindle cell proliferation with mild atypia and low mitotic activity admixed with inflammatory (lymphocyte and plasma cell) infiltration, arranged in hyper- and hypocellular area with myxoid stoma, features in favor of inflammatory myofibroblastic tumor. Immunohistochemistry confirmed the specimen was negative for anaplastic lymphoma kinase. Following surgical excision, the patient received no further adjuvant therapy and remained asymptomatic, with normal ultrasound findings on four successive bimonthly postoperative visits.</div></div><div><h3>Conclusion</h3><div>Although rare, inflammatory myofibroblastic tumors should be considered in infants who have large abdominal tumors and abdominal pain.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103089"},"PeriodicalIF":0.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pleural effusion after Nuss procedure: a case series","authors":"Hendrik van Braak ,&nbsp;Suzanne W.J. Terheggen-Lagro ,&nbsp;Joël Israels ,&nbsp;Joost van Schuppen ,&nbsp;Eline E. Deurloo ,&nbsp;Justin R. de Jong","doi":"10.1016/j.epsc.2025.103086","DOIUrl":"10.1016/j.epsc.2025.103086","url":null,"abstract":"<div><h3>Introduction</h3><div>Pleural effusion is an underreported and poorly understood complication of the Nuss procedure.</div></div><div><h3>Cases presentation</h3><div><em>Case 1</em><em>:</em> A 16-year-old female presented five weeks postoperatively with dyspnea (CRP 258 mg/L), left-sided pleural and pericardial effusion. Drainage and treatment with amoxicillin/clavulanic acid, gentamicin, diuretics, ibuprofen, and prednisolone led to improvement. After steroid discontinuation, effusion recurred despite treatment with amoxicillin/clavulanic acid and gentamicin. Cultures remained negative. She required thoracic drainage and received oral clindamycin, later switched to ciprofloxacin, with eventual recovery.</div><div><em>Case 2</em><em>:</em> A 17-year-old male presented with right-sided chest pain and pleural effusion two weeks after a complicated Nuss procedure (due to extensive adhesiolysis for pneumonia-related lung adhesions. Despite antibiotics, symptoms progressed, and he was admitted (CRP 240 mg/L). Chest drainage yielded 1300 mL clear fluid; cultures were negative. Recurrent effusion eventually required video-assisted thoracoscopic surgery. He was treated with amoxicillin/clavulanic acid after surgery.</div><div><em>Case 3</em>: A 14-year-old female developed fever one week postoperatively (CRP 123 mg/L), with no abnormalities on imaging. Three weeks later, she developed right-sided effusion; 600 mL was drained, and she received ceftriaxone and clindamycin. Recurrence occurred within two weeks; oral prednisolone was added, resulting in rapid improvement. She was discharged on cotrimoxazole and tapered steroids. Two months later, imaging for persistent fatigue revealed Nuss bar dislocation and pneumothorax, requiring bar repositioning.</div></div><div><h3>Conclusion</h3><div>Pleural effusion after the Nuss procedure can be caused by a reactive inflammatory response, triggered by pleural or mechanical irritation. If an infection and bar displacement are ruled out, a course of corticosteroid therapy may be effective.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103086"},"PeriodicalIF":0.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}