Journal of Pediatric Surgery Case Reports最新文献

{"title":"Transient gallbladder wall thickening in pediatric acute hepatitis: A case series","authors":"Abdulaziz Hussein","doi":"10.1016/j.epsc.2025.103030","DOIUrl":"10.1016/j.epsc.2025.103030","url":null,"abstract":"<div><h3>Introduction</h3><div>Transient gallbladder wall thickening is an uncommon sonographic finding in pediatric patients diagnosed with acute hepatitis. It may mimic primary gallbladder pathology such as cholecystitis, potentially leading to unnecessary surgical procedures.</div></div><div><h3>Clinical presentation</h3><div>Four pediatric patients between the ages of 4 and 8 years presented with acute viral hepatitis and symptoms of abdominal pain, jaundice, and fatigue. The first patient was a 5-year-old girl whose initial ultrasound showed gallbladder wall thickening of 5.6 mm. Follow-up ultrasound 7 weeks later revealed a reduction of the thickness to 1.8 mm. The second patient was a 4-year-old girl who had epigastric pain and dark urine. Ultrasound revealed gallbladder wall thickening of 5.1 mm, which decreased to 0.9 mm on the follow-up ultrasound done after 7 weeks. The third patient was an 8-year-old boy who presented with jaundice and abdominal discomfort. His gallbladder wall measured 5.7 mm initially and decreased to 2.2 mm after 7 weeks. The fourth patient was an 8-year-old boy who had gallbladder wall thickening of 7.0 mm, which on follow-up imaging 4 weeks later had decreased to 3.0 mm. All patients were managed conservatively, without any surgical intervention.</div></div><div><h3>Conclusion</h3><div>Children with acute viral hepatitis can develop transient gallbladder wall thickening, which typically self-resolves within a few weeks and does not require any specific intervention.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"118 ","pages":"Article 103030"},"PeriodicalIF":0.2,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903380","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":"Gastric volvulus in a neonate with congenital diaphragmatic hernia: A case report","authors":"Nicole Chicoine ,&nbsp;Carrie Foster ,&nbsp;Mihai Puia-Dumitrescu ,&nbsp;Ashley H. Ebanks ,&nbsp;Samuel E. Rice-Townsend ,&nbsp;Rebecca Stark ,&nbsp;for the CDH Study Group","doi":"10.1016/j.epsc.2025.103023","DOIUrl":"10.1016/j.epsc.2025.103023","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastric volvulus in neonates with congenital diaphragmatic hernia (CDH) is rare and typically presents beyond the neonatal period. Early neonatal presentation poses diagnostic and management challenges.</div></div><div><h3>Case presentation</h3><div>A term (41-week) male neonate (3.6 kg) with an unremarkable prenatal course and normal prenatal ultrasound was born via vacuum-assisted vaginal delivery. Apgar scores were 0, 3, and 5 at 1, 5, and 10 minutes. He developed respiratory distress and worsening metabolic acidosis, requiring intubation. Chest radiograph showed a left-sided CDH with a large gastric bubble despite Replogle placement, raising concern for gastric volvulus. Due to progressive instability, he was transferred to our quaternary center and taken urgently to the operating room. Intraoperatively, a large left-sided diaphragmatic defect (2.5 × 3 cm) was identified with herniation and volvulus of the stomach, along with herniation of the small intestine, colon, and spleen. The stomach was detorsed, and the defect was repaired with a patch. His postoperative course was uneventful; feeds were initiated on postoperative day (POD) 5, and he was discharged home on full feeds on POD 33. At his 6-week follow-up, he remained asymptomatic with no recurrence.</div></div><div><h3>Conclusion</h3><div>While gastric volvulus in patients with CDH is rare and typically presents beyond the neonatal period, it can also occur in neonates. Awareness of this early presentation can prompt timely surgical intervention and favorable outcomes.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"118 ","pages":"Article 103023"},"PeriodicalIF":0.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899690","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":"Bilateral intralobar and extralobar pulmonary sequestration: A case report","authors":"Afef Toumi ,&nbsp;Marwa Messaoud ,&nbsp;Amine Ksia ,&nbsp;Mabrouk Abdelaaly ,&nbsp;Amina Ben Salem ,&nbsp;Lassaad Sahnoun","doi":"10.1016/j.epsc.2025.103027","DOIUrl":"10.1016/j.epsc.2025.103027","url":null,"abstract":"<div><h3>Background</h3><div>Bilateral pulmonary sequestration is a rare condition, with the coexistence of intralobar (ILS) and extralobar sequestration (ELS) being particularly uncommon. Antenatal diagnosis of such bilateral presentations remains exceedingly rare.</div></div><div><h3>Case presentation</h3><div>A 26-week of gestational age fetus was diagnosed by prenatal ultrasound with an echogenic lesion in the right hemithorax and an echogenic lesion in the left hemithorax. Fetal MRI at 36 weeks confirmed bilateral pulmonary lesions. A male infant was delivered at 39 weeks with no respiratory symptoms. Postnatal angiothoracic computed tomography (CT) with 3D vascular reconstruction confirmed left extralobar and right intralobar sequestrations. Although the child remained asymptomatic, elective surgery was scheduled at 9 months to prevent potential complications while allowing for continued growth and lung development. The ELS was successfully excised via a thoracoscopic approach, with an uneventful postoperative course. At 12 months, a right lower lobectomy was performed, through thoracotomy, to remove the ILS. The postoperative period was marked by a transient pulmonary infection, which resolved with antibiotic therapy. Histopathological examination confirmed the diagnosis of pulmonary sequestration. At 18 months of follow-up, the child exhibited normal growth and development without any complications.</div></div><div><h3>Conclusion</h3><div>In cases of bilateral, intrapulmonary and extrapulmonary sequestrations, a sequential resection before the age of 1 year seems to be a safe and effective management option.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"118 ","pages":"Article 103027"},"PeriodicalIF":0.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143899689","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":"Intralobar pulmonary sequestration combined with pulmonary mucoepidermoid carcinoma in an adolescent: A case report","authors":"Brooklynne A.S. Dilley-Maltenfort,&nbsp;John Roebel,&nbsp;Todd Boyd,&nbsp;Rachael Courtney,&nbsp;Daniel Evans,&nbsp;Anne Mackow","doi":"10.1016/j.epsc.2025.103026","DOIUrl":"10.1016/j.epsc.2025.103026","url":null,"abstract":"<div><h3>Introduction</h3><div>Primary pulmonary carcinomas in children are exceedingly rare, representing only 0.2 of every 1,000,000 childhood cancer diagnoses. Approximately 9 % of them are pulmonary mucoepidermoid carcinoma (PMEC). Due to nonspecific symptoms that mimic common respiratory conditions, their diagnosis is often delayed.</div></div><div><h3>Case presentation</h3><div>A 17-year-old previously healthy male presented with fever, cough, and nasal congestion and was treated with antibiotics for presumed pneumonia. Despite completing treatment, his symptoms persisted. Over the following month, serial chest X-rays showed a persistent left lower lobe opacity with atelectasis. A chest computerized tomography (CT) revealed a 2.7-cm non-calcified mass in the left lower lobe with post-obstructive changes. He was admitted to our institution with worsening symptoms but improved on IV antibiotics and was discharged home shortly thereafter. We did a flexible bronchoscopy to investigate the calcified mass and found compression of the posterior basal segment bronchi. Samples of the bronchoalveolar lavage grew <em>Haemophilus influenzae</em>. Elective surgical resection was delayed due to insurance issues for several months. While awaiting clearance, he presented with an episode of hemoptysis, which resolved spontaneously. A repeat CT showed slight enlargement of the mass and worsening bronchiectasis. He underwent a video-assisted thoracoscopic left lower lobectomy during which we found a systemic vessel arising from the thoracic aorta, which confirmed the diagnosis of an intralobar pulmonary sequestration. The lobe containing the mass and the sequestration was completely removed. The pathology confirmed a <strong>low-</strong>grade pulmonary mucoepidermoid carcinoma (PMEC) within the intrapulmonary sequestration. The patient was discharged on postoperative day 3 and returned to normal activities without further respiratory symptoms. At 1 month of follow up he continues to be asymptomatic and remains under surveillance by the oncology team.</div></div><div><h3>Conclusion</h3><div>Children and adolescents with persistent respiratory symptoms require a comprehensive imaging workup to rule out pulmonary malignancies, which, although rare, can still occur in this population.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"118 ","pages":"Article 103026"},"PeriodicalIF":0.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143918603","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":"Management of comorbid congenital diaphragmatic hernia and Hirschsprung disease: A case report","authors":"Nzuekoh N. Nchinda ,&nbsp;Carrie Foster ,&nbsp;Jimiane Ashe ,&nbsp;Matthew B. Dellinger ,&nbsp;Samuel E. Rice-Townsend","doi":"10.1016/j.epsc.2025.103028","DOIUrl":"10.1016/j.epsc.2025.103028","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital diaphragmatic hernia (CDH) and Hirschsprung disease (HD) are each rare, potentially life-threatening congenital diseases. Early recognition of combined presentation allows for optimal management.</div></div><div><h3>Case presentation</h3><div>A 39-week gestation male with prenatally diagnosed left-sided CDH was intubated and placed on mechanical ventilation promptly after delivery. Preoperative transthoracic echocardiogram showed signs of pulmonary hypertension, a patent foramen ovale, and mitral valve annulus hypoplasia. He underwent CDH repair with a synthetic patch on his fourth day of life and recovered well initially. However, he developed intermittent abdominal distension during advancement of enteral feeds. An abdominal x-ray suggested a distal bowel obstruction. A contrast enema raised concern for Hirschsprung disease, which was confirmed pathologically with a suction rectal biopsy at four weeks of age. He underwent a laparoscopic-assisted Swenson pull-through at five weeks of age. He recovered appropriately and was able to successfully advance to goal enteral feeds. By hospital discharge, he was on room air, oral and gavage feeds, and was spontaneously stooling without the need for rectal irrigations.</div></div><div><h3>Conclusion</h3><div>Concurrent congenital diaphragmatic hernia and Hirschsprung disease is exceptionally rare, but has been reported. Recognition of this possibility when feeding difficulties persist after CDH repair is key to allow proper management.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"118 ","pages":"Article 103028"},"PeriodicalIF":0.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892026","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":"Endoscopic trans-gastric drainage of a peri-splenic abscess after laparoscopic appendectomy for perforated appendicitis: a case report","authors":"Ryan T. Davis ,&nbsp;Ibrahim B. Baida ,&nbsp;Katelyn R. Ward ,&nbsp;Laith H. Jamil ,&nbsp;Begum Akay ,&nbsp;Nathan M. Novotny","doi":"10.1016/j.epsc.2025.103029","DOIUrl":"10.1016/j.epsc.2025.103029","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative abscesses after perforated appendicitis occur in 10–30 % of pediatric patients, but not all are amenable to percutaneous drainage.</div></div><div><h3>Case presentation</h3><div>A 4-year-old female presented with abdominal pain and vomiting and was diagnosed with perforated appendicitis with an associated pelvic abscess. She underwent laparoscopic appendectomy, during which a perforated appendix and diffuse peritoneal contamination were noted. Two 15-French Blake drains were placed intraoperatively. She was admitted to the pediatric intensive care unit (PICU) for close monitoring and received intravenous piperacillin-tazobactam. Drains were removed on postoperative day (POD) 6, and she was discharged on POD 10 with a peripherally inserted central catheter (PICC) for continued outpatient piperacillin-tazobactam infusions. Three days later, she returned with fever, loose stools, recurrent abdominal pain, and a white blood cell count of 45.9 bil/L. Computed tomography (CT) revealed a 4.3-cm peri-splenic abscess. Antibiotics were escalated to meropenem, vancomycin, and metronidazole. As no safe percutaneous access route was available, endoscopic ultrasound (EUS)-guided drainage was performed. Two 7-French, 5-cm double-pigtail plastic stents were placed into the collection. Abscess cultures from the EUS-guided trans-gastric drainage were almost fully suppressed with a few <em>Streptococcus anginosus</em> present. She recovered well, was discharged on post-procedure day 4, and completed 21 days of intravenous meropenem. Follow-up CT on post-procedure day 23 confirmed resolution. Stents were removed as an outpatient procedure 123 days after placement.</div></div><div><h3>Conclusion</h3><div>Trans-gastric endoscopic ultrasound-guided drain placement seems to be an effective approach for upper abdominal abscesses that are not amenable to percutaneous drain placement.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"118 ","pages":"Article 103029"},"PeriodicalIF":0.2,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144170090","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":"Neonatal iliopsoas abscess: A case report","authors":"Mohamoud Abdulahi ,&nbsp;Abdirahman Omer Ali ,&nbsp;Abdirahman Ibrahim Said ,&nbsp;Hassan Elmi Moumin ,&nbsp;Abdiaziz Walhad ,&nbsp;Abdisalam Hassan Muse","doi":"10.1016/j.epsc.2025.103024","DOIUrl":"10.1016/j.epsc.2025.103024","url":null,"abstract":"<div><h3>Introduction</h3><div>Iliopsoas abscess (IPA) is a rare and potentially challenging condition in neonates, particularly in resource-limited environments.</div></div><div><h3>Case presentation</h3><div>A term female neonate, born at 38 weeks gestation, presented at 28 days of age with an 18-day history of left thigh swelling, reduced limb movement, and fever. Initial treatment at an outside facility consisted of intravenous ampicillin-cloxacillin for two days, after which she was discharged without oral antibiotics. Ultrasound imaging at our facility revealed a 220 ml fluid collection in the left iliopsoas muscle and the left anteromedial compartment of the thigh. Surgical drainage was performed on day of life 30 via an incision through the lumbar triangle of Petit, with placement of a non-suction drain. Intravenous antibiotics were subsequently changed to vancomycin, metronidazole, and gentamicin. The abscess recurred on day of life 38, necessitating a second surgical drainage, which yielded 30 ml of thin pus mixed with blood. Following the second drainage, the patient improved and was discharged on oral cephalexin for 14 days. At the one-month follow-up, she exhibited satisfactory progress, with no asymmetry in movements or any tissue swelling.</div></div><div><h3>Conclusion</h3><div>Neonates with swelling of the inner aspect of the thigh should undergo an ultrasound to rule out an iliopsoas abscess. Patients should be closely monitored for early recurrence after a surgical drainage, even if they are still under antibiotic treatment.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"118 ","pages":"Article 103024"},"PeriodicalIF":0.2,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894660","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":"Intestinal intussusception from a Meckel's diverticulum and intestinal malrotation: a case report","authors":"Rawan Sharma,&nbsp;Shin Miyata,&nbsp;Olivia Gentry,&nbsp;Christopher Blewett,&nbsp;Richard Herman","doi":"10.1016/j.epsc.2025.103025","DOIUrl":"10.1016/j.epsc.2025.103025","url":null,"abstract":"<div><h3>Introduction</h3><div>Most cases of pediatric intussusception are idiopathic, with a pathologic lead point identified in only 25 % of cases. Meckel's diverticulum (MD) is the most frequent pathologic lead point in children. The co-occurrence of intussusception and malrotation is known as Waugh's syndrome. The simultaneous presence of intestinal malrotation and intussusception due to a MD is a rare entity.</div></div><div><h3>Case presentation</h3><div>A 5-month-old girl with no significant medical history was brought to the emergency room after one day of non-bilious, non-projectile vomiting, without any rectal bleeding. A two-view abdominal x-ray was performed, showing evidence of a small bowel obstruction without bowel wall thickening or free air. Due to the non-specific findings and symptoms concerning for intussusception, an ultrasound (US) was ordered. The US suggested an ileocolic intussusception. The patient underwent an attempted pneumatic reduction (PR) with air. After three unsuccessful attempts with persistent dilated loops of small bowel the patient was taken to the operating room for surgical reduction. We did initially a laparoscopy and found dilated bowel and no colon in the right lower quadrant, which rose concern for intestinal malrotation. We decided to convert the operation to a laparotomy. We found an ileocolic intussusception, and a more proximal ileo-ileal intussusception, with a MD as the lead point, and intestinal malrotation. We did a manual reduction of both intussusceptions, resected 25 cm of small bowel containing the MD due to its ischemic appearance, did an appendectomy, and a Ladd's procedure for the malrotation. The patient recovered well postoperatively and was discharged home on postoperative day four.</div></div><div><h3>Conclusion</h3><div>Intestinal malrotation should be ruled out in patients undergoing surgical reduction of intussusception, as these two entities are occasionally associated and can present with non-typical symptoms.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"118 ","pages":"Article 103025"},"PeriodicalIF":0.2,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882549","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 uterovaginal prolapse in a term neonate: a case report","authors":"Jejaw Endale ,&nbsp;Yidnekachew Getachew ,&nbsp;Samuel Gashu ,&nbsp;Belachew Dejene ,&nbsp;Mihret S. Tesfaye ,&nbsp;Hiwot Y. Anley","doi":"10.1016/j.epsc.2025.103019","DOIUrl":"10.1016/j.epsc.2025.103019","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital uterovaginal prolapse in neonates is a rare condition, and it is often associated with spinal cord defects.</div></div><div><h3>Case presentation</h3><div>A 3-day-old female term neonate born via cesarean section with a weight of 3.2 Kg was admitted to our pediatric surgery unit due to a protruding mass in the vaginal introitus and swelling in the lower back. On physical examination, the mass measured 4 by 5 cm was and appeared to be the vagina and part of the uterus. There was no discharge or bleeding. The mass was easily reducible but recurred when the patient cried. A spinal ultrasound confirmed a 3 by 2-cm defect in the lumbosacral area, consistent with a meningomyelocele. The patient also had bilateral clubfoot. A transfontanellar ultrasound showed obstructive hydrocephalus, likely due to aqueductal stenosis, and showed a small posterior fossa with an inferiorly displaced vermis, suggesting Chiari malformation type II. Several attempts at manual reduction and packing of the mass with a plaster were made but were unsuccessful. The patient was taken to the operating room for a vaginal cerclage. Two incisions were made on the vaginal wall at the 6 o'clock and 12 o'clock positions, approximately 1 cm above the fourchette. A circumferential suture of reabsorbable material was then placed and securely tied. The postoperative course was uneventful. The patient was subsequently transferred to the neurosurgery department for further evaluation and management. At three months of follow-up there have been no signs of tissue damage, and no recurrence of the prolapse<strong>.</strong></div></div><div><h3>Conclusion</h3><div>Congenital uterovaginal prolapse is a rare anomaly, and most cases occur in patients with neural tube defects. Vaginal cerclage seems to be a safe and effective management option.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"118 ","pages":"Article 103019"},"PeriodicalIF":0.2,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877589","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":"Atypical presentation of occult congenital diaphragmatic hernia as intermittent obstructive symptoms: A case report","authors":"Connor V. Haynes ,&nbsp;Carly T. Thaxton ,&nbsp;Matthew P. Shaughnessy ,&nbsp;David H. Stitelman","doi":"10.1016/j.epsc.2025.103018","DOIUrl":"10.1016/j.epsc.2025.103018","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital diaphragmatic hernias (CDH) diagnosed beyond one month of life are rare and designated late-onset. Late-onset CDH can present with a variety of clinical manifestations including respiratory and gastrointestinal symptoms, which may be acute onset or long-standing chronic issues.</div></div><div><h3>Case presentation</h3><div>A 32-month-old boy with a five-month history of obstructive bowel symptoms was brought to the emergency department due to acute respiratory distress and abdominal pain. He was born at 41w1d with no prenatal suspicion of congenital anomalies. At the age of 27 months, the previously healthy patient with normal stooling patterns presented with a picture of bowel obstruction and was subsequently admitted three times over the next five months, with a maximum stay of eight days, due to ongoing obstructive symptoms. Multiple abdominal and chest radiographs during this period did not reveal an obvious structural etiology. Upon his respiratory distress presentation, repeat radiography revealed bowel loops in the left hemithorax with rightward mediastinal shift. Laparoscopy and thoracoscopy demonstrated a posterior left diaphragmatic hernia with omentum adherent to lung. Laparotomy was performed for reduction and suture repair of the diaphragm. Omentum fixed to the splenic flexure of the colon resulted in a fibrotic band of scar tissue and bowel caliber change. These bands were lysed. The post-operative course was uneventful, and the patient has maintained normal bowel movements without abdominal pain for three months.</div></div><div><h3>Conclusion</h3><div>Late-onset congenital diaphragmatic hernia must be included in the differential diagnosis of children who present with new-onset acute intestinal obstruction.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"117 ","pages":"Article 103018"},"PeriodicalIF":0.2,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856027","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}