Journal of Pediatric Surgery Case Reports最新文献

{"title":"Hematochezia caused by an ileal duplication in a 9-year-old male: A case report","authors":"Diana Castaneda-Cruz ,&nbsp;Sarah Goodrich ,&nbsp;Meera N. Menon","doi":"10.1016/j.epsc.2025.103085","DOIUrl":"10.1016/j.epsc.2025.103085","url":null,"abstract":"<div><h3>Introduction</h3><div>Enteric duplications are rare congenital anomalies of the gastrointestinal tract, often presenting with nonspecific symptoms, including abdominal pain and hematochezia. Symptoms that also exist with other more common etiologies, such as Meckel's diverticulum.</div></div><div><h3>Case Presentation</h3><div>A 9-year-old male pediatric patient with atopic dermatitis was brought into his pediatrician's office due to a five-month history of hematochezia, weight loss, abdominal pain, and fatigue. He was referred to the emergency department and was subsequently admitted to the Pediatric Hospitalist service. During his admission, he underwent an extensive evaluation. Results were largely unremarkable, with a normal hemoglobin level of 12.1. Positive findings included an elevated ESR of 15, IgE of 326, and IgM of 226. A Meckel's scan demonstrated focal radiotracer uptake in the anterior lower midline abdomen, prompting surgical intervention for a suspected Meckel's diverticulum. A transumbilical single incision was created, and a GelPoint ^Ⓡ Mini Advanced Access Platform (CNGL3) was inserted for laparoscopic assistance. Intraoperative findings revealed a 23cm segment of duplicated ileum which was subsequently resected. Pathology revealed tubular type small intestinal duplication with gastric heterotopia. The intraoperative findings of duplication of the ileum, with pathology confirming the presence of gastric mucosa within the duplication, explained the positive Meckel's scan. Following discharge from the hospital, the patient had follow-up appointments with gastroenterology and nutrition services.</div></div><div><h3>Conclusion</h3><div>Ileal duplications must be included in the differential diagnosis of children with chronic gastrointestinal bleeding. Meckel's scintigraphy may be positive if ectopic gastric mucosa is present in the duplication.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103085"},"PeriodicalIF":0.2,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852254","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":"Anomalous congenital band causing duodenal and transverse colon obstruction in a 3-year-old girl: A case report","authors":"Amnah Fallatah ,&nbsp;Muhammad Afzal ,&nbsp;Sania Alblushi ,&nbsp;Zeinab Alsulaiman ,&nbsp;Huda Hussain Abugrain ,&nbsp;Ahmed Tabash","doi":"10.1016/j.epsc.2025.103081","DOIUrl":"10.1016/j.epsc.2025.103081","url":null,"abstract":"<div><h3>Introduction</h3><div>Intestinal obstruction is commonly seen in children and may result from various acquired or congenital causes. Obstruction due to an anomalous congenital band (ACB) is exceptionally rare. These bands can develop anywhere along the gastrointestinal tract and often pose a diagnostic challenge preoperatively.</div></div><div><h3>Case presentation</h3><div>A 3-year-old girl presented with chronic constipation, abdominal pain, and bilious vomiting. She was initially diagnosed and treated for conditions such as simple constipation, cystitis, enteritis, and gastritis, but showed no improvement. The radiological evaluation included abdominal radiography, ultrasound, dual-contrast computed tomography (CT), and a single-contrast enhanced image of the upper gastrointestinal tract (GIT). Surgical intervention was undertaken based on CT and upper GIT contrast imaging findings indicating an obstruction in the second part of the duodenum. Operative findings revealed an ACB arising from the root of the small intestinal mesentery, obstructing both the duodenum and the transverse colon. The band was divided, and a portion of it was sent for histopathological examination. The postoperative period was uneventful, her symptoms fully resolved, and she was discharged on the 6th postoperative day. At the 2-month follow-up, she remained asymptomatic. To our knowledge, no such case has previously been documented in the literature.</div></div><div><h3>Conclusion</h3><div>Anomalous congenital bands should be considered in the differential diagnosis of children presenting with intestinal obstruction in the absence of previous abdominal operations, particularly when preoperative imaging findings are inconclusive.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103081"},"PeriodicalIF":0.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841170","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":"Spontaneous closure of a patent processus vaginalis: a case report","authors":"Haley Kittle ,&nbsp;Amber Lee Geng ,&nbsp;Loren Berman ,&nbsp;Erin Teeple","doi":"10.1016/j.epsc.2025.103084","DOIUrl":"10.1016/j.epsc.2025.103084","url":null,"abstract":"<div><h3>Introduction</h3><div>Patent process vaginalis and inguinal hernia are prolific in infants, and their repair is a common pediatric surgical procedure. However, there is a paucity of direct evidence detailing the spontaneous closure of patent processus vaginalis.</div></div><div><h3>Case presentation</h3><div>A 4-month-old boy born prematurely at 34-weeks with low gestational birth weight, underwent laparoscopic gastrostomy tube placement for oropharyngeal dysphagia and was incidentally found to have bilateral patent processes vaginalis. Due to his lack of symptoms, he was managed under the watchful waiting approach. His parents were educated about signs and symptoms of inguinal hernia and were instructed to contact the team with any concerns. He represented at 6 years of age with symptomatic right-sided inguinal hernia, and during planned laparoscopic surgical repair, he was found to have spontaneous closure of the processus vaginalis on the left side. His right sided hernia was repaired, and his left side was left untouched. The patient tolerated the procedure well and has had no signs nor symptoms of right sided recurrence nor new onset of left sided hernia to date. He will follow up as needed if there are any concerns for hernia on the left side.</div></div><div><h3>Conclusion</h3><div>Patent processus vaginalis may progress to symptomatic inguinal hernia or may close spontaneously. Patients with bilateral patent processus vaginalis may exhibit a different outcome on each side.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103084"},"PeriodicalIF":0.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830078","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":"Appendiceal Crohn's disease presenting with urinary symptoms: a case report","authors":"Monalisa Attif Hassan ,&nbsp;Katherine A. Lin ,&nbsp;Patricio C. Gargollo ,&nbsp;Michael C. Stephens ,&nbsp;Nathan C. Hull ,&nbsp;Denise B. Klinkner","doi":"10.1016/j.epsc.2025.103083","DOIUrl":"10.1016/j.epsc.2025.103083","url":null,"abstract":"<div><h3>Introduction</h3><div>There is limited pediatric data describing the presentation and management of Crohn's disease of the appendix. Although appendectomies are common pediatric procedures, there is a paucity of literature regarding appendiceal Crohn's disease in pediatric patients.</div></div><div><h3>Case presentation</h3><div>A 15-year-old male presented with six months of chronic right lower quadrant pain, intermittent low-grade fevers, dysuria, and gross hematuria without urinary frequency. Laboratory studies revealed sterile pyuria, elevated CRP, and elevated fecal calprotectin. Endoscopic histopathology suggested celiac disease, and celiac serologies were positive. A computed tomography scan with intravenous contrast of the abdomen and pelvis (CT) showed a dilated, thick-walled appendix with mild surrounding inflammation, an appendicolith, and asymmetric thickening of the right posterolateral bladder wall with possible fistulous connection.</div><div>Diagnostic laparoscopy revealed a thickened appendiceal base densely adherent to the posterior bladder wall. He underwent an open ileocecectomy and cystoscopy. Cystoscopy showed posterior bladder inflammation. Pathology demonstrated transmural inflammation, ulceration, and noncaseating granulomas consistent with Crohn's disease. The patient was discharged on postoperative day three.</div><div>Seven days later, he presented with pain, nausea, and fever. A CT revealed a small pelvic fluid collection, which was aspirated. He was treated with IV antibiotics and started on infliximab before discharge. At his one-year follow-up appointment, the patient remains well on infliximab and a gluten-free diet with resolution of symptoms.</div></div><div><h3>Conclusion</h3><div>Crohn's disease of the appendix can cause chronic abdominal pain and urinary symptoms such as dysuria and hematuria.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103083"},"PeriodicalIF":0.2,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860545","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":"Conservative management of a button battery tracheoesophageal fistula in a resource-limited setting: a case report","authors":"Thadei Liganga ,&nbsp;Desderius Chussi ,&nbsp;Ezekiel Gathii","doi":"10.1016/j.epsc.2025.103080","DOIUrl":"10.1016/j.epsc.2025.103080","url":null,"abstract":"<div><h3>Introduction</h3><div>Tracheoesophageal fistula (TEF) is a morbid and potentially fatal complication of button battery ingestion. Conservative management is usually the initial management of choice. A minimum of 4–8 weeks is required for a spontaneous closure of the TEF.</div></div><div><h3>Case presentation</h3><div>A 3-year-old male child presented with hypersalivation, throat pain, choking when feeding, and dysphagia after an accidental ingestion of a lithium button battery 8 hours prior to admission. Esophagoscopy revealed a button battery in the proximal esophagus and circumferential necrosis of the esophageal mucosa at the site. We placed a nasogastric (NG) tube for enteral feedings and kept him without any oral feedings for seven days. At that point we removed the NG tube and initiated oral feedings. He quickly developed choking, so we did a contrast esophagram. Contrast spilled into the airway, confirming the diagnosis of a TEF in the proximal esophagus. We replaced the NG tube and kept him exclusively on NG feedings for 5 more weeks. Follow-up contrast esophagrams were done on the 6th, 10th and 16th weeks post injury, which showed a gradual reduction in the fistula size. No further TEF was seen 16 weeks post injury, so we removed the NG tube and restarted oral feedings. A follow-up study 3 months later showed no abnormalities, and he has been asymptomatic since then.</div></div><div><h3>Conclusion</h3><div>Spontaneous closure of button battery-induced TEFs can be expected to take up to 16 weeks. Prolonged conservative management should be considered before shifting to a surgical approach.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103080"},"PeriodicalIF":0.2,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144781358","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":"Tubular colonic duplication and intestinal malrotation in a child: A case report","authors":"Sukhdeep Jatana ,&nbsp;Troy Perry","doi":"10.1016/j.epsc.2025.103074","DOIUrl":"10.1016/j.epsc.2025.103074","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric colonic duplication is a rare entity that has a wide range of clinical presentations. It is rarely associated with other congenital malformations.</div></div><div><h3>Case presentation</h3><div>A 2-year-old girl presented to the emergency department with a five-day history of obstipation, vomiting, and worsening abdominal distension. She had a history of chronic constipation. She was found to have an elevated white blood cell count and C-reactive protein. Abdominal plain films and computed tomography findings were suggestive of a large bowel obstruction and included a mesenteric swirl sign concerning for an intestinal volvulus. The patient was taken to the operating room for an emergent exploratory laparotomy. The colon was noted to be significantly dilated. We found an additional loop of bowel coming off from the cecum. This was a tubular duplication, two feet in length, that was also dilated. The duplication had its own mesentery and blood supply coming off the ileocolic pedicle. The site of the colonic obstruction was in the transverse colon, caused by an adhesive band. We performed an extended right hemicolectomy as the colon appeared unhealthy and we suspected that the duplicated colonic segment could have contributed to the patient's symptoms and could be at risk of volvulus in the future. The duplicated colonic segment was resected with the normal colon. We then examined the small bowel and found that it was malrotated, so we did a Ladd procedure. The patient recovered uneventfully and was discharged six days later. She continues to do well, and her chronic constipation has resolved.</div></div><div><h3>Conclusion</h3><div>Colonic duplications must be included in the differential diagnosis of children who develop chronic constipation and/or acute intestinal obstruction. Patients who have colonic duplications should be studied to rule out other intestinal anomalies such as intestinal malrotation.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103074"},"PeriodicalIF":0.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772353","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":"Splenogonadal fusion in a 9-year-old patient: a case report","authors":"Axelle Boudon ,&nbsp;Olivier Hild ,&nbsp;Yann Chaussy","doi":"10.1016/j.epsc.2025.103077","DOIUrl":"10.1016/j.epsc.2025.103077","url":null,"abstract":"<div><h3>Introduction</h3><div>Splenogonadal fusion is a rare, benign congenital anomaly characterized by an abnormal connection between the spleen and a gonad. Its occurrence is rarely reported in pediatric surgical literature.</div></div><div><h3>Case presentation</h3><div>We present a case of splenogonadal fusion in a 9-year-old patient, which was discovered incidentally during surgery for undescended testis. His only prior condition was an anomaly of the distal right lower limb characterized by right lateral longitudinal ectromelia. Inguinal exploration revealed the left testicle within the inguinal canal. Dissection of the spermatic vessels and vas deferens exposed an unusual fibrous structure attached to the upper pole of the testis. Applying gentle traction on this fibrous cord revealed a splenic-like structure in the inguinal canal. The left testicle was successfully descended into the scrotum without sectioning the fibrous connection. Postoperative recovery was uneventful. At a three-month follow-up visit, the left testicle was palpable in the upper part of the scrotum. To further investigate the congenital anomaly, a contrast-enhanced abdominopelvic computed tomography scan was performed postoperatively. This scan revealed a typical main spleen structure in its usual position in the left hypochondrium, extending into a cord of splenic tissue arising from its lower pole, coursing along the left paracolic gutter and entering the deep inguinal ring. The vascularization of the splenic tissue showed no abnormalities.</div></div><div><h3>Conclusion</h3><div>Splenogonadal fusion is often asymptomatic and is usually discovered incidentally during inguinal exploration for an inguinal hernia or undescended testis. Some anatomical forms are associated with congenital defects of the lower extremities.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103077"},"PeriodicalIF":0.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772352","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":"Imperforate anus, multiple intestinal atresia and unilateral facial hypoplasia: A case series","authors":"Joy Ayemoba ,&nbsp;Carmelle Romain ,&nbsp;Kathryn J. Rowland","doi":"10.1016/j.epsc.2025.103076","DOIUrl":"10.1016/j.epsc.2025.103076","url":null,"abstract":"<div><h3>Introduction</h3><div>Imperforate anus and intestinal atresia are rare but well understood congenital disorders which affect the alimentary tract. Like intestinal atresia, facial hypoplasia is another congenital anomaly likely secondary to a vascular injury in utero.</div></div><div><h3>Case presentation</h3><div>Case 1 discusses a female born at 32 weeks with a prenatal diagnosis of duodenal atresia and discovery of imperforate anus and unilateral maxillary hypoplasia at birth. She was emergently taken to the operating room for bowel obstruction. During that operation, she underwent repair of multiple segments of atresia, a duodenoduodenostomy, and creation of an end ileostomy and mucus fistula. At two months of age, she returned to the operating room to restore continuity of the distal atretic bowel. At six months old she presented with a partial bowel obstruction secondary to a jejunal duplication cyst. Case 2 discusses a full-term male presenting with unilateral facial hypoplasia and imperforate anus at birth. Given failure to pass meconium and worsening abdominal distension he was taken to surgery, where multiple segments of intestinal atresia were identified. During this operation he was left in discontinuity following creation of a diverting loop ileostomy and colostomy. Two months later, he underwent repeat exploratory laparotomy during which multiple segments of atretic bowel were repaired. At four months of age, he underwent reversal of the diverting loop ileostomy followed by completion of posterior sagittal anorectoplasty at nine months old.</div></div><div><h3>Conclusion</h3><div>Intestinal atresias should be highly suspected in patients who present with anorectal malformations in conjunction with facial hypoplasia.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103076"},"PeriodicalIF":0.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772302","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":"Three-dimensional modelling and printing for preoperative planning in the resection of an ischiorectal epithelioid sarcoma: a case report","authors":"Rachel J. Livergant ,&nbsp;Trevor D. Hamilton ,&nbsp;Daniel G. Rosenbaum ,&nbsp;Sima Zakani ,&nbsp;John Jacob ,&nbsp;Shahrzad Joharifard","doi":"10.1016/j.epsc.2025.103079","DOIUrl":"10.1016/j.epsc.2025.103079","url":null,"abstract":"<div><h3>Introduction</h3><div>Epithelioid sarcomas are rare malignant mesenchymal tumours, accounting for approximately 3–4 % of pediatric soft-tissue sarcomas, and present unique surgical challenges due to their infiltrative nature and proximity to critical anatomical structures. While three-dimensional modelling has emerged as a valuable adjunct in preoperative planning for complex tumours, its use in pediatric soft-tissue sarcomas is rare, with no described cases involving epithelioid sarcomas.</div></div><div><h3>Case presentation</h3><div>A 13-year-old girl presented with a year-long history of perineal pain and a palpable mass. Imaging revealed a tumour involving the rectum and external sphincter, abutting the posterior vaginal wall. Biopsy confirmed epithelioid sarcoma and staging showed indeterminate pulmonary nodules. She underwent neoadjuvant chemoradiotherapy. Two surgical options were considered: abdominoperineal resection with hysterectomy or vaginal preservation with increased risk of residual disease. A three-dimensional model with 2cm margins was created to aid decision-making. After multidisciplinary review and model consultation, the patient opted for vaginal preservation. She underwent abdominoperineal resection with VRAM flap reconstruction. Final pathology confirmed negative margins. Nearly three years later, she developed a pancreatic tail metastasis and progressive pulmonary lesions, which were treated with distal pancreatectomy, splenectomy, radiotherapy, and cryoablation. Additional metastases in the stomach, scalp, retroperitoneum, and flank are being managed with palliative radiotherapy.</div></div><div><h3>Conclusion</h3><div>Three-dimensional printed models can be helpful in the preoperative planning for the resection of tumours of the ischiorectal region.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103079"},"PeriodicalIF":0.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772350","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":"Awake thoracoscopic mediastinal biopsy in a teenager: a case report","authors":"Morgan L. Brown,&nbsp;Samantha M. Koenig,&nbsp;Vincent Mortellaro,&nbsp;Mike K. Chen,&nbsp;Elizabeth A. Beierle","doi":"10.1016/j.epsc.2025.103078","DOIUrl":"10.1016/j.epsc.2025.103078","url":null,"abstract":"<div><h3>Introduction</h3><div>Mediastinal masses are a common pathology encountered by pediatric surgeons. These masses may cause airway compression that precludes the use of general anesthesia; however, pathologic diagnosis may depend upon tissue obtained only through a surgical biopsy. We describe an innovative technique to obtain adequate tissue for diagnosis from an anterior mediastinal mass in the setting of airway compression.</div></div><div><h3>Case presentation</h3><div>A 13-year-old child presented with three months of chest pain and weakness. Initial workup with chest x-ray identified a mediastinal mass. A chest computerized tomography (CT) revealed a 14.5 by 9.7 cm anterior mediastinal mass causing tracheal compression. Bone marrow and lymph node biopsies were non-diagnostic, and a three-day trial of oral prednisone (40 mg twice daily) had minimal effect on airway compromise. Prominent vasculature precluded a window for safe percutaneous biopsy or through a Chamberlain approach. The patient was taken to the operating room for an awake thoracoscopic biopsy of the mediastinal mass using intravenous ketamine and local anesthesia. The patient was placed in left lateral decubitus position. A 5-mm trocar was placed in the posterior axillary line with two additional 5-mm trocars triangulated posteriorly. Loss of negative intrathoracic pressure allowed for visualization of the mass. Biopsies were taken using laryngeal biopsy forceps and a chest tube was left in place. The patient was discharged home on the first postoperative day after chest tube removal. The pathology was consistent with classic Hodgkin lymphoma, intermediate risk, Stage IIA. The patient was treated with chemotherapy per the AHOD0031 protocol and continues to be followed by the oncology service.</div></div><div><h3>Conclusion</h3><div>Awake, video-assisted thoracoscopic surgery seems to be a feasible option for incisional biopsies in teenagers that have mediastinal tumors causing airway compression precluding the use of general anesthesia.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103078"},"PeriodicalIF":0.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772351","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}