Journal of Pediatric Surgery Case Reports最新文献

{"title":"Lateral proximal esophagostomy and bouginage for the management of type-A esophageal atresia: a case series","authors":"Pastor Escárcega-Fujigaki ,&nbsp;Guillermo Hernández-Peredo-Rezk ,&nbsp;Haydee Vélez-Blanco ,&nbsp;Guadalupe-Gisela Caltzontzin-Basurto ,&nbsp;Carlos-Alberto Mesa-Aguirre ,&nbsp;Carlos Gutiérrez-Avalos","doi":"10.1016/j.epsc.2025.103070","DOIUrl":"10.1016/j.epsc.2025.103070","url":null,"abstract":"<div><h3>Introduction</h3><div>Type A esophageal atresia (EA) is a rare congenital anomaly. Multiple surgical approaches and techniques have been proposed for its treatment, highlighting the complexity of its correction.</div></div><div><h3>Case presentation</h3><div>Case 1 was of a female infant delivered at 35 weeks of gestation (weight, 2.7 kg; height, 47 cm; Apgar, 8–8), diagnosed with Type A EA and duodenal atresia. At 4 days of age, lateral proximal esophagostomy (LPE), duodenal membrane resection, and gastrostomy were performed. The patient was discharged after 36 days, with the parents instructed to perform bouginage. Owing to the pandemic, esophageal anastomosis was performed at 2 years of age. Subsequently, two esophageal dilatations were required; Nissen fundoplication with closure of gastrostomy and LPE were performed 4 months later. At approximately 5 years of age, the patient showed no difficulties in feeding. Case 2 was of a male infant delivered at 37 weeks of gestation (weight, 2.8 kg; height, 50 cm; Apgar, 8–9), diagnosed with Type A EA with VACTERL association. Gastrostomy and LPE were performed at 6 and 26 days of age, respectively; the patient was also discharged, with the parents instructed to perform bouginage. Due to malnutrition, esophagoplasty was performed at 1 year and 10 months. Subsequently, two esophageal dilations were performed, followed by closure of gastrostomy and LPE after 2 and 7 months, respectively. At the 3-year follow-up, the patient exhibited no feeding difficulties.</div></div><div><h3>Conclusion</h3><div>Lateral proximal esophagostomy and bouginage appear to be a feasible option for the management of type-A esophageal atresia.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103070"},"PeriodicalIF":0.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739570","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":"L-shaped sternotomy for the resection of a large thoracic tumor in a 10-year-old child: a case report","authors":"Saeyoung Lee ,&nbsp;Alberto Jarrin Lopez ,&nbsp;Gabriella Grisotti ,&nbsp;Vinod Sebastian ,&nbsp;Sunghoon Kim","doi":"10.1016/j.epsc.2025.103075","DOIUrl":"10.1016/j.epsc.2025.103075","url":null,"abstract":"<div><h3>Introduction</h3><div>In pediatric patients, large intrathoracic tumors have a broad differential and varied presentation. Based on patient anatomy, the size of the tumor, and malignant potential, adequate intra-operative exposure must be balanced with long-term functional recovery.</div></div><div><h3>Case presentation</h3><div>A previously healthy 10-year-old girl presented with a 2-month history of dyspnea, left shoulder pain, heart murmur, and significant weight loss. Physical examination revealed diminished breath sounds on the left side and a systolic murmur on auscultation, as well as an asymmetric chest. Elevated inflammatory markers were noted, with imaging showing a large heterogeneous tumor occupying most of the left thoracic cavity, 13.5 x 10.3 × 13.3 cm, including cystic and adipose tissue with calcifications. The tumor exerted mass effect on the left pulmonary vessels, lung, and left ventricle, causing mediastinal shift and pleural effusion. Surgical resection was performed using an L-shape sternotomy, with curvilinear left lateral extension in the anticipated inframammary crease and division of the 6th intercostal space, allowing complete en bloc excision without spillage. Pain management included intercostal nerve cryoablation, facilitating early mobilization out of bed, and minimizing the need for narcotic analgesia. Postoperatively, the patient recovered well, with pain managed by Tylenol, Ibuprofen, oxycodone, and Dilaudid. Follow-up after six months showed no recurrence of the tumor, and biopsies revealed a cystic mature teratoma with chronic inflammation in surrounding tissues.</div></div><div><h3>Conclusion</h3><div>The L-shaped sternotomy seems to be an effective approach for the resection of large thoracic tumors in children.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103075"},"PeriodicalIF":0.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739572","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":"Familial intestinal malrotation and cleft lip and palate: A case report","authors":"Kamela Loo ,&nbsp;Krista Lai ,&nbsp;Vidhi Shah","doi":"10.1016/j.epsc.2025.103072","DOIUrl":"10.1016/j.epsc.2025.103072","url":null,"abstract":"<div><h3>Introduction</h3><div>The etiology of intestinal malrotation is unknown and it can occur in isolation or with other congenital anomalies. Although case reports have reported genetic etiologies of intestinal malrotation, association with cleft lip and palate is rare.</div></div><div><h3>Case presentation</h3><div>A 37 1/7-week male infant was born via C-section with a birth weight of 3270g and a prenatal diagnosis of cleft lip and palate. His Apgar scores at 1 and 5 minutes were 7 and 8, respectively, and he briefly required continuous positive airway pressure in the delivery room before weaning to room air. The infant was admitted to the neonatal intensive care unit for hypoglycemia and poor feeding. On day of life twelve, he developed bloody stools, metabolic acidosis, and abdominal distention, which progressed to respiratory failure, coagulopathy, and hypovolemic shock. Abdominal x-rays demonstrated a stomach bubble with paucity of distal gas. An abdominal ultrasound demonstrated inversion of the superior mesenteric vein and artery, which was highly suggestive of an intestinal malrotation with midgut volvulus. The patient underwent an emergent Ladd procedure without bowel resection. He had an uneventful postoperative recovery, with progression to full enteral feedings. The patient's older half sibling also had cleft lip and palate, experienced recurrent vomiting, and was diagnosed with malrotation requiring an elective Ladd procedure.</div></div><div><h3>Conclusion</h3><div>This case study suggests that the association of cleft lip and palate and intestinal malrotation may have a genetic background. Newborns who have cleft lip and palate who have siblings with this association should undergo imaging studies to rule out intestinal malrotation.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103072"},"PeriodicalIF":0.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144739569","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 abdominoscrotal hydroceles causing vascular compression in an infant: a case report","authors":"Nzuekoh N. Nchinda ,&nbsp;Caitlin A. Smith ,&nbsp;Sarah L.M. Greenberg","doi":"10.1016/j.epsc.2025.103073","DOIUrl":"10.1016/j.epsc.2025.103073","url":null,"abstract":"<div><h3>Introduction</h3><div>An abdominoscrotal hydrocele is a rare condition characterized by a large fluid-filled mass that spans scrotal, inguinal and intrabdominal components. Early surgical management is recommended in order to prevent complications from compression or torsion.</div></div><div><h3>Case presentation</h3><div>A previously healthy two-month-old male initially presented to a surgery clinic with asymptomatic congenital bilateral scrotal hydroceles; this was managed conservatively. He presented again at five months of age to the emergency department with acute right lower extremity swelling and mild discoloration. Testicular ultrasound showed large bilateral abdominoscrotal hydroceles. Magnetic resonance imaging angiogram additionally showed right external iliac vein opacification adjacent to the ipsilateral abdominoscrotal hydrocele, suggestive of compression or thrombosis. Duplex ultrasound of the iliac vessels showed significant narrowing of the right external iliac vein with associated turbulent, high-velocity flow. The patient underwent bilateral hydrocelectomy via open inguinal incisions and recovered well. Follow-up Doppler ultrasound was performed two weeks postoperatively and showed resolution of the prior right external iliac vein compression.</div></div><div><h3>Conclusion</h3><div>Bilateral abdominoscrotal hydroceles are rare and can present with vascular complications. Surgical management is recommended in symptomatic and complicated cases of abdominoscrotal hydroceles.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103073"},"PeriodicalIF":0.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144725019","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 obstruction due to ileo-sigmoid knotting in a child: a case report","authors":"Ephrem Nidaw Kerego ,&nbsp;Yonatan Solomon Eshetu","doi":"10.1016/j.epsc.2025.103071","DOIUrl":"10.1016/j.epsc.2025.103071","url":null,"abstract":"<div><h3>Introduction</h3><div>Ileo-sigmoid knotting is a rare cause of intestinal obstruction in which the ileum twists around the base of the sigmoid colon, or vice versa, forming a knot that creates a double closed-loop obstruction and can lead to bowel ischemia and necrosis.</div></div><div><h3>Case presentation</h3><div>A 7-year-old boy presented with a 12-hour history of worsening abdominal pain, initially colicky and central, later becoming diffuse, accompanied by bilious vomiting. On examination, the child appeared acutely ill and lethargic, with signs of hypovolemic shock including tachycardia (145 bpm), hypotension (80/45 mmHg), feeble pulses, and dry mucous membranes. The abdominal examination revealed marked distention and generalized tenderness. X-ray of the abdomen showed multiple centrally located air fluid levels. Laboratory results showed leukocytosis with neutrophilia. After fluid resuscitation and stabilization, he was taken to the operating room for an emergency laparotomy. We found a 100cm-long segment of ischemic ileum caused by a counterclockwise knot formed by a redundant sigmoid colon. The knot was untwisted, and the gangrenous ileum was resected. Because there was only a very short segment of healthy ileum proximal to the ileocecal valve, we did a limited right hemicolectomy and an ileo-colic anastomosis. The child recovered well and was discharged on the fifth postoperative day. He remained asymptomatic on the last follow up visit, one month after the operation.</div></div><div><h3>Conclusion</h3><div>Ileo-sigmoid knotting should be included in the differential diagnosis of children who develop acute abdominal pain with signs of intestinal obstruction.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103071"},"PeriodicalIF":0.2,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722784","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":"Intussusception secondary to a double Meckel's diverticulum in a 2-month-old infant: a case report","authors":"Natalia Guzmán Alfonso ,&nbsp;Jorge Ricardo Beltrán Chitiva ,&nbsp;Juan J. Valero ,&nbsp;Esteban Felipe Patiño Calderón ,&nbsp;Álvaro Andrés Trujillo Ceballos ,&nbsp;Carlos Andrés Cadavid Restrepo","doi":"10.1016/j.epsc.2025.103052","DOIUrl":"10.1016/j.epsc.2025.103052","url":null,"abstract":"<div><h3>Introduction</h3><div>Double Meckel's diverticulum is extremely rare. Only five cases have been reported in the pediatric population, none of which were associated with intestinal intussusception.</div></div><div><h3>Case presentation</h3><div>A 2-month-old, full-term infant born at 37 weeks of gestation was admitted with a one-day history of vomiting and blood-streaked stool. Laboratory tests were within normal limits. Abdominal x-ray showed distended bowel loops. Abdominal ultrasound showed findings suggestive of an Ileocolic intussusception. Due to the duration of symptoms, an enema reduction was not attempted. He was taken to the operating room for an exploratory laparoscopy. We used a single-port technique through a small incision at the umbilicus. We found an ileo-ileal intussusception and exteriorized the involved segment through the umbilical incision. The intussusception was manually reduced, and we found two Meckel's diverticula on the antimesenteric border of the affected segment, one measuring 1.5 cm by 2 cm, and the other one 1 cm by 1 cm. The larger one served as the leading point for the intussusception. We resected the affected segment that included the two diverticula and did a primary anastomosis. Because the bowel was somewhat compromised, we planned to do a second look. The patient remained the intermediate care unit, extubated. We took him back to the operating room 72 hours later and confirmed that the anastomosis was intact. He resumed enteral feedings three days after the last operation and was discharged home two days later. The pathological examination confirmed two true Meckel's diverticula with no evidence of heterotopic gastric mucosa.</div></div><div><h3>Conclusion</h3><div>Patients who are found to have a Meckel's diverticulum should have their entire small bowel inspected to rule out a second Meckel's diverticulum, which although rare, has been reported.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103052"},"PeriodicalIF":0.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694935","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":"Corrigendum to “Congenital H-type recto-vaginal fistula with normal anus: a case report” [J Pediatric Surg Case Rep 120 (2025) 1–4 103054]","authors":"Samuel Kefiyalew Kelbessa,&nbsp;Berhanu Nigusse Bikila,&nbsp;Amanuel Mesfin Oljira","doi":"10.1016/j.epsc.2025.103067","DOIUrl":"10.1016/j.epsc.2025.103067","url":null,"abstract":"","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"121 ","pages":"Article 103067"},"PeriodicalIF":0.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104426","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":"Transverse and left colon volvulus in a child with cerebral palsy: a case report","authors":"Younis Al-Mufargi ,&nbsp;Shiyam Al-Shaibani ,&nbsp;Balqees Al-Mujaini ,&nbsp;Mohsin Alriyami ,&nbsp;Mostafa Mahmoud Hamad ,&nbsp;Abdulmalik Al-Atar","doi":"10.1016/j.epsc.2025.103065","DOIUrl":"10.1016/j.epsc.2025.103065","url":null,"abstract":"<div><h3>Introduction</h3><div>Colonic volvulus is an uncommon cause of intestinal obstruction in children, with sigmoid volvulus being the most frequently reported type. Transverse and left colonic volvulus is exceedingly rare, particularly in patients with underlying neuromuscular disorders such as spastic cerebral palsy (CP).</div></div><div><h3>Case presentation</h3><div>A 10-year-old male child with a known history of spastic cerebral palsy (CP) presented to the emergency department with progressive abdominal distension for five days and urinary retention for two days. He had a history of chronic constipation and was on oral baclofen for the management of his spasticity. He was febrile (38 °C), tachycardic, and had a severely distended and tense abdomen. Abdominal imaging, including x-ray and computed tomography (CT) revealed grossly distended large bowel loops with no clear transition point, suggestive of large bowel obstruction. He was taken emergently to the operating room for an exploratory laparotomy. We found that the transverse and left colon had volvulized and had patchy ischemia. The right and sigmoid colon were healthy. We did a resection of the volvulized colon, followed by a primary colo-colic anastomosis. The patient's postoperative recovery was uneventful. He resumed enteral feedings on postoperative day 3 and was discharged home shortly afterwards. At the 6-week follow up he continued to do well and had regular bowel function.</div></div><div><h3>Conclusion</h3><div>Volvulus of the transverse and left colon should be considered in children who develop a bowel obstruction, particularly in those with a history of chronic constipation and/or cerebral palsy.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"120 ","pages":"Article 103065"},"PeriodicalIF":0.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665862","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":"Choledocholithiasis causing cystic duct perforation in an infant: A case report","authors":"Spencer C. Buted ,&nbsp;Jenny L. Stevens ,&nbsp;Kristine S. Corkum","doi":"10.1016/j.epsc.2025.103063","DOIUrl":"10.1016/j.epsc.2025.103063","url":null,"abstract":"<div><h3>Introduction</h3><div>Infant choledocholithiasis causing a distal obstruction resulting in a cystic duct perforation is a rare finding especially in infants with no underlying risk factors.</div></div><div><h3>Case presentation</h3><div>A 5-month-old, previously healthy male with poor weight gain presented with worsening irritability and abdominal pain. Laboratory studies on presentation to the emergency department were notable for a leukocytosis to 15.14 × 10³ mcL and total bilirubin of 1.7 mg/dL. Imaging (ultrasound, x-ray, computed tomography) showed moderate intra-abdominal free fluid, no identifiable gallstones, and non-obstructive gaseous bowel distension. We decided to perform a diagnostic laparoscopy which revealed bilious ascites. An exploratory laparotomy was performed; a distal common bile duct stone and perforation of the cystic duct was noted with intraoperative cholangiogram. An open, trans-cystic common bile duct exploration was performed to clear the distal obstruction and cholecystectomy and ligation of the cystic duct proximal to the perforation was performed. Patency of biliary tract was confirmed with repeat intraoperative cholangiogram. The patient had an uncomplicated post-operative course with resumption of oral liquids on post-operative day 4. He was discharged on post-operative day 11; his outpatient follow-up is significant for weight gain and no symptom recurrence.</div></div><div><h3>Conclusion</h3><div>Cystic duct perforation is a potential complication of choledocholithiasis in infants.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"120 ","pages":"Article 103063"},"PeriodicalIF":0.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670358","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":"Torsion of a herniated ovary in an infant: a case report","authors":"Ismail Benomar ,&nbsp;Hidaya Zitan ,&nbsp;Loubna Aqqaoui ,&nbsp;Ali Lahrech ,&nbsp;Houda Oubejja ,&nbsp;Fouad Ettayebi","doi":"10.1016/j.epsc.2025.103066","DOIUrl":"10.1016/j.epsc.2025.103066","url":null,"abstract":"<div><h3>Introduction</h3><div>Inguinal hernias are relatively common in newborns; however, herniation of the ovary through the canal of Nuck is a rare condition that can lead to ovarian torsion and infarction if not promptly managed.</div></div><div><h3>Case presentation</h3><div>We report the case of a 3-month-old female infant, born at term following an uneventful pregnancy and neonatal period, with normal growth parameters and psychomotor development. She presented with a non-reducible, tender right inguinal mass associated with local signs of inflammation. Symptoms had been evolving over five days. Doppler ultrasonography revealed an enlarged, heterogeneous ovarian structure with absent vascular flow, indicative of adnexal torsion. Surgical exploration confirmed torsion of the right fallopian tube and a necrotic ovary within an inflamed hernia sac. A right salpingo-oophorectomy was performed. The patient was discharged 24 hours postoperatively. Histopathological examination revealed ovarian gangrene without evidence of neoplastic or dysplastic changes. Postoperative recovery was uneventful, and no complications were observed at the 3-month follow-up.</div></div><div><h3>Conclusion</h3><div>Ovaries herniated into the inguinal canal require prompt reduction and hernia repair to avoid potential complications such as torsion and infarction, as observed in our patient.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"120 ","pages":"Article 103066"},"PeriodicalIF":0.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653693","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}