Journal of Pediatric Surgery Case Reports最新文献

{"title":"Small bowel volvulus secondary to ascariasis in a 4-year-old boy: A case report","authors":"Mihret S. Tesfaye ,&nbsp;Hiwot Y. Anley ,&nbsp;Samuel Kefiyalew ,&nbsp;Samuel Gashu ,&nbsp;Jejaw Endale","doi":"10.1016/j.epsc.2025.102960","DOIUrl":"10.1016/j.epsc.2025.102960","url":null,"abstract":"<div><h3>Introduction</h3><div>Small bowel volvulus occurs when a section of the small bowel rotates abnormally around its mesentery. Small bowel volvulus due to Ascaris infestation is a rare surgical occurrence.</div></div><div><h3>Case presentation</h3><div>A 4-year-old boy from rural Ethiopia was brought to our pediatric emergency department with a four-day history of worsening abdominal pain, distension, and multiple episodes of bilious vomiting. He had a history of passing worms per rectum. On physical exam he was tachycardic, febrile, and had a distended, tender abdomen with guarding and rigidity. A plain abdominal X-ray showed multiple air-fluid levels and dilated bowel loops, suggestive of a small bowel obstruction. He was taken emergently to the operating room for an exploratory laparotomy. We found a volvulized partially necrotic segment of small intestine, 40 cm proximal to the ileocecal valve. The volvulized bowel was filled with worms. We devolvulized the bowel manually, did an enterotomy to remove the worms, resected 10 cm of necrotic bowel, and did an end-to-end anastomosis. On the 4th postoperative day, he exhibited signs of an anastomotic leak and was taken back to the operating room. We found no leak but could palpate more intraluminal Ascaris worms. We did a resection of a short segment of the ileum, removed all palpable Ascaris and did a re-anastomosis. He had an uneventful recovery following the second operation. Once he resumed bowel function, he received mebendazole 100 mg twice daily for 3 days. A second round of treatment was given 6 weeks later.</div></div><div><h3>Conclusion</h3><div>Patients with intestinal Ascaris infestation carry a risk of developing small bowel volvulus and should therefore be closely monitored for that while they receive medical treatment. In the event of a volvulus, early intervention is critical to optimize outcomes.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"114 ","pages":"Article 102960"},"PeriodicalIF":0.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143148244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic schwannoma in a 2-year-old boy: A case report","authors":"Maria Koenen ,&nbsp;Scott Keckler ,&nbsp;Jon Ryckman","doi":"10.1016/j.epsc.2025.102957","DOIUrl":"10.1016/j.epsc.2025.102957","url":null,"abstract":"<div><h3>Introduction</h3><div>Schwannomas are benign tumors that arise from the Schwann cells found in peripheral nerve sheaths. These uncommon masses are rare tumors of childhood. When they do occur, the vast majority are located in the head and neck region. Pelvic schwannomas are exceedingly rare in patients under 10 years old.</div></div><div><h3>Case presentation</h3><div>A previously healthy 2-year-old boy presented with intermittent abdominal pain and poor appetite. Physical exam revealed a large, palpable abdominal mass that extended from the pelvis to well above the umbilicus. Ultrasound and CT imaging delineated a 14 cm mass that seemed to originate from the pre-sacral area. Rhabdomyosarcoma was the primary differential diagnosis, along with teratoma. An open biopsy was performed, and pathology revealed a cellular schwannoma. Given that the mass was non-malignant but symptomatic, the patient was taken for surgical resection. A midline laparotomy was performed and the mass carefully freed from surrounding structures. It was adherent but not invasive. Complete resection was performed without injury to surrounding structures. The patient discharged home on post-operative day 3 and has since had full symptom resolution. The final pathology was consistent with the original biopsy results. Genetic testing was negative for neurofibromatosis. While recurrence is unlikely, yearly ultrasounds are planned for monitoring.</div></div><div><h3>Conclusion</h3><div>Pelvic schwannoma is an uncommon, but important, addition to the differential diagnosis for pediatric pelvic masses and should be managed with surgical resection and genetic testing when encountered.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"114 ","pages":"Article 102957"},"PeriodicalIF":0.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior mediastinal mature teratoma in a 13-month-old girl: A case report","authors":"Gashaw Arega ,&nbsp;Nibretu Bekele ,&nbsp;Daniel Hailu ,&nbsp;Fathia Omer ,&nbsp;Michael A. Negussie ,&nbsp;Tihitena Negussie","doi":"10.1016/j.epsc.2025.102958","DOIUrl":"10.1016/j.epsc.2025.102958","url":null,"abstract":"<div><h3>Introduction</h3><div>Mature teratomas in the anterior mediastinum are rare, making up only 1–5% of mediastinal tumors. While they are usually seen in adults, it is uncommon for toddlers to have such tumors, especially large ones with concomitant pericardial effusion.</div></div><div><h3>Case presentation</h3><div>A 13-month-old female toddler presented with a one-month history of dry cough, progressively worsening respiratory distress, low-grade fever, intermittent rapid breathing, and non-drenching night sweats. Despite multiple evaluations and treatments for presumed hyperactive airway disease with antibiotics and salbutamol inhalers, her symptoms persisted. There was no history of prior hospitalizations, and the child was fully vaccinated with normal growth and developmental milestones. On examination, she appeared in significant respiratory distress with tachypnea, nasal flaring, subcostal and intercostal retractions, and oxygen saturation of 85 % on room air. Respiratory examination revealed decreased air entry bilaterally. Other systemic examinations were unremarkable. A chest x-ray film at the referring center revealed a mediastinal mass with an associated pleural effusion. A chest ultrasound identified a multiseptated cystic anterior mediastinal mass. A contrast-enhanced CT confirmed a 13 × 12 × 8 cm heterogeneous mass with cystic, fatty, and calcified components compressing and displacing the superior vena cava, pulmonary artery, and aorta without invasion. The trachea and mainstem bronchi were narrowed and displaced posteriorly. Serum alpha-fetoprotein and beta-human chorionic gonadotropin levels were normal, favoring a benign diagnosis. Surgical excision was performed via clamshell thoracotomy, achieving complete resection of the solid portion and aspiration of the cystic components. Histopathology confirmed a mature cystic teratoma with no immature or malignant elements. The child recovered well postoperatively, was discharged home on postoperative day seven, and is in good health at five months of follow up.</div></div><div><h3>Conclusion</h3><div>Large anterior mediastinal mature teratomas in toddlers are rare but manageable with early diagnosis and complete surgical resection.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"114 ","pages":"Article 102958"},"PeriodicalIF":0.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric pancreatic perineurioma: A case report","authors":"Eakes A ,&nbsp;Hill B ,&nbsp;Beierle EA","doi":"10.1016/j.epsc.2025.102959","DOIUrl":"10.1016/j.epsc.2025.102959","url":null,"abstract":"<div><h3>Introduction</h3><div>Perineuriomas are rare, benign, peripheral nerve sheath tumors that are distinguished from other lesions such as neurofibroma with specific immunohistochemical stains.</div></div><div><h3>Case presentation</h3><div>The patient was an 18-year-old female with a history of spina bifida and neuroblastoma. She was asymptomatic but at a follow up visit for urinary issues related to her spina bifida, an ultrasound of the kidneys revealed a retroperitoneal mass near the left kidney. Cross sectional imaging was completed and identified a left paraspinous mass measuring 13.3 x 10.1 × 11.2 cm, arising from the pancreas. Laboratory evaluations including liver function tests, complete blood count, renal panel, urine metanephrines, alpha fetoprotein and beta-hCg were normal. Complete resection of the mass required a distal pancreatectomy and splenectomy performed via laparotomy. Histologic evaluation of the mass was consistent with perineurioma. Postoperative recovery was unremarkable and the patient remains free of disease at one year followup with ultrasound imaging.</div></div><div><h3>Conclusion</h3><div>Perineurioma, a rare peripheral nerve sheath neoplasm, should be considered in the differential diagnosis for retroperitoneal masses in the pediatric population.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"114 ","pages":"Article 102959"},"PeriodicalIF":0.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143148249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic basidiobolomycosis in a 2-year-old child: A case report","authors":"Ahmed Ateik ,&nbsp;Saif Ghabisha ,&nbsp;Ali Almutamaiz ,&nbsp;Amar Almutawakel ,&nbsp;Azza Mohamed ,&nbsp;Faisal Ahmed","doi":"10.1016/j.epsc.2025.102956","DOIUrl":"10.1016/j.epsc.2025.102956","url":null,"abstract":"<div><h3>Introduction</h3><div>Isolated hepatic basidiobolomycosis is infrequently reported in the literature. Hepatic involvement is typically associated with disseminated disease. Hepatic basidiobolomycosis can mimic hepatic malignancies, posing a diagnostic and therapeutic challenge.</div></div><div><h3>Case presentation</h3><div>A 2-year-old male was referred to us with a two-month history of abdominal pain and a right upper quadrant abdominal mass. He had no history of vomiting, jaundice, decreased appetite, or diarrhea. Laboratory tests showed leukocytosis (white blood cell count of 15.5 × 10⁹/L) with normal eosinophil count, elevated C-reactive protein (CRP; 30 mg/L; normal: &lt;3 mg/L) and elevated erythrocyte sedimentation rate (ESR; 83 mm/h; normal: &lt;10 mm/h). Liver function tests were within normal limits. Abdominal ultrasonography (USG) showed a well-defined isoechoic homogenous 7 × 7 × 6 cm mass-like lesion in the right hepatic lobe. An abdominal computed tomography (CT) scan confirmed a localized irregular hypodense area in the right hepatic lobe, raising concerns for a hepatic abscess or malignancy. However, tumor markers were not able to be measured. A true-cut needle biopsy showed primarily normal liver tissue with eosinophilic infiltration, proving inconclusive. Fungal cultures were unavailable. The patient was taken to the operating room for an exploration. We find a non-encapsulated mass in the right hepatic lobe, without any other gastrointestinal involvement. Intraoperative biopsies were not available, so we decided to proceed with a complete resection of the mass. The histopathological analysis showed Splendore-Hoeppli bodies and eosinophils around thin-walled hyphae, strongly supporting the diagnosis of basidiobolomycosis. The patient recovered well from the operation and received voriconazole (6 mg/kg every 12 hours) for six months. At two years of follow-up, he has no signs of recurrence.</div></div><div><h3>Conclusion</h3><div>Hepatic basidiobolomycosis should be included in the differential diagnosis of children with a painful hepatic mass. The lack of proper diagnosis can lead to unnecessary liver resections.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"114 ","pages":"Article 102956"},"PeriodicalIF":0.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant congenital cervical Teratoma: A case report","authors":"Jennifer Milsten ,&nbsp;Selin A. Weitkamp ,&nbsp;Alexander G. Aghte ,&nbsp;Joern-Hendrik Weitkamp","doi":"10.1016/j.epsc.2024.102938","DOIUrl":"10.1016/j.epsc.2024.102938","url":null,"abstract":"<div><h3>Introduction</h3><div>Congenital teratomas affecting the head and neck region are rare, accounting for only 2–5% of all germ cell tumors. Congenital cervical teratomas occur in 1 per 20,000 to 40,000 live births. Due to their location, giant neck teratomas obstruct the airway and esophagus, leading to polyhydramnios and requiring an ex-utero intrapartum therapy (EXIT) procedure to allow survival.</div></div><div><h3>Case presentation</h3><div>A large fetal neck mass resulting in fetal neck extension and polyhydramnios was noted at 24 weeks' gestation by ultrasound and further characterized by fetal MRI. The infant was delivered by classical c-section for non-reassuring fetal heart rate status at 33 weeks’ gestational age. The mass was overlying both mandibles, extending down the neck, leading to extensive neck extension and obscuring anatomic landmarks. Resuscitation required puncturing vocal cord adhesions with a rigid bronchoscope and suctioning of airway fluid prior to intubation. The extensively vascularized mass was successfully resected at one week of age, when it weighed 1088 g and was 21cm × 12cm x 8 cm in dimension. Pathology was consistent with a grade 3, stage II mixed immature and mature teratoma including tissue derivatives of three germ layers.</div></div><div><h3>Conclusion</h3><div>Despite the unusually large size of this giant congenital neck teratoma, management by a multidisciplinary team with prenatal planning of resuscitation and postnatal treatment allowed for a positive outcome for the infant.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102938"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of pediatric diaphragmatic eventration using dynamic chest radiography: A case report","authors":"Takatoshi Abe ,&nbsp;Kozo Nomura ,&nbsp;Seisho Sakai ,&nbsp;Rie Tanaka ,&nbsp;Shuhei Minami ,&nbsp;Hidenori Iwasaki ,&nbsp;Yasuhiro Ikawa","doi":"10.1016/j.epsc.2024.102932","DOIUrl":"10.1016/j.epsc.2024.102932","url":null,"abstract":"<div><h3>Introduction</h3><div>Diagnosis of diaphragmatic disease using dynamic chest radiography (DCR), a novel imaging testing modality has been previously reported in adults; however, there have been no prior reports of its use in pediatric patients. Herein, we report the novel case of a 14-year-old girl diagnosed with diaphragmatic eventration (DE) using DCR with extremely low-dose pulsed X-rays.</div></div><div><h3>Case series</h3><div>A 14-year-old girl with pectus excavatum was referred to our hospital for surgery. Pre-operative chest radiography revealed that the right diaphragm was higher than the left however, this difference was judged to be within the normal range. Computed tomography (CT) revealed a Haller index of 3.00. Although the patient had no symptoms, she complained of an unsatisfactory appearance, which was considered an indication for surgery. The Nuss procedure was performed under artificial pneumothorax, and DE was not suspected. Six months after surgery, we performed DCR instead of chest radiographs to evaluate the position of the bar and the patient's respiratory status. Utilizing the captured images, we further measured and analyzed the diaphragm movement. DCR revealed a clear impairment of diaphragmic movement on the affected side, and the patient was subsequently diagnosed with DE. However, as she was asymptomatic, we decided to follow up conservatively.</div></div><div><h3>Conclusion</h3><div>This is the first report of DCR in a pediatric patient. DCR appears to be a useful tool for the diagnosis of diaphragmatic eventration in children.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102932"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balanced care in managing hepatoblastoma in a patient with trisomy 18: A case report","authors":"Lori-Anne Lajeunesse ,&nbsp;Mona Beaunoyer ,&nbsp;Monia Marzouki ,&nbsp;Caroline P. Lemoine","doi":"10.1016/j.epsc.2024.102930","DOIUrl":"10.1016/j.epsc.2024.102930","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite a high mortality rate during the first year of life, an increasing number of patients with Trisomy 18 (T18) survive into childhood. Offering invasive medical and surgical procedures to this population continues to raise ethical questions. We present the case of a child with T18 and hepatoblastoma, highlighting therapeutic and ethical challenges.</div></div><div><h3>Case presentation</h3><div>A 2.5-year-old female with T18 known for a bicuspid aortic valve and developmental delay presented with an abdominal mass. Alpha-fetoprotein level was elevated (46,540 ng/mL) and imaging showed a single exophytic segment 5–6 liver mass and no metastatic disease, compatible with a PRETEXT II hepatoblastoma. Multidisciplinary discussions took place focusing on treatment options, the patient's quality of life, and her global prognosis. Given the patient's overall good condition, few comorbidities, and the family's wishes to proceed with curative measures, a bisegmentectomy 5,6 was performed. The patient was discharged 12 days postoperatively having suffered no surgical complication. Pathology revealed a mixed epithelial and mesenchymal hepatoblastoma. She received two cycles of adjuvant chemotherapy (cisplatin) without suffering from any complication. Now 5.5 years post-treatment, she remains disease-free. The family is grateful their daughter's chromosomal anomaly did not negatively influence medical and surgical teams in offering her optimal treatment options.</div></div><div><h3>Conclusion</h3><div>Unless suffering from severe underlying medical comorbidities, patients with T18 and hepatoblastoma can receive gold standard care. Multidisciplinary collaboration involving surgeons, medical providers, as well as families are essential to determine optimal individualized treatment strategies.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102930"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pentalogy of Cantrell in a resource-limited setting: A case report","authors":"Suleiman Ayalew ,&nbsp;Michael A. Negussie ,&nbsp;Hiwot Tesfaselassie Afework ,&nbsp;Dagnachew Akalu Kassie ,&nbsp;Abebe Molla Mogess ,&nbsp;Mesfin Tesera Wassie","doi":"10.1016/j.epsc.2024.102935","DOIUrl":"10.1016/j.epsc.2024.102935","url":null,"abstract":"<div><h3>Introduction</h3><div>Pentalogy of Cantrell is a rare congenital condition involving defects in the abdominal wall, sternum, diaphragm, pericardium, and heart. This report adds to the scarce literature by presenting a unique case from a resource-limited setting.</div></div><div><h3>Case presentation</h3><div>An 8-h-old male neonate was admitted to the NICU with a thoracoabdominal defect observed at birth. Delivered in transit at term to a healthy mother with no prenatal anomalies identified, the neonate exhibited a pulsatile mass from the xiphisternum to the umbilicus, covered by a thin membrane with visible cardiac activity. Imaging and clinical evaluation confirmed herniation of the heart and liver through the defect, consistent with ectopia cordis and omphalocele, accompanied by a sternal defect and diaphragmatic communication. Echocardiography revealed severe intracardiac anomalies, including a single ventricle, single atrium, truncus arteriosus, and mild pericardial effusion. Additionally, a meningomyelocele was identified alongside bilateral clubfoot deformities. Initial management included stabilization with fluids, antibiotics, oxygen, and protective dressings for the exposed structures. The neonate experienced cardiac arrest on the third day of admission, and surgical intervention was not performed.</div></div><div><h3>Conclusion</h3><div>Prenatal screening and prompt multidisciplinary intervention are essential to improve outcomes in cases of Pentalogy of Cantrell.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102935"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gangrenous small bowel volvulus due to ascariasis in a 9-year-old female: A case report","authors":"Bethlehem Aliye Asfaw ,&nbsp;Kinfemicheal Tilahun Yigzaw ,&nbsp;Om Prakash Bhatta ,&nbsp;Yonathan Aliye Asfaw ,&nbsp;Bewketu Abate Fenta ,&nbsp;Mesfin Tesera Wassie","doi":"10.1016/j.epsc.2024.102936","DOIUrl":"10.1016/j.epsc.2024.102936","url":null,"abstract":"<div><h3>Introduction</h3><div>While ascariasis is typically asymptomatic or presents with mild gastrointestinal symptoms, it can lead to severe complications, such as intestinal obstruction and volvulus, particularly in children with a high worm burden.</div></div><div><h3>Case presentation</h3><div>A 9-year-old girl presented to the pediatric emergency department with four days of central abdominal pain, repeated bilious vomiting containing worms, increasing abdominal distension, constipation, and a low-grade fever. She was taken to the operating room for an exploratory laparotomy for suspected bowel obstruction. Intraoperatively, 300 mL of pus was found in the peritoneal cavity, along with a 360-degree gangrenous volvulus of small bowel involving most of the small bowel, from 80 cm distal to the ligament of Treitz to 20 cm proximal to the ileocecal valve. Adhesions and fibrin deposits were noted throughout the peritoneum. The purulent fluid was suctioned out, and the ischemic bowel was completely resected. A large burden of Ascaris worms was found in the lumen of the bowel and was completely removed. We did a jejunostomy and an ileal mucous fistula. Postoperatively, the patient received intravenous ceftriaxone, metronidazole, potassium supplements, and maintenance fluids. Due to the high output of the jejunostomy, we decided to take down the jejunostomy shortly after the initial operation. The ostomy closure was complicated by an anastomotic leak. We explored her and found a pin hole on the antimesenteric side of the anastomosis. We repaired the leak primarily, but the patient developed a recurrence of the leak shortly thereafter, at which time we decided tore-create the jejunostomy and the mucous fistula. Before we could provide further care, her parents decided to leave the hospital against medical advice. We eventually contacted the parents and learned that she died at another institution 10 days after leaving our hospital. The cause of her death was not disclosed.</div></div><div><h3>Conclusion</h3><div>Even though intestinal infestations are generally mildly symptomatic, Ascariasis and other parasitic infestations should be included in the differential diagnosis of children who live in endemic areas and develop acute abdominal conditions.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102936"},"PeriodicalIF":0.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}