Journal of Pediatric Surgery Case Reports最新文献

{"title":"Segmental absence of intestinal musculature increasingly recognized in premature infants with perforated viscus: A case series","authors":"Carolina Pinzon-Guzman ,&nbsp;Alexander Kevorkov ,&nbsp;Karl Grenier ,&nbsp;Maeve O'Neill Trudeau ,&nbsp;Pramod Puligandla ,&nbsp;Etienne St-Louis","doi":"10.1016/j.epsc.2024.102915","DOIUrl":"10.1016/j.epsc.2024.102915","url":null,"abstract":"<div><h3>Introduction</h3><div>Segmental absence of intestinal musculature (SAIM) is a pathological diagnosis, denoting focal absence of the muscularis propria in the presence of intact surrounding structures. This condition often presents as spontaneous intestinal perforation (SIP) and can be difficult to distinguish clinically from necrotizing enterocolitis (NEC).</div></div><div><h3>Case presentations</h3><div>We present 5 cases of premature babies with gestational age ranging from 24 + 3 weeks up to 32 + 1 weeks, who all presented with intestinal perforation before the 15th day of life. Three patients presented with a distended abdomen and discoloration and were subsequently found to have pneumoperitoneum on abdominal x-ray (AXR). The 2 other patients presented with clinical deterioration but without signs of intestinal perforation and were subsequently found to have pneumoperitoneum on AXR. All underwent bowel resection of perforated bowel with either ileostomy with mucous fistula or primary end-to-end anastomosis. Two patients required repeat exploratory laparotomies within a week of their initial surgery due to pneumoperitoneum in subsequent AXR caused by new perforations in other parts of the small bowel. One patient sustained an iatrogenic liver injury intra-operatively and passed away 1 day post-operatively. All patients were found to have SAIM on histopathological examination.</div></div><div><h3>Conclusion</h3><div>SAIM is a pathological diagnosis that can manifest as SIP and may denote a risk for recurrent peritonitis in premature infants who underwent bowel resection for perforated viscus without a clear etiology.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102915"},"PeriodicalIF":0.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571443","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":"Heteropagus (parasitic) twins and concomitant omphalocele: A case report","authors":"Samuel Gashu ,&nbsp;Belachew Dejene ,&nbsp;Yidnekachew Getachew ,&nbsp;Gobena Mormata ,&nbsp;Mihret solomon Tesfaye","doi":"10.1016/j.epsc.2024.102909","DOIUrl":"10.1016/j.epsc.2024.102909","url":null,"abstract":"<div><h3>Introduction</h3><div>Heteropagus twins are extremely rare, occurring in one to two million live births. To date, fewer than 75 cases of epigastric heteropagus twins have been reported, and only a handful of these cases have involved heteropagus twins with a concomitant omphalocele.</div></div><div><h3>Case presentation</h3><div>We present a case of heteropagus twins in a 2-day-old neonate with a fully formed parasitic mass attached to the lower anterior chest wall and epigastrium. The parasitic twin was acephalic and acardiac, had bowel structures, pelvic bones, bilateral lower limbs, and a single upper limb. The blood supply of the parasitic twin primarily originated from the right internal mammary artery, and the venous return was via the right internal mammary vein to the superior vena cava. The parasitic twin's bowel loops overlapped the left lobe of the autosite's liver, which was partially contained in a midline omphalocele-like abdominal wall defect. The autosite also had a small patent foramen ovale and a patent ductus arteriosum with a left-to-right shunt. A successful dissection and excision of the parasitic twin was done to remove the rudimentary limbs, pelvis, and part of the parasitic trunk. The autosite's omphalocele was repaired at the same time. The patient had an uneventful postoperative recovery.</div></div><div><h3>Conclusion</h3><div>Early surgical separation of heteropagus twins is crucial to optimize the outcomes of the healthy twin.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102909"},"PeriodicalIF":0.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533017","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":"Granular cell tumor of the breast in a 17-year-old female: A case report","authors":"Juan R. Medina-Morell ,&nbsp;Jorge I. Cheverez-Ocasio ,&nbsp;Viviana Negron-Gonzalez ,&nbsp;Gloria Ramos-Rivera","doi":"10.1016/j.epsc.2024.102913","DOIUrl":"10.1016/j.epsc.2024.102913","url":null,"abstract":"<div><h3>Introduction</h3><div>Granular Cell Tumors (GCTs) are rare soft tissue neoplasms originating from Schwann cells, often benign but mimicking breast carcinoma clinically and radiologically.</div></div><div><h3>Case presentation</h3><div>A 17-year-old female with a second-degree family history of breast cancer presented with a painful left breast mass (∼3 cm) persisting for three years. Initial evaluation with fine needle aspiration (FNA) suggested a benign lipoma, but imaging reported BIRADS IV mass. Mammography revealed an ovoid mass with irregular margins, Sono-mammogram reported heterogeneous slightly lobulated mass with excentric sonolucent of 3 x 2.4 × 1.8 cm, no increased vascularity on sono-doppler and core needle biopsy confirmed a GCT, positive for S-100 and CD68. The patient was taken to the operating room for surgical excision. A 4 cm curvilinear incision was made over the left breast mass, just lateral to the nipple at the 3 o'clock position. En-bloc excision of the mass was carried out with 1 cm margins. The specimen was removed and sent for frozen section analysis that confirmed the cytological diagnosis of a granular cell tumor with clear margins. The excised mass was sent for permanent section to pathology. Final histopathology confirmed a benign GCT with free margins. Due to the infiltrative nature of the tumor, a second excision in similar fashion was required to obtain wider margins, which was uneventful. Clear margins were pursued due to the tumor's infiltrative nature and patient's family history of breast cancer, despite the low risk of recurrence with positive margins. The patient remains clinically disease-free at three-year follow-up.</div></div><div><h3>Conclusion</h3><div>Granular cell tumors of the breast, though benign, are often mistaken for carcinoma due to their clinical similarity. Complete excision with clear margins, which may require re-excision due to their infiltrative nature, is crucial to prevent recurrence.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102913"},"PeriodicalIF":0.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533018","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":"Endovascular diagnosis and treatment of arterio-esophageal fistula after foreign body ingestion in children: A tale of two cases","authors":"Claire E. White-Dzuro ,&nbsp;Bryan D. Steitz ,&nbsp;Eunice Y. Huang ,&nbsp;Christopher M. Baron ,&nbsp;Lyndy Wilcox ,&nbsp;Jamie R. Robinson","doi":"10.1016/j.epsc.2024.102912","DOIUrl":"10.1016/j.epsc.2024.102912","url":null,"abstract":"<div><h3>Introduction</h3><div>An arterio-esophageal fistula (AEF) is an abnormal communication between an artery and the esophagus. While a rare complication, patients are at risk of disastrous hemorrhage. The goal of this study is to highlight endovascular management options of AEF in children.</div></div><div><h3>Case series</h3><div>We present two cases of children with AEF. Both children were female, 3 years of age or younger, and had hematemesis upon presentation. For each patient, esophageal foreign body impaction was confirmed with radiography prompting emergent surgery. A multidisciplinary team was involved in the management of both patients, consisting of combinations of pediatric surgery, pediatric otolaryngology, pediatric cardiothoracic surgery and pediatric interventional radiology. Angiography successfully localized the AEF in both patients after several hours of unsuccessful open dissection and failed attempts at hemorrhage control. Further, angiographic embolization successfully controlled the hemorrhage in one patient. One of the two children experienced cardiac arrest intraoperatively due to hemorrhagic shock, which resulted in their death.</div></div><div><h3>Conclusion</h3><div>Our study highlights the importance of a multidisciplinary team to care for patients with AEF and the role of endovascular techniques in aiding rapid diagnosis and potential management of the fistula.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102912"},"PeriodicalIF":0.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533016","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":"Thoracoscopic closure of an H-type tracheoesophageal fistula: A case report","authors":"Kazuo Oshima ,&nbsp;Yujiro Tanaka ,&nbsp;Keisuke Suzuki ,&nbsp;Chizuka Seki ,&nbsp;Mina Yoshida ,&nbsp;Hiroaki Komuro","doi":"10.1016/j.epsc.2024.102910","DOIUrl":"10.1016/j.epsc.2024.102910","url":null,"abstract":"<div><h3>Introduction</h3><div>Isolated h-type tracheoesophageal fistula (H-TEF) without esophageal discontinuity is rare and poses challenges in selecting a surgical approach due to the height of the fistula within the thoracic cavity.</div></div><div><h3>Case presentation</h3><div>A female neonate was born prematurely at 31 weeks of gestation with a weight of 1200 g. She was intubated at birth due to respiratory distress. She was later diagnosed with CHARGE syndrome. Nasogastric tube feedings were initiated shortly after birth. Air bubbles could be seen coming out the nasogastric tube, which were suspicious for a tracheoesophageal fistula (TEF). A contrast esophagogram confirmed an h-type TEF at the level of the second thoracic vertebral body. When the patient was five months old and had a weight of 3 Kg, she was taken to the operating room for a thoracoscopic repair of the TEF. She was placed in complete left lateral position. Four 5-mm ports were placed in the right hemithorax. The right vagus nerve was identified. We first created a pleural flap with the mediastinal pleura. Blunt dissection of the esophagus and the trachea allowed clear identification of the TEF. A vessel loop was placed around the TEF. The TEF was divided. The esophageal end the tracheal sides of the TEF were closed with interrupted stitches. The pleural flap was interposed between the two stumps. The operation took 238 minutes. The postoperative period was uneventful, and she had no recurrence of the TEF. She underwent a tracheostomy one month later, and a laparoscopic fundoplication three months after that. She was discharged home at one year of age.</div></div><div><h3>Conclusion</h3><div>Thoracoscopy appears to be a suitable approach for the repair of high thoracic h-type TEF.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102910"},"PeriodicalIF":0.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142551536","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":"Trans-anal prolapse of intussuscepted ileal Hartmann's pouch: A case report","authors":"Yu Liu,&nbsp;Youcheng Zhang,&nbsp;Ting Wang","doi":"10.1016/j.epsc.2024.102911","DOIUrl":"10.1016/j.epsc.2024.102911","url":null,"abstract":"<div><h3>Introduction</h3><div>Postoperative complications of stomas in necrotizing enterocolitis (NEC) typically affect the proximal limb. Complications of the distal limb are rarely reported.</div></div><div><h3>Case presentation</h3><div>A 17-day-old newborn underwent an end ileostomy and an ileal Hartmann's pouch due to necrotizing enterocolitis (NEC). Eight weeks after the surgery, he passed bloody stool through the anus. No drop in his hemoglobin level was observed. He was made NPO, and no further bloody stool was seen after 24 hours. Ten weeks post-surgery he developed acute vomiting, and a 10-cm segment of bowel was seen prolapsed through the anus. The end of the prolapsed bowel was blind, raising the suspicion of a complete prolapse of the ileal Hartmann's pouch. He was taken to the operating room for an exploratory laparotomy. We found that the ileal Hartmann's pouch had intussuscepted into the ileocecal valve, progressed through the colon and the rectum, and prolapsed through the anus. We reduced the bowel manually. The involved ileum and colon were markedly swollen, and partially necrotic. The necrotic segments were resected, and the ileostomy was reversed. The patient was discharged one month later and had no adverse complications at two months of follow up.</div></div><div><h3>Conclusion</h3><div>Although rare, intussusception of an ileal Hartmann's pouch should be ruled out in patients that have a Hartmann's pouch and develop vomiting and bloody stool.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"112 ","pages":"Article 102911"},"PeriodicalIF":0.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593118","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":"Left-sided gallbladder in a 17-year-old male: A case report","authors":"William G. Lee ,&nbsp;Shannon T. Wong-Michalak ,&nbsp;Eveline H. Shue ,&nbsp;Eugene S. Kim ,&nbsp;Christopher T. Watterson ,&nbsp;Juan Carlos Pelayo","doi":"10.1016/j.epsc.2024.102908","DOIUrl":"10.1016/j.epsc.2024.102908","url":null,"abstract":"<div><h3>Introduction</h3><div>Left-sided gallbladder (LSG) is a rare anatomic variant in the pediatric population where the gallbladder lies to the left of the round ligament. The diagnosis of LSG is often made intraoperatively as preoperative imaging has poor sensitivity for detection. As LSG is also associated with biliary and vascular anatomic variation, lack of familiarity with these anatomic variants can lead to higher rates of bleeding and bile duct injury.</div></div><div><h3>Case presentation</h3><div>A 17-year-old previously healthy male with history of scoliosis and sickle cell trait was referred for surgical management of symptomatic cholelithiasis. The patient had presented with multiple transient episodes of severe epigastric pain and nausea with ultrasound findings of cholelithiasis. There was no comment on the ultrasound report of any anatomic variation or abnormal location of the gallbladder. However, review of the imaging demonstrated a gallbladder that was situated on the left side of the liver and medial to ligamentum teres hepatis (round ligament). During the laparoscopic cholecystectomy, we confirmed that the gallbladder was located to the left of the round ligament and inferior to segment III of the liver. A retrograde top-down approach was utilized to clearly delineate the cystic artery and duct. The cystic artery was identified by its entry point into the gallbladder crossing anterior to the common bile duct in a right-to-left fashion. The cystic duct was identified and noted to drain into the right-side of the common hepatic duct. Due to clear delineation of the gallbladder anatomy with this approach, intraoperative cholangiography or fluorescence cholangiography were not utilized. He was discharged on postoperative day one without any complications.</div></div><div><h3>Conclusion</h3><div>LSG is associated with biliary and vascular anomalies, which may lead to intraoperative complications. Therefore, the biliary anatomy should be clearly elucidated prior to proceeding with cholecystectomy in cases of LSG.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102908"},"PeriodicalIF":0.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533019","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":"Laparoscopic repair of transurethral extrusion of a ventriculoperitoneal shunt: A case report","authors":"Hannah Baker ,&nbsp;Ryan Jafrani ,&nbsp;Cristine S. Velazco ,&nbsp;Hubert Swana","doi":"10.1016/j.epsc.2024.102907","DOIUrl":"10.1016/j.epsc.2024.102907","url":null,"abstract":"<div><h3>Introduction</h3><div>Transurethral protrusion of ventriculoperitoneal shunt is a rare finding with few reported cases in the literature. As most presentations are treated with an open surgical approach, our case details successful management with laparoscopic intervention. Here we describe the presentation, diagnosis, and management of a pediatric patient with erosion and extrusion of a ventriculoperitoneal shunt through the urethra.</div></div><div><h3>Case presentation</h3><div>A 3-year-old girl with a history of congenital hydrocephalus treated with ventriculoperitoneal shunt presented to the Emergency Department after an incidental finding of the peritoneal end of the shunt protruding from the urethra draining cerebrospinal fluid (CSF). The patient was asymptomatic with vitals and laboratory values within normal limits. Urine and CSF cultures were negative. Preoperative x-ray showed distal midline protrusion of the shunt. Due to exposed hardware with risk of infection, a combined surgical effort between pediatric urology, neurosurgery, and general surgery was implemented. Laparoscopy was utilized to transect the shunt tubing with subsequent removal through the urethra, revealing a posterior cystotomy. The bladder defect was closed entirely with absorbable suture. The shunt hardware was removed in its entirety and an extraventricular drain (EVD) was placed. The patient subsequently underwent an endoscopic third ventriculostomy (ETV) and did not require shunt replacement. The postoperative course was uneventful with benign follow up imaging.</div></div><div><h3>Conclusion</h3><div>Minimally invasive surgical intervention can be utilized as a safe and effective alternative to open surgery for treatment of ventriculoperitoneal shunt migration. As cases may present asymptomatically, a high index of suspicion with detailed physical exam should be applied.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102907"},"PeriodicalIF":0.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534068","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":"Acquired colovesical fistula in a neonate: A case report","authors":"Mohamad El mahmoud ,&nbsp;Noura Almutairi ,&nbsp;Abdullah Alotaibi ,&nbsp;Mohammed Alonazi ,&nbsp;Abdullah Abduldaem ,&nbsp;Essa Alkhodair","doi":"10.1016/j.epsc.2024.102902","DOIUrl":"10.1016/j.epsc.2024.102902","url":null,"abstract":"<div><h3>Introduction</h3><div>Colovesical fistula (CVF) is an abnormal communication between the colon and the urinary bladder, allowing fecal matter to enter the bladder. Acquired CVF are extremely rare in newborns.</div></div><div><h3>Case presentation</h3><div>A 4-week-old male with trisomy 21 presented with septic shock and suspected necrotizing enterocolitis. Feedings were stopped and he initiated a course of intravenous antibiotics. A Foley catheter was inserted upon admission by the urology team due to difficulty with straight catheterization. It drained clear urine for approximately 20 days, after which it was removed without complications. Ten days after the removal of the Foley catheter he developed watery diarrhea and bile-stained urine, suspicious of a CVF. An abdominal X-ray revealed that the Foley catheter had entered the peritoneal cavity beyond the urinary bladder limits and showed air in the bladder. A cystourethrogram confirmed the diagnosis of a CVF. He was taken to the operating room for a cystoscopy, which confirmed a wide opening at the posterior dome of the bladder, followed by an exploratory laparotomy during which a bladder-to-sigmoid colon was identified and divided. The involved segment of the sigmoid colon was also resected. A double-barrel ileostomy was created to protect the sigmoid anastomosis. The bladder defect was closed in two layers with absorbable sutures. A Foley catheter was left in place. The patient recovered well. A cystourethrogram 10 days after the operation confirmed no leak, and the Foley catheter was removed. The ileostomy was closed 1 months after the CVF repair.</div></div><div><h3>Conclusion</h3><div>Neonatal acquired CVF is very rare but should be suspected in patients who develop bile-stained urine and watery stool.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102902"},"PeriodicalIF":0.2,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534122","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":"Necrotizing enterocolitis and optimal surgical timing: Case series","authors":"Mariel Magdits ,&nbsp;Gabriella Grisotti ,&nbsp;Lan Vu","doi":"10.1016/j.epsc.2024.102906","DOIUrl":"10.1016/j.epsc.2024.102906","url":null,"abstract":"<div><h3>Introduction</h3><div>The pathophysiology and management of necrotizing enterocolitis (NEC) with identification of the subset of NEC totalis and the timing of surgical intervention, remains an area of active research and clinical uncertainty. A third of deaths from NEC are attributed to NEC totalis. This case series presents three distinct cases of total or near-total NEC.</div></div><div><h3>Case series</h3><div>Case 1: A female preterm infant born at 27 weeks of gestation developed sepsis at six days of life, diagnosed with NEC evidenced by portal venous gas and diffuse pneumatosis intestinalis. Surgical exploration 8 weeks later revealed extensive involvement of the entire small bowel, culminating in a fatal outcome. Case 2: A male preterm infant delivered at 24 weeks and 4 days gestation presented with respiratory distress syndrome shortly after birth and developed abdominal distension and ongoing metabolic acidosis and thrombocytopenia. On day 12 post-NEC diagnosis, surgical exploration revealed extensive bowel necrosis involving most of the small bowel and right colon. The patient did not survive the operation due to intraoperative hemorrhage secondary to the degree of acute inflammation. Case 3: A preterm female infant delivered at 25 weeks and 5 days gestation exhibited respiratory failure and a tense abdomen within the first week of life. Upon transfer to a higher level of care, imaging revealed massive pneumoperitoneum and exploration demonstrated extensive bowel necrosis from the mid jejunum to the distal transverse colon. Prompt surgical intervention within 24 hours post-diagnosis resulted in bowel resection and jejunostomy creation, leading to improved clinical condition and ongoing survival.</div></div><div><h3>Conclusion</h3><div>The presented case series suggests that timing in surgical intervention for NEC may play a role in outcomes.</div></div>","PeriodicalId":45641,"journal":{"name":"Journal of Pediatric Surgery Case Reports","volume":"111 ","pages":"Article 102906"},"PeriodicalIF":0.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445025","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}