Portal hypertensive enteropathy (PHE) can cause chronic or acute gastrointestinal (GI) bleeding. Although there is a consensus on the diagnosis and treatment guidelines for PHE in adults, there are few reports on children. We aimed to report the clinical progress and outcomes of children with PHE treated with Kasai surgery and compare them with those of adults with PHE. In total, 309 patients who underwent postoperative endoscopy were enrolled among 336 patients who underwent Kasai surgery for biliary atresia at Severance Children's Hospital between May 2005 and March 2022. The PHE diagnosis rate was 15.2 % (n = 47). PHE was not diagnosed until 2012; however, the diagnosis rates significantly increased over time (13.3 % and 36.1 % between 2013 and 2017 and 2018–2022, respectively). Of the 47 patients diagnosed with PHE, 14 (29.8 %) had GI bleeding caused solely by PHE. None of the PHE patients required ICU care at the time of bleeding, compared to 32 (24.1 %) in the gastroesophageal varix (GEV) group. After initial management, the rates of re-bleeding, refractory bleeding, and mortality were 78.6 %, 28.6 %, and 0.0 %, respectively, in the PHE group. Pediatric PHE diagnosis rates after Kasai surgery have increased since clinicians have become aware of the existence of the disease. Pediatric PHE has a high re-bleeding rate (78.6 %), although fatal GI bleeding is rare compared to GEV. Diagnosis and treatment of pediatric PHE can be performed according to adult guidelines. III.
Abstract Rationale: Mesenteric venous thrombosis is an uncommon but potentially fatal condition that can cause bowel ischemia. It results from a systemic hypercoagulable state or abdominal infection draining into the portal venous system. Several cases regarding portomesenteric venous thrombosis as a complication of appendicitis were reported in adults, but there are far fewer reports in pediatric patients. The mortality rate of the condition is high if untreated, especially in children, reaching up to 50%. Patient concerns: A healthy 15-year-old male with no significant past medical history presented with right lower quadrant pain, lethargy, and fever. The computed tomography scan showed a focal thrombosis at the superior mesenteric vein branch and an inflamed appendix. Diagnoses: Mesenteric venous thrombosis complicating acute appendicitis. Interventions: Intravenous antibiotics along with anticoagulants and laparoscopic appendectomy Outcomes: After 1 month, a follow-up ultrasonography revealed full resolution of the thrombosis. Lessons: Appendicitis is one of the most frequently encountered causes of pediatric surgical emergencies; therefore, physicians should be conscious of mesenteric venous thrombosis as a possible complication of acute appendicitis, irrespective of whether patients have thrombophilic conditions or not.
This study aimed to report the surgical outcomes of laparoscopic glue hernioplasty (LGH) compared with conventional laparoscopic suture hernioplasty (LSH) in pediatric female inguinal hernia repair. We retrospectively analyzed 465 female pediatric patients who underwent laparoscopic inguinal hernia repair between January 2013 and December 2020. LGH and LSH were performed in 95 and 370 cases, respectively. Surgical outcomes (length of hospital stay, operative time, complications, and recurrences) were compared between the LGH and LSH groups. We found that the operation times for bilateral hernia repair were shorter in the LGH group (LGH: 35.5 ± 8.2 min, LSH: 45.2 ± 11.6 min; p < 0.001). No significant differences in complications or recurrences were observed between the two groups during the follow-up period. Our findings suggest that LGH is a feasible and easily applied surgical technique for the treatment of pediatric female inguinal hernia.
The aim of this study was to provide clinical evidence supporting the safety and effectiveness of laparoscopic surgical glue injection hernioplasty (LSGIH) for indirect inguinal hernia repair in female patients.We conducted a prospective study of LSGIH beginning in January 2013. N-butyl-2-cyanoacrylate was used as the surgical glue for closure of the hernia sac. Twenty-eight female patients with a mean age of 51.1 ± 35.3 months (24 days to 10 years) received LSGIH. The total number of LSGIH operations was 42, including bilateral inguinal hernioplasties.Postoperatively, all the patients were discharged from the hospital within 24 hours without incident. The mean operation time for LSGIH was 41.0 ± 9.7 minutes (30-66 minutes). The mean follow-up period was 23.2 ± 8.3 months (14.6-38.2 months) up to now. There were no postoperative complications or recurrences during the follow-up period.Our prospective study supports LSGIH as a simple, safe, and useful technique for pediatric inguinal hernioplasty. This method required only one working port and one camera port. However, further clinical prospective trials, including male patients, should be performed to confirm the long-term safety and effectiveness of LSGIH.
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