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Iliopsoas abscess (IPA) is uncommon in childhood and very rare in the neonate and infant. We present a case of IPA after an umbilical granuloma in an infant. A baby girl with a birth weight of 2,970 g was born at thirty-seven weeks and two days gestation by Caesarean Section. On the fourteenth day after birth, her umbilicus was wet and developed the granulomatous formation. At two months of age, she presented with right leg and groin swelling with mild bluish discoloration and without fever. She had poor movement of her right leg and showed apparent discomfort. Her umbilicus was dry and there was no granulomatous material. Ultrasonography and computed tomography demonstrated an iliopsoas abscess in the right position. Therefore, an extraperitoneal surgical drainage was performed, aspirating yellowish pus. Culture of the purulent material revealed Staphylococcus aureus. Systemic antibiotic therapy was continued for ten days. After three days of drainage, full-range motion of the right leg was gained, and then after eleven days, CT findings comfirmed the disappearance of the iliopsoas abscess. IPA is extremely rare and it is difficult to diagnose. However, it should be included in the differential diagnosis of an infant with poor leg movement and swelling of the groin to the femur.

We present an unusual case of acute abdomen caused by torsion of an acces- sory spleen with situs inversus in a child. A three-year-old girl was admitted to our hos- pital with an 11-day history of right flank pain with fever. Her medical history revealed an operation of coarctation of the aorta with situs inversus at one month of age. Physi- cal examination revealed a right flank mass and tenderness. A contrast-enhanced CT scan showed a normally enhanced small spleen in the right upper quadrant and a 7.0 6.0 3.5 cm, hypodense, marginal enhancing mass in the right midabdomen adjacent to the intestine. An emergency laparotomy was decided upon with a preoperative diagno- sis as an acute abdomen. During surgery,a mass was found under the greater omentum and two accessory spleens of 1.5 cm in diameter were found surrounding the main spleen. Several loops of bowel were adherent to the mass. The loops of bowel were dissected away. A pediculated congested mass was observed as an accessory spleen emerging from the greater omentum. The mass was twisted on its vascular pedicle and strangulated. The necrotic mass was removed and the postoperative recovery was uneventful. Though tor- sion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in childhood. J. Med. Invest. 59 : 220-223, February, 2012

Purpose We present a new fistulectomy method for the second pharyngeal arch remnants. Materials and Methods Between 1991 and 2003, 4 patients have been treated with a new fistulectomy method. Surgical Procedure Under general anesthesia with nasotracheal intubation, the neck and mouth are prepared as one operative field. A nylon thread is inserted into the cervical opening. On the oral site of the nylon thread, a small gauze ball is tied and gently pulled from the neck site. At both opening sites of the fistula, a very small incision around the nylon thread is performed. Using the nylon thread as a guide, a fistulectomy is carried out. Results In all 4 patients, no complications have occurred during and after the fistulectomy. No recurrences were seen during 15 months to 9 years. Conclusions This is a simple and useful procedure for the treatment of second pharyngeal arch remnants. It produces an excellent cosmetic result compared with the standard method because only one small incision is necessary.

We describe an extremely rare case of subcapsular rupture of the liver associated with hemophilia A in a neonate. Although, the neonate was in good condition after birth, at 13 hours, he became pale and his abdomen distended. At 17 hours after birth, an emergency laparotomy was performed. The subcapsular rupture of the left side of the liver was found. The ruptured area was closed with a continuous suture, and additional mattress sutures with pledget provided satisfactory hemostasis. On the second day after the operation, relaparotomy was done because recurrent bleeding was suspected. There was no bleeding from the sutured liver. Oozing was found at the suture line on the abdominal wall. An additional postoperative observation was a decrease of factor VIII less than 1%, and hemophilia A was confirmed.

The author describes an extremely rare case of coexistence with imperforate anus, malrotation, and double zonal aganglionosis. A colostomy was performed on a 2-day-old male infant at the proximal sigmoid colon, because the finding of an invertgram revealed an intermediate type of imperforate anus. At the age of 1 month, a distal colostogram showed the low type without fistula. An upper gastrointestinal series revealed malrotation. At 4 months of age, Ladd's procedure and an anoplasty were done. The function of the colostomy was not good. At laparotomy, a narrowing terminal ileum was removed for being a suspected intestinal obstruction. Histologic findings of the removed ileum revealed aganglionosis. A rectal suction biopsy showed the positive finding of acetyl cholinesterase staining. Therefore, the patient was diagnosed with extensive aganglionosis. At 9 months of age, a 1-stage ileoendorectal pull-through with a right colon onlay patch was performed. Histologically, a skipped ganglionic bowel segment at the right colon, a double zonal aganglionosis, was found among the extensive aganglionosis. Although the ganglionic right colon was used for the colon patch, which was placed for antiperistaltic movement, postoperatively the bowel function was excellent. The author herein describes an extremely rare case of coexistence of imperforate anus, intestinal malrotation, and double zonal Hirschsprung's disease. A case with this association, to the author's knowledge, has not been reported previously in the literature.

Heterotopic pancreas (HP) is rarely recognized during surgery. Many reports concerning this anomaly are simple case reports. We herein review our experiences with HP. We retrospectively investigated cases of HP from April 1975 to September 2006. We discussed the frequencies in the laparotomized patients, and patient’s age, gender, operative indication, location of HP, post-operative diagnosis and pathology. A total of 12 patients with HP, 3 boys and 9 girls, aged 1 day to 10 years of age were investigated. Ten patients had one pattern of HP and the remaining two had more than one. The locations of the HP were as follows: Meckel’s diverticulum, 4; stomach, 3; duodenum, 3; jejunum, 3; and ileum, 2. Only in one patient HP had caused an intussusception. The remaining 11 cases were identified incidentally during the operation. In 11 of 12 patients, HP was removed without post-operative complications. Classification of pathologies according to Heinrich is as follows: type I, 4; type II, 4; type III, 2 and unknown, 2. Patients with HP are usually asymptomatic. However, HP caused an intussusception in our series. Incidental HPs should be removed whenever identified during laparotomy.

Intussusception is one of the common causes of intestinal obstruction in early childhood. Although a genetic predisposition has been suggested in some cases, its etiology is considered to be incidental, and it has not been traditionally regarded as having any genetic basis. Authors report on cases of so-called idiopathic intussusception that demonstrate a strong familial tendency.We reviewed medical records of idiopathic intussusception reduced in our institute between 1975 and 2004. There were 564 patients. Their parents and/or grandparents were interviewed directly or by telephone about the occurrence of familial intussusception.A family history of idiopathic intussusception, including third-degree relatives, was noted on 39 pedigrees. Occurrences between father and son were 1, mother and son 4, mother and daughter 2, mother and son and daughter 1 (sibling), siblings 10, sibling and cousin 1, uncle or aunt and nephew or niece 6, uncle and nephew and niece (cousin) 1, and cousins 13. Among 564 patients with idiopathic intussusception, 20 patients, both of 6 pairs of siblings and both of 4 pairs of cousins were treated in our institute. So in 554 pedigrees of idiopathic intussusception, the incidence of familial intussusception, including third-degree relatives, was estimated to be 7.0% or 1 in 14.2 cases.We concluded that hereditary predisposition, such as anatomical basis, may be considered as an etiological factor in many cases of idiopathic intussusception. In these predisposed families, if they have inducements such as viral infections as the acquired agents, intussusception will occur very easily.

Menkes' kinky hair disease is a rare congenital disorder of copper metabolism with X-linked recessive inheritance. It is well known that it is frequently associated with urologic abnormalities. The authors experienced three such cases, but each of them was different. Multiple bladder diverticula, right vesico-ureteral reflux, and right hydronephrosis were noted on the first baby boy. In the second case, hematomas in the left kidney, pelvis, ureter and the adipose capsule, which were thought to be the abnormality of vessels, were noted in the neonatal period. In the third body, multiple bladder diverticular were noted at the age of 1 year. One year, 10 months later, a spontaneous rupture at the huge diverticulum occurred.

In this report, we describe the first case of recurrent perforations of viscus due to ventriculoperitoneal shunt for the treatment of hydrocephalus. Based on our own experience and a survey of literature, we suggest that perforation of the gastrointestinal tract should be suspected in patients with ventriculoperitoneal shunt, particularly when abdominal symptoms or ventriculitis are presented. To manage this complication, at the first perforation in the present case, a fibrin sealant was effective for closure of the perforated stomach wall. At the second perforation, when laparotomy was performed, we could not find any abnormality in the abdominal cavity except for a sheath and slight omental adhesions near it.

A case of chylothorax following Bochdalek herniorrhaphy in an infant is presented. To our knowledge, it is only the third case to be reported in the literature.