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Introduction Superior temporal artery pseudoaneurysms were first described by Thomas Bartholin in 1740, and since then approximately 400 cases have been reported in the literature. It is estimated that of aneurysms that are surgically repaired, traumatic aneurysms, pseudoaneurysms, and arteriovenous (AV) fistulas of the superficial temporal artery (STA) account for 0.5%–2.0%. Of these, only a few reported are in the pediatric population. Case An otherwise healthy 16-year-old male presented to UNM Pediatric Surgery Clinic with a small temporal mass in January 2020. He had previously been punched in the side of the head in August 2019 and noticed the mass after the bruising and swelling in the area had subsided. The mass was then determined to most likely be a posttraumatic pseudoaneurysm of the temporal artery, based on exam showing a 1 cm soft, mobile, pulsatile mass. A CT angiogram of the head and neck confirmed. Observation, IR intervention, and surgical removal were discussed with the patient and his mother in clinic, and they opted for surgical removal. In February 2020, he underwent an excision of left superficial temporal artery pseudoaneurysm under general anesthesia. Intraoperatively, it was noted that a part of the superficial temporal vein was densely adherent to the pseudoaneurysm, and was small inferior to the pseudoaneurysm, and engorged superiorly, concerning for a possible fistula formation. This was not confirmed intraoperatively, but a portion of the left superficial temporal vein had to be excised as there was no clear plane between the pseudoaneurysm and the vein. Pathology results did not demonstrate a fistula formation, but did confirm a pseudoaneurysm of the STA.

Amyand's hernia is an exceedingly rare condition in which the appendix is found in an inguinal hernia. The appendix can be normal, inflamed, infected, or perforated. Here, we present a case of perforated appendicitis in an Amyand's hernia in an extremely preterm infant with subsequent post-operative complications including necrotic bowel and venous thrombosis of the mesentery. This article stresses the importance of complications that can arise in Amyand's hernia, especially in an extremely preterm infant.

As rates of childhood obesity rise, the frequency of laparoscopic cholecystectomy to treat gallbladder disease in the pediatric population is increasing. Knowledge of biliary anatomy and its variants is vital to performing this operation safely. Duplication of the extrahepatic biliary tree is a rare but important variant. The significance of duplicated common bile duct anatomy is important as these variations may pre-dispose patients to stone formation and obstruction. Here we present the case of an 11-year-old girl with gallstone pancreatitis and a duplicated common bile duct. The patient underwent interval laparoscopic cholecystectomy following resolution of pancreatitis. A duplicated common bile duct type Vb was identified on intraoperative cholangiogram and subsequent endoscopic retrograde cholangiopancreatography.

We report the multi-modality treatment of a massive cervicothoracic lymphatic-venous malformation (LVM) in a 13-year-old boy that was present at birth as a small cervical mass. At four years of age, sclerotherapy significantly reduced the size of the malformation but over subsequent years the mass increased dramatically in size and resulted in a consumptive coagulopathy and limited left shoulder function. Treatment with sildenafil was without effect. The consumptive coagulopathy improved with subcutaneous enoxaparin. A multi-disciplinary team excised part of the mass when he was 11 years old. After surgery, gradual enlargement of the mass and rise in d-dimer prompted treatment with sirolimus. Two sessions of sclerotherapy arrested enlargement of the mass. Multi-modality treatment resulted in a marked reduction of the LVM in the child. However, enlargement of the mass and further treatment is anticipated as a cure has not yet been found.

Omphalocele is a congenital condition characterized by midline defect of the anterolateral abdominal wall whereby intra-abdominal contents covered by peritoneal sac are found herniated. It can be defined by size of defect or visceral contents. There are various ways of surgical management of omphalocele. Giant omphalocele presents particular challenge in reconstructing the abdominal wall. In this regard the use of tissues expansion as an adjunct in an attempt to recreate functional abdominal wall domain has been emerging. We are presenting a case of giant omphalocele that was closed with the help of extra peritoneal inter muscular tissue expanders.The patient was born at 37 weeks to a 33 year old healthy gravida 3, para 0 G3P0 mother via planned cesarean section. There were no prenatal, natal or postnatal complications. The giant omphalocele was diagnosed prenatally on screening Ultrasound. The patient remained in the neonatal intensive care unit for 6 weeks. The sac was large with abdominal contents including the entire liver. The sac was allowed to epithelialize completely over the course of two years. Due to the small size of the abdominal wall defect contents of the sac, loss of abdominal domain and inability of the abdominal cavity to accommodate the liver, we chose for rectangular tissue expander placement at age 30 months. 3 months later the patient was planned for tissue expander removal and abdominal wall closure. The tissue expanders were removed and omphalocele closure was performed. The patient has been followed up at 6 months and without recurrence of hernia.The management of giant omphalocele is technically challenging. Use of tissue expansion helps in recreating functional abdominal wall domain. There is growing evidence in the literature supporting the use of intra-abdominal tissue expansion in the management of giant omphalocele however because of hemodynamic consequences we think that the use of rectangular shaped, extra peritoneal, inter muscular tissue expanders is more desirable and has additional advantage of facilitating component separation.

Intestinal barrier dysfunction has been implicated in necrotizing enterocolitis (NEC), but has not been directly measured in human NEC.Small intestines removed during surgery were immediately mounted in an Ussing chamber. mRNA expression of tight junction (TJ) proteins was measured with RT-PCR.Fifteen infants were included, 5 with NEC and 10 with other diagnoses. Average transepithelial resistance (TER) was 11.61±1.65Ω/cmThese studies show for the first time that NEC intestinal tissue have increased intestinal permeability, even at grossly healthy-appearing resection areas. The increase in intestinal permeability in NEC appeared to be related in part to a decrease in occludin and an increase in MLCK expression.Level 2.

Background Ovarian mature cystic teratomas (MCTs) rarely transform to primary primitive neuroectodermal tumors. This case report offers evidence that MCTs might have undetected microfoci of malignant neural tumors. Case We describe the case of a 12-year-old girl who presented with right-sided abdominal pain and distention. Intraoperative findings revealed a right ovarian MCT. However, pathology showed a 0.5-cm focus of malignant neural tumor within the 11-cm MCT. Summary and Conclusion This patient will need close follow-up with a multidisciplinary team because the clinical implications of this transformation has yet to be defined.

Study design A case of acute celiac artery compression syndrome after spinal fusion in a patient with Scheuermann kyphosis is reported. Objective To describe the unusual complication of acute celiac artery compression after surgical kyphosis correction, to outline diagnostic methods, and to review the pertinent literature. Summary of background data Chronic celiac artery compression syndrome is well described, yet there is only 1 reported case of acute celiac artery compression after surgical correction of kyphosis. There have been no previous reports of this complication leading to foregut ischemic necrosis after correction of Scheuermann kyphosis. Methods Case report and literature review. Results After an anterior release and posterior spinal fusion for a 106 degrees kyphotic deformity performed under 1 anesthetic, our patient developed a perforated gastric antrum on postoperative day 5, evolving to ischemic necrosis of the stomach, gallbladder, and spleen discovered on postoperative day 7. Abdominal angiography indicated that his celiac artery had been occluded at its origin. After this event, the patient required a prolonged intensive care hospital stay and required a Roux-en-Y gastro-jejeunostomy reconstruction. He is now doing well at 1-year follow-up with independent ambulation and a regular diet. Conclusion Acute celiac artery compression after surgical kyphosis correction is a rare but potentially serious adverse event. Spinal deformity surgeons and intensivists should be aware of this entity, and should have a high index of suspicion for it if sepsis of unknown origin, an acute abdomen, or elevated liver enzymes are encountered after surgery after correction of a kyphotic deformity.

Nontuberculous mycobacterial (NTM) adenitis of the head and neck region is well-described in healthy children, most commonly presenting under the age of 5years. Extracervicofacial NTM adenitis is less common. We present a case of NTM inguinal adenitis in a 2-year-old girl, followed by a systematic review of the literature.