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Introduction: Laparoscopic appendectomy is standard of care for acute appendicitis and commonly involves use of linear staplers for dividing the appendiceal base and mesoappendix. We present a series of a rare complication, postoperative intestinal volvulus from retained staples. Cases: Patients are a 1) 10-year-old male, 2) 13-year-old, and 3) 12-year-old female all diagnosed with acute appendicitis and treated with laparoscopic appendectomy using linear endostapler.Case 1 had abdominal pain 10 days post-operation with peritonitis on exam, leukocytosis, high lactate. CT imaging was concerning for volvulus. Emergent laparotomy reduced the volvulus caused by adhesion to the mesentery from free staples. He was discharged ten days later.Case 2 had emesis and abdominal pain 22 days postoperatively, with CT findings concerning for volvulus. Emergent laparoscopy found an adhesive band from mesentery to terminal ileum involving staples and was reduced. He was discharged the following day.Case 3 had abdominal pain and emesis two days postoperatively. Ultrasound showed hemorrhagic ovarian cyst, and later showed ascites. Pain persisted; STAT CT showed closed loop bowel obstruction requiring emergent laparotomy. A staple was embedded into mesentery with an adhesive band causing a volvulus. Post-operative course was complicated by re-operations and re-admission for additional obstruction. She discharged 14 days after the initial exploratory laparotomy. Conclusion: Post-operative volvulus, a serious complication, can occur following surgical procedures that involve the use of staplers. Free staples left behind in the peritoneal cavity carry a risk of causing such complication. Removal of free staples is recommended at the conclusion of any operation where staples are used.

Peutz-Jeghers Syndrome is an autosomal dominant disorder linked to abnormalities in STK11, and is associated with mucocutaneous pigmentation, sex cord tumors, and gastrointestinal polyps. While it is extremely rare in children under the age of 2, several cases of profound disease have been documented in this population. Here, we detail a case of Peutz-Jeghers Syndrome presenting initially as intussusception, where massive polyp burden nearly occluded the duodenum of a 15-month-old patient and required multimodal operative intervention. Further, we posit that race-based implicit bias may contribute to delays in care and the identification of patients at risk for rare diseases, particularly with atypical presentation, such as the child highlighted in this case.

Thymomas are exceedingly rare in the pediatric population, with lymphoma being a much more likely etiology of a mediastinal mass in a child. Here, we present the interesting case of a large mediastinal mass incidentally identified in an 11-year-old female, which was initially concerning for malignancy. After extensive workup revealing the likely benign nature off the lesion, resection was pursued to relieve cardiopulmonary mass effect. Final pathology was returned as benign infarcted thymoma.

Rectal prolapse is typically associated with chronic constipation in the pediatric population. Historically, it has been well managed with the adoption of an aggressive bowel regimen, with refractory cases responding well to operative intervention. Here, we present a case of new, acute onset refractory rectal prolapse as an alarm symptom of abdominal compartment syndrome in a 2-year-old female. To our knowledge, this presentation of rectal prolapse heralding abdominal compartment syndrome is unique in the available pediatric literature.