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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.

Introduction: Neonates presenting with bilious vomiting require emergent evaluation to rule out malrotation with volvulus. Enteric duplication cysts are congenital gastrointestinal lesions that can cause intestinal obstruction. However, they are not typically associated with a presentation and imaging findings suspicious for intestinal malrotation with volvulus. Case presentation: An eight-week-old male presented with progressive feeding intolerance, weight-loss, and bilious vomiting. Upper gastrointestinal series showed a complete obstruction at the ligament of Treitz with a “bird beak” sign. Due to the clinical assessment and imaging findings, malrotation with volvulus was suspected and the patient underwent surgical exploration during which an obstructing enteric duplication cyst was found on the proximal jejunum. The duplication cyst and the adjacent jejunum were resected, and bowel continuity was restored by a primary anastomosis. The diagnosis of an enteric duplication cyst was confirmed on the histopathological examination. Conclusion: To our knowledge this is the first reported case of a jejunal enteric duplication cyst located at the ligament of Treitz leading to intestinal obstruction and having findings on imaging studies mimicking those of an intestinal malrotation with volvulus. Enteric duplication cysts should be included in the differential diagnosis of newborns with acute bilious vomiting.

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.

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.

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.

Introduction/Purpose. Tracheoesophageal fistula (TEF) represents one of the most common congenital developmental malformations of the upper digestive tract. The optimal surgical management has several controversies, particularly in rapidly developing countries. Morbidity and mortality are highly variable between centers and are dependent on various factors. However, complex medical care has considerably improved, especially in developing countries. This study describes the experience of our center in patients with TEF with emphasis on the clinical characteristics, postoperative immediate and long-term respiratory and gastrointestinal complications, and the mortality rate of such cases which would allow us to compare our results with other regional pediatric tertiary centers. Methods. This is a retrospective review of the medical electronic charts of patients with TEF that were followed at Sidra Medicine in the state of Qatar. The review included the patients who were operated upon in the period of 2011-2021 but continued to follow at our institution in the period of 2018-2021. Demographic data, associated anomalies, preoperative, operative, and postoperative courses, and growth parameters were collected. Results. A total of 35 patients with TEF (24 males and 11 females) were collected. 49% were full term. We identified seven patients (20%) with isolated TEF, TEF with VACTERL association in 29% of our patients, other chromosomal anomalies in 17%, or associated with other anomalies (not related to VACTERL) in 34% of the patients. The majority of the patients (94%) were of type C-TEF (TEF with esophageal atresia–EA/TEF). All patients were operated except for one patient who died at 2 days of life due to cardiac complications. Median age at which surgery was performed was 2 days (range 1-270 days). Median follow-up was 32 months (range 7-115 months). Immediate postoperative complications were encountered in eleven patients (33%) and included anastomosis leak in 12%, air leak in 6%, sepsis in 6%, chylothorax in 3%, vocal cord palsy and fistula recurrence (combined) in 3%, and failure of TEF closure in 3% of the patients. Long-term respiratory complications were encountered in 43% of our patients. Long-term gastrointestinal complications included gastroesophageal reflux (GERD) in 63%, dysphagia in 31%, and anastomotic stricture in 34% of the patients. Growth was affected in around a quarter of the patients at 6 months after surgery and 22% at 12-month assessment postoperatively. While only five patients died at our institution, only one was directly related to failure of TEF closure and postoperative complications. Conclusion. This descriptive study reports the clinical outcome of TEF from a rapidly developing country. The distribution of the patients’ characteristics and postoperative complications was almost comparable to those from developed countries. This study would aid in addressing the prognostic factors and establishment of evidence-based management pathways of newborns with TEF to improve the clinical outcome in our center and other pediatric tertiary centers in developing countries.