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Background: Stenosis of the permanent tracheostoma causes the patient reduced quality of life. We herein report a treatment of permanent tracheostomal stenosis with local steroid injection after laryngotracheal separation in a patient with severe motor and intellectual disabilities. Case presentation: The patient was a 22-year-old woman with congenital myopathy who underwent laryngotracheal separation at the age of 21 years. Tracheostomal enlargement was performed at the age of 22 years. Two months after the operation, permanent tracheostomal stenosis developed owing to a hard cicatricial constriction. Although the size of the tracheostoma decreased, yet the patient did not have any respiratory distress. Therefore, we started local steroid injection therapy using triamcinolone acetonide instead of revision surgery. After those 3 injections, the tracheostomal stenosis was apparently dilated. The patient received this treatment 19 times in 3 years and 4months. She has not needed this treatment in the past 1 year and 8 months. No adverse effect of the corticosteroid was seen during the 5-year period. Conclusions: On the basis of our experience, if patients have no symptoms related to stenotic airway obstruction, triamcinolone acetonide injection therapy, instead of revision surgery, is a simple, safe, and highly effective procedure for permanent tracheostomal stenosis.

Hepatolithiasis is well known to be a late complication after biliary reconstruction. However, there were few reports regarding hepatolithiasis in late complications of long-term, native liver survivors in postoperative patients of biliary atresia. Here, we present a 52-year-old woman who underwent Kasai portoenterostomy for biliary atresia type Ⅲ at the age of 110 days. She was asymptomatic for over 30 years, and birthed three normal babies. Then she suffered from repeated cholangitis due to multiple hepatolithiasis since age 50. A lithotripsy via Roux-en-Y limb was performed but failed due to hepatic hilum strictures. Finally, she underwent living donor liver transplantation. Endoscopic lithotripsy and hepatectomy for hepatolithiasis often fail in biliary atresia patients due to unresolvable intrahepatic or hilar bile duct stenosis and liver dysfunction. Therefore, we consider that liver transplantation is curative and strongly recommended for symptomatic hepatolithiasis as a late complication after biliary atresia surgery.

Adenomyoma of the gastrointestinal tract is a rare tumor-like lesion, which occasionally leads to intussusception if it occurs in the small bowel. We report a case of ileal adenomyoma causing intussusception in a 16-month-old boy. The patient was treated by enema reduction; however, he immediately experienced recurrence of intussusception. An intestinal mass with multiple small cysts was detected by ultrasonography, suggesting the presence of a lead point. Partial enterectomy was performed to resect the mass and Meckel's diverticulum, which was incidentally found 10 cm distal to the mass. The histopathological diagnosis was adenomyoma of the small intestine and Meckel's diverticulum with gastric heterotopia. This is a rare case of adenomyoma and Meckel's diverticulum occurring at separate locations. While adenomyoma of the small intestine has a good prognosis, our case also followed an uneventful postoperative course.