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Aim More than 90% of pediatric solid organ abdominal injuries are treated non-operatively. It remains difficult to decide who should graduate to surgical management, more so if adult physicians must make these decisions on pediatric patients. The purpose of this study was to examine outcomes of all pediatric abdominal trauma cases in a single center, focusing on the decision-making algorithm for operative or non-operative treatment by pediatric and adult physicians. Methods We undertook a retrospective review of a pediatric trauma database from April 2006 to March 2016. Groups were divided into operative and non-operative, single or multi-organ injury, and adult or pediatric physician. Operative treatments included laparotomy or interventional radiology procedures. Primary outcome was survival within 30 days. Results There were 53 abdominal trauma cases; among them, 48 (90.6%) survived and 5 (9.4%) died within 30 days. The probability of survival for mortalities was less than 11%. Forty-two cases were treated non-operatively and 11 operatively. Injury Severity Score was higher in operative group (17 [9, 41]/9 [4, 16.3]). Adult physicians saw 33 patients including seven operative, whereas pediatric physicians saw 20 including four operative cases. There was no statistical difference for the management decision between adult and pediatric physicians. Conclusion Our decisions for intervention were within acceptable rates. Adult physicians did not tend to operate more, but there were cases that did not fit the criteria of the algorithm. Further investigation is needed to look at which factors should be focused on to determine whether or not operative treatments are indicated.

This report describes an unusual case of sarcomatoid carcinoma of the bladder in a 3-year-old girl. Although saving the patient's life is most essential, it is also essential to consider quality of life. The patient underwent neoadjuvant chemotherapy with gemcitabine and cisplatin for bladder preservation. The tumor considerably decreased in size. After 4 courses of chemotherapy, the patient underwent a partial cystectomy followed by postoperative irradiation with 2 courses of chemotherapy. Seventy months after the operation, she remains alive, showing complete remission with normal bladder function. Chemotherapy resulted in tumor shrinkage and allowed for bladder preservation.

This paper presents two cases of mediastinal schwannoma originating from the intrathoracic vagal nerve together with a review of 65 cases given detailed explanations in the Japanese literature. The first case: A 48-year-old man was admitted to the hospital because of an abnormal shadow in a chest X-ray film. Under a diagnosis of left mediastinal tumor, an operation was carried out. The tumor and string attached to the tumor were resected en bloc through a thoracotomy. Pathological diagnosis was schwannoma. Left recurrent nerve paralysis was evident by postoperative horseness. We thought that the tumor was a schwannoma arising from the vagal nerve proximal to the origin of the recurrent nerve. The second case: A 51-year-old woman was admitted to the hospital because of an abnormal shadow in a chest X-ray film. From a CT scan and a MRI we diagnosed preoperatively that the tumor arose from the vagal nerve distal to the origin of the recurrent nerve. Thoracoscopic surgery was performed. The tumor was resected with transection of the vagal nerve. Pathological diagnosis was schwannoma. The postoperative course was uneventful. Mediastinal schwannoma originating from the intrathoracic vagal nerve presents difficulty in preoperative diagnosis. Although it uncommonly appears, some malignant cases have been reported and hence complete resection is desirable. However, we have to consider treatments which differ from case to case in terms of postoperative complications.

Ultrasonographic examinations was made in 24 children who had undergone a portenterostomy to correct extrahepatic biliary atresia. Abnormalities were observed in six patients. These were the result of ongoing inflammatory reactions because all had been suffering from cholangitis after surgery, and the size of the biliary tract structure changed in accordance with the occurrence and subsidence of the cholangitis. Ultrasonographic examination showed dilation of the intrahepatic bile duct in one patient and cystic lesions in five patients. Treatment included percutaneous transhepatic bile drainage for dilated bile ducts, alcohol injections for intrahepatic cysts, and reoperation for cysts in the porta hepatis. Treatment was not required for cysts in controllable cholangitis. The results of these approaches were excellent, indicating that they were of benefit in treatment intrahepatic abnormalities occurring after portoenterostomy.

A 2-year-old female with recurrent infections after hepatoportoenterostomy is reported. An intrahepatic cyst appeared to be the source of the recurrent infections. Short-term percutaneous drainage of the cyst was performed three times, but the cyst persisted and there was recurrent fever. We then introduced pure alcohol into the cyst twice through a drainage catheter; there was a prompt decrease in discharge from the cyst, which gradually decreased in size and disappeared 8 months later. There were no further episodes of infection. It was apparent that the alcohol injections were very effective in treating the recurrent infections.