Pancreaticoduodenectomy for choledochal cyst.

Background/aims: Choledochal cyst (CDC) is a rare congenital cystic dilatation of the biliary system that can affect children and adults. Standard treatment for CDC includes surgical excision of the cystic bile duct with restoration of bilioenteric continuity by Roux-en-Y hepaticojejunostomy. In rare situations, however, surgical excision of a CDC may require pancreaticoduodenectomy (PD).

Gastric tube-pericardial fistula: a remote complication of esophageal replacement for long gap esophageal atresia.

Several short and long-term complications of esophageal replacement have been described in the literature. We report the case of a gastric tube-pericardial fistula occurring 20 years after initial repair of long gap esophageal atresia with a reversed gastric tube.

A practical algorithm for accurate diagnosis and treatment of perinatally identified biliary ductal dilation: three cases that underscore the importance of an individualised approach.

Choledochal cysts (CDCs) identified during the prenatal or immediate postnatal period are unusual with a majority being identified in older children and adults. Although authors advocate surgical resection of these presumed CDCs with reconstruction, there has been no agreement on the optimal timing of such an intervention when the initial diagnosis of CDC is made prenatally or during the newborn period. We present the cases of three children with biliary ductal dilation who were presumed to have CDC by ultrasound and/or magnetic resonance imaging during the perinatal period and who ultimately required different approaches to treatment.

Percutaneous distal perfusion of the lower extremity after femoral cannulation for venoarterial extracorporeal membrane oxygenation in a small child.

Femoral cannulation in pediatric patients requiring extracorporeal membrane oxygenation (ECMO) is commonly associated with distal limb ischemia. Authors have previously reported successful lower limb perfusion using various open techniques to cannulate a distal lower extremity artery at the time of initial ECMO cannulation. These procedures include open femoral artery antegrade cannulation and distal posterior tibial artery retrograde cannulation in older children and adults.

Button-loop feeding jejunostomy.

Introduction: Post-pyloric feeding via a surgical jejunostomy allows for enteral nutrition in patients that cannot receive oral or gastric feeding. Regardless of the technique used to create a jejunostomy, complications such as tube dislodgement, jejunostomy closure, or bowel obstruction can occur.

Surgical Technique: We present a simple and efficient jejunostomy technique that does not require a sewn anastomosis and employs an easily exchangeable feeding button.