Multi-disciplinary care in patients with complex pediatric general and thoracic surgical pathology: lessons learned from a 20-year experience.

Purpose: Complex pediatric surgery patients with thoracic tumors invading the mediastinum and infradiaphragmatic tumors extending into the chest are at risk for surgical morbidity and mortality if the patient's care is not coordinated. We sought to identify areas of focus when managing these patients to improve care.

Methods: A 20-year, retrospective study of pediatric patients with complex surgical pathology was performed.

Complete Absence of the Extrahepatic Biliary Tree in a Newborn With Pigmented Stools.

"Yellow stools in neonatal cholestasis exclude biliary atresia." This conventional wisdom led to the development of the infant stool color card, which alerts parents to seek medical referral when pale stools are observed, a strategy that has been shown to improve survival in infants with biliary atresia (BA). Here, we present a case of a newborn with significant direct hyperbilirubinemia (direct bilirubin level of up to 9.

Ovarian volume ratio is a reliable predictor of ovarian torsion in girls without an adnexal mass.

Purpose: The aims of this study were to identify ultrasound-based predictors of ovarian torsion in girls without an adnexal mass and establish a set of normal values for ovarian volume ratio (OVR).

Methods: A retrospective review was performed of all premenarchal patients ≥3 years of age with a normal pelvic ultrasound between January 2016 and January 2019. A comparison group of premenarchal girls presenting between 2011 and 2019 with torsion in the absence of an adnexal mass was utilized.

Patience is a virtue: Multiple preoperative visits are associated with decreased recurrence in pediatric pilonidal disease.

Background/purpose: This study aimed to compare preoperative management strategies for patients undergoing trephination for pilonidal disease and evaluate risk factors for recurrence.

Methods: A retrospective review was performed of children undergoing index surgical treatment with trephination for pilonidal disease between September 2017 and April 2019. Intraoperative and postoperative management were standardized.

Premenarchal patients present differently: A twist on the typical patient presenting with ovarian torsion.

Background/purpose: The aim of this study was to characterize differences between pre- and postmenarchal females with ovarian torsion.

Methods: A single-center review was conducted of all nonneonatal pediatric patients with ovarian torsion from 2011 to 2018. Clinical data were compared between pre- and postmenarchal patients.

Trephination versus wide excision for the treatment of pediatric pilonidal disease.

Background/purpose: To evaluate outcomes of trephination compared to wide excision in children undergoing initial surgical treatment of pilonidal disease.

Methods: A retrospective review was conducted of patients undergoing initial pilonidal excision between September 2017 and September 2018. Operations were categorized as either trephination or wide excision via an open or closed-wound technique.

Giant Bullous Emphysema With Placental Transmogrification: A Case Report of a 14-Year-Old With Right Middle- and Lower-Lobe Involvement.

Giant bullous emphysema with placental transmogrification is an extremely rare entity, with 30 previously reported cases. Of these reported cases, it is typically identified with varied clinical and radiological impressions, presents in young adulthood to elderly, is always unilateral, and usually involves just one lobe. Despite the unknown pathogenesis, this diagnosis carries an excellent prognosis and is curative with complete resection.

Fetal omphalocele in a common bottlenose dolphin (Tursiops truncatus).

A routine pregnancy ultrasound examination of a 30-yr-old, multiparous, common bottlenose dolphin, Tursiops truncatus, detected an approximately 16-wk (gestational age) fetus with an omphalocele, an abdominal wall defect at the base of the umbilical cord. Throughout the pregnancy, ultrasound allowed for identification of the omphalocele contents, which included a portion of the liver and intestinal loops. The maximum diameter of the omphalocele was 11.

Magnet-associated intestinal perforation results in a new institutional policy of ferromagnetic screening prior to MRI.

Foreign body ingestions are common and the vast majority pass through the gastrointestinal tract without complication. Some ingestions, however, result in serious morbidity and mortality. We present a case in which the patient's chief complaint of severe posterior neck pain was unrelated to his foreign body ingestion (multiple magnets).

Acute appendicitis presenting with a painful inguinal mass: complication related to patent processus vaginalis and testicular maldescent.

Appendicitis with or without perforation is a common pediatric emergency department diagnosis, as are the findings of patent processus vaginalis and cryptorchidism. We describe the unique presentation of perforated appendicitis complicated by a tender inguinal mass resulting from the presence of purulence as well as a cryptorchid but viable testis within a patent processus vaginalis. We describe our diagnostic approach and review the literature relevant to inguinoscrotal presentations of appendicitis.