Jurgen Schleef

Background: Adnexal torsion is an uncommon cause of abdominal pain, and its clinical presentation in children is nonspecific. In some studies, serum D-dimer showed promise as a biochemical marker. The aim of this multicenter prospective observational study was to evaluate the sensitivity and specificity of preoperative serum D-dimer levels for diagnosing adnexal torsion in children and adolescents. Methods: Female patients aged <18 years presenting to the emergency departments of participating centers with symptoms suggestive of adnexal torsion between January 2022 and December 2024 were invited to participate in the study. Preoperative serum D-dimer levels were measured in all patients undergoing surgical exploration. Patients’ characteristics were examined using descriptive and inferential statistics, and the accuracy of preoperative serum D-dimer levels for diagnosing adnexal torsion was assessed using univariate logistic regression and a receiver operating characteristic curve. Results: Twenty-eight patients aged 4–17 years were enrolled. Adnexal torsion was found in 17 patients, on the left side in 4 (23.53%) and on the right side in 13 (76.47%). Almost all patients were treated laparoscopically, and no postoperative complications occurred. Preoperative serum D-dimer levels were higher among patients with adnexal torsion than among those without. The univariate model of serum D-dimer levels had an odds ratio of 1, a sensitivity of 0.77, and a specificity of 0.82 (p = 0.27). Conclusions: No direct association was observed between preoperative serum D-dimer levels and adnexal torsion. Nonetheless, the sensitivity and specificity suggest the possible utility of including serum D-dimer levels in multi-marker diagnostic models to complement rather than replace existing tools.

Background: Vascular malformations are relatively common in children. Current therapeutic strategies include observation, medical therapy, sclerotherapy or embolization, laser therapy, cryoablation, and surgery, depending on the type and anatomical location of the malformation. Surgery is commonly limited to small and/or circumscribed lesions, to debulking in case of large volumes, or in drug-resistant cases. Sclerotherapy is a minimally invasive treatment generally used to treat dysplastic vasculature and to significantly improve patients’ symptoms. Herein, we describe our preliminary experience with bleomycin electrosclerotherapy (BEST) in the treatment of peripheral low-flow venous and lymphatic malformations in the pediatric population. Methods: We prospectively collected and analyzed data from patients who underwent BEST for peripheral low-flow vascular malformations (venous and lymphatic) and were treated at our institution from May 2022 onward. Results: Twelve patients (4 boys and 8 girls) with peripheral low-flow vascular malformations who underwent BEST were enrolled in this preliminary study. The median patient age at the first procedure was 81 months (IQR = 46–128). The most frequent anomaly was peripheral low-flow venous malformation. No relevant postoperative complications were encountered in any of the patients. All patients underwent a clinical evaluation of the malformation 1 month after the procedure. A clinical and ultrasonographic evaluation of the malformation was performed 2 months after the procedure to determine whether to repeat BEST. In cases of clinical resolution, a second ultrasonographic evaluation was performed 6 months after the procedure. Conclusions: BEST appears to be a promising and safe option for treating peripheral low-flow vascular malformations in children. Further studies with a greater number of patients and longer follow-up periods are needed to confirm our preliminary experience.

Background: Vascular malformations are relatively common in children. Current therapeutic strategies include observation, pharmacological therapy, sclerotherapy, laser therapy, embolization, and surgery, depending on the type and anatomical location of the malformation. Herein, we describe our preliminary experience with bleomycin electrosclerotherapy (BEST) in the treatment of peripheral low-flow venous and lymphatic malformations in a pediatric population. Methods: We prospectively collected and analyzed data from patients who underwent BEST for peripheral low-flow vascular malformations (venous and lymphatic) and were treated at our institution from May 2022 onward. Results: Twelve patients (4 boys and 8 girls) with peripheral low-flow vascular malformations who underwent BEST were enrolled in this preliminary study. The median patient age at the first procedure was 81 months (IQR = 46–1128). The most frequent anomaly was peripheral LFVM. No relevant postoperative complications were encountered in any of the patients. All patients underwent a clinical evaluation of the malformation 1 month after the procedure. A clinical and ultrasonographic evaluation of the malformation was performed 3 months after the procedure to determine whether to repeat BEST. In cases of clinical resolution, a second ultrasonographic evaluation was performed 6 months after the procedure. Conclusion: BEST appears to be a promising and safe option for treating peripheral low-flow vascular malformations in children.

Purpose Acute appendicitis is one of the most common surgical conditions in pediatric and general surgery. The purpose of this study was to retrospectively investigate the management strategies of the appendiceal stump during transumbilical laparoscopic-assisted appendectomy for acute appendicitis in terms of surgical time, hospital length of stay, and postoperative complications. Methods The records of patients < 18 years of age who were treated for acute appendicitis at our Pediatric Surgery Unit from December 2018 to January 2024 were retrospectively reviewed. Data were extrapolated from the departmental database, and clinical notes were reviewed. Results The records of 278 patients who underwent appendectomy within a 5-year period at our institution were essentially used to compare appendiceal stump inversion and simple ligation. Appendiceal stump invagination was performed in 208 patients (74.8%), comprising 106 females (51.0%) and 102 males (49.0%), with a median age of 11 years (IQR 8–15) and a median weight of 36.5 kg (IQR 28–54). Twenty-six (12.5%) patients had associated conditions. The appendiceal stump was not invaginated in 70 children (25.2%), consisting of 26 females (37.1%) and 44 males (62.9%), with a median age of 11 years (IQR 8–14) and a median weight of 38.3 kg (IQR 29.5–47). Fourteen patients (20%) had associated pathologies. The two groups were similar in terms of sex (P = 0.05), age (P = 0.40), weight (P = 0.78), and associated pathologies (P = 0.12). Notably, 78.6% of appendicitis cases treated without stump invagination were uncomplicated, whereas 20% were complicated (4.3% abscess and 15.7% peritonitis cases). In contrast, stump invagination was performed in 87% of uncomplicated appendicitis and 13.1% of complicated appendicitis cases (6.8% abscess and 6.3% peritonitis cases). Therefore, simple ligation was also effective in complicated appendicitis cases (P = 0.03). In addition, the median surgical duration was 63.5 min (IQR 46–90) for patients undergoing stump inversion and 69 min (IQR 60–115) for patients undergoing simple ligation respectively (P = 0.02). Interestingly, statistical analysis revealed no significant differences in length of hospital stay (P = 0.21) and postoperative complications (P = 0.15). Conclusion Simple ligation does not compromise treatment efficacy nor increase postoperative complications, nor the length of hospital stay.

Introduction: Lipomas are among the most encountered neoplasms in clinical practice, occurring mainly in adults between the fourth and sixth decades of life. Deep-seated lipomas in children are found in the thorax, chest wall, mediastinum, pleura, pelvis, retroperitoneum, and paratesticular area. Herein, we present a case of a three-year-old child with a giant mesenteric lipoma, along with a review of the literature on mesenteric lipomas in childhood. Case presentation: A three-year-old male toddler was referred to our hospital for severe, intermittent abdominal pain. Imaging studies at admission revealed a fat lesion occupying most of the peritoneal cavity and dislocating adjacent structures. An urgent laparotomy was performed. A giant lipoma arising from the mesentery and leading to the torsion of the mesenteric radix was confirmed and completely excised alongside an adherent small tract of jejunum. The child recovered uneventfully and is still being followed-up with no signs of recurrence. Discussion: Lipomas of the mesentery in children are very rare, and they are reported to be more common among children younger than three years of age. Mesenteric lipomas appeared to be more frequent in males than females. Even though they might be asymptomatic, voluminous lipomas can also create a lead point for intermittent torsion of the mass causing ischemia and infarction. Abdominal pain was the most frequent symptom, and the ileum was the tract of bowel more frequently involved by the tumor. Laparotomy was reported to be the preferable approach to safely remove this abdominal mass, especially in case of huge dimensions.

Introduction: Lipomas are among the most encountered neoplasms in clinical practice, occurring mainly in adults between the fourth and sixth decades of life. Deep-seated lipomas in children are found in the thorax, chest wall, mediastinum, pleura, pelvis, retroperitoneum, and paratesticular area. Herein, we present a case of a three-year-old child with a giant mesenteric lipoma, along with a review of the literature on mesenteric lipomas in childhood. Case presentation: A three-year-old male toddler was referred to our hospital for severe, intermittent abdominal pain. Imaging studies at admission revealed a fat lesion occupying most of the peritoneal cavity and dislocating adjacent structures. An urgent laparotomy was performed. A giant lipoma arising from the mesentery and leading to the torsion of the mesenteric radix was confirmed and completely excised alongside an adherent small tract of jejunum. The child recovered uneventfully and is still being followed-up with no signs of recurrence. Discussion: Lipomas of the mesentery in children are very rare, and they are reported to be more common among children younger than three years of age. Mesenteric lipomas appeared to be more frequent in males than females. Even though they might be asymptomatic, voluminous lipomas can also create a lead point for intermittent torsion of the mass causing ischemia and infarction. Abdominal pain was the most frequent symptom, and the ileum was the tract of bowel more frequently involved by the tumor. Laparotomy was reported to be the preferable approach to safely remove this abdominal mass, especially in case of huge dimensions.

Introduction: Acute appendicitis is one of the most common surgical conditions in pediatric and general surgery. To date, the management of the appendiceal stump during appendectomy remains controversial. The purpose of this study was to retrospectively investigate the management strategies of acute appendicitis in a tertiary children’s hospital in terms of surgical techniques and time, hospital length of stay, and postoperative complications. Methods: The records of patients < 18 years of age who were treated for acute appendicitis at our Pediatric Surgery Unit from December 2018 to January 2024 were retrospectively reviewed. Data were extrapolated from the departmental database, and clinical notes were reviewed. Results: The records of 278 patients who underwent appendectomy within a 5-year period at our institution were essentially used to compare appendiceal stump inversion and simple ligation. The two groups were similar in terms of sex (P = 0.05), age (P = 0.40), weight (P = 0.78), and associated pathologies (P = 0.12). Statistical analysis revealed no significant differences in length of hospital stay (P = 0.21) and postoperative complications (P = 0.15). Notably, 78.6% of appendicitis cases treated without stump invagination were uncomplicated, whereas 20% were complicated (4.3% abscess and 15.7% peritonitis cases). In contrast, AS invagination was performed in 87% of uncomplicated appendicitis and 13.1% of complicated appendicitis cases (6.8% abscess and 6.3% peritonitis cases). Therefore, simple ligation was also effective in complicated appendicitis cases (P=0.03), with no significant difference in postoperative complications (P = 0.15). Conclusions: Simple ligation does not compromise treatment efficacy nor increase postoperative complications, nor the length of hospital stay. Specifically, our data suggest that simple ligation is at least as effective as invaginating the appendiceal stump, and it might probably simplify the whole procedure.

Cholelithiasis is increasing in the pediatric population, and there are currently no guidelines for the management of asymptomatic patients with both cholelithiasis and a predisposing condition. This study seeks to highlight situations where prophylactic cholecystectomy may be desirable. We retrospectively reviewed the medical records of children who underwent elective laparoscopic cholecystectomy between October 2011 and September 2022. Thirty‐two patients were included in the study. Five different groups of patients were identified based on associated pathologies. Twenty‐six patients were symptomatic (81.25%), and six were asymptomatic (18.75%). All patients underwent a laparoscopic cholecystectomy. Hematologic and cystic fibrosis patients with asymptomatic cholelithiasis had a shorter length of hospital stay than patients with the same condition who progressed from asymptomatic to symptomatic gallstone disease. Consequently, patients with associated diseases (particularly hematologic diseases and cystic fibrosis) may benefit from early laparoscopic cholecystectomy, which could reduce the probability of surgical difficulties and shorten the length of hospital stay.

Background: Cholelithiasis is increasing in the pediatric population. While its etiology is primarily idiopathic, it is often related to underlying diseases, and a significant number of patients may be asymptomatic. There are currently no guidelines for the management of asymptomatic patients with both cholelithiasis and a predisposing condition. Therefore, this study seeks to highlight situations where prophylactic cholecystectomy may be desirable based on pre, intra, and postoperative complications, length of hospital stay, and disease recurrence. Methods: We retrospectively reviewed the medical records of patients who underwent elective laparoscopic cholecystectomy between October 2011 and September 2022. Data, including clinical presentation at the time of diagnosis and admission, imaging, treatments, complications, and length of hospital stay, were collected. Results: Thirty-two patients (21 females and 11 males) were included in the study. The median age was 14 years (range <1–17). Five different groups of patients were identified based on associated pathologies. Ten patients had hematologic disease (31.25%), four had cystic fibrosis (12.5%), six were overweight or obese (18.75%), two had an autoimmune disease (6.25%), and ten had no underlying disease (31.25%). Twenty-six patients were symptomatic (81.25%), and six were asymptomatic (18.75%). The idiopathic etiology group was entirely symptomatic. All patients underwent a laparoscopic cholecystectomy. There was one patient (in the idiopathic etiology group) who required conversion from laparoscopy to open surgery and a reintervention (3.13%). Hematologic and cystic fibrosis patients with asymptomatic cholelithiasis had a shorter length of hospital stay than patients with the same condition who progressed from asymptomatic to symptomatic gallstone disease. Conclusions: Patients with cystic fibrosis and hematologic diseases who have concomitant asymptomatic cholelithiasis may benefit from early laparoscopic cholecystectomy, which could reduce the probability of surgical and postsurgical complications and shorten the length of hospital stays.