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Vi TNH, Tri TT, Duy HP, Kiet PT, Cuong NM, Tuan HX, Duc NM. Laparoscopic treatment for median arcuate ligament syndrome in children: A case report. Radiol Case Rep 2024; 19:2004-2007. [PMID: 38449485 PMCID: PMC10917635 DOI: 10.1016/j.radcr.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
In median arcuate ligament syndrome (MALS), the median arcuate ligament compresses the celiac trunk and surrounding nerves leading to chronic functional abdominal pain and vague gastrointestinal symptoms. MALS can be effectively treated by dividing the arcuate ligament through open surgery or laparoscopy. This is a rare vascular condition and mostly encountered in adult patients. We hereby report a case of a pediatric patient diagnosed with MALS and treated successfully by laparoscopic approach. An 11-year-old girl presented with severe abdominal cramps for 3 months, accompanied by nonbilious vomiting. Computed tomography (CT) angiography demonstrated clear images of celiac trunk compression suggesting MALS. Laparoscopic surgery to cut the ligament and decompress the celiac artery was performed. The patient was discharged on day 7 postoperative with no recurrence of symptoms after 12 months of follow-up. This report suggested the diagnostic value of CT scan, and the safety and the feasibility of laparoscopic surgical techniques to treat MALS in children.
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Affiliation(s)
- Trinh-Nguyen Ha Vi
- Department of Pediatric Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Tran Thanh Tri
- Department of Hepato-Pancreato-Biliary Diseases and Liver Transplantation, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Ho Phi Duy
- Department of Hepato-Pancreato-Biliary Diseases and Liver Transplantation, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Phan Tuan Kiet
- Department of Hepato-Pancreato-Biliary Diseases and Liver Transplantation, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Nguyen Manh Cuong
- Department of Pediatrics, Vietnam Military Medical University, Hanoi, Vietnam
| | - Ho Xuan Tuan
- Department of Medical Imaging, Da Nang University of Medical Technology and Pharmacy, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Tri TT, Duy HP, Thuan LNA, Kiet PT, Van Khanh NH, Nhi TTY, Tran NTT, Duc NM. Gallbladder perforation following trauma in an 18-month-old child with a common bile duct cyst. Radiol Case Rep 2023; 18:4528-4532. [PMID: 37868011 PMCID: PMC10587450 DOI: 10.1016/j.radcr.2023.09.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023] Open
Abstract
Gallbladder rupture caused by blunt abdominal trauma is an uncommon injury, particularly in children. This condition occurs even less frequently in children with common bile duct cysts. The history is difficult to obtain, the clinical symptoms are indistinct, and their assessment is obscured by a slew of other lesions. Radiography cannot produce clear images. Thus, the diagnosis is frequently delayed and confirmed only during surgery. Case reports of gallbladder injury after abdominal trauma are relatively rare and there are only 50 case reports in literature for 100 years. Herein, we present the case of an 18-month-old girl who had a ruptured gallbladder funnel due to blunt abdominal trauma caused by domestic violence, with an early clinical presentation of septic shock and chylous effusion. The patient underwent surgery after being diagnosed with chylous ascites that had not responded to medical treatment. Based on the findings, single-stage laparoscopic surgery is confirmed to aid in the diagnosis and treatment of gallbladder injury in the presence of a common bile duct cyst.
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Affiliation(s)
- Tran Thanh Tri
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Ho Phi Duy
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Luu-Nguyen An Thuan
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Phan Tuan Kiet
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Truong-Thi Yen Nhi
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Nguyen-Thi Tuyen Tran
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Tri TT, Thach PN, Duy HP, Thuan LNA, Kiet PT, Duc NM. Post-traumatic intrahepatic pseudoaneurysm: A case of successful conservative treatment. Radiol Case Rep 2022; 18:895-898. [PMID: 36593921 PMCID: PMC9804004 DOI: 10.1016/j.radcr.2022.11.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Although post-traumatic intrahepatic pseudoaneurysms are rare in adults and even more uncommon in children, this serious complication can result in life-threatening bleeding. Most case studies have recommended surgical or endovascular interventions for preventing rupture or managing the bleeding from a ruptured intrahepatic pseudoaneurysm. Some studies also reported pseudoaneurysms could resolve without intervention and advised conservative therapy. In this case study, we describe a 19-month-old boy diagnosed with an intrahepatic pseudoaneurysm, upper gastrointestinal bleeding from the biliary tract, and hematoma infection. The patient received successful conservative treatment. After 36 days, the patient was discharged without signs of gastrointestinal bleeding and the steady shrinkage of the hematoma surrounding the pseudoaneurysm. The pseudoaneurysm and hematoma vanished at follow-up 18 months after the trauma. Conservative treatment may be considered a viable option, particularly for cases of post-traumatic intrahepatic pseudoaneurysms in children.
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Affiliation(s)
- Tran Thanh Tri
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Pham Ngoc Thach
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Ho Phi Duy
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Luu-Nguyen An Thuan
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Phan Tuan Kiet
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh city, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 District 10, Ho Chi Minh City 700000, Viet Nam,Corresponding author.
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Tri TT, Thach PN, Duy HP, Trung BH, Tuan HX, Duc NM. Pancreaticopleural fistula in children: Report of 2 cases. Radiol Case Rep 2022; 17:987-990. [PMID: 35106110 PMCID: PMC8784284 DOI: 10.1016/j.radcr.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
Pancreaticopleural fistula is an extremely rare complication of pancreatic duct injury. The reported treatments include conservative approaches, such as pleural drainage, and interventional approaches, such as sphincter stenting via endoscopic retrograde cholangiopancreatography and surgery. However, no specific consensus treatment has been defined. We present 2 cases of pediatric patients with pancreaticopleural fistulas due to pancreatic trauma and pancreatitis that were successfully treated surgically. The most prominent symptom in both cases was dyspnea caused by pleural effusion. Thoracoabdominal computed tomography scans showed large pleural effusions and visible fistulas from the pancreatic duct to the thoracic cavity through the esophageal hiatus and aortic hiatus. Following unsuccessful conservative treatment using pleural drainage, the 2 patients underwent surgical fistulo-jejunostomy and cystojejunostomy. Both patients were stable and were discharged on postoperative days 10 and 12. Conservative treatment for pancreaticopleural fistula often fails, and a surgical approach, such as fistulo-jejunostomy and cystojejunostomy, can serve as an efficacious management strategy when conservative treatment fails.
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Affiliation(s)
- Tran Thanh Tri
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Vietnam
- Department of General surgery, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Pham Ngoc Thach
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Ho Phi Duy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Bui Hai Trung
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Ho Xuan Tuan
- Department of Radiology, School of Medicine and Pharmacy, University of Da Nang, Da Nang City, Vietnam
- Corresponding author. H.X. Tuan, 41 Le Duan, District Hai Chau, Da Nang City 500000, Vietnam.
| | - Nguyen Minh Duc
- Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- Co-corresponding author. N.M. Duc, 2 Duong Quang Trung, District 10, Ho Chi Minh City 700000, Vietnam.
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Tri TT, Duy HP, Trung BH, Thuan LNA, Thach PN, Hien NX, Duc NM. A rare pediatric case of portal vein aneurysm thrombosis. Radiol Case Rep 2021; 17:286-289. [PMID: 34876951 PMCID: PMC8628219 DOI: 10.1016/j.radcr.2021.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022] Open
Abstract
Portal vein aneurysm (PVA) is rarely encountered, and published papers describing this etiology in adults and children typically include only case reports or small case series. We present a clinical case of PVA in a child associated with severe complications, including diffuse thrombosis of the portal venous system. A 10-year-old boy presented with abdominal pain and vomiting, resulting in an initial diagnosis of pancreatic head tumor based on suspicious images on abdominal grayscale ultrasound. Contrast-enhanced computed tomography confirmed a diagnosis of occlusive PVA thrombosis (36 × 37 × 95 mm). Lacking drastic symptoms, the patient was treated with conservative anticoagulant therapy. On follow-up, the thrombosis appeared to shrink gradually and disappeared at 6 months based on Doppler ultrasound imaging. The PVA was reduced in size, and hepatopetal flow was restored. Surgeons and radiologists should be aware of this rare entity to ensure that a precise diagnosis can be established and to provide suitable treatment.
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Affiliation(s)
- Tran Thanh Tri
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, 700000, Vietnam
| | - Ho Phi Duy
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, 700000, Vietnam
| | - Bui Hai Trung
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, 700000, Vietnam
| | - Luu-Nguyen An Thuan
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, 700000, Vietnam
| | - Pham Ngoc Thach
- Department of General Surgery, Children's Hospital 2, Ho Chi Minh City, 700000, Vietnam
| | - Nguyen Xuan Hien
- Department of Radiology, Tam Anh General Hospital, Hanoi, 100000, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 700000, Vietna.,Department of Radiology, Children's Hospital 02, Ho Chi Minh City, 700000, Vietnam
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