Damage control surgery in a <1 kg neonate: a brief report.

Damage control surgery is a feasible and successful approach for the management of unstable neonates with intra-abdominal catastrophes, including liver injuries. We report the case of a premature infant with a liver injury secondary to the placement of an umbilical vein catheter who was successfully managed using damage control surgery techniques.

Modified laparoscopic gastrostomy technique reduces gastrostomy tract dehiscence.

PURPOSE: To describe a modification in the Georgeson technique for laparoscopic gastrostomy tube (LGT) placement and compare the rate of reoperation for disruption of the gastrostomy tract after LGT by our modified technique to our own series of percutaneous endoscopic gastrostomy (PEG) tubes as well as the published rates of reoperation for LGTs and PEGs. METHODS: In 2003, we modified our technique for LGT to include laparoscopically placed sutures to secure the stomach to the abdominal wall. A retrospective review was performed on all children undergoing LGT placement and PEGs from March 2003 to October 2009. In addition, a review of the literature was performed to identify the published rates of complications for these procedures. RESULTS: During this time period, we have performed 85 LGT using this modified technique. In that same period, there have been 34 PEGs placed. The modification in our technique was instituted after a patient required reoperation for dislodgement in a laparoscopic U-stitch gastrostomy. To date, in the modified LGT group, there have been no disruptions of the gastrostomy tract in either the early or late periods, <90 days or >90 days, respectively. There have been 5 (5.9%) early dislodgements of the gastrostomy tube. All of these were before postoperative day 14 (at postoperative days 1, 2, 6, and 12), and all were replaced with placement verified by contrast study. None required reoperation. In the PEG group, there was 1 (2.9%) early and 1 (2.9%) late dislodgements and tract disruption that required reoperation. The published rate of dislodgement requiring reoperation in the Georgeson series of LGTs is 2.6%. The published rate of reoperation for dislodgement in PEGs is 4%-6%. CONCLUSION: This modification of the Georgeson technique has been successful in reducing the need for reoperation associated with gastrostomy replacement after dislodgement.

Early metastasizing spindle epithelial tumor with thymus-like differentiation (SETTLE) of the thyroid.

Spindle epithelial tumor with thymus-like elements is a rare thyroid lesion of children and young adults thought to be derived from branchial pouch remnants or foci of ectopic thymus. The lesion is poorly understood, and although it was originally believed to follow an indolent clinical course, its potential for late metastasis is becoming generally acknowledged. We have recently seen a unique case of this rare tumor in an 11-year-old boy, in which an unexpected and salient feature is the presence of a micrometastasis in a single lymph node at presentation. With the exception of 1 case with extensively infiltrative tumor and metastatic disease at the time of onset, in all other cases dissemination occurred years after surgical resection of the primary lesion. We review all previously reported cases and provide a detailed study of the histologic and ultrastructural appearances of this lesion.