Background: Small intestinal volvulus often occurs with malrotation. However, in some cases, it could develop without any other clinical conditions, and this is called primary segmental volvulus (PSV) of the small intestine. Two types of PSV (early and late neonatal) have been described previously, especially in preterms. Moreover, there were other cases occurring beyond the neonatal period. Methods: The medical records of 14 cases definitively identified as PSV were retrospectively reviewed. The patients were divided into 2 groups according to postnatal age at diagnosis: neonatal group and beyond neonatal group. Then, the 2 groups were compared in terms of clinical features. Results: There were 11 patients in the neonatal group (78.6%) and 3 patients in the beyond neonatal group (21.4%). There were no differences in gestational age, birth weight, and ratio of prematurity. In the neonatal group, the antenatal abnormal sonographic findings were found more frequently and the perforation of the involved segment were relatively common. Meanwhile, the involved segment was confined to the ileum and more commonly associated with mesentery change in the beyond neonatal group. There was no mortality. Conclusion: The 2 clinical types of PSV according to postnatal age at diagnosis show some differences in clinical features. Moreover, PSV should be considered a possible cause of surgical problems beyond the neonatal period.

Purpose: Alimentary tract duplication (ATD) is a rare congenital condition that may occur throughout the intestinal tract. Clinical symptoms are generally related to the involved site, size of duplication, or associated ectopic mucosa. This study aimed to identify clinical implications by anatomical locations and age group and then suggest a relevant management according to its distinct features. Methods: We retrospectively reviewed the clinical data of pediatric patients who received a surgical management due to ATD. Furthermore, data including patients' demographics, anatomical distribution of the duplication, clinical features according to anatomical variants, and outcomes were compared. Results: A total of 25 patients were included in this study. ATD developed most commonly in the midgut, especially at the ileocecal region. The most common clinical presentation was abdominal pain, a sign resulting from intestinal obstruction, gastrointestinal bleeding, and intussusception. The non-communicating cystic type was the most common pathological feature in all age groups. Clinically, prenatal detection was relatively low; however, it usually manifested before the infantile period. A laparoscopic procedure was performed in most cases (18/25, 72.0%), significantly in the midgut lesion (p=0.012). Conclusion: ATD occurs most commonly at the ileocecal region, and a symptomatic one may usually be detected before the early childhood period. Surgical management should be considered whether symptom or not regarding its symptomatic progression, and a minimal invasive procedure is the preferred method, especially for the midgut lesion.

The occurrence of internal hernia through a defect in the broad ligament is a very rare condition, which may cause small bowel obstruction. This is a case of a 50-year-old woman who developed intestinal obstruction induced by internal hernia and who had undergone laparoscopic myomectomy 7 years prior to visiting our emergency room. Abdominopelvic computed tomography showed luminal narrowing of the ileum and dilatation of the pelvic loop of the small bowel at the left side of the uterus. We detected internal hernia through the defect in the broad ligament and managed it successfully by performing a laparoscopic procedure using a barbed suture, V-Loc (Covidien,

Gastrostomy with concurrent laparoscopic Nissen fundoplication (LNF) is often performed as a laparoscopic gastrostomy (LG) by surgeons. Since 2014, we started performing percutaneous endoscopic gastrostomy (PEG) as gastrostomy with LNF. This study aims to compare the outcomes of LG and PEG with LNF. Patients were recruited into two groups: LNF with LG (historical control) or PEG. Demographic data, operation time, time to start feeding, time to full feeding, length of hospital stay (LOS), and complications were compared between the groups. Fourteen patients underwent LNF with LG and 49 underwent LNF with PEG. The median age and body weight of patients were 4.25 years and 14.15 kg in the LG group and 2.58 years and 10.60 kg in the PEG group, respectively. Operation times were significantly shorter in the PEG group (1.81 vs. 2.61 h). The times to start feeding and full feeding as well as LOS were shorter in the PEG group. Nevertheless, complications were similar in both groups. In conclusion, PEG with LNF was associated with significantly shorter operation times, times to start feeding and reach full feeding, and LOS. PEG is a suitable method for LNF in chronically ill children.

Rapunzel syndrome is a very rare condition. The trichobezoar, in cases of Rapunzel syndrome, extend from the stomach into the duodenum and small bowel. Trichobezoars are usually encountered in young women with psychiatric problems, such as trichotillomania, trichophagia, or mental retardation and pica. Large trichobezoars, which are associated with Rapunzel syndrome, are removed during open surgery which requires large incisions. This Case Report describes 2 girls who had Rapunzel syndrome where the trichobezoars reached the jejunum and laparoscopic surgery was successful in the removal of the trichobezoars. Laparoscopic removal of a trichobezoar can be considered as a treatment option for children with Rapunzel syndrome.