The ex-utero intrapartum treatment (EXIT) procedure preserves fetal oxygenation via the umbilical cord in urgent respiratory distress. We report a rare case of congenital extralobar pulmonary sequestration with pedicle torsion. A 22-year-old primigravida at 29 + 4 weeks presented with a fetal supradiaphragmatic mass, hydrothorax, and cardiac displacement; fetal magnetic resonance imaging (MRI) confirmed pulmonary sequestration. Rapid fetal deterioration led to the termination of the pregnancy and the application of ex-utero intrapartum treatment procedure during Cesarean section. Before cord clamping, intubation along with thoracocentesis enabled neonatal breathing. The 2140 g newborn required intensive care for respiratory distress, heart failure, and pulmonary hypertension and was discharged stable after 3 weeks. Elective thoracoscopy at the age of 6 months removed the sequestration, confirming pedicle torsion; recovery was uneventful. This case highlights the importance of early diagnosis, multidisciplinary collaboration, and timely use of ex-utero intrapartum treatment to manage life-threatening fetal lung anomalies.

Background: Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition in neurologically impaired children. Although generally safe, inadvertent visceral organ damage during placement may result in rare, catastrophic events like gastrocolic perforation. Subsequent laparoscopic repair introduces further subtle risks, including the retention of broken surgical sharps due to the physical limitations of minimally invasive environments. Finding and extracting these small ferromagnetic components poses a severe technical dilemma, often prolonging anesthesia or forcing conversion to open laparotomy. Magnet-assisted techniques offer a rapid, low-impact rescue alternative. Case Presentation: A 14-year-old boy with severe neurodevelopmental deficits (Dandy–Walker malformation, cerebral palsy, refractory generalized epilepsy) presented with severe peritonitis two weeks following a PEG tube placement. Urgent diagnostic laparoscopy identified multi-site visceral injuries: a through-and-through perforation involving both the anterior and posterior walls of the transverse colon alongside an anterior gastric perforation, secondary to severe colon interposition. While laparoscopically repairing these visceral defects, a 26-mm curved suturing needle fractured inside a 10-mm working trocar, and the sharp tip disappeared into the peritoneal environment. Initial thorough inspection failed to localize the sharp. Postoperative abdominal radiography verified the fragment’s location within the left upper quadrant. During a secondary re-exploration, an improvised magnetic delivery system (comprising small sterile neodymium spheres sealed within a surgical glove finger) was passed through a trocar to rapidly target, capture, and extract the fragment. The subsequent course was complicated by standard adhesive mechanical ileus, requiring further laparoscopic adhesiolysis before successful stabilization. Conclusion: Concurrent gastrocolic organ perforation and intra-operative instrument fracturing represent a compounding crisis in fragile pediatric cohorts. This case highlights the biomechanical vulnerabilities of minimal-access closures and confirms that an improvised, glove-contained magnetic capture array provides a safe, highly reproducible means to locate and remove retained sharps without open surgery.

Background/Objectives: Management of prehepatic portal hypertension involves endoscopic and medical therapies with subsequent shunting if symptoms persist. Lately, surgical shunts, particularly the Meso-Rex shunt, are increasingly considered early in the disease course, offering benefits such as minimized hyperammonemia, improved somatic growth, and preservation of liver function. Our study evaluates post-operative outcomes after different surgical procedures in children with prehepatic portal hypertension. Methods: This single-centre retrospective case series included six children undergoing surgical shunting for prehepatic portal hypertension over a 5-year period. Medical records before and after surgery, followed for an average of 4.0 years, were analyzed. Results: Five patients underwent a Meso-Rex bypass, while one patient underwent a mesorenal shunt procedure. All cases showed clinically significant regression of esophageal varices six months post-surgery. Thrombocyte as well as leukocyte count significantly increased in five out of six patients during the long-term follow-up. Currently, five out of six surgically formed shunts (83%) continue to function normally. Conclusions: Our study supports early surgical intervention for improved long-term outcomes in managing portal hypertension, reducing complications like hypersplenism and variceal bleeding. Early consideration and ongoing monitoring are crucial for long-term success in children with portal hypertension.