Jang S, et al. Ann Surg Treat Res. 2020 Oct;99(4):205-212. https://doi.org/10.4174/astr.2020.99.4.205

Jeong YC, et al. Ann Surg Treat Res. 2024 Jun;106(6):322-329. https://doi.org/10.4174/astr.2024.106.6.322

An extragastrointestinal stromal tumor (EGIST) is a gastrointestinal stromal tumor that arises outside of the gastrointestinal tract. Most EGISTs are located in the omentum, mesentery, and retroperitoneum. The occurrence of an EGIST at the perianal region is very rare. Herein, we report our experience with EGISTs in the perianal area and review the literature. A 70-year-old man presented to our hospital with a 2-year history of anal discomfort. A pelvic magnetic resonance imaging scan showed a homogenous, well-defined, soft tissue density mass. The patient underwent mass excision, and the pathological examination confirmed that the mass was an EGIST. The size of the tumor was 4.3×3.2 cm, and the mitotic count was 1 per 50 high-power fields. The tumor cells were immunohistochemically positive for KIT and CD34 but were negative for S-100 and alpha-smooth muscle actin. There were no other abnormal findings in the gastrointestinal tract; upon pathological review, this case was confirmed as perianal EGIST. Therefore, EGIST should be considered as a differential diagnosis of perianal masses.

Rationale: Deep vein thrombosis (DVT) is rare in pediatric patients. Congenital inferior vena cava (IVC) anomalies are asymptomatic; however, these can cause DVT in younger patients rarely. Patient concerns: In this case, a 14-year-old male patient was referred to our hospital for lower abdominal pain. Diagnoses: At the first hospital he visited, computed tomography revealed a thrombus in the veins of the abdomen and lower extremities; however, an accurate diagnosis could not be made because the thrombus was thought to be inconsistent with abdominal pain. Close examinations revealed swelling of the lower extremities and pain while walking. Contrast-enhanced computed tomography revealed the absence of IVC (AIVC), resulting in DVT at the external iliac, gonadal, inferior mesenteric, and collateral veins of the right pelvic cavity. Interventions: The patient received anticoagulation therapy. Outcomes: At a follow-up 6 months later, his symptoms improved, and a thrombus was not found. AIVC could cause DVT. Lessons: DVT is rare in pediatric patients and is difficult to diagnose when the initial symptoms are vague. Conservative treatments are the most commonly used treatment; long-term follow-up is needed.

Original Article Is surgery always necessary for multiple magnet ingestion in children?—evidence for an endoscopy-first approach Hansol Kim, Ayoung Kang, Soo-Hong Kim, Jae Young Kim, Taejin Park, Taek Jin Lim, Yeoun Joo Lee

Choledochal cyst (CC) is a rare biliary tract disease characterized by cystic dilation of the biliary duct that requires surgical resection because of its malignant potential and associated complications. Minimally invasive surgeries (MIS), such as laparoscopy and robotics, have been increasingly used for the treatment of CC. This study investigated the current treatment trends and outcomes of pediatric CC in Korea, with a focus on MIS. We reviewed papers and conference abstracts on pediatric CC in Korea, published between 2000 and 2024. The incidence of CC in Korea is similar to that in Japan, with a rate of 1 in 13,000 individuals and a male-to-female ratio of 1:3 to 1:4. Type I CC was the most common (73.8%), followed by type IVA (16.0%). The first pediatric laparoscopy for CC in Korea was performed in 2006, and the first robotic surgery was in 2011. According to national surveys conducted by the Korean Association of Pediatric Surgeons in 2002 and 2017, all surgeries performed in the 2000s were open procedures. By the late 2010s, 54.3% of surgeries had been performed using MIS (laparoscopy, 31.1%; robotic surgery, 23.2%). Although few institutions have reported MIS outcomes for CC in Korea, laparoscopic surgery has been shown to be safe and cosmetically favorable. The surgical outcomes of robotic surgery are similar, but with challenges such as longer operation times, difficulties in small patients, and higher costs. Although laparoscopic surgery is currently the standard treatment in Korea, robotic surgery may become another standard procedure if the technological limitations can be overcome.