Purpose
In the time of the global coronavirus disease 2019 (COVID-19) pandemic, preoperative confirmation of COVID-19 infection in patients in need of surgery is critical for the safety of medical staff and patients. Our purpose in this study was to analyze the experience with preoperative COVID-19 screening tests on naso-pharyngeal swabs in pediatric patients requiring surgery.
Methods
From May 1st to December 31st, 2020, we retrospectively reviewed the medical records of patients under 18 who had undergone elective and emergency pediatric surgery in Kangwon National University Hospital. During this period, all patients were tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) preoperatively on their nasopharyngeal smears (Allplex™ 2019-nCoV Assay, Xpert^® Xpress SARS-CoV-2). Patients were divided into 2 groups before (group A) and after (group B) the introduction of Xpert^® Xpress SARS-CoV-2, and the COVID-19 positive rate was confirmed by classifying the patients into 4 groups according to the risk of COVID-19 infection as assessed by clinical judgment.
Results
We screened 45 patients, of whom 35 (77.8%) were asymptomatic patients, and 10 (22.2%) had a fever. Elective surgery was done after checking the screening results in all cases. For emergency surgery patients (n=25), before the introduction of Xpert^® , only 3 out of 13 (23%) patients had emergency surgery after the screening results were confirmed. However, after the introduction of Xpert^® , all patients had emergency surgery after the screening results were confirmed. All patients were confirmed negative.
Conclusion
Clinical judgment on the risk of COVID-19 infection and the introduction of the Xpert^® test for emergency surgery patients resulted in safe surgery for all patients without COVID-19 exposure.

Purpose
Meckel's diverticulum (MD) is the most common congenital malformation of the gastrointestinal tract. The clinical presentation of MD is nonspecific and various, which can make diagnosis difficult. The aim of this study was to analyze the clinicopathologic characteristics and treatment outcomes of symptomatic MD in children.
Methods
We retrospectively reviewed the medical records of 38 pediatric patients diagnosed with MD who underwent surgery from April 1999 to September 2017. Five MD cases which were found incidentally during another surgery were excluded from this study. Sex, age, clinical presentation, diagnostic method, surgical treatment, histopathological findings were analyzed.
Results
Twenty-five cases occurred in boys and 8 cases occurred in girls. At the time of diagnosis, the age ranged from 6 months to 17 years, with an average of 92.4 months. Thirteen patients (39.4%) were presented with melena, 7 patients (21.2%) with intestinal obstruction, 5 patients (15.2%) with intussusception, 5 patients (15.2%) with perforation, and 3 patients (9%) with diverticulitis. Meckel's scan was performed in 12 out of 13 patients with lower gastrointestinal bleeding, and all 12 (100%) showed a positive tracer. Out of total 33 patients, 12 underwent laparoscopic assisted bowel resection, 7 underwent laparoscopic assisted diverticulectomy, 5 underwent laparoscopic diverticulectomy, 7 underwent open bowel resection, and 2 underwent open diverticulectomy. There was only 1 postoperative wound infection in all 33 cases. There were 21 (63.6%) ectopic tissues in 33 symptomatic MD patients. Gastric mucosa was observed in 19 patients (57.6%), pancreatic tissue was found in 1 patient (3%), and both gastric mucosa and pancreatic tissue was present in 1 patient (3%).
Conclusion
Surgical resection of MD is safe and effective in symptomatic MD. Laparoscopic or laparoscopic assisted diverticulectomy or bowel resection is the treatment option for symptomatic MD.

Purpose
Abdominal computed tomography (ACT) is widely used to diagnose appendicitis in children. Despite its high sensitivity and specificity, “negative appendectomies” still occur when the patient undergoes surgery but the final pathologic diagnosis does not support appendicitis. The aim of this study is to determine which findings support true appendicitis in patients with unclear findings on preoperative ACT.
Methods
We performed a retrospective review of the records of 620 pediatric patients who underwent surgery for acute appendicitis between January 1, 2007 and December 31, 2020. We re-reviewed the scans in 101 patients who were deemed to have unclear preoperative findings on ACT, looking for the following features: periappendiceal fat infiltration, periappendiceal fluid collection, appendiceal wall thickening, appendiceal gas, and right lower quadrant lymphadenopathy. We then compared the presence of these features between patients with true appendicitis and those who underwent negative appendectomy.
Results
The presence of an enlarged appendix, with a maximum diameter of more than 8 mm, and the presence of periappendiceal fat infiltration were associated with true appendicitis.
Conclusion
If ACT findings are unclear in a patient with suspected acute appendicitis, the presence of an enlarged appendix and periappendiceal fat infiltration should be assessed to differentiate those with true appendicitis.

Chromosome 22q11.2 deletion syndrome is common and presents with multiple congenital anomalies ranging from congenital heart disease to cognitive and neuropsychiatric conditions. Congenital large epigastric hernia is extremely rare in neonates. We present a case of a large congenital epigastric hernia in a neonate with DiGeorge syndrome.

Obscure gastrointestinal bleeding (OGIB) from the small bowel is difficult to diagnose, especially in children. We report a 10-year-old boy who presented sudden onset of severe anemia with massive OGIB who had a history of total gastrectomy in the neonatal period. Abdominal computed tomography, esophagogastroduodenoscopy, colonoscopy, Meckel's diverticulum scan, superior mesenteric arteriography, and celiac arteriography found no definite bleeding focus. Finally, capsule endoscopy revealed numerous vascular ectasias and multiple bleeding foci at jejunoileal region. With laparotomy and manual milking up of the small bowel by the surgeon, intraoperative endoscopy with argon plasma coagulations and hemo-clippings were done by the gastroenterologist, successfully. Intraoperative endoscopic management seems to be the treatment of choice for preventing massive unnecessary bowel resection. Here, we report a patient with OGIB, 10 years after gastrectomy for spontaneous rupture of stomach in the neonate period, which was diagnosed and managed successfully with a multiteam approach.

Diverticular bleeding and gastric heterotopia (GHT) in the proximal lower gastrointestinal tract are rare in adolescents. Here, we report a case of cecal diverticular bleeding associated with GHT. A 17-year-old adolescent boy was discharged after treatment for cecal diverticular bleeding. Subsequently, he visited the hospital due to an episode of hematochezia and sustained pain in the right lower abdomen. A colon study showed a diverticulum causing external compression in the cecum. His hemoglobin level was 7.2 g/dL. Abdominopelvic computed tomography showed thickening of the ascending and transverse colon, suggesting non-specific colitis. Single-incision laparoscopic ileocecal resection was performed. Pathologic findings demonstrated congenital diverticulum with GHT in the cecum, and an ulcer with perforation in the cecal area. In cases of hematochezia among adolescents, clinicians should be aware of the possibility of rare diseases such as GHT.