Purpose
The Korean Association of Pediatric Surgeons (KAPS) has conducted annual national surveys, each year addressing a different topic regarding pediatric surgical diseases, and the data of these surveys are discussed at each respective annual spring meeting of KAPS.
Methods
In 2002 and 2017, KAPS conducted two national surveys for choledochal cysts. The authors reviewed the data from the national surveys and analyzed the differences or changes in demographic characteristics, clinical findings, diagnostic methods, treatment, and outcomes of pediatric patients with choledochal cysts who had been treated by KAPS members.
Results
A total of 348 and 241 patients with choledochal cysts were enrolled in the first and second national surveys, respectively. The male-to-female ratio was 1:3.4 and 1:2.7 in the first and second national surveys, respectively. In both national surveys, abdominal pain was the most common clinical symptom. The most common type of choledochal cyst was type I in 71.3% and 73.9% of patients in the first and second national surveys, respectively. In the first national survey, all 348 patients underwent open surgery. However, in the second national survey of 241 patients, open, laparoscopic, and robotic surgeries were performed in 102 (42.3%), 75 (31.1%), and 56 (23.2%) patients, respectively. Cyst excision with Roux-en-Y hepaticojejunostomy was performed in 339 (98.8%) of 343 patients in the first national survey and 240 (99.6%) of 241 patients in the second national survey.
Conclusion
These national surveys provide current status, general information, and comprehensive treatment and outcomes for pediatric patients with choledochal cysts in Korea. This study could provide significant knowledge and reference for pediatric surgeons seeking to better understand choledochal cysts and treatment options for this disease.

Purpose
High jejunal atresia occurring near the ligament of Treitz is rare. It is a complicated type of small bowel atresia, and its treatment is challenging. Our study describes the clinical characteristics and proper management of high jejunal atresia.
Methods
We performed a retrospective review of seven neonates who underwent operations for high jejunal atresia between January 2000 and April 2021.
Results
The sex ratio showed a male predominance, and all patients were prenatally diagnosed with small bowel atresia. Six patients presented with a typical triple bubble appearance on the preoperative abdominal film. The location of the atresias were around the ligament of Treitz or less than 10 cm from the ligament of Treitz, and the types of atresia comprised three cases of type I, two of type IIIb, and two of type IV. Five of the seven patients underwent the operation without proximal enteroplasty. The median duration from operation to full feeding was 23 days, with three patients requiring more than a month to reach full feeding. There were no other operation-related complications. At the long-term follow-up, all patients tolerated oral feeding well.
Conclusion
This study indicates that high jejunal atresia close to the ligament of Treitz exhibits a high incidence of type I and complex types of atresia, and that primary anastomosis, without proximal enteroplasty, can be applied through surgical intervention.

Purpose
The
objective
of this study, conducted at a single center, was to determine the appropriate subgroup of pediatric appendicitis patients for nonoperative management (NOM) and evaluate the effectiveness of this approach. Furthermore, the study aimed to identify the factors that influence the likelihood of treatment failure.
Methods
Out of the 37 children diagnosed with acute appendicitis who underwent NOM, 31 patients successfully completed the treatment without the need for appendectomy. However, 6 patients experienced recurrence of symptoms and subsequently required appendectomy.
Results
The two groups of patients who experienced successful NOM and those who required appendectomy did not exhibit significant differences in terms of baseline characteristics, laboratory findings, or antibiotic treatment. Furthermore, factors such as the presence of appendicolith or perforation did not demonstrate a significant association with treatment failure. Additionally, the multivariable logistic regression analysis did not identify any predictors of recurrence.
Conclusion
The study emphasizes the viability of NOM even in cases of complicated appendicitis, especially in the era of coronavirus disease 2019 limiting the chance of surgical treatment. It has shown potential in reducing the risk of complications that may arise from early surgical intervention in high-risk patients.

A choledochal cyst (CC) is an abnormal dilatation of the bile duct that is known to be a precursor of cholangiocarcinoma (CCA). Biliary intraepithelial neoplasia (BilIN) is a premalignant lesion that is considered to be found during the carcinogenesis of CCA. While BilINs are frequently identified in adult populations during pathology, there has been no report of them in the pediatric population. We first report a case of BilIN incidentally diagnosed from a CC in a 7-year-old child. This case suggests that BilIN should not be overlooked in children, especially those with risk factors such as anomalous pancreaticobiliary ductal union. Also, it supports the importance of early and complete resection of CC and its impact on preventing neoplastic changes in the biliary system.

Fournier’s gangrene is a life-threatening necrotizing fasciitis of genitalia and perineum. It is an exceedingly rare disease in infants and presents a diagnostic and therapeutic challenge for pediatric surgeons. Risk factors for Fournier’s gangrene in children include low birth weight, premature birth, trauma, burns, immunocompromising conditions, and sepsis. We report a very rare case of Fournier’s gangrene in a female infant. A 1-month-old girl visited the emergency room with a fever (39.2°C) and skin discoloration in the suprapubic area. The skin color change spread rapidly from the genitalia and inguinal area to the abdominal wall and flank. Ultrasonography and computed tomography demonstrated air bubbles in the subcutaneous layer of the suprapubic and inguinal areas, which strongly indicated Fournier’s gangrene. An emergency operation was performed; a low transverse incision was made in the suprapubic area to open subcutaneous tissue from skin to fascia and curettage and irrigation were performed. Necrotizing fasciitis improved dramatically after surgical treatment. The baby is now in good condition and has grown normally after discharge from the hospital. Clinical suspicion of Fournier’s gangrene and quick decision to surgery contributed to good prognosis. This report would be helpful to clinicians in diagnosing and treating infant patients with Fournier’s gangrene.

Posterior reversible encephalopathy syndrome (PRES) is a distinctive neurological disorder characterized by specific clinical and radiological features. While its etiology is multifaceted, the vasogenic theory provides a comprehensive framework for understanding its pathogenesis. Notably, PRES has been observed in cancer patients undergoing cytotoxic chemotherapy, immunotherapy, and select neurosurgical interventions. In this context, we present an unprecedented case involving a 7-year-old girl who developed PRES subsequent to abdominal surgery for adrenal neuroblastoma, a scenario hitherto unreported in medical literature. The patient’s medical history encompasses a diagnosis of stage IV neuroblastoma - high risk. Her treatment course comprised six cycles of neoadjuvant chemotherapy, followed by an open right adrenalectomy coupled with retroperitoneal lymph node dissection. Following surgery, the patient’s clinical profile evolved to encompass the classic symptoms of PRES, including headache, blurred vision, and elevated blood pressure. Neuro-imaging confirmed the diagnosis, with subsequent robust clinical recovery achieved by day 12. Continuation of adjuvant therapy in accordance with established protocols was pursued. Successful management of PRES pivots on several crucial principles: timely recognition, meticulous hydration, vigilant blood pressure control, and attentive intensive care. By adhering to these tenets, complete clinical recuperation can be realized, sparing patients enduring neurological deficits or vision impairment. This case underscores the importance of remaining vigilant for PRES in postoperative settings, particularly in pediatric patients undergoing surgical interventions for malignancies. Further studies and vigilance are warranted to expand our understanding of this intriguing condition and optimize therapeutic strategies.

Jejunoileal atresia (JIA) is a rare congenital disorder in newborns leading to intestinal obstruction, necessitating urgent surgery. A delay in diagnosis can result in severe complications like sepsis, bowel perforation, and even death. Over the years, improvements in neonatal care, surgical techniques, and nutrition have led to a marked decrease in mortality rates for JIA patients. While the exact cause remains uncertain, it is thought to result from an ischemic insult during later in utero. JIA is categorized into 4 types, detailing the structure and implications of each type. Clinically, mothers may exhibit polyhydramnios, and infants usually present with symptoms like bilious vomiting and abdominal distension. A significant percentage of affected infants do not pass meconium within the first day of life. Diagnosis is commonly through abdominal radiographs, with some cases requiring contrast enemas. Once diagnosed, immediate surgery is advised, with the primary goal to restore intestinal function and length. Nowadays, the survival rate for JIA patients exceeds 90%. This improvement is attributed to a better understanding of the condition, advancements in surgical techniques, and the introduction of total parenteral nutrition. The prognosis varies, with short bowel syndrome being a significant factor determining the outcome. Short bowel syndrome’s prognosis depends on the remaining small bowel length, the ileocecal valve’s presence, and dependence on long-term nutrition. In conclusion, the treatment and prognosis for JIA have seen substantial improvements due to advances in medical care. Early diagnosis and intervention are crucial. While many patients lead a normal life, those with complications like short bowel syndrome may require long-term care. Future efforts should emphasize refining surgical techniques, gaining a deeper understanding of JIA, and enhancing postoperative care. There's also a need for more research into JIA’s genetics and etiology.