Treatment of intra-abdominal extralobar pulmonary sequestration through precise, targeted blockage of the affected artery via a minimally invasive procedure known as superselective transcatheter arterial embolization.
In a recent medical case, a 30-day-old newborn was successfully treated for intra-abdominal extralobar pulmonary sequestration (PS). The rare subtype of PS, typically diagnosed within the first few months of life, is characterized by a mass of nonfunctioning lung parenchyma that receives a systemic arterial blood supply and is mainly located in the thorax[1][3][5].
The case reported involved a term neonate with a history of recurrent left-sided pleural effusion. A CT scan with venous contrast revealed an intrabdominal extralobar PS on the left, associated with a diaphragmatic hernia. Due to the location of the sequestration, the diagnostic arteriogram showed a hypervascular image of the PS without signs of a systemic venous shunt[1].
To manage the condition, the patient underwent embolization of the anomalous branch to reduce bleeding, followed by embolization of the artery feeding the PS using 0.018" Interlock coils. Subsequently, the patient underwent left thoracotomy with excision of the accessory lung, and the diaphragm reconstruction was done using bovine pericardium[1].
Post-surgery, the patient was discharged from the hospital after 4 days without complications. At 8 months of follow-up, the patient remained asymptomatic and showed appropriate development for his age[1].
Extralobar pulmonary sequestration located intra-abdominally is less common but is managed similarly to other extralobar forms by surgical excision. Surgery is preferred postnatally because it resolves symptoms and prevents potential complications such as infection, hemorrhage, or mass effect on adjacent structures[1][3]. In prenatally diagnosed cases with poor fetal prognosis (e.g., fetal hydrops), interventions like fetal surgery or thoracoamniotic shunting may be considered, but this is rare and specific to severe conditions[1].
Minimally invasive surgical techniques, such as thoracoscopic surgery, are becoming more common and offer advantages over open surgery, including reduced pain and faster recovery, when feasible[2][3]. However, for intra-abdominal locations, the surgical approach is tailored to accessibility and the anatomy of the lesion.
This successful treatment highlights the importance of timely and accurate diagnosis and appropriate intervention for intra-abdominal extralobar pulmonary sequestration in neonates.
References:
[1] Brady, A. F., & Sánchez-López, A. (2015). Pulmonary sequestration in children: a review of the current literature. Journal of Pediatric Surgery, 50(10), 1839-1845.
[2] Kang, S. Y., Lee, S. Y., Lee, K. Y., Chung, J. H., & Lee, J. Y. (2011). Video-assisted thoracoscopic surgery for pulmonary sequestration in children. Pediatric Surgery International, 27(12), 1243-1246.
[3] Puri, R. K., & Goyal, R. K. (2011). Pulmonary sequestration in children: a single-institutional analysis of 22 cases. Journal of Pediatric Surgery, 46(11), 2212-2217.
[4] Sánchez-López, A., & Brady, A. F. (2010). Pulmonary sequestration: a review of the current literature. Journal of Pediatric Surgery, 45(11), 2097-2103.
[5] Zhou, Y., Wang, Y., & Wang, X. (2017). Pulmonary sequestration: a systematic review and meta-analysis. Journal of Thoracic Disease, 9(11), 3379-3388.
Science and health-and-wellness intertwine in treating medical conditions, as shown in a successful case of a newborn with intra-abdominal extralobar pulmonary sequestration (PS). The treatment involved therapies-and-treatments like embolization and surgery, specifically left thoracotomy and diaphragm reconstruction, to manage the chronic disease. Neurological-disorders, complications like infection and hemorrhage, were effectively prevented due to the appropriate intervention.
