Special Articles

What I learned from Pediatric Surgery and
What I want to pass on to young pediatric surgeons

Akio Kubota
Second Department of Surgery, Wakayama Medical University

Abstract
　For two years before I started my career as a pediatric surgeon, I majored in Nuclear Medicine and Radiology. Until I looked back on half my life when I chaired the 50th Anniversary of Japan Society of Pediatric Radiology in 2014, I thought the two years was a detour to pediatric surgery. However, while I looked back on half my life, I noticed that the two years as a radiologist was not just a waste of time, but gave me a radiological point of view to see new disorders.
　Lots of neonates with suspected Hirschsprung’s disease (HD) were referred to me, but in most of them, HD was ruled out after a manometric study. I wondered what they were, and reviewed their plain abdominal X-rays. Then I realized that they could be categorized into three patterns, which I call “Benign transient non-organic ileus of neonates (BTNIN)”. I encountered a few cases that on X-rays can not be categorized into these patterns, and eventually they were diagnosed as cow milk allergy. After a prospective study, we recognized that the pathogenesis of most cases of “BTNIN” was cow milk allergy.
　As the survival of extremely-low-birth-weight neonates has been increasing, the incidence of meconium disease (MD) or meconium plug syndrome (MPS) has been increasing. The small intestinal obstruction had been attributed to sticky meconium or meconium plug per se. However, after closer observation of contrast enema with Gastrografin, I knew the meconium was not the cause of the mechanical obstruction, but the consequence of functional obstruction, or excessive water absorption from meconium in the stagnated small intestine leading to formation of sticky meconium and secondary mechanical obstruction. In 1995, I proposed a new concept “meconium-related ileus”. Nowadays, the concept “MRI” is widely accepted in the field of neonatal medicine.
　Acknowledgement: I am deeply grateful to Prof. Hitoshi Yoda, the organizing chairman of the 52nd Ann Meeting of Japan Society of Pediatric Radiology, for his kindly invitation to deliver a special lecture at the meeting. It was my great pleasure and honor.

Keywords：Cow milk protein allergy, Meconium-related ileus, Meconium Disease, Hirschsprung’s disease