[ anomalies des arcs aortiques etude de 7 cas]

Anomalies of the aortic arch and the great vessels emerging from the heart are rare. We report here seven cases: double aortic arch [three cases], compressive arterial brachiocephalic trunk [three cases] and retroesophageal right subclavian artery [one case]. The anomalies of the aortic arch were associated to cleft palate in one case and to Klippel Feil syndrome in an other case; this association was never been reported to the best of our knowledge. Surgical treatment was indicated in five cases and was performed in two cases with favourable outcome. One patient died

[Left multiocular cystic nephroma: a pediatric case report]

The authors reports a clinical case of cystic nephroma in a 12-year-old girl which the data non specific clinics and the character little informative exams of imagery contribute to make difficult the diagnosis of this rare affection. Only histologic studies affirm the diagnosis

[Alimentary tract duplication in children]

Duplications of the alimentary tract are a rare congenital anomalie in children, characterized by an important anatomoclinical polymorphism. Diagnosis suspected on clinics and evoked by radiology, requires histological confirmation. Thirty four children with duplications were managed in our department, from 1991 to 2009. Their hospital chart was retrospectively studied. Clinical signs consisted on pain and abdominal mass. The radiological investigations depended on the location of the digestive duplication. There was four oesophageal duplication, five on the stomach, the pylorus was involved in two cases, the duodenum in three cases, the jejuno-illeum is seventeen cases, the colon in two cases and the rectum in one case. All cases benefited from surgical treatment, and resection procedure was chosen according to duplication type and site. Histological study showed six cases of ectopic gastric mucosa. Diagnosis and surgical precocious treatment of digestive duplications are the only warn complications of this benign pathology

[Long terms result of surgical treatment of intestinal malrotation]

The total volvulus of small intestine [TVSI] on intestinal malrotation [IM] is a rare pathology. The incidence is 16 for one thousand neonatal occlusions. The purpose of this work was to evaluate the long-term results of the Ladd procedure in the treatment of the TVSI on IM. It's a retrospective study concerning 36 cases of TVSI on IM treated in the unity of pediatric surgery "B" in Tunis children's hospital over a period of 18 years. This study was about 26 boys and 10 girls, old from one day to 9 years at the time of the diagnosis. Twenty nine children were of less than 1 year old [80,5 per cent], among which 24 cases [66,6 per cent] before 1 month. The bilious vomits were the most frequent mode of revelation [91 per cent]. The diagnosis was realized by the ultrasound in 63 per cent of the cases [19/30] and by the oesogastroduodenal enema in 92 per cent of the cases [13/14]. All the patients were treated according to the Ladd procedure with immediate simple consequences operating in 80 per cent of the cases. Among 33 operated and alive patients, the distant evolution was favorable in 90 per cent of the cases with an average recession of 8 years. No patient presented a second recurrence of the volvulus. A single patient presented an occlusion on brides and two patients have a chronic constipation. The treatment of intestinal malrotation is based on the Ladd procedure which is a safe and effective surgical technique

Is there an age for a testicular torsion?

Classically, testicular torsion occurs in neonates or during puberty. Between these two ages, is really an exception? In order to answer the question, we reviewed the charts of the patients referred to the department of pediatric surgery of children's hospital between 2000 and 2008. We studied the preoperative examinations, the operative data and the long term evolution. Cases of torsion occurring during neonatal or pubertal periods were excluded. During nine years, 85 patients with 'acute scrotum symptoms" underwent surgery. The ages of patients ranged from one month to 11 years [average age: 70 month in 49 patients, among which 12 had true testicular torsion. Consultation at the emergency room occurred after one to 72 hours [average of 17]. The localization of the pain was on the left in eight cases and on ectopic testicle in two. The testicular volume was increased in 11 cases. Cremasteric reflex was absent in four cases. The doppler flow was normal in four cases and absent in two. During surgery, the testis appearance was considered as normal in six testicles, as necrotized in three [and an orchidectomy was performed] and as ischemic in three. In seven cases, a peroperative controlateral testicle fixation was performed and later one in two. The postoperative course was simple, without infection and with a normal testicular volume in eight cases, increased in one ischemic testis. Testicular atrophy was noted in an ischemic testis, after several months. Whatever the age, testicular torsion remains a surgical emergency even with a normal doppler flow

[ epidemiological data of children burns in Tunis. about 134 cases]

Burns injuries represented the most children common domestic accident which can be responsible of a dramatic consequences. To analyse the epidemiological data and preventive aspects of this victims, a retrospective study is reported between 1 January and 31 December 2006 concerning 134 children who were examined during this period in the emergency of the surgery department [B] of the children Hospital of Tunis. In 43 cases, a hospitalisation was necessary. The mean age of the patients was 36 months. The accident occurs in the house in 99 per cent of cases, especially in the kitchen in 93 per cent. The most common agents were scalding liquid in 89.5 per cent followed by flames in 8 percent. The mean total burns surface areas was 4 per cent for the non-hospitalised children and 14 per cent for those whose been hospitalised, 16 per cent of this children developed an infection of the burns injuries during their hospitalisation. In 3 cases an amputation was necessary due to a third degrees burn with carbonisation of the members. One patient died 48hrs after his admission by a respiratory distress. The children burn injuries can be considerably reduced by preventive measures and active public health programs to promote immediate cooling of burns with cool water which is at least as important as subsequent medical and surgical treatment in determining the outcome of burns in children

[Surgical aspects of intussusception due to lymphoma in children]

Introduction: Bowel's intussuception is a rare kind of child Burkitt lymphoma revelation mode. The management of this situation is full of traps. The retrospective study of 6 observations aims to analyse the clinical, evolutionary and therapeutic side of this revelation mode

Results: Four boys and two girls, aged from three to seven years with an average of 5 years, had Burkitt lymphoma revealed by a Bowel's intussusception. The abdominal ultrasound find the secondary cause in 3 cases .One patient had a full-column barium enema All the cases had a laparotomy. Three cases had a surgical resection. A biopsy of mesenteric lymph nodes was done in 3 cases. A chemotherapy was initiated as soon as we made the diagnosis .There was no after effects in all the cases. No recurrence was noted until two years and a half after the treatment

Conclusion: The diagnosis of lymphoma must be suspected when the bowel's intussuception occurs in more than 5 years old children. A biopsy must be done in the event of suspicion of lymphoma. The surgical procedure must be adapted to each case