Hypertrophic pyloric stenosis: a 331 cases report

Hypertrophic pyloric stenosis [HPS] is a frequent infant disease. Its diagnosis is very easy, based on its classical clinical features and ultrasonography. The aim of this study is to evaluate the management of HPS in the Paediatric Surgery Department of Casablanca over a period of 25 years [1977-2002]. We recorded 331 cases and we compared the management of this pathology before and after 1992. The mean age of diagnosis was 52 day-old before 1992 and 34 day-old after 1992. The diagnosis was based on oesophago-gastric barium swallow before 1992, and only on abdominal ultrasonography after. The surgical incision is umbilical since 1992. Death rates decreased from 8% to 2%, showing improvement of the management of HPS since 1992. This improvement can be achieved through an earlier diagnosis and an adequate medical care before surgery

Acute renal failure in children: a 111 cases report

Acute renal failure [ARE] is not exceptional in child. The aim of this study was to analyze the epidemiology, etiologies and the prognosis of ARE in children in Casablanca. We report 111 children with ARE, treated from 1991 to 2001 in the department of nephrology and pediatric unit of Ibn Rochd Universitary Hospital of Casablanca. The children were separated into 3 groups: newborn [6 cases], infants [28 cases] and child [77 cases]. Oligoanuria was observed in 71 cases [63%]. Causes of ARE were: functional ARF in 16 cases [14.4%], organic ARF in 86 cases [77.4%] due to glomerulonephritis in 39 cases [45.3%], hemolytic-uremic syndrome in 21 cases and acute tubular necrosis in 19 cases [18.2%]. Obstructive ARF was observed in 9 cases. The treatment depended on the cause of ARF. Renal replacement therapy was necessary in 37 cases [33%]. Eighty three children [90.2%] recovered a normal renal function, 9 children [9.7%] involved to chronic renal failure. Death occurred in 14 cases [12.6%]. We conclude that ARE prognosis depends on the cause and the early treatment

Inflammatory pseudo-tumour of the liver in child: a case report

The inflammatory pseudo-tumour is a very rare benign tumour in the child. Its hepatic localization leads to diagnosis difficulties particularly with malignant tumours. We report the case of a 17 month-old boy who had an enormous abdominal mass which was 18 cm diameter. The hepatic origin has been visualized by echography and magnetic resonance imaging. The diagnosis of liver inflammatory pseudo-tumour has been realized after surgical biopsy. The treatment consisted in total resection of the tumour, taking the liver left lobe, with good clinical evolution and good recession of 34 months. The diagnosis of the liver inflammatory pseudo-tumour is histologic. It may be based on the needle biopsy of the tumour assisted by the imaging, which allows to have a conservative attitude for these benign tumours

Pancreas pseudocysts in children: therapeutic alternatives

Pancreatic pseudocysts are rare in child. The aim of this study is to review the experience of the Pediatric Surgery Department of the Casablanca Children Hospital and to evaluate the therapeutic results. We retrospectively reviewed 19 cases of pancreatic pseudocyst. Mean age of children was 8 year-old. The post-traumatic origin was the most frequent etiology. Main clinical symptoms were abdominal pain, vomiting and abdominal mass. Diagnosis was based on abdominal ultrasound and CT scan in 42% of cases. Two patients were only observed with a good outcome. Three patients had percutaneous drainage, six needed an open external drainage and 9 had an open internal drainage with a success rate of 78%. Kystojejunostomy is a reliable technique of treating a PSK. However new techniques of endoscopic and percutaneous drainage may be useful in some indications

[Congenital cysts and branchial fistula of the head and neck: a 148 cases report]

We report our experience of 148 cases of congenital cystic anomalies of the head and neck, operated in a twenty-year period. The goal of this study is to evaluate the frequency of the different anomalies and our diagnostic and therapeutic approach. This retrospective study has analyzed 148 cases of children who had surgery for a congenital cyst or fistula of the head or the neck. Thyroglossal duct cyst was the most frequent anomaly [52.7%]. The diagnosis was mostly clinical without need to further explorations. Surgical repair was well codified and consisted in an excision of 78 thyroglossal cysts, 41 dermoid cysts and 29 branchial fistulas. Six cases of thyroglossal cysts needed redo surgery. Six other patients had non specific complications

Ascite urineuse ne's-natale re've'latrice d'un syndrome de jonction pyelo-ure'te'rale

The authors report one case of uretero pelvic junction obstruction syndrome revealed at birth by respiratory distress in relationship with urinary ascite. The diagnosis was given by abdominal ultra-sonography and intravenous urography.The infant's condition didn't permit the surgical correction which was delayed to thirty months old. The decision strategy and the benefit of prenatal diagnosis are discussed

[Place of the hormonotherapy by HCG in treatment of ectopia testis in children]

Although cryptorchidism is known since the antiquity, some of its aspects are still not very clear and its treatment, particularly by hormone doesn't realize the unanimity. In order to codify the indication of HCG in cryptorchidism, a prospective study has been realized at the Infant Surgical Clinic of the Hospital Center lbn Rochd of Casablanca. This study concerned also a group of children treated in a "non codified" way since 1988, in order to analyse better the correlation between clinic and surgery. This study concerned 415 children with 528 ectopia testis. 318 of them have been treated with HCG, 6000 to 12000 UI according to the age. The whole success of hormonotherapy has been about 41%. The parameters that conditionned this success are: the age of the child [children older than 6 have had a better result], the seat of the testis [the lower was the testis, the easier was the success], the testicular mobility and the absence of the peritoeal process. In the case of unsuccess of the hormonotherapy, the surgical act permitted to notice aperirtoneal process undiagnosed clinically [95%], a gubernaculum testis high inserted [95%], a short spermatic pedicle [10%] or an non permeable inguinoscrotal duct [35%]. The analysis of this series and data of litterature permits to recommend HCG in the children from 2 to 10 years old, of whom the testis is palpable, without peritoneal process and with a notable mobility of testis. The other cases must belong to the surgery

[Treatment of Hydatic cyst of the lung in children]

A Conservative treatment was adopted in 340 cases of hydatic cyst of the lungin children The authors relate the results and discuss the well-founded of this attitude. 313 patients totalizing 394 cysts were treated surgically. In 306 cases, the treatment was conservative and consisted either a cystectomy with or without capitonnage of the cavity or a pericystectomy. In 7 cases, the treatment consisted in a regulated exeresis egmentectomy or lobe ctomy. 6 death [1,7 p. cent] were noted, they were due to bronchic fistula in most cases. 37 patients [11,8 P. cent] presented post-operative complications. Global results, compared to other series with high rate of exeresis, show that there is no difference between conservative treatment and regulated exeresis. Otherwise, many fistulas of whom some were responsible of deceases would have been avoided through a more eclectic attitude, adjusted to the nature of lesions. This study allows to precise the surgical attitude to adapt according the nature of the cyst

[ biliary fistulae of hydatid cyst of the liver in the child]

The authors report on a series of 40 cases of biliary fistula complicating hydatic cysts of the liver in the child observed during 15 years. They discuss the frequency of the fistula in the child, its mechanism and treatment. The anatomical and clinical characters of the immediate fistula [30 cases] affirmed by the billions or purulent contain of the cyst or by the visualization of the fistula in peroperative, and secondary fistula [10 cases] complicating healthy but voluminous cysts, were localized in the right side of the liver. All the cysts were treated by resection of the projecting vault with drainage of the covity. The average duration of the exhaustion of the fistula is 20 days with an extreme from 7 to 90 days. Four patients deceased. In the case of the immediate fistula, the mortality and the morbidity are more important as in the adult. Certain measures would permit to decrease the complications which are especially subphrenic abscess and purulent retention in the cavity, and permit to shorten the duration of hospitalization without resorting to agression methods as the pericystectomy

Reliability of ultrasonography in the diagnosis of acute intestinal intussusception in children

Ultra-sound imaging finding of the invaginated bud are described in 111 young children referred with a suspected acute intestinal intussusception [A.I.I.] during a period of 32 months. An initial group of 30 children were examined by ultrasonography and a barium enema for diagnostic and possible therapeutic purposes. The second series of 81 children had a therapeutic enema only when ultra-sound images provided a positive diagnosis. The authors consider that the overall accuracy for ultrasonography in A.I.I. was 100%, and suggest an algorithm for pratical decisions in A.I.I. in children