ABSTRACT
Lymphangiomas are malformations of the lymphatic system, which is a common disease in children, usually superficial in body, but seldom seen in visceral organs. We present the case of a child with lymphangioma of the gallbladder. Also we reviewed the literatures. A 2-year-6-month-old boy complained of progressing difficulty in walking for 6 months. Cerebral MRI showed abnormal signals in the white matter suggesting leukodystrophy. Ultrasound of abdomen showed a mixed-echoic mass in the site of gallbladder. CT scan showed an enlarged gallbladder with increased density. Bloodcounting, liver function, and alpha fetal protein were within normal range. Exploratory laparotomy was done in order to rule out malignancy. The liver was found normal at surgery, and the gallbladder looked enlarged and deformed. The gallbladder wall was thick and edematous, and adherent with liver. The gallbladder was excised. Pathological examination gave the diagnosis as lymphangioma of the gallbladder wall. The postoperative recovery was uneventful. There was no evidence of recurrence. Searching in literatures, three cases of lymphangioma of gallbladder in adults were found. According to the pathology of lymphangioma and the anatomy of gallbladder, the outcome of this disease should be benign and may be symptomless throughout the life. No death was reported due to lymphangioma of gall bladder, nor severe complications endangering life at any age. The only indication for surgery in the reported cases was to rule out the risk of being malignancy. If MRI or other means can make a definite preoperative diagnosis of lymphangioma, being a stable lesion, surgery would be unnecessary unless there is a progressive organic obstruction causing repeated infection or persistent abdominal pain.
Subject(s)
Child, Preschool , Humans , Male , Gallbladder Neoplasms , Diagnosis , Lymphangioma , DiagnosisABSTRACT
Objective To investigate pathogenic factors,clinical characteristics,pathological changes in 6 patients with localized or disseminated intestinal neuronal dysplasia(IND).Methods The clinical retrospective study was performed in 6 cases with localized and disseminated IND.Results In 6 patients,constipation and partial intestinal obstruction were the major symptoms.Preoperatively,dia-gnoses were revaluated as intestinal stenosis in 2 cases,long sigmoid in 2 cases and long-segment aganglionosis and total gastrointestinal IND in the rest 2 cases,respectively.Exploratory laparotomy was performed on all these patients.Pathological study suggested that 4 of them were localized IND,on whom enterectomy and intestinal anastomosis were performed successfully.However,2 cases of disseminated IND died postoperatively.Conclusions Disseminated IND may be caused by congenital factors,while localized IND by the acquired factors which including intestinal obstruction,local ischemia or inflammation.The surgical interventions are effective for localized IND,and intestine transplantation might be prospective treatment for disseminated IND.
ABSTRACT
Objective To evaluate the laparoscopic Palomo procedure in the management of varicocele in adolescent by assessment of the postoperative testicular growth and the changes of the biggest vessel diameter of varix. Methods From July 1999 to March 2004, laparoscopic high mass - ligation of testicular vessels according to Palomo procedure was performed on 31 boys who all presented with left varicocele Before and after operation at 1 month,3 and 6 months, the biggest vessel diameter of varicocele was measured by ultrasonography, testicular blood supply was evaluated by color Doppler flow imaging(CDFI) ,and fastis was recorded in length, width and thickness by ultrasonographic measurement, which volume was calculated by the formula V =?/6 ? length ? width ? thickness. Also the ratio of left to right testicular volume was calculated, and the left testicle was thought atrophy if the ratio was below 75% The biggest vessel diameter of varix, testicular blood supply, and the postoperative testicular increasing volume were compared before and after operation. Results The biggest vessel diameter of varicocele significantly reduced 1 month after operation(P