[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

[Insertion of intercostal drain into the liver in a right congenital diaphragmatic hernia]

Mortality of congenital diaphragmatic hernia [CDH] remains high despite the progress in resuscitation assessment. The diagnosis can be difficult especially in the right side form. We report a liver diaphragmatic hernia which been erratically diagnosed as a right pleuropneumopathy. An intercostal drain was inserted into the hepatic parenchyma. The diagnosis was secondarily rectified after thoracic tomodensitometry. The diagnosis of CDH must be systematically evoked in new-borns or infants presenting respiratory or gastrointestinal symptoms with chest X-ray abnormalities

[ splenic angioma in children: a case report]

The splenic angioma is a rare benign tumor, not very symptomatic and often of fortuitous discovery. The surgical treatment is essential for the bulky lesions which involve a significant risk of rupture and hemoperitonium. We report the observation of a eight years old girl at which the splenic angioma was discovered in a fortuitous way at the time of an ultrasonography required in the assessment of a urinary tract infection. The abdominal computed tomography scan confirmed the diagnosis by showing an hypodense lesion well limited with intense raising aftercontrast injection. The fear of a rupture made pose the indication of a partial splenectomy with simple continuations

[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

[Epidemiological characteristics of the traffic accidents at the child in big Tunis]

Purpose: to kick away epidemiological profile of traffic accidents at the child in the region of Tunis

Patient and methods: It is about a retrospective study of 1191 files concerning children aged between 0 to15 years, victims of public highway accident admitted to the emergency of the institution of the Paediatric Surgery [B] between 1st January and 31 December 2003

Results: The age bracket the most concerned was that of children aged between 4 and 8 years [53.5 per cent]. Twice on three, the victim was a male [63 per cent]. The accidents were more frequent in spring and graver during the weekend. Three peaks of frequency were noted during the day; at twelve o'clock, at 15 p.m and 18 p.m. The victims became especially from the most unfavourable cities of the the capital, 98.6 per cent were pedestrians. The light care was responsible for 77 per cent of accidents. In 84 percent of cases, the driver having caused accident alerted the helps. The transport was not medically in 70 per cent of cases. The cranio-cerebral region was the most concerned in this series [66 per cent], while the thoraco-abdominal region was interested in 28.7 percent and members in 21.2 percent of cases. 11.68 per cent were hospitalized. The rate of death represents 1.1 per cent of patients. Neurological after-effects represented 1/4 of observed after-effects

Conclusion: The analysis of results every year conclude at the decrease of the traffic accident generally, contrasting with an increase of grave accidents responsible for a more important number of death and this at the same time as the increase of the number of vehicles on the road in Tunisia. We conclude to the importance of the prevention and the amelioration of the quality of the coverage to be begun by, the improvement of the conditions of collection and the implementation of structures of reception multi-field

[Crossed renal ectora : a two cases report]

Crossed renal ectopia is a rare congenital anomaly, in which, the two kidneys are in the same side with one of the ureters which crosses the midline to be brought together in the bladder on the opposite side. Generally asymptomatic and of fortuitous discovery, this anomaly can appear by abdominal pains, urinary tract infection or a hematuria. The diagnosis rests on the radiological examinations in particular the ultrasonography, the intravenous urography and the CT scann. The treatment is surgical and is reserved for the complicated forms. We report two observations of children with a crossed renal ectopia The first observation is that of a 5 years old girl, presenting urinary tract infections at repetition whose etiologic assessment comprising a renal ultrasonography, a voiding cystourethrography as well as a three-dimensional tomodensitometry objectified a vesico-ureteral reflux grade HI, on left kidney in crossed ectopia. After sterilization of the urines, this patient profited from a surgical cure of her left vesicoureteral reflux with simple continuations.The second observation concerns a 10 years old boy, carrying a malformation anorectale, operated at birth, and at which the malformatif assessment [renal ultrasonography, vertebral radiography] objectified a left kidney in crossed ectopia with vesicoureteral ipsilateral reflux grade Ill associated with complex vertebral anomalies. This child was operated according to the same technique with simple operational continuations. From these two observations and after review of the literature, we recall the clinical, radiological and therapeutic characteristics of this malformation and discuss the pathogenic assumptions

[Congenital bladder diverticula in children. Report of four cases]

Abstract: The conginital bladder diverticulum is related to a weakness in the bladder musculature especially in the para-hiatal region. It is mostly asmptomatic but in some cases it may produce urinary tract infection or urinary retention. We present our experience with the management of congenital bladder diverticula in infants

Materials and Methods: The authors report a series of 4 patients treated from 1994 to 2003, for congenital bladder diverticulum in the department of surgery B at the children's hospital of Tunis. The diagnosis was established in three cases on recurrent urinary tract infection and in the fourth case on urinary retention. A bilateral vesicoureteral reflux was found in one patient and an intradiverticular stone in another one. Surgical treatment with excision of the diverticulum was undertaken in all patients

Results: After surgical treatment none of the patients has had reccurrence of the diverticulum, and all remain asymptomatic

Conclusion: Congenital bladder diveticulum has a wide clinical spectrum. Urinary tract infection and urinary retention are the most frequent presentation forms. The surgical treatment is indicated in all symptomatic cases

[Pathogen complete ureteric duplication in children. A 20 cases report]

Duplex System is a relatively rare malformative uropathy. It represents 0.2% of general population, with 15 to 25% of pathogen forms. A retrospective study of 20 cases, reported in 12 years is presented. Patient's age at diagnosis varied between 10 days and 10 years [mean age: 47.5 months]. Feminine predominance was noted, with a sex-ratio of 0.42. Clinical features were dominated by urinary infection [65% of cases]. Antenatal diagnosis represented 25% of cases. Diagnosis was confirmed by ultrasound, intravenous urography, cystography and cystoscopy. We noted a vesico-ureteral ref lux in the lower pole in 15 cases, 9 ureteroceles and two ectopic ureteral implantation. Conservative treatment was endoscopic in 5 cases of vesico-ureteral reflux and surgical [reimplantation +/- ureterocele excision] in 10 patients. An upper pole nephrectomy was done in 8 cases and a lower pole nephrectomy in 1 case. Outcome was uneventful in all cases. Ureteric duplication is complex with prognosis depending essentially on early diagnosis and the degree of renal parenchyma damage