[Ileal prolapse through patent omphalomesenteric duct. A review of six cases]

Meal prolapse through the umbilicus is a severe complication of patent omphalomesenteric duct which exposes to the risk of intestinal necrosis in case of diagnostic or therapeutic delay. This is a retrospective study of six cases of ileal prolapse complicating a patent omphalomesenteric duct observed between 1986 and 2004 in the pediatric surgery department of Monastir. The mean age of the six patients was 67 days. The diagnosis was performed on the observation of an out-f low of intestinal liquid or stools through the umbilicus associated to an ileal prolapse. Five patients were treated by intestinal resection and anastomosis and the sixth had a wedge-shaped resection of the omphalomesenteric duct. One patient died from a severe sepsis. The evolution was favourable for the other patients. The ileal prolapse complicates 50 to 80 per cent of the umbilical enteric fistula. It exposes to the risk of occlusion and intestinal necrosis. So, the treatment must be urgent and consists on the resection of omphalomesenteric duct with ileal anastomosis.This treatment can be done by classic surgery or, more recently, by coelioscopy. The mortality can reach 33 per cent in the event of diagnostic or therapeutic delay. The ileal prolapse is a rare form of the patent omphalomesenteric duct which must be diagnosed and treated quickly to ovoid complications

[Primary type 1 hyperoxaluria - about two particular cases]

Primary hyperoxaluria type I is an autosomal recessive disease due to congenital defect in alanine glyoxylate aminotransferase [ACT]. It is a rare disorder in witch only combined liver-kidney transplantation is curative. Our two cases of primary type I hyperoxaluria were particular by the early renal failure, thrombocytopenia and intestinal invagination. On the basis of our two cases we discuss diagnostic and therapeutic methods

[Lung abscess revealing a congenital cystic adenomatoid lung malformation]

Congenital cystic adenomatoid lung malformations [CCAM] are, todays, more frequently diagnosed during the pregnancy thanks to progresses in ultrasonographic explorations. On occasion, CCAM may remain asymptomatic and be discovered after being complicated by infection. This was the case of our patient. Amani _ was delivered by spontaneous vaginal delivery at term after a well-controlled pregnancy. She had good staturo-ponderal and psychomotor developments. When she was eight-year-old, she was treated for right pneumonia. Three years later, she was admitted in a general pediatrie unit because of right lower lobe abscess. Thoracic computed tomography, indicated since the infection was recurrent in the same lobe and after the constatation of a persistent cystic feature on chest radiograph, revealed multiple cystic lesions compatible with CCAM. The anatomopathological study of the surgically removed lobe concludes for a cystic adenomatoid lung malformation type I. Cystic adenomatoid lung malformations are frequently revealed by recurrent infections in old children. Thoracic computed tomography is very interesting for the diagnosis when pneumonia relapses in the same site

[Primary peritonitis in children]

Background: Primary peritonitis is rare in children. It raise problems of aetiology diagnosis, and therapy. The aim of this study is to review the particularities of this pathology by emphasizing these difficulties of the treatment

Methods: Its a retrospective study of 14 cases of primary peritonitis treated in the infant surgery unit of Monastir hospital in the period between January 1984 and December 2003.The mean age was 2 years ;the sex ratio was 1/6.The beginning of the clinical symptoms were usually acute

Results: The diagnosis was done by surgical exploration in 13 cases/14; in only one case the diagnosis was highly suspected because of the results of the peritoneal drainage. The post operative course was uneventful for 11 patients; two died probably because of liver failure and presented a residual peritonitis

Conclusion: primary peritonitis of the child is rare. until now, it is still a controversial pathology. Its treatment can be only medical but the surgical treatment which can be laparoscopic must be indicated if there is a doubt

[ abdominal cystic lymphangioma in childhood: a report of 12 cases]

Cystic abdominal lymphangioma is a rare malformative tumor, often discovered in childhood. The aim of this work is to study diagnostic and therapeutic aspects of this malformation. We report a retrospective study of 12 cases treated at the pediatric surgery department of Monastir over a 19-year period. The average age of the patient was 4 years. Diagnosis was suspected prenatally in only 1 case. Clinical signs have no specificity. Ultrasonography [11 cases] suggested the diagnosis in 10 cases. Computed tomography was performed in 4 cases. All patients underwent surgery. Lymphangioma was intraperitoneal in 11 cases and retroperitoneal in 1 case. Total resection was possible in 9 cases. Pathology was confirmed diagnosis in all cases. Postoperative outcome was uneventful for all patients. Because of no specificity of its signs, lymphangioma had many diagnostic difficulties. Ultrasonography constitutes the most important diagnostic imaging. The treatment is surgical and total resection is wished, which will be correlated with an excellent prognosis