[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

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

[Evaluation of pain in patients with spinal cord injury]

The aim of this study is to evaluate the pain in patients with spinal cord injury and it recurrences on daily activities. We report a prospective study about 30 cases of patients hospitalized for a spinal cord injury between march and may 2002. Pain was evaluated regarding to the time of appearance, the duration, the frequency, the type based on the TASP, the intensity based on the visual analogic scale, the sleep and social repercussion and daily actvities consequences. We report a series of 14 women and 16 men with a mean age of 30,4 years. The mean time of spinal cord injury occurence was about 2, 9 years. Twenty four patients were suffering from pain [80%]. In 61%of cases, the pain was chronic evolving for at least three months. It was noxious in 45%of cases and neuropathic in 80%of them. There were sleeping disturbances in 66%of cases and social repercussions in 62, 5%of patients. A professional reintegration was acquired in onIy 33%of patients. Pain is a frequent symptom in spinal cord injury. The evaluation of the pain can improve the management of patients suffering from this pathology. The improvement of therapeutic results needs evaluating scales standardization

[ 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

[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