Mesenteric cystic lymphangioma

Abdominal cystic lymphangioma is a very rare congenital tumor of lymphatic origin. It usually appears in the pediatric age and frequently presents with non-specific symptoms and deceptive signs causing, at times, diagnostic dilemmas. Ultrasonography and computer tomography imaging are considered the diagnostic modalities of choice. Two cases of mesenteric cystic lymphangioma, one presenting as perforated appendicitis and the other as recurrent gastritis, are reported. Infection in the first and volvulus in the second case is behind the mode of presentation. The diagnostic approach and treatment are described with emphasis on the operative tactic applied for upper jejunal resection. A high index of suspicion, accuracy and repeated physical examination and, most important, the liberal use of ultrasonography in all cases of unclear abdominal illness may contribute considerably to a correct diagnosis and decreased morbidity

Mesenteric cystic teratoma in children

Mesenteric teratoma is an extremely rare tumor, arising, akin all other teratomas, from totipotent primordial cells and displays a mixture of tissues of tridermal or bidermal origin. Two cases of mature mesenteric teratoma in a 5-month-old girl and a 4-month-old boy, the youngest reported in the literature, excluding a case recently diagnosed prenatally, are described. Diagnostic tools, differential diagnosis and management are also discussed

Lipomatosis of the parotid gland in children

Parotid lipomatosis is extremely rare in children. Only 4 cases have previously been reported in the English language medical literature. Surgical excision is frequently complicated by recurrence. We report, a fifth case, on a 5-month-old girl with rapidly progressive parotid lipomatosis. Emphasis is laid on the importance of preserving the unusually delicate tumor capsule to prevent tissue spillage and recurrence. The creation of an appropriate cleavage between the mass and the expanded skin with sparse subcutaneous fat, safeguarding the tumor capsule on one side and the skin blood supply on the other, represents a rewarding technical challenge

Complete separation of the testis and epididymis presenting as inguinal hernia

Complete separation of the epididymis from the testis is a rare phenomenon. In all reported cases, both structures remained undescended. We recently managed a 2-month-old boy with bilateral inguinal hernia and complete dissociation of the epididymis from the testis on the left side. At exploration, a right indirect inguinal hernia was confirmed while on the left side, an indirect inguinal hernia was associated with an undescended abdominal testis completely separated from a normally descended epididymis. This could reflect an essential role of the epididymis in the process of testicular descensus. The diversity of congenital abnormalities possibly encountered in the inguinoscrotal region during infancy and childhood necessitates the acquisition of insightful knowledge in the pathological anatomy of this area and adequate surgical skill to avoid undesirable intraoperative confusion with its negative impact on proper diagnosis and appropriate management

Pediatric inguinal hernia: outcome of repair

Controversial issues in the diagnosis and management of inguinal hernia in children, with a relatively high rate of reported postoperative complications [up to 8%], suggested the examination of our current policy in the management of pediatric inguinal hernia. The determination of risk factors, predisposing to postoperative complication may be identified so as to improve postoperative outcome. A prospective audit of 499 children with inguinal hernias, treated in a teaching hospital between 1987 and 1995 was performed. A detailed protocol was used to record the data. There were 394 boys and 105 girls between one day and 14 years of age. There were 130 [26%] neonates. Out of 499 patients, 478 were operated upon either electively [429] or as emergency [46]. The hernia was correctly diagnosed by the parents 366 times and by a physician 118 times. All emergency cases underwent a routine attempt of conservative reduction; this was successful in 33 of 46 [56%] cases. Patients discharged after conservative reduction for delayed elective operation defaulted in 12 of 33 [36.4%] cases. A hernia appearance on the opposite side was noticed in 17 [3.4%] cases. In 5% complication such as wound infection, recurrence, misplaced testis, respiratory distress, ileus, bleeding per rectum and anesthesia were recorded. Low educational level of the surgeon, prematurity, younger age or both of the patient and emergency operation were identified as risk factor predisposing to complications. Parental finding of an inguinal swelling is an acceptable diagnosis for hernia in children. Failure to demonstrate the hernia should not be considered an indication for invasive diagnostic procedure like herniography. Following conservative reduction, herniotomy must be performed within 24-48 hours because of high rate of default [36.4%], if herniotomy is delayed. We do not advocate a routine contralateral exploration as the incidence of the appearance of a hernia is small [3.4%]. Pediatric herniotomy is not a suitable operation for unsupervised training