[Left multiocular cystic nephroma: a pediatric case report]

The authors reports a clinical case of cystic nephroma in a 12-year-old girl which the data non specific clinics and the character little informative exams of imagery contribute to make difficult the diagnosis of this rare affection. Only histologic studies affirm the diagnosis

[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

[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

[Bilateral wilms tumors: diagnosis and therapeutic management. about 12 cases]

Bilateral Wilms tumor [WT] is uncommon malignancy, the incidence is about 5% of all nephroblastoma. It shows association with some congenital anomalies. there is no scheduled regimen for bilateral WT and their management offers a great challenge. To evaluate the clinical characteristics and the treatment result. 12 patients with bilateral WT diagnosed between 1997 and 2005, were retrospectively reviewed. Data collected: patients characteristics, chemotherapy, modality of surgical resection, renal function and survival. 11 patients [pts] had synchronous tumor and one metachronous lesions. The median age at primary diagnosis was 17 months [range 6m - 72m]. Congenital malformation were present in 4 children. 1 pt had hemi-hypertrophy, genitourinary horse kidney, 3 had hypertension.. All pts received preoperative prolonged chemotherapy [CT] for 25 to175 days [median 45 days] 7 received double agent chemotherapy. [VCR + Actinomycine], 2 triple agents: one [VCR + Actino + Adriblastine], the others [Etoposide, Carboplatine, Cyclophosphamied] for tumor progression. Two pt died before surgery due to infection. Bilateral partial nephrectomy 1 case total unilateral nephrectomy with partial nephrectomy on the other side in 3 cases. 9 pts are alive without disease and normal renal function 87 months after. The 10th in course of treatment after unilateral nephrectomy.Prolonged preoperative chemotherapy permit conservative surgical treatement of favorable histology bilateral Wilm's tumor and may improve the preservation of renal masses and function without impairing patient survival

[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

[Neurological diseases in the "triple a" syndrome]

Introduction: The 3A syndrome or Allgrove syndrome is an autosomic recessive disease characterized by the association of oesophagus achalasia, alacrymie and suprarenal insufficiency. Neurological disorders can appear at any time of the course's disease and would be due to a neuropathy affecting the central nervous system as well as the peripheral nervous system

Patient and methods: From1991 to 2005, we noticed 22 cases of Allgrove syndrome. The follow-up of these patients enabled us to notify the neurological abnormalities appear later in the evolution

Results: neurological symptoms appear at any time of the course's disease. All cases were backward pupil. 8 patients had a nasal voice due to palate paralysis. 7 patients had xerostomia wich is included in the dry syndrome due to the degeneration of salivary glands. One patient had a neurological motor disorder and 3 patients had a sensitive disorders with loss of cold feeling and vasomotor disorders in the hands and feet. These symptoms appear after 4 years on average after diagnosis. An orthostatics hypotension was noticed among three patients as a dysautonomic sign

Conclusion: All of these data approve that neurological disorders appear at a variable time of the course's disease. This polyneuropathy affects the oesophagus and always leads to the recurrence of the digestives signs

Pyloric atresia: a case report

Pyloric atresia is an uncommun condition occuring in 1/100.000 live births. It can be isolated or associated with other congenital anomalies. Authors present a case of isolated pyloric atresia in a male neonate explored for non bilious vomiting. Diagnosis was done on plain abdominal x-ray which showed a distended stomach as a single gas-filled bubble with a gasless abdomen. Digestive opacification showed distended stomach. The surgical treatement consisted on the excision of the web in combination with pyloroplasty. Pyloric atresia is establish on plain radiograph and must alert the surgeon of the severity of this condition

Under hepatic appendicitis complicated by peritonitis and under hepatic abcess - about a case report

Appendicitis in the child under 3 years old is rare and often arises in a serious and complicated form considering the delay of diagnosis. Its localization is sometimes ectopic and the clinical signs are often misleading. The diagnosis primarily rests on the clinical examination. Abdominal echography and the tomodensitometry are reserved for the diagnostic doubts, we bring back the observation of a 2 year and 9 months old girl which consulted for acute abdominal pain, fever and stop of the matters. The clinical examination showed an abdominal distension with diffuse sensitivity. Abdominal echography was normal. The biological exams objectivated an hyperleucocytosis with polynucleosis. The patient was kept under surveilance the evolution was done towards the persistence of the fever and the installation of a liquid diarrhoea making carry the diagnosis of acute gastro-enteritis. After 5 days of hospitalization, apparition of an abdominal defense generalized with saddles striated with blood the abdomen radiography showed grelic hydroaeric levels and echography revealed the presence of an under hepatic collection. The post-operative evolution was good. In the light of this observation, the authors make a review of the literature while insisting on the diagnostic difficulties of appendicites of the child

[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

cystic dilatation of choledoque. A case report

The cystic dilation of choledoque is a rare congenital affection. It represents the first cause of extra hepatic cholestase in child. The discovery is generally made in childhood. The diagnosis rests primarily on echography. Because of the secondary risk of degeneration of the cyst and its complications, the complete surgical resection is essential. We report the case of an infant of female sex admitted in our service at the age of 11 months for abdominal distension, fever, icter and melena. The clinical examination found an supra-umbilical mass. Radiological explorations [echography, scanner and IRM] were in favour of a pseudo cyst of the choledoque. The treatement consisted on an exeresis of the cyst followed with bilio-digestive and ilio-jejunal anastomosis. The post-operative evolution was simple. At the occasion of this observation, the authors make a review of literature