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2.
Indian J Pediatr ; 2007 Oct; 74(10): 937-43
Artigo em Inglês | IMSEAR | ID: sea-83589

RESUMO

OBJECTIVE: To study the clinical presentation, management and results of treatment of 41 consecutive cases of choledochal cyst (CC) managed from 1999 to 2006. METHODS: The age of the patients ranged from 20 days to 11 years. Eleven cases were 1 year or less in age (infantile group) and 30 patients were more than 1 year old (classical pediatric group). Children less than 1 year old presented with jaundice (72%), hepatomegaly (54%) and clay-colored stools (63%); whereas those above one year in age presented with pain (83.3%) and jaundice (47.6%). Three cases had biliary perforation with localized or generalized biliary peritonitis. Ultrasonography (US) diagnosed/suggested CC in all 41 patients, however, contrast-enhanced computed tomographic (CECT) scan (n=12), radionuclide DISIDA scan (n=5) and magnetic resonance cholangiopancreatogram (MRCP) (n=3) also contributed to the diagnosis. 19 patients, including 4 from the 'infantile' group, had significant dilatation of intrahepatic biliary ducts. RESULTS: Nine patients from the 'infantile' group had cystic type I CC (type Ic), while 2 patients had fusiform dilatation of the common bile duct (type If disease). In contrast, 21 of the older patients had type If disease while 9 had type Ic disease. Operative management included primary complete excision of the cyst with a Roux-en-Y hepaticodochojejunostomy (HDJ) (n=32), Lilly's modification of submucosal resection with a HDJ (n=8) and cyst excision with a hepaticodochoduodenostomy (HDD) (n=1). All 3 patients with biliary perforation had primary excision of the CC with a HDJ. Unusual operative findings included accessory hepatic ducts (n=2), anteriorly placed common or right hepatic arteries (n=3) and partially or completely blocked proximal extrahepatic bile ducts (n=3). There were 2 postoperative deaths, one had cirrhotic liver disease with portal hypertension, the other had deep icterus with poor general condition. Both patients succumbed to overwhelming sepsis. One patient required reexploration and refashioning of the HDJ for biliary leak. Short-term follow-up was satisfactory in all 39 patients. CONCLUSION: Infants with CC constitute a distinct group with regard to clinical presentation and the pathological should be kept in mind while evaluating neonates and infants with cholestatic jaundice and older children with recurrent abdominal pain. Primary excision of the cyst with a HDJ provides satisfactory results in the management of the vast majority of cases of CC including those in infants, massive CC and in the presence of biliary perforation and peritonitis.


Assuntos
Anastomose em-Y de Roux , Criança , Pré-Escolar , Cisto do Colédoco/diagnóstico , Diagnóstico por Imagem , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Icterícia Obstrutiva/etiologia , Jejunostomia , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade
3.
Indian J Pediatr ; 2006 Sep; 73(9): 832-4
Artigo em Inglês | IMSEAR | ID: sea-80909

RESUMO

A two-month-old girl was operated for a left-sided eventration of the diaphragm. At surgery, a mass representing an extralobar pulmonary sequestration (EPS) was found inferior to the left lobe of the lung and was excised. Histopathological examination of the resected specimen showed presence of a type II congenital cystic adenomatoid malformation (CCAM) within it. A review of the relevant literature is presented.


Assuntos
Malformação Adenomatoide Cística Congênita do Pulmão/complicações , Eventração Diafragmática/etiologia , Feminino , Hérnia Diafragmática/etiologia , Humanos , Lactente
4.
Indian J Pediatr ; 2005 Feb; 72(2): 169-71
Artigo em Inglês | IMSEAR | ID: sea-83974

RESUMO

A 23-day-old male baby with a history of perinatal hypoxia presented with refusal of feeds and abdominal distension. The child had a right-sided cystic upper abdominal mass and features of neonatal septicemia. Abdominal ultrasound (US) and contrast-enhanced CT scan showed bilateral adrenal abscesses. Laparotomy with drainage of the abscesses successfully treated the condition. The literature on the subject is reviewed.


Assuntos
Abscesso Abdominal/diagnóstico , Doenças das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/patologia , Drenagem , Humanos , Recém-Nascido , Masculino , Tomografia Computadorizada por Raios X
5.
Artigo em Inglês | IMSEAR | ID: sea-125247

RESUMO

Necrosis of the entire stomach is extremely rare in neonates. We report a case of total gastric necrosis in a full-term neonate. The possible pathophysiology, diagnostic features and therapeutic options for gastric necrosis in a newborn are discussed.


Assuntos
Humanos , Recém-Nascido , Necrose/diagnóstico , Estômago/patologia
6.
Artigo em Inglês | IMSEAR | ID: sea-124177

RESUMO

We present a case of advanced hepatobastoma in a 9-month-old child who was treated with chemotherapy (three cycles of PLADO regimen conisting of cisplatin and Adriamycin) followed by surgical excision (left lobectomy). At 1-year follow up, the is doing well and is disease-free.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Cisplatino/administração & dosagem , Terapia Combinada , Diagnóstico Diferencial , Doxorrubicina/administração & dosagem , Hepatoblastoma/diagnóstico , Humanos , Lactente , Neoplasias Hepáticas/diagnóstico , Terapia Neoadjuvante , Tomografia Computadorizada por Raios X
7.
Indian J Pediatr ; 2003 Jan; 70(1): 91-2
Artigo em Inglês | IMSEAR | ID: sea-84737

RESUMO

A two-and half-year-old boy presented with a short history of fever, jaundice and abdominal distension. At laparotomy, a rhabdomyosarcoma (RMS) arising from the common bile duct (CBD) was found. The tumor including the CBD was successfully excised and a Roux-en-Y hepaticodochojejunostomy was performed. Postoperatively, the child received chemotherapy and is doing well on one-year follow-up the recent literature on the subject is reviewed.


Assuntos
Anastomose em-Y de Roux , Pré-Escolar , Neoplasias do Ducto Colédoco/cirurgia , Humanos , Masculino , Rabdomiossarcoma Embrionário/cirurgia , Resultado do Tratamento
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