Hypertrophic pyloric stenosis: a 331 cases report

Hypertrophic pyloric stenosis [HPS] is a frequent infant disease. Its diagnosis is very easy, based on its classical clinical features and ultrasonography. The aim of this study is to evaluate the management of HPS in the Paediatric Surgery Department of Casablanca over a period of 25 years [1977-2002]. We recorded 331 cases and we compared the management of this pathology before and after 1992. The mean age of diagnosis was 52 day-old before 1992 and 34 day-old after 1992. The diagnosis was based on oesophago-gastric barium swallow before 1992, and only on abdominal ultrasonography after. The surgical incision is umbilical since 1992. Death rates decreased from 8% to 2%, showing improvement of the management of HPS since 1992. This improvement can be achieved through an earlier diagnosis and an adequate medical care before surgery

Inflammatory pseudo-tumour of the liver in child: a case report

The inflammatory pseudo-tumour is a very rare benign tumour in the child. Its hepatic localization leads to diagnosis difficulties particularly with malignant tumours. We report the case of a 17 month-old boy who had an enormous abdominal mass which was 18 cm diameter. The hepatic origin has been visualized by echography and magnetic resonance imaging. The diagnosis of liver inflammatory pseudo-tumour has been realized after surgical biopsy. The treatment consisted in total resection of the tumour, taking the liver left lobe, with good clinical evolution and good recession of 34 months. The diagnosis of the liver inflammatory pseudo-tumour is histologic. It may be based on the needle biopsy of the tumour assisted by the imaging, which allows to have a conservative attitude for these benign tumours

Pancreas pseudocysts in children: therapeutic alternatives

Pancreatic pseudocysts are rare in child. The aim of this study is to review the experience of the Pediatric Surgery Department of the Casablanca Children Hospital and to evaluate the therapeutic results. We retrospectively reviewed 19 cases of pancreatic pseudocyst. Mean age of children was 8 year-old. The post-traumatic origin was the most frequent etiology. Main clinical symptoms were abdominal pain, vomiting and abdominal mass. Diagnosis was based on abdominal ultrasound and CT scan in 42% of cases. Two patients were only observed with a good outcome. Three patients had percutaneous drainage, six needed an open external drainage and 9 had an open internal drainage with a success rate of 78%. Kystojejunostomy is a reliable technique of treating a PSK. However new techniques of endoscopic and percutaneous drainage may be useful in some indications

[Congenital cysts and branchial fistula of the head and neck: a 148 cases report]

We report our experience of 148 cases of congenital cystic anomalies of the head and neck, operated in a twenty-year period. The goal of this study is to evaluate the frequency of the different anomalies and our diagnostic and therapeutic approach. This retrospective study has analyzed 148 cases of children who had surgery for a congenital cyst or fistula of the head or the neck. Thyroglossal duct cyst was the most frequent anomaly [52.7%]. The diagnosis was mostly clinical without need to further explorations. Surgical repair was well codified and consisted in an excision of 78 thyroglossal cysts, 41 dermoid cysts and 29 branchial fistulas. Six cases of thyroglossal cysts needed redo surgery. Six other patients had non specific complications

[Femoral nerve block for fractured or the femur in children [15 cas]]

The orthopedic treatment of the fractured femoral shaft child is based either on the reduction with plaster immobilization, usually practiced under general anesthesia, or on pulling during 10 days followed of plaster immobilization without any analgesia. The block of the femoral nerve is a simple technic that permits a good quality analgesia after fracture of the femur and can be practiced out operative room. We tried to value the possibility of realization of orthopedic treatment of femoral fractures under block of femoral nerve alone. These are the preliminary it is an open prospective study about 15 children aged from 2 to 9 years, they suffer from fractured femoral shaft. The fracture was insulate, there was no alteration of consciousness and any antalgesis medication has been is realized by an anesthesist doctor or sergeon with admiscture of Xylocaine 1% and marcain 1,5%. The pain, the muscular relaxation and the hemodynamic variation are noticed before during 5,10 and 15 minutes after the achievenement of the block. Finally, we noticed also the quality of recution. The spontaneous pain or this caused by papation of the fractured member disappeared 10 minutes after the achievenement of the femoral block, on average, and the muscular relaxation of the thigh has been obtained 11 minutes later. The pulling of the member with manipulation of the fracture focus permitted to get in all the cases an acceptable, or else anatomic reduction of the fracture. The block of the insulate femoral nerve has been for us an effective method and easy to realize even ambulatory