Isolated Tracheal Oesophageal Congenital Fistula: A Case Report.

Esotracheal fistula is a rare malformation represented by a thin ascending channel between the esophagus and the posterior surface of the trachea. Diagnosis is sometimes difficult due to the atypical character of the symptomatology. Diagnosis is made by a gastro-duodenal oesophageal transit (TOGD) and the treatment is surgical. We report a case of isolated congenital esotracheal fistula collected in the pediatric visceral and urogenital surgery department at the Mohammed VI University Hospital Center in Oujda, Morocco, previously not discovered, and its surgical treatment as well as an updated literature review of this entity.

Spontaneous gastric perforation in a newborn: About a case.

Spontaneous neonatal gastric perforation is rare. We report a case of a newborn from a pregnancy and birth with no complications, who presented on day 5 of life with sudden severe abdominal distension, and subsequently bilious vomiting. The radiography of the abdomen without preparation showed a massive pneumoperitoneum. The CT scan showed a pneumoperitoneum more accentuated at the supra-mesocolic level with a defect in the anterior wall of the stomach. The laparotomy found a perforation in the anterior gastric wall, which was sutured in one plane. The postoperative course was simple. The evolution of spontaneous gastric perforations in newborns is usually favorable. The key to avoiding complications is obviously to make a good diagnosis and perform the correct surgical treatment as soon as possible.

Recurrent non-bilious vomiting in a child: A case report of an uncommon diagnosis.

Annular pancreas (AP) is a congenital anomaly and a recognised cause of duodenal obstruction which can affect all age groups. It may manifest early in the neonatal period, but it may also have varied and often delayed symptoms. We report the case of AP in an 18-month-old girl with a long history of recurrent post-prandial non-bilious vomiting treated for a long time with the clinical diagnosis of gastroesophageal reflux. Upper gastrointestinal study was suggestive of partial duodenal obstruction and computed tomography revealed a complete ring of pancreatic parenchyma surrounding the second part of the duodenum. Diamond-shaped duodenoduodenostomy was achieved successfully and the post-operative period was uneventful. Although rare, AP must be kept in mind of any paediatric surgeon while confronted to symptoms of partial duodenal obstruction.

Rapunzel syndrome: An infrequent cause of paediatric mechanical occlusion.

Despite numerous cases of trichobezoars reported in the literature, few Rapunzel syndromes have been described. Rapunzel syndrome is a rare case of bowel obstruction resulting from hair ingestion (trichobezoar). The obstruction can occur in any level of the intestinal tract. This syndrome is usually reported in patients affected by trichotillomania and trichophagia. We reported a case of Rapunzel syndrome in a 5-year-old girl diagnosed on an abdominal computed tomography scan and confirmed during surgery.

Blunt renal trauma in children: the experience of Mohammed VI University Hospital of Oujda in Morocco between 2015 and 2021.

Introduction: blunt renal traumas in children are rare and their management is not suited to a very clear consensus. We sought to report our experience in managing renal injuries in children presented after blunt abdominal trauma. Methods: data of children aged less than 16 years with blunt renal injuries between January 2015 and April 2021 were retrospectively reviewed. Demographic characteristics, clinical course, biological results, radiological findings, associated injuries, management and follow up of included patients were described. Renal lesions were classified according to the American Association for the Surgery of Trauma (AAST). Results: we included a total of 20 children, of whom 70% (n=14) were males. The mean of age was 8.50 ± 3.42 years. Falls in 65% (n=13) and motor-vehicle accidents in 35% (n=7) were the two main mechanisms of injuries. Abdominal pain was the most common symptom and macroscopic hematuria was assessed in 55% of patients (n=11). Low-grade injuries (I-III) represented 40% of the cases (n=8), 60% of injuries were AAST grade IV (n=12) and none with AAST grade V was diagnosed. Spleen injuries in 25% (n=5) as well as traumatic brain injuries in 25% (n=5) were the most identified concomitant injuries followed by liver lesions in 15% (n=3). 75% of renal injuries (n=15) were managed conservatively and all cases that required an operative management were with AAST grade IV. No nephrectomy in our series was performed and the follow up was favorable with a median of 3 years. Conclusion: our data suggest that the majority of children with blunt renal injuries can be managed conservatively regardless the grade of lesions as long as no hemodynamic instability or symptomatic urinoma are identified.

Uncommon Cause of Chronic Vomiting in Children.

Gastric outlet obstruction (GOO) is unusual and must be suspected in children with chronic vomiting and abnormal weight status. The treatment depends on etiology, and surgery is not always the first remedy. Diagnosis is easily confirmed by upper gastrointestinal fibroscopy.We report the case of an 11-year-old girl, who was presented with non-bilious emesis and weight loss. Abdominal computed tomography, ultrasound, and upper gastrointestinal fibroscopy showed dilated stomach with pyloric stenosis, which was confirmed by abdominal laparoscopic exploration and cured by Heineke-Mikulicz pyloroplasty. We also compare our study to previously reported cases.

An Unusual Presentation of Hydatid Disease in a Child: A Case Report.

The subcutaneous localization of the hydatid cyst in the abdominal wall is rarely encountered particularly in the pediatric population and is sometimes difficult to diagnose preoperatively. Here, we report the case of a 6-year-old boy who presented with two isolated episodes of low abundant hemoptysis and in whom a mass on the right lumbar region already considered as a lipoma was studied. Laboratory and radiological examinations were requested and the parietal cyst was surgically managed. The macroscopic and the pathological examination confirmed the diagnosis of the hydatid disease and helped in identifying the nature of the thoracic lesion that disappeared spontaneously after two episodes of hydatid vomiting. Hydatid cyst should be considered as a diagnosis for any masses of the abdominal wall. Moreover, biopsy and partial resection of the mass must be avoided.

Mixed ovarian germ cell tumor in a child: A case report of a rare association.

INTRODUCTION AND IMPORTANCE: ovarian tumors and especially mixed ovarian germ cell tumors are rarely seen in the paediatric population. CASE PRESENTATION: we report the case of a 13-year-old girl which was successfully treated for a mixed ovarian germ cell tumor with a favorable evolution. CLINICAL DISCUSSION: the incidence of mixed ovarian germ cell tumors, clinical manifestations, histologic distribution and prognosis are predominentely distinct in children and adolescents as compared to adult population. The diagnosis should be suspected in young girls with chronic abdominal pain and palpable swelling of the lower abdomen. Conservative surgery is the first therapeutic procedure that consists of a total resection of the mass with preservation of the reproductive function. Circulating tumor markers have the potential in diagnosis, prognostic stratification and for follow-up. CONCLUSION: mixed ovarian germ cell tumors are uncommen in children. Their management must be multidisciplinary and conservative surgery by laparotomy represent the standard of care.

Perforated gastric ulcer: An unusual cause of peritonitis in children.

Perforated gastric ulcer is a particularly rare cause of peritonitis in children. Only few cases have been reported in the literature. It is a serious emergency condition which can be overlooked leading to life-threatening consequences. We report a case of a 12-year-old girl who presented with acute abdominal pain and signs of peritonitis. Surgical exploration found a gastric perforation on the anterior side of the antrum. Primary repair of the perforation was performed after thorough decontamination and taking biopsies from its edges. The post-operative period was uneventful. Helicobacter pylori test was negative. Histopathology result was suggestive of ulceration in the gastric wall and did not isolate H. pylori. Gastro-duodenal ulcer perforation should be considered in the differential diagnosis of children presenting with acute abdomen, especially when imaging showing pneumoperitoneum.

Ovarian tumours in children : a review of 18 cases.

BACKGROUND: To review the experience of Children's Hospital of Rabat in managing ovarian tumours in children. MATERIALS AND METHODS: There were 18 patients between 2 and 15 years of age who presented with an ovarian tumour at Children's Hospital of Rabat between January 2000 and December 2008. Data collected from the hospital medical records included age at diagnosis, patient's history, presenting complaints, radiological examination, tumour markers, management, operative procedure, histopathological examination and outcome of the patients. RESULTS: The most common presenting complaint was abdominal pain in 10 (55%) patient. 77% of ovarian tumours were germ cell tumours; 71% of these were teratomas which were benign in 66% of cases. Unilateral salpingo-oophorectomy was the most common surgical procedure performed in 15 patients (83%) through laparotomy. Laparoscopic ovarian cystectomy was carried out in 2 (11%) patients with benign cystic teratoma. Of the 7 (39%) patients with malignant tumours, three received postoperative chemotherapy. Outcome was good in most cases. There were no cases of resistance to treatment, or death. CONCLUSION: Early diagnosis of ovarian tumours in children and adolescents is important. Since most of these tumours are benign, surgical treatment should be conservative to minimise the risk of subsequent infertility, while the treatment of malignant tumours should include complete staging, resection of the tumour, postoperative chemotherapy when indicated, to give the patient a chance for future childbearing.