Mesenteric cystic lymphangioma associated with intestinal malrotation in a newborn.

Mesenteric cystic lymphangiomas are uncommon benign cystic tumors rarely associated with other congenital malformations. We herein describe a case of a 9-day-old female presented with a two-day history of bilious vomiting, feeding intolerance, weakness and lethargy. Preoperative studies were diagnostic of intestinal malrotation. At laparotomy a cystic mesenteric mass was identified. Histopathological examination confirmed the diagnosis of mesenteric cystic lymphangioma. The exact aetiology of mesenteric lymphangioma is unknown and this case supports the theory that lymphangioma is a primary congenital malformation.

Management of foreign body ingestion and food bolus impaction in children: a retrospective analysis of 675 cases.

Although foreign body ingestion is a common problem in children, there are no clear guidelines regarding the management of ingested foreign bodies. The aim of this study was to evaluate the effectiveness of our protocol in the work-up and management of children with ingested foreign bodies. Between September 2002 and August 2010, a total of 675 children with suspected foreign body ingestion were seen in the emergency department. At initial presentation, the majority of foreign bodies were located in the stomach (n=392, 58.1%) followed by the small intestine (n=221, 32.7%) and esophagus (n=62, 9.2%). Based on our protocol, 84 (12.4%) patients were admitted at initial presentation, and 5 after a 48-hour observation period at home; 61 (9%) required prompt endoscopic removal. Sixty-eight (10.1%) patients returned for endoscopic removal after a four-week observation period, and 3 (0.4%) patients underwent delayed surgery due to complications. The overall success rate of endoscopic retrieval was 96.1%. There were no major complications. The majority of ingested foreign bodies will pass spontaneously and most children can be safely observed at home. Selective endoscopic intervention is the preferable method for the removal of ingested foreign bodies in pediatric patients.

Anastomotic strictures following esophageal atresia repair: a 20-year experience with endoscopic balloon dilatation.

OBJECTIVES: The aim of the study was to evaluate the safety, effectiveness, and long-term results of endoscopic balloon dilatation in children with anastomotic strictures following esophageal atresia (EA) repair. PATIENTS AND METHODS: From January 1988 to January 2008, 59 patients were treated with balloon dilatation for anastomotic stricture following EA repair. Indication for dilatation was dysphagia of varying degree. Outcome parameters included the number of dilatations, response to dilatation, effectiveness, and complications. Response to dilatation was considered excellent when there was no need for any additional dilatation for recurrent dysphagia, satisfactory when up to 5 dilatations were required, and fair when >5 sessions were required. The treatment was considered effective when dysphagia was grade 0 or 1 for >12 months after the last dilatation session. RESULTS: A total of 165 balloon dilatations were undertaken, with an average of 279 per patient (range 1-9). Age range at diagnosis was 1 to 36 months (mean 10.5). Response to dilatation was excellent in 21 cases (35.6%), satisfactory in 26 (44.1%), and fair in 12 (20.3%). The treatment was effective in 47 patients (79.7%) and ineffective in 12 (20.3%). The median follow-up period was 19.5 months. Four patients underwent surgery; in 1 patient a retrievable stent was placed. No perforation occurred. CONCLUSIONS: Endoscopic balloon dilatation can be accomplished safely and effectively as a first-line therapy for the management of anastomotic strictures following EA repair.

Sonographic diagnosis and monitoring of an intramural duodenal hematoma following upper endoscopic biopsy in a child.

Intramural duodenal hematoma is an uncommon complication of pediatric endoscopic biopsy that occurs mainly in children with bleeding disorders. We report the case of a 5-year-old girl who presented with signs of partial duodenal obstruction and acute pancreatitis due to duodenal hematoma following endoscopic biopsy. The lesion was diagnosed and monitored by sonography and resolved with conservative management.

A case of maturing perineal lipoblastoma in an infant.

OBJECTIVE: To report the unusual occurrence of a perineal lipoblastoma presenting as a painless enlarging mass in an infant. CASE PRESENTATION AND INTERVENTION: A 7-month-old boy presented with a 6-month history of an asymptomatic progressively enlarging perineal mass. Imaging studies were unable to provide a diagnosis. Complete resection of the mass was achieved and there was no recurrence at 18-month follow-up. Histopathologic findings were consistent with a maturing perineal lipoblastoma. CONCLUSION: This case report serves as a reminder to physicians and especially pediatric surgeons to consider perineal lipoblastoma in the differential diagnosis of soft tissue perineal masses in infancy.

Primary omental torsion in children: ten-year experience.

Primary omental torsion (POT), is a rare cause of acute abdomen commonly affecting obese male adults, whereas it is extremely rare in children. In this retrospective study, we present our experience regarding the management of five children with POT and discuss the diagnostic and therapeutic implications of this entity. We retrospectively reviewed the medical records of children diagnosed for POT, from January 1996 to July 2006 at our department. Among 2,734 children operated for acute appendicitis, five patients were diagnosed with POT (ratio 1:587 or 0.18%). Clinical presentation, laboratory findings, diagnostic imaging results as well as surgical and histological findings were reviewed. There were four boys and one girl, M/F ratio 4:1, with a mean age of 9.5 years (range 7.2-10.3). All subjects were obese and their weight percentages were over 85% for their age group. On admission the clinical symptoms and laboratory findings were similar to those of acute appendicitis. They were submitted to laparotomy and the surgical findings were; free serosanguineous fluid in the peritoneal cavity, normal appendix and an ischemic twisted mass of the omentum at the right side of the abdomen. The mass and the appendix were excised and the postoperative course was uneventful. The histological examination of the specimens revealed hemorrhagic ischemic necrosis of the omentum and normal appendix. POT is very rare in children. In the pediatric age group the clinical presentation and the laboratory findings are similar to those of acute appendicitis and it is extremely difficult to be diagnosed preoperatively. Obesity seems to be an important predisposing high-risk factor. Excision of the twisted omentum is the treatment of choice.