Primary Segmental Intestinal Volvulus in a Neonate.

Primary segmental intestinal volvulus is a rare disease with an aggressive clinical course. Early diagnosis and prompt management prevents life-threatening necrosis and perforation. A 1-day-old newborn girl with this disorder is reported to emphasize the presentation, imaging findings and management.

Management of congenital neck lesions in children.

INTRODUCTION: A retrospective clinical trial was conducted to evaluate the clinical features and treatment outcomes and to determine the incidence of complications in children with congenital neck lesions (CNLs) treated at our institution with a special emphasis on thyroglossal duct remnant (TGDR), branchial cleft anomaly (BCA), and dermoid cyst (DC). MATERIALS AND METHODS: This series had 72 patients with CNL. The diagnosis of CNL was made by physical examination, ultrasound (US) in most, and for a potential extension of the mass computed tomography (CT) or magnetic resonance imaging (MRI) in a few patients and confirmed by histopathological examination in all of the children. RESULTS: Of the patients in this series, 39 (54.2%) children had thyroglossal duct remnant (TGDR). The most common surgical procedure (n = 36) in these children was Sistrunk's procedure. Four children (10.3%) with TGDR had associated anomalies including Turner syndrome and Morgagni hernia. During the study period, 25 (34.7%) children with branchial cleft anomaly (BCA) were treated and most of these were second branchial anomalies. There were eight children (11.1%) with dermoid cyst (DC). CONCLUSION: TGDR is the most common CNL and is presented clinically rather late with regard to BCA and DC in this series. Surgical resection is optimal choice of therapy in CNLs not only for aesthetic reasons but also for the recurrent infections and the potential danger of malignancy. Definitive surgery may be associated with high morbidity, especially recurrence. Associated anomalies may be observed, especially in children with TGDR. Although the Sistrunk's procedure is a safe and successful technique, life-threatening complications should also be kept in mind during the management of these lesions and early and adequate surgical treatment is suggested.

Primary abdominal wall hydatid cyst: a case report.

Hydatid disease is endemic in our country. A case of a 13-year-old girl with primary intermuscular hydatid cyst in the abdominal wall without other organ involvement is presented and discussed. At laparotomy, the entire endocyst, seen to push the peritoneum inwards, was totally extracted from the abdominal muscle planes without destroying the cyst wall. The postoperative course was uneventful. She is currently disease-free with a follow-up of two years. Hydatid cyst should be considered in endemic areas in patients presenting with a soft tissue mass in the abdominal wall.

Isolated salpingeal torsion in children: a case series and review of the literature.

This study was carried out to evaluate and determine the history, clinical presentation, and physical examination and laboratory findings in a pediatric (n=1) and adolescent (n=2) population with isolated tubal torsion (ITT) and to examine its surgical management. A retrospective review of all the cases of ITT treated in our hospital between January 2000 and December 2012 was performed. The diagnosis of ITT was performed by physical examination and radiological studies including ultrasonography (US), color Doppler US, and computed tomography (CT) and confirmed by surgical intervention. There were 3 children with ITT in the study period. Two of the patients were adolescents and one was diagnosed in the neonatal period. Two patients had left-sided ITT. The neonatal patient was diagnosed with abdominopelvic mass antenatally. ITT in the other two children occurred three days after the onset of symptoms. All the patients in this study were treated with salpingectomy. ITT is rarely diagnosed preoperatively, and is treated mostly by salpingectomy. A better recognition of this entity may help to improve the treatment of this rare condition. As advocated for ovarian salvage in adnexal torsions, earlier diagnosis and preservation of the tube, if possible, with prompt surgical intervention may increase the future reproductive potential of these patients.

Intralesional bleomycin sclerotherapy in childhood lymphangioma.

This clinical trial was conducted to evaluate the efficacy of intralesional bleomycin sclerotherapy (IBS) in children with lymphangioma and to determine the incidence of complications in the treatment. Seventeen lymphangioma cases were treated with IBS from 2004 to 2012. Age, mode of presentation, locations and types of lesions, and results of treatment were studied. Lymphangioma was diagnosed by physical examination and imaging studies. Most of the lesions were located in the cervical region (n=8) and of macrocystic type (n=13). After the first injection, three patients were lost to follow-up. Good response was seen in 50% of the lesions, complete resolution in 35.7%, and poor response in 14.3%. No serious complications or side effects were observed after IBS. The average follow-up was 18.5 months. IBS is effective in the treatment of lymphangioma. Although no major adverse effects have been encountered, complications should be kept in mind and in the event of their occurrence be treated immediately.

Management of epididymal cysts in childhood.

BACKGROUND: A retrospective review was carried out to evaluate the clinical presentation of children with epididymal cysts (EC) and outcome of management at our institution. METHODS: There were 49 patients with EC in this series. The diagnosis of EC was made by physical examination and confirmed by ultrasound (US). RESULTS: The average age at presentation was 10.7 years (2 months-16 years). Scrotal mass (n: 22) and pain (n: 21) were the most frequent symptoms. Seven patients were lost to follow-up. The cysts were solitary in 32 patients and multiple in 10 patients. The mean value of cysts was 6.7 mm (2-20 mm). The cyst localisations were 22 in left, 16 in right, and bilateral in 4 patients. Complete involution of cysts was detected in 14 children. The average involution time was 11.2 months (1-37 months). In 20 cases, a decrease in cyst size was found. Cyst excision was performed in 8 patients with persistent scrotal pain or no cyst involution observed during follow-up. CONCLUSION: Conservative management of epididymal cysts is practical. However, surgical excision is recommended in patients with intractable scrotal pain or if the cyst size does not seem to involute.

Treatment of acute scrotum in children: 5 years' experience.

BACKGROUND: A retrospective review was carried out to determine the incidence of various causes and outcome of management in patients with acute scrotum. METHODS: Fifty children had a diagnosis of acute scrotum between 1st January 2007 and 15th May 2012. Age, mode of presentation, associated anomalies, and results of treatment were studied. Diagnosis of acute scrotum was confirmed by physical examination, Doppler ultrasound and biochemical investigations. RESULTS: Clinical presentation consisted of sudden swelling and pain in the inguinoscrotal region. The average age was 7.5 years (2 months-14 years). Causes of acute scrotum were orchitis/epididymo-orchitis (O /EO) in 22, strangulated inguinal hernia (SIH) in 16, testicular torsion (TT) in 11, and torsion of testicular appendage (TTA) in 1. Associated urological anomalies were found in 5 patients with O /EO. Medical treatment was applied to patients with O /EO, and surgical treatment was performed in patients with SIH, TT and TTA. CONCLUSION: In this series, O /EO was found to rank first as the cause of acute scrotum. Immediate surgical treatment in acute scrotum patients, except those with O /EO, is necessary. Associated urological anomalies should be investigated in patients with O /EO.

Torsion of an epididymal cyst: a case report and review of the literature.

Torsion of an epididymal cyst (EC) on its pedicle is an extremely rare condition that resembles acute testicular torsion. Herein, a boy with EC torsion managed surgically is presented and discussed in light of the relevant literature. The presented child is probably the fourth case of pediatric EC torsion, and to our knowledge, the first report of a child who was known to have EC and was followed conservatively until the occurrence of EC torsion.

Foreign body aspiration: a four-years experience.

BACKGROUND: Foreign bodies (FB) in the airway require prompt removal in children. We reviewed our experience in patients with suspected airway FB. METHODS: A retrospective study was conducted in 189 consecutive children who admitted to the Department of Pediatric Surgery, SSK Tepecik Training Hospital between 1997-2001. Patients data on presentation, bronchoscopy findings and results were obtained. Of the 189 bronchoscopies, 127 (67.2%) showed FB which are commonly located in the right mainstem bronchus. Most of FB were nonradiopaque. Pips and hazelnuts were the most common FB. Mean hospital stay was 2.5 days. Many patients (151 out of 189; 79.9%) had transient stridor or fever that ceased within 24 hours after bronchoscopy. No mortality was observed rin relation with bronchoscopy. CONCLUSION: Chest radiographs of the children with FB in the airways are inconclusive. Children with a history of small particles in their mouths and subsequently showing wheezing, or choking episode should undergo prompt bronchoscopy. Complications related to bronchoscopy are uncommon.