Infectious mononucleosis manifested as a cecal mass.

An 11-year-old boy presented with symptoms of periappendiceal abscess. At laparotomy, a tumor-like mass involving the ileocecal mesentery and adjacent part of the cecum and covered by the omentum was found. A right hemicolectomy was performed, followed by primary ileocolic anastomosis. On histologic examination, the tumor-like mass proved to be a lymph node block pushing the adjacent wall of the cecum. The overall histologic and immunophenotypic findings were consistent with (a) abnormal immune lesion mimicking lymphomatous process because of infection by Epstein-Barr virus and (b) extensive acute inflammatory infiltration of the cecum and adjacent tissues.

Multiple failed urethroplasties: definitive repair with the Duckett island-flap technique.

BACKGROUND/PURPOSE: The correction of postoperative complications after hypospadias repair presents frequently serious problems, and the results are not always satisfactory. The aim of this study is to present our experience with the tubularized island flap technique (Duckett procedure) in patients who had been submitted to repeated unsuccessful attempts for the repair of hypospadias and its complications. METHODS: During an 8-year period (1994 through 2001), 21 patients, aged 4 to 18 years, presented with severe recurrent hypospadias (3 to 13 times). In all patients, the urethral orifice was quite proximal because of disruption of the neourethra and was associated with severe penile ventriflexion. In addition, there were diverticula with hair ingrowth in 5 boys and lack of the prepuce in 4. All patients underwent the Duckett island-flap technique. The inner layer of the prepuce was used in 17. The dorsal penile skin was used for the island flap formation in the remaining 4 patients in whom the prepuce had been resected during the previous operations. RESULTS: After repair, the meatus was located at the top of the glans in all patients. There were 5 complications (24%): distal fistula near the glans (n = 1), meatal stenosis (n = 1), diverticula at the proximal anastomosis (n = 2), and anastomotic stenosis (n = 1). All of them were treated successfully by meatotomy, fistula closure, diverticula tapering, and dilatations, respectively. CONCLUSIONS: The island-flap technique gives satisfactory results in patients with multiple failed urethroplasties; it is applicable even in boys with resected prepuce and has an acceptable complication rate.