Unusual repair in a rare case of hepatothorax due to right-sided diaphragmatic rupture: case report.

Intra-thoracic herniation of abdominal organs following diaphragmatic rupture represents an unusual clinical occurrence with great diagnostic difficulty. The authors present a case of right diaphragmatic rupture related to peritonitis due to perforated duodenal ulcer in previous (1 year before) thoraco-abdominal trauma with complete intra-thoracic herniation of the liver, gallbladder, ascending and transverse colon and lung collapse. The preoperative diagnosis has been based on clinical, chest X-ray, and ultrasound examination. The patient, because of very serious respiratory and hemodynamic distress, immediately underwent surgery (thoraco-laparotomic approach) with reduction of the liver, gallbladder, ascending and transverse colon in the abdominal cavity, perforated duodenal ulcer suture and repair of diaphragmatic tear using an unusual repair mode: suture of autologous fascia lata graft to the diaphragm. Postoperative chest radiography showed the normal location of right diaphragmatic border.

Valproic acid-induced acute pancreatitis in pediatric age: case series and review of literature.

Valproic acid (VPA) is commonly prescribed medication for epilepsy, migraine and bipolar disorder. Although the common adverse effect associated with VPA are typically benign, less common adverse effect can occur; these include hepatotixicity, teratogenicity and acute pancreatitis (AP). VPA-induced pancreatitis does not depend on valproic acid serum level and may occur anytime after onset of therapy. Re-challenge with VPA is dangerous and should be avoided. The diagnosis of VPA-induced pancreatitis seems to be underestimated because of difficulties in determining the causative agent and the need for a retrospective re-evaluation of the causative factor. More of idiopathic pancreatitis should be a drug-induced pancreatitis. We report four cases of VPA-induced AP found in a group of 52 cases of AP in children come to our attention from January 2008 to December 2012. The aim of these reports is to point out our experience about clinical presentation, diagnosis, management, outcome in children with VPA-induced AP and review of literature.

[Management of pediatric cholelitiasis: our experience]. / Management della colelitiasi in età pediatrica: nostra esperienza.

AIM: The aim of this retrospective study was to report our experience about characteristics of clinical presentation, etiologies, diagnosis and medical or surgical treatment of pediatric cholelitiasis. METHODS: Twenty-four children, ranging from 7 to 17 years of age (14 females and 10 males), with diagnosis of cholelitiasis were studied from 2008 through 2011. Exclusion criteria included: active infection, cholangitis, severe anemia or thrombocytopenia in cases with hemolytic diseases. Diagnosis was performed with abdominal ultrasonography-scanner (US). Furthermore, complete peripheral blood examination was performed to all patients. Follow-up was conducted by clinical and US and/or CT supports between 6 and 24 months. RESULTS: Laparoscopic cholecystectomy was performed in 16 patients, conservative management in 10. No cases of majority morbility or death rate were found. RMN-colangiography was conducted in 2 cases with cholestasis elevated index: no stone were found in common bile duct. During follow-up evaluation, 2 patients began sympotimatic and were undergone to cholecystectomy. "Wait and see" management was performed in all asymptomatic cases. In only 2 cases ursodeoxycholic acid (UDCA) was administrated. CONCLUSION: Laparoscopic cholecystectomy is a "gold standard" also for a treatment of cholelitiasis in childhood; it is an efficacy and safe treatment also for pediatric gallstones. Medical therapy with UDCA lead not to dissolution of gallstones but it had a positive effect on the symptoms.

[Acute pancreatitis in pediatric age: our experience in 52 cases]. / Pancreatite acuta in età pediatrica: nostra esperienza su 52 casi.

AIM: The aim of this study was to report our experience about clinical presentation and management in children with mild and sever acute pancreatitis (PA). METHODS: At the onset of clinical manifestations the following laboratory and instrumental tests were performed to all patients: abdominal ultrasonography, measurement of blood amylase and lipase and PCR; preventive antibiotic therapy, gabexate mesylate and proton pump inhibitors were also administrated to all patients. During the follow-up CT and dosage amylase and lipase in blood were performed. RESULTS: Results summarize data of 52 patients with suspected diagnosis of acute pancreatitis admitted to our hospital within 24 h of symptoms (from January 2008 to December 2011). Age ranged between 4-18 years, and the study included 30 females and 22 males. According to Santorini Consensus Conference, 40 patients were defined having a mild and 12 a severe pancreatitis. All patients with mild PA underwent a medical and/or surgical treatment (endoscopic retrograde cholangiopancreatography, laparoscopic cholecystectomy); there were 2 fatalities between patients with severe PA and 2 cases of pancreatic pseudocyst treated with guided CT drainage and therapy with octreotide. All patients had abdominal pain but the location, severity and duration of pain were extremely variable. Blood dosage of amylase was altered in 83% of cases and of lipase in 100%. Ultrasonography showed abnormalities in 89% of the patients and TC showed alterations of pancreatic parenchyma in 100% of the cases when performed at 48 h. CONCLUSION: In absence of randomized controlled studies, systematic review or guidelines for diagnosis and management of PA in pediatric age we used our experiences on adult patients, aware of this approach limitation.