Wilms tumor in a left pelvic kidney: A case report.

INTRODUCTION: Wilms tumor(nephroblastoma) is the most common renal tumor in childhood.The most frequent anomalies and syndromes associated with this tumor involve the genitourinary tract. The occurrence of Wilms tumor with renal ectopia is rare.When present,Wilms tumor is usually found in association with other forms of renal ectopia like horseshoe kidneys or crossed fused renal ectopia. However, reports of the occurrence of Wilms tumor in unilateral pelvic renal ectopia is uncommon. We report a case of Wilms tumor in a pelvic left kidney. PRESENTATION OF CASE: A 10 year old girl presented to the out-patient department with a one year history of lower abdominal mass, pain and hematuria. Examination revealed a mass in the suprapubic region. Radiological investigations showed a tumor in a left pelvic kidney. She was managed with preoperative chemotherapy, surgery and adjuvant chemotherapy. Histopathologic examination of the nephrectomy specimen confirmed the diagnosis of nephroblastoma. DISCUSSION: The occurrence of Wilms tumor in association with renal ectopia is rare. There are few reports of tumors arising in unilateral pelvic ectopic kidneys. A multi-modal treatment approach involving the use of chemotherapy, surgery and radiotherapy (for high-risk tumors) in the management of Wilms tumor gives good outcome. CONCLUSION: Tumors arising from a pelvic kidney should be considered as part of the differential diagnosis of lower abdominal masses in children.

PNEUMATIC REDUCTION OF INTUSSUSCEPTION IN CHILDREN: EXPERIENCE AND ANALYSIS OF OUTCOME AT JUTH, JOS, A TERTIARY HEALTH CENTRE IN NORTH CENTRAL NIGERIA.

CONTEXT: Intussusception is a common childhood abdominal surgical emergency worldwide resulting in considerable morbidity and mortality if not promptly treated. Ultrasound-guided pneumatic reduction has been proven to be the most reliable and successful non-operative management option with the least complication rate. AIMS: To evaluate our local experience with the ultrasound-confirmed pneumatic reduction of childhood intussusception and to determine factors that predict successful outcome. SETTINGS AND DESIGN: A retrospective study of children less than 2 years old who presented to our facility with uncomplicated idiopathic intussusceptions between June, 2012 and June, 2017. MATERIALS AND METHODS: The clinical diagnosis was confirmed by abdominal ultrasonography. Pneumatic reduction with a locally assembled equipment was performed on selected and resuscitated patients; abdominal ultrasound scan was then performed to confirm successful reduction. The procedure was considered to have failed if unsuccessful after the third attempt. Laparotomy was performed on patients with failed procedure. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences version 24 was used for data analysis. Categorical variables were compared using Fisher exact test (with odds ratios and 95% confidence intervals where appropriate) and numeric variables compared using the student t-test. Statistical significance was set at p< 0.05. RESULTS: Twenty five out of 36 children with intussusception were selected for the procedure with M:F ratio 1.8:1 and a mean age of 7.08 (SD 4.18) months. Only 9 (36%) presented early (ie within 24 hours). While non-bilious vomiting was the commonest symptom, blood-stained finger on rectal examination was the commonest sign in the patients. The overall success rate was 60% (15 patients). Early presentation accounted for only 5 (33%) of successful procedures. The presence of an abdominal mass was associated with increased likelihood of success (OR 9.75,[95% CI [1.38-68.78], p≥0.022), while the presence of a rectal mass was associated with a reduced likelihood of success (OR 0.16 95%CI [0.026-0.917], p≥0.042 ). Age, sex, and duration of symptoms before presentation did not influence outcome. Early presentation was however significantly associated with success at first attempt, compared to late presentation, in those with successful outcomes. Recurrence was observed in one (6.7%) of the successful cases. The mean duration of hospital stay in those that had successful outcome, 3.4(SD1.0) days was significantly shorter than that for those who had laparotomy for failed reduction, 8.0(SD3.1) days (p<0.001). There was no bowel perforation and no mortality recorded. CONCLUSIONS: The successful pneumatic reduction rate was 60%. The major predictors of success in this study were the presence of abdominal mass and the absence of intussusception apex in the rectum. Early presentation was significantly associated with success at first attempt, compared to late presentation, in those with successful outcomes. There was no bowel perforation or mortality. Ultrasound-confirmed pneumatic reduction of intussusception is a simple, easy, safe and effective non-operative management of uncomplicated intussusception in well selected children in our environment.