Primary hepatic carcinoid tumor in children.

Primary carcinoid tumors of the liver are rare, with fewer than 60 cases currently reported in the English literature. We present the evaluation and management of a solid hepatic tumor in a 14-year-old boy. Intraoperative biopsy was indeterminant for malignant potential, and the patient underwent complete resection by left hepatic lobectomy. Final histopathologic evaluation of the mass revealed a carcinoid tumor. Extensive endoscopic and radiologic workup revealed no other primary source. The patient recovered well from surgery and is currently free of disease 32 months after initial resection. Review of the literature suggests that primary hepatic carcinoid tumors are particularly rare in children. As the liver is frequently a site for carcinoid metastasis from the gastrointestinal tract, any patient with a suspected primary hepatic carcinoid tumor must undergo an extensive search for an extrahepatic primary site. These tumors are typically indolent but may metastasize. In addition, medical therapy is of limited benefit in reducing tumor bulk. The mainstay for treatment of primary hepatic carcinoid tumors is surgical resection, and these tumors carry a more favorable prognosis than other primary hepatic malignancies and metastatic carcinoid. Follow-up is long-term, as these tumors can recur many years after initial resection.

Primitive neuroectodermal tumor of the sternum in a child: resection and reconstruction.

Pediatric primary malignancies of the sternum are rare. They represent less than 1% of all bone tumors. Primitive neuroectodermal tumor of the chest wall or Askin's tumor is more often seen in the ribs than in the sternum. Surgical treatment involves resection of the tumor followed by primary reconstruction. We report the case of a 16-year-old adolescent boy who was diagnosed to have primitive neuroectodermal tumor of the sternum and underwent resection with primary reconstruction of the anterior chest wall. We describe for the first time the use of a 2-mm Gore-Tex Dualmesh plus biomaterial (W.L. Gore and Associates, Flagstaff, Ariz) and locking mandibular multiperforated titanium plates with screws (Stryker-Leibinger, Freiburg, Germany) for primary sternal reconstruction in a child. Despite having a wide resection, he did not require postoperative ventilation and had an uncomplicated recovery. The reconstructed chest wall has a normal contour with normal pulmonary physiology.

Multiple foreign body ingestion and ileal perforation.

Foreign body ingestion is a common problem encountered in the pediatric age group. The swallowed object is often passed with little or no morbidity. Problems ensue if the ingested foreign body is hazardous, is multiple, or becomes impacted. We describe an ileal perforation following the ingestion of an alkaline disc battery, a magnet, and a steel ball impacted in the ileum for about 48 h. The magnet and the steel ball were attracted to each other, forming a composite unit. The disc battery and the magnet were attracted to each other across a loop of ileum, causing necrosis and perforation of the ileum.

Appendicitis with perforartion in a neonate.

Appendicitis is a very rare clinical entity in neonates. Preterm and male neonates are commonly affected. It is often seen in association with surgical conditions like Hirschsprung's disease and necrotizing enterocolitis. Non-specific clinical features result in delay in the diagnosis and predisposes to perforation. The risk of perforation is very high (85%) in neonatal appendicitis. Management includes pre-operative stabilization, appendicectomy and peritoneal drainage in cases of perforation with peritonitis. Prognosis is uniformly poor with mortality rate as high as 70%. Herewith reporting a neonate with multiple perforations who was successfully managed.

Colonic fistula complicating electric burns--a case report.

Intestinal fistula is an uncommon complication of electric burns. The authors report the case of an 11-year-old child who sustained accidental burns from a high-voltage electric current and was admitted to their hospital with full-thickness burns of both the upper limbs and deep burns of the anterior abdominal wall. Staged surgery was required, and the authors were involved in the management of the burn of the anterior abdominal wall. Laparotomy was done because omentum was found prolapsing out of the abdominal wound. Three scattered areas of subserosal burn of the small bowel were noticed, which required no intervention. The rest of the viscera all were normal. During the course of his stay, he had a fecal fistula on the 19th postburn day, which was found to be from the transverse colon. Conservative management of the fistula with total parenteral nutrition for 23 days resulted in complete healing.

Hunt-Lawrence pouch after total gastrectomy: 4 years follow up.

A 12-year-old boy had undergone total gastrectomy for gastric volvulus with subsequent severe weight loss and malnutrition. A Hunt-Lawrence pouch was constructed to provide gastric reservoir capacity and the child at 4-years follow-up has regained near normal weight for his age and is attending to school and other activities.

Intrapancreatic gastric duplication cyst presenting as lower gastrointestinal bleeding.

This report describes a rare foregut malformation of a noncontiguous gastric duplication cyst embedded within the body and tail of the pancreas. An 8-month-old boy presented with massive malena of 3 days' duration. The laparotomy showed an intrapancreatic cyst with bleeding and ulcer perforation into a loop of adherent jejunum. Histologically, the cyst contained gastric mucosa. This is believed to be the first reported instance of an intrapancreatic gastric duplication causing massive lower gastrointestinal bleeding in an infant.