Laparoscopic management of obstructive hepatoduodenal adhesions after open antireflux procedure.

The case of a 3-year-old child who underwent open antireflux surgery for severe gastroesophageal reflux is presented. One month after the procedure, the child presented with abstinence from feeds, and vomiting after food intake. Esophagogastroscopy ruled out pathology in the area around the wrap. Upper gastrointestinal contrast studies demonstrated a kinking of the duodenal loop. Laparoscopy revealed severe adhesions between the duodenum and liver with kinking of the duodenum. The adhesions were taken down with careful dissection using hooked laparoscopic scissors. The symptoms subsided immediately after surgery and the further course and follow-up examinations were uneventful. The complication of mechanical ileus due to hepatoduodenal adhesions with severe kinking of the duodenum after antireflux surgery and with successful laparoscopic management has never been reported to date.

Advantages of fibrin glue spray in laparoscopic liver biopsies.

Fibrin glue has been shown to be a highly effective adjuvant in surgical repair. We present the case of a 14-year-old boy, who was operated on a right side abdominal neuroblastoma at the age of 4 years. The regular follow-up examinations later on were uneventful; however after 10 years, focal lesions were observed on the surface of the liver, which were confirmed by computer tomograms. To rule out further malignancy and histologically investigate the lesions, laparoscopic biopsy of the affected sites of the liver was performed. After obtaining the biopsy samples, the sites were sealed with fibrin glue using the special laparoscopic spray applicator head. The spray technique of sealing liver biopsy sites was found to be more effective and economical than the traditional technique of fibrin glue application. The advantages of spray application for parenchymatous organ intervention in the laparoscopic setting have been elaborated.

Frasier syndrome in a pre-menarchal girl: laparoscopic resection of gonadoblastoma.

Frasier syndrome (FS) is characterized by male pseudohermaphroditism, slowly progressing nephropathy, and frequent development of gonadoblastoma. These patients are, however, often diagnosed when evaluated for primary amenorrhea. We report the case of FS in a pre-menarchal girl at the age of 6 years. Ultrasound examinations were performed and were inconclusive as to the presence or size of the gonads. Diagnostic laparoscopy was performed and the presence of bilateral streak gonads was documented and a bilateral salpingo-oophorectomy was performed. The postoperative course was uneventful. Histological examination of the streak gonads confirmed the presence of gonadoblastoma. To our knowledge, this is the first case in the literature of a pre-menarchal patient diagnosed with FS and a laparoscopic bilateral gonadoblastoma resection. Laparoscopic aspects regarding safe streak gonad removal in the pediatric population have been elaborated.

Laparoscopic resection of solitary congenital liver cyst in a neonate.

Solitary congenital liver cysts are a rare finding and present a challenge in the diagnosis. Routine prenatal ultrasounds confirmed the presence of an isolated cystic mass in the upper abdominal cavity of a fetus during the third trimester of gestation. Ultrasound examination performed after birth confirmed the presence of a floating cyst in the upper abdomen. Laparoscopy was performed on the 12th day to confirm the diagnosis using a 2.7 mm scope and instruments. Using a monopolar hooked cautery, the cyst was resected free from the liver surface without any complication. The postoperative course was uneventful. Histopathologic analysis demonstrated a true liver cyst with a mesothelial lining and hepatic residues. To our knowledge, this is the first case reported in literature where a solitary liver cyst was resected using minimal invasive techniques in a newborn.

Look twice before you clamp: decapitation of an omphaloenteric duct. A case report.

OBJECTIVE: To report a case of accidental decapitation of a persistent omphaloenteric duct (POD) in congenital hernia of the umbilical cord in a newborn male. CASE PRESENTATION AND INTERVENTION: The newborn was transferred to an intensive care unit, where under closer inspection the diagnosis of an omphalocele was presumed. Surgical exploration at our Pediatric Surgical University Clinic revealed a clamped and decapitated POD in the umbilical cord. The decapitation had gone unnoticed due to severe asphyxia resulting from meconium aspiration encountered at the time of delivery. Using general anesthesia, the clamp was removed under sterile conditions. The decapitation of the POD in the herniated umbilical cord was confirmed at this time. The severed intestine was sutured and closed using 5-0 Vicryl sutures. The further course was uneventful. CONCLUSION: Herniation of the umbilical cord at the time of birth by intestinal loops or POD is rare, but caution should be taken by midwives before clamping in order to avoid the type of injury seen in this case.

Experience with management of anterior abdominal wall defects using bovine pericard.

During 5 years from 1999 until 2003, our experience with 29 (100%) neonates managed for anterior abdominal wall defects is presented. Twenty-one (72%) neonates presented with gastroschisis and 8 (28%) neonates with giant omphaloceles. The male:female ratio was almost equal in gastroschisis (1:1) while a male predominance was observed in omphaloceles (6:1). A primary closure of the defect was possible in 5 (17%) cases and a single patch along with skin closure was achieved in a further 9 (31%) cases. In 15 (52%) neonates the defect was large and two patches were employed to sufficiently cover the defect. All patients (97%), except one (mortality due to extreme prematurity), were managed successfully. Depending upon the size of the defect and the metabolic condition of the neonate, the defect closure was completed after a mean of 85.7 days. Special protocols were created to manage the bovine pericard patches, which behaved differently to lyophilized dura patches previously used at our center. Integration of the patches was successful in 28 (97%) neonates; however, one neonate with gastroschisis presented significant challenges in the management. Bovine pericard patches are optimal biomaterials for the closure of anterior abdominal wall defects in gastroschisis and omphaloceles.

Giant pedunculated lipofibroma of the elbow.

Lipofibromas are rare hamartomatous lesions almost exclusively involving the medial nerve and have been reported to date only in the adult population. The case of a giant pedunculated lipofibroma involving the radial nerve in the elbow of a 1-year-old child is presented.

Unusual case of needle embodiment in talar neck.

An unusual case of a needle head injury, with deep embodiment of the needle head in the neck of the left talus bone is presented. The needle head was removed at our centre after two previous unsuccessful surgical attempts at other hospitals. The mechanism of trauma and the surgical procedure has been described.