A Rare Case of a Giant Choledochal Cyst in a Caribbean Infant.

Choledochal cysts are uncommon dilatations of the biliary tree. Giant choledochal cysts are those that exceed a maximum diameter of 10cm. Our case describes a female infant who presented to our paediatric surgery department with a three-day history of vomiting, abdominal distention, pale stool, and irritability. On palpation, she was found to have a large abdominal mass and the computed tomography (CT) scan showed a giant choledochal cyst. The patient underwent laparotomy with cholecystectomy, choledochal cyst drainage and complete excision, with hepaticojejunosotomy. At the last follow-up three years post-surgery, all growth parameters and liver enzymes were within normal ranges. To the best of our knowledge, this is the first documented case of a giant choledochal cyst in the paediatric Caribbean population.

Retrograde Intussusception and Giant Meckel's Diverticulum: An Uncommon Encounter.

Retrograde intussusception (RINT) and giant Meckel's diverticulum (MD) are both rare pathologies and are seldom encountered in surgical practice. Thus, it is exceptional for both conditions to be seen in the same patient, with very few published case reports in the paediatric population. This case describes a three-month-old male who was referred to our paediatric surgery unit following a diagnosis of intussusception on an ultrasound scan. The patient presented to the paediatric emergency department one day prior with a clinical history of fever, cough, vomiting and irritability. After resuscitation, the patient was admitted for overnight observation in the paediatric ward. However, the patient's symptoms persisted with notable abdominal distension. Abdominal X-ray (AP erect) showed features of small bowel obstruction, while abdominal ultrasound showed a concentric mass in the right upper quadrant consistent with intussusception. Following this diagnosis of intussusception, pneumatic enema reduction under ultrasound guidance was attempted but proved unsuccessful. The patient was then taken for emergency laparotomy. At surgery, an ileo-ileal RINT with a proximal giant MD was discovered. Successful manual reduction of the RINT and wedge resection of the giant MD with primary ileo-ileal anastomosis was performed. The postoperative recovery and follow-up were uneventful.

Minimally Invasive Parathyroidectomy in a Child With Acute Pancreatitis.

Acute pancreatitis (AP) is rarely seen in the paediatric population and is typically not associated with those aetiologies seen in adult pancreatitis. This case describes a 12-year-old female who presented with acute abdominal pain and constipation, with biochemical evidence of elevated serum amylase, calcium (Ca) and parathyroid hormone (PTH) levels. A diagnosis of AP was made, which was settled with conservative management. Further investigations, namely CT and technetium 99m (Tc-99m) sestamibi scans, revealed a solitary parathyroid adenoma. She subsequently underwent minimally invasive parathyroidectomy (MIP), following which Ca and PTH levels normalized postoperatively.