[Atypical intraperitoneal cystic masses]. / Masas quísticas intraperitoneales atípicas.

Omental, mesenteric and retroperitoneal cystic masses are very rare in pediatric population. They usually present as asymptomatic abdominal tumors and only occasionally a preoperative diagnosis is made. We presented 4 cases presented to our hospital during a 2-year period. All patients were male with an age ranged from 5 months to 7 years. Three patients had previous diagnosis of cystic mass by abdominal ultrasound. Three patients presented with acute abdomen and one patient with bowel obstruction. All patients underwent successful resection of the mass with no perioperative mortality.

Fístula aorto-esofágica por ingestión de batería de botón / Aorto-esophageal fistula due to ingestion of button battery

Introducción. La ingestión de cuerpos extraños es muy común en niños pequeños. En la mayoría de las ocasiones no hay consecuencias; sin embargo, en caso de que el cuerpo extraño ingerido sea una batería de botón, el efecto puede ser inclusive la muerte. Caso clínico. Los autores relatan el caso de un paciente preescolarque sufrió fístula aortoesofágica fatal por quemadura del esófago por una batería de botón ingerida. Discusión. Una vez que se instala la fístula, se manifiesta como una hemorragia gastrointestinal y colapso vascular. Conclusiones. Esta complicación es frecuentemente mortal (AU)

Introduction. Foreign body ingestion is frequently encountered in young children. In the majority of cases it will not lead to an adverse outcome. However, in case of coin battery ingestion more serious adverse outcomes, including death, have been reported. Case report. The authors report a patient in whom fatal aortoesophageal fistula developed after impaction of a button battery. Discussion. Once of aortoesophageal fistula occurs, it presents with typical large-herald upper gastrointestinal bleeding and cardiovascular collapse. Conclusions. This complication is frequently a lethal event (AU)

[Aorto-esophageal fistula due to ingestion of button battery]. / Fistula aorto-esofágica por ingestión de batería de botón.

INTRODUCTION: Foreign body ingestion is frequently encountered in young children. In the majority of cases it will not lead to an adverse outcome. However, in case of coin battery ingestion more serious adverse outcomes, including death, have been reported. CASE REPORT: The authors report a patient in whom fatal aortoesophageal fistula developed after impaction of a button battery. DISCUSSION: Once of aortoesophageal fistula occurs, it presents with typical large-herald upper gastrointestinal bleeding and cardiovascular collapse. CONCLUSIONS: This complication is frequently a lethal event.

[Ingested magnetic button. A rare cause of intestinal rupture]. / Botón magnetizado ingerido. Una causa rara de perforación intestinal.

Indoor wounds in infants probably represent widest range of minor lesions. However, there are casualties as consequence of falls, burns and ingestion of foreign bodies. Intestinal rupture due to ingested magnetic device is a very unusual event. We report the case of a four-month old female patient with this complication is presented. During first laparotomy intestinal rupture and magnetic buttons of cellular telephone as causal agent was found. Three days after operation, she required a second look due to cecum rupture. Primary reparation was performed. In order to demonstrate a pathogenic hypothesis, the bottom was put in a porcine bowel segment surrounding for a metallic jail, resulting in bowel rupture. We concluded that the ingested magnetic devices can produce intestinal rupture.

[Congenital duodenal obstruction: comparison of two corrective methods]. / Obstrucción duodenal congénita: comparación de dos métodos correctivos.

INTRODUCTION: There are few studies on congenital duodenal obstruction. The poor peristalsis of the proximal duodenum that causes functional obstruction is a well known problem that occurs in the immediate postoperative period. The optimum technique to address the problem is still controversial. OBJECTIVE: To compare the results obtained using two different surgical techniques to resolve congenital duodenal obstruction. PATIENTS AND METHODS: A five-year retrospective review of the neonates who underwent surgery for duodenal obstruction was undertaken. Two different surgical techniques were used: the Kimura operation and Heinecke-Mikulicz enteroplasty. The clinical characteristics, operative time, onset of oral feeding, hospital stay, complications and mortality were analyzed. The results of both groups were compared. RESULTS: Forty-one patients were included; 27 were operated on with the Kimura technique and 14 underwent Heinecke-Mikulicz duodenoplasty.Thirty-five patients had duodenal atresia (86%) and 6 (14%) an annular pancreas. All of them had post-Vater's papilla obstruction and 8 (20%) had trisomy 21. The clinical characteristics of both groups were similar. No significant difference was found in the operative time, onset of oral feeding and hospital stay. Eight patients in each group developed septicemia (30% in the Kimura group vs. 57% in the Heinecke-Mikulicz group, p = 0.16) and one patient in each group died (4% in the Kimura group vs.7% in the Heinecke-Mikulicz group, p = 0.78). CONCLUSION: The Kimura duodenal-duodenal anastomosis and Heinecke-Mikulicz duodenoplasty seem to be useful procedures to resolve congenital duodenal obstruction.

[Traumatic perforation of the small intestine in childhood]. / Perforación traumática del intestino delgado en la infancia.

INTRODUCTION: Traumatic perforation of the small bowel occurs in approximately 1 percent of children with either blunt or penetrating trauma to the abdomen. Difficulty in recognition of initial subtle signs of hollow viscus injury can lead to delay in both diagnosis and operative intervention. MATERIAL AND METHOD: Medical records for patients discharged with traumatic small bowel perforation from the General Surgery Department between 1991 and 1999 were reviewed. RESULTS: Bowel injuries were noted in 41 children. Blunt trauma (battered child syndrome, bike injuries, etc.), was responsible for 37 cases and penetrating wounds in three (firearm wounds and bike pedal accidents). There were 32 boys and a mean age of 6.8 years. The site of perforation was duodenal in four cases, jejunum in 21, and ileum in sixteen. Associated injuries occurred in 11 patients, including stomach, pancreas, liver, spleen, bladder, and ureter. Twenty-nine had simple closure, while seven were resected. Four children died. CONCLUSIONS: These injuries require prompt surgical intervention and are in general curable with excellent prognosis if one is alert to the possibility of their occurrence, if one is familiar with the approaches to prompt and accurate diagnosis, and if associated injuries are not serious.

[Bochdalek hernia with late manifestation. Relevant clinico-surgical features]. / Hernia de Bochdalek de expresión tardía. Aspectos clínico-quirúrgicos relevantes.

INTRODUCTION: Congenital diaphragmatic hernia presents after the first hours of life in 5 to 25% of cases. Presenting symptoms may be quite non-specific, and gastrointestinal rather than respiratory in origin. Bochdalek hernia should be considered when an infant has respiratory distress, vomiting and abdominal pain. MATERIAL AND METHOD: Five-year retrospective study was made of children with congenital posterolateral (Bochdalek) hernia presenting more than 10 days after birth. The records are of 17 patients. The group was divided in two subgroups. The first, was made up of four patients who had digestive emergencies and complications such as colon and gastric perforation. One infant of this group had a left sided defect and inflammatory hepatic-pulmonary fusion. The second group was made up of 13 patients between 2 weeks and four years og age. Main complaints were vomiting, abdominal pain, and respiratory distress. Ten patients were female and 10 had a left-side defect. Herniated viscerae were small bowel, stomach, spleen, and colon. There were six deaths. CONCLUSIONS: Bochdalek hernia in children after the newborn period is a common entity. Frequent digestive and respiratory signs are present. Complications such as colon and gastric perforation are common.

[Interstitial gastric emphysema in children]. / Enfisema gástrico intersticial en niños.

UNLABELLED: Gastric pneumatosis is an unusual clinical finding in infants and children and it appears in the three following similar conditions: pneumatosis cystoides; emphysematous gastritis, and gastric emphysema. MATERIALS METHODS AND RESULTS: The clinical pictures and radiographic appearance of this association are described in four patients in whom the clinical course made suspect interstitial gastric emphysema. Two patients had hypertrophic pyloric stenosis and two, unspecific erosive gastritis. In the first two patients, a Fredet-Ramstedt procedure was performed. All patients survived. Differential diagnostic considerations, the importance of correct radiological diagnosis, and the results of proper therapy are discussed. CONCLUSIONS: Pyloric and duodenal obstruction in infants is the main etiologic factor in gastric emphysema.

[Gunshot injuries in the pediatric area]. / Heridas provocadas por proyectil en el área de pediatría.

Gunshot and air weapon wounds in children have become a significant source of morbidity and mortality in our community in the last four years. Ninety five children, 15 years of age and younger, were admitted to the Pediatric Surgical Service for gunshot and air mechanism wounds during this period. Review of the circumstances of injury revealed that more than 50% were accidental 71% were male patients, and 65% were caused by gunshots and outside of the home. Thoracic region was affected in 42%; abdomen, 20%; skull, face and neck, 13.4%; lower extremities, 13.4%; upper extremities 9%; genitalia, 2.0%; and perineal region, 0.8%. Rapid resuscitation and triage of major injury allowed us a survival of 97%. Social service intervention and educational task can offer significant benefit to these children but, ultimately gun control laws with strict enforcement are needed to stop this type of violence toward children.

[The Peutz-Jeghers syndrome and intestinal invagination]. / El síndrome de Peutz-Jeghers e invaginación intestinal.

Peutz-Jeghers syndrome is a autosomal dominant disorder characterized by hamartomatous polyposis of the gastrointestinal tract and mucocutaneous melanin pigmentation. This condition can occur and cause symptoms at any age, but intestinal obstruction due to intussusception is a frequent complication. Two cases of this syndrome associated to intussusception are reported. Both patients were girls, 2 and 8 years old respectively and underwent surgical treatment.

[Appendicitis in children under 3]. / Apendicitis en niños menores de tres años.

There are many differences between acute appendicitis in the older child and the infants. An understanding of the under three years of age child's response to intra-abdominal infection in contrast to that of the older child and an appreciation for the supportive treatment of the child are vitally important in further lowering the morbidity of young children with acute appendicitis. The purpose of the present study was to investigate the factors contributing to the high perforation rate seen in this age group. A retrospective analysis was done in 88 patients under the age of three who underwent appendectomy. These patients ranged from 4 and 35 months in age. There were 51 (77.4%) male patients. The main complaints were fever, pain and vomiting. Duration of symptoms was more than 24 hours in 80%. Abdominal radiographs showed signs of small bowel obstruction. Peritonitis was found in the majority of the cases (90%). overall morbidity was 31.8% and mortality 1.1%. These data suggest that duration of symptoms is directly proportional to complications rate.

[The split notochord syndrome. A report of 2 cases]. / Síndrome de notocorda hendida. Informe de dos casos.

Split notochord syndrome has been described in several previous case reports; however, we recently treated two patients with a previous undescribed variant of this syndrome. A 2,800 g male baby was admitted to the neonatal patients room with a non covered mass on the lumbo-sacral region, and a portion of intestine, with meconium being passed attached to it the legs were equine-varus and the anus was absent. Radiographs were consistent with a double spine defect (lumbar and sacral split notochord), and the patient was taken to the operating room for closure. A 2,600 g male baby was first seen in other hospital, and was admitted with a circular defect in the mid-line of the lumbosacral region. This defect was conformed by knee, leg, ankle and fingers. Radiographs showed bony structures consistent with incomplete lower extremity. During surgery, the skin overlying the mass was excised, showing a wide spine defect including stomach, duodenum, jejunum, ileum and colon, covered by a peritoneal membrane; there was not communication between this structure and the normal digestive tract.