Hepatic hemangiomas in infants and children: a review of 30 cases.

From 1958 through 1992, 30 patients with hepatic hemangiomas were seen and treated at Children's Hospital Los Angeles. The majority of the patients were less 1 month of age (90 % younger than the first year of life) and there was no difference in sex distribution. Patients presented with coagulopathy, heart failure, abdominal mass, and respiratory distress. Eleven patients (33%) had hemangiomas in other sites. Fourteen patients were treated with steroid therapy. Of these, eight patients did not respond and received radiotherapy. Eleven patients who had the hemangioma confined to an anatomical lobe had resection of the hemangioma by liver lobectomy. Five of the most recent patients were successfully treated with hepatic artery embolization. Two other patients who were seen many years ago underwent diagnostic laparotomy and biopsy of the lesion before treatment with steroids. In one patient who presented with ruptured hepatic hemangioma, hepatic arterial ligation was performed. In another patient, seen recently, treatment with interferon alpha-2 was initiated, but the patient died. There were six deaths in the series. Four patients died of intractable congestive heart failure, steroids are given first. Course of steroid therapy may be repeated if necessary. Whereas formerly radiation therapy was added to the treatment of a patient resistant to steroids, therapeutic hepatic arterial embolization is a very good alternative for these patients. Surgical excision of the lesion can be performed by liver lobectomy if there is a solitary hemangioma within the boundaries of the surgical excision. Recently, in massive hemangioma with intractable thrombocytopenia, interferon alpha-2 therapy has been used, but so far our experience of this mode of therapy is limited.

Benign mesenchymoma of childhood: a case report.

The authors describe an unusual case of benign mesenchymoma of the groin in a 9-month-old boy.

Duplications of the alimentary tract in infants and children.

Duplications of the alimentary tract are rare congenital anomalies that could present a diagnostic as well as therapeutic challenge. Twenty-seven patients with duplications of the alimentary tract were treated at Childrens Hospital Los Angeles between 1961 and 1992. Ages ranged from a few days to 5 years (67% younger than 1 year). The most common symptoms were nausea and vomiting, and the most common sign was a palpable abdominal mass. Three patients presented with gastric duplication, which was excised. The majority of the duplications were in the jejunum and ileum. All patients except one had primary resection of the duplication. One patient with a 45-cm tubular jejunal duplication was treated with mucosal stripping of the duplication. Five patients had cecal duplication, three patients presented with melena because of ectopic gastric tissue in the duplication, and two presented with intestinal obstruction. One of the latter patients presented with intussusception with cecal duplication as the leading point. Three patients with colonic duplication presented with abdominal pain and vomiting leading to excision of the duplication. Of the five patients with rectal duplication, three presented with chronic constipation. The other two patients presented elsewhere with perianal swelling, which eventually was drained because of a mistaken diagnosis of perianal abscess. Subsequently, these two patients came to us with persistent perineal fistula. In all our patients, rectal duplications were removed through a sacroperineal incision. The only patient in this series who died was a 6-week-old boy with gastric duplication; his death was attributed to an associated severe cardiac lesion.(ABSTRACT TRUNCATED AT 250 WORDS)