Pediatric abdominal chylolymphatic cysts-sneaky abdominal masqueraders.

Chylolymphatic mesenteric cyst of the abdomen is a rare differential for cystic tumors, more so in the pediatric age group and has varied clinical pres- entations.There have been very few cases reported worldwide. To the best of our knowledge, a multicystic chylolymphatic cyst of the abdomen as demonstrated below is the first reported occurrence worldwide in the paediatric age group.

Pediatric abdominal chylolymphatic cysts: Sneaky abdominal masqueraders.

Chylolymphatic mesenteric cysts of the abdomen is a rare differential for cystic tumors, more so in the pediatric age group, and they have various clinical presentations. There have been very few cases reported worldwide. To the best of our knowledge, a multicystic chylolymphatic cyst of the abdomen as demonstrated below is the first reported occurrence worldwide in the pediatric age group. We herein report the case of a 1-year-old who presented to us with gradual distension of the abdomen for 4 months with occasional episodes of vomiting and a lobulated cystic abdominal mass on palpation. He was mistakenly treated with anti-tuberculous treatment for suspected loculated ascites. The imaging revealed a multiloculated mass in the abdomen in close relation to the small bowel. He was also worked up for tuberculosis, and the findings were negative. Laparotomy revealed multiple cysts closely applied to the jejunum, starting at 4 cm from the duodenojejunal flexure, which was resected and anastomosed. To the best of our knowledge, this is the first reported case of an abdominal chylolymphatic cyst occurring as a chain of multiple cysts in the pediatric age group, and we want to emphasize the importance of further imaging in a case of suspected loculated tuberculous ascites as this is a differential diagnosis with a treatable surgical option. Surgical excision of these cysts should be done in toto as an individual excision of each of these cysts in an attempt to preserve the bowel length may end up jeopardizing the blood supply of the affected bowel.

Intestinal obstruction with a twist: a rare case of congenital portal vein aneurysm causing intestinal obstruction.

Bilious vomiting is often a presenting feature of upper intestinal obstruction in newborn. We present a case of intestinal obstruction in a newborn baby caused by abnormal vascular band arising from portal vein aneurysm in association with a midgut volvulus. Congenital anomalies of portovenous system are very rare, and it usually presents with portal hypertension in late infancy or childhood. In this particular child, the portal vein aneurysm contributed to intestinal obstruction due to both a failure of intestinal rotation and a mechanical band over the transverse colon.

Coexistent duplication of urethra and a refluxing ectopic ureter presenting as recurrent epididymo-orchitis in a child.

Congenital anomalies of the kidney and urinary tract (CAKUTs) occur in 3-6 per 1000 live births, accounting for most cases of paediatric end-stage kidney disease.1 However, the molecular basis of CAKUT and anomalies of the external genitalia is poorly understood. We, herein, describe a case with left recurrent epididymo-orchitis with a coexistent urethral duplication and an ectopic ureter with an ipsilateral non-functioning kidney, which is, to the best of our knowledge, the first reported case of its kind. This case may bring about a paradigm shift in our comprehension of the development of the two entities. Understanding the pathogenesis may help develop preventive and renal preservation strategies. The Sonic hedgehog gene and bone morphogenetic protein 4 play crucial roles in preventing anomalies of the ureters and the external genitalia. In this article, we look at possible molecular pathways that could explain the synchronicity of this rare entity.

Twisted intra-abdominal cyst in a neonate: a surprise revelation.

We, herein, present a male neonate with an antenatally detected intra-abdominal cyst who presented at 18 days of life at which time, the ultrasound revealed a 5×4 cm cyst. Since he was asymptomatic, we planned to repeat the ultrasound a month later and operate if the cyst showed no regression. However, a week later, he presented with an acute abdomen, irritable cry and a repeat ultrasound showing a larger (8×6 cm) cystic mass with debris within. He was taken up for an emergency laparotomy. Intraoperatively, the cyst was found arising from the left lateral abdominal wall free from all structures with a twisted pedicle. Histopathology surprisingly revealed seminiferous tubules within the cyst wall with the vas deferens, thus confirming the diagnosis of a torsion of intra-abdominal testis. Hence, we emphasise the importance of examining for an undescended testis when dealing with a male neonate presenting with a cystic intra-abdominal mass.