Assuntos
Anormalidade Torcional , Baço Flutuante , Humanos , Baço Flutuante/cirurgia , Baço Flutuante/complicações , Baço Flutuante/diagnóstico por imagem , Anormalidade Torcional/cirurgia , Anormalidade Torcional/diagnóstico , Criança , Feminino , Masculino , Baço/anormalidades , Baço/diagnóstico por imagem , Esplenopatias/cirurgia , Esplenopatias/diagnóstico por imagemRESUMO
Összefoglaló. A splenogonadalis fúzió ritka fejlodési rendellenesség, melynek lényege az ivarmirigy (leggyakrabban a here) és a lépszövet rendellenes kapcsolódása. A szerzok egy féléves csecsemo esetét kívánják bemutatni, akinél már a megszületést követoen észlelheto volt a bal oldali here megnagyobbodása. A mutét elotti képalkotó vizsgálatok (ultrahang, MRI), a fizikális vizsgálat és az intraoperatív lelet a splenogonadalis fúzió lehetoségét vetette fel. A mutét során a makroszkóposan lépszövetnek imponáló elváltozás eltávolításra került, majd rutinorchiopexia történt. A hisztológiai vizsgálat alátámasztotta a feltételezett diagnózist. Az entitást 1883-ban írták le eloször, azóta kevesebb mint 200 esetrol számoltak be az angol nyelvu irodalomban. Az utóbbi 30 évben magyar szerzoktol egy közlemény jelent meg. Az elváltozás a banális szülési trauma okozta haematomára, újszülöttkori heretorzióra, malignus heretumorra is hasonlíthat, komoly differenciáldiagnosztikai problémát okozva. A splenogonadalis fúzió jóindulatú elváltozás, a helyes diagnózis esetén elkerülheto a felesleges orchiectomia. Orv Hetil. 2022; 163(7): 288-290. Summary. Splenogonadal fusion is a rare congenital malformation specified as the presence of splenic tissue connected to the gonads (mainly testis). The authors present the case of a 6-month-old male infant, in whom left inguino-scrotal mass was noticed soon after birth. The mass, based on preoperative diagnostic setup (ultrasound, MRI), physical examination and intraoperative findings were suspicious for splenogonadal fusion. At surgery, the mass was resected from the testis, which macroscopically resembled a splenic tissue. Following the resection, orchiopexy was performed. Histology confirmed splenogonadal fusion. Since the first description of the malformation in 1883, only less than 200 cases have been reported in the English literature. Only a single article has been published in Hungary in the last 30 years. Splenogonadal fusion represents a serious differential diagnostic problem. Hematoma caused by trauma, neonatal testicular torsion, benign or malignant testicular tumors may also present similarly. In our case, proper presumptive diagnosis made it possible to avoid unnecessary orchiectomy. Orv Hetil. 2022; 163(7): 288-290.
Assuntos
Imageamento por Ressonância Magnética , Neoplasias Testiculares , Humanos , Lactente , Recém-Nascido , Masculino , Orquiectomia , UltrassonografiaRESUMO
Primary peritonitis is very rare in healthy children without predisposing factors. In the absence of unique factors and signs, the clinical picture does not differ from secondary peritonitis. Therefore, the diagnosis is almost always an intraoperative diagnosis. Case report: We admitted a previously healthy 15-year-old boy with symptoms of acute enteritis. Within 24 hours, he developed acute abdomen and signs of septic shock. Computer tomography of the abdomen revealed air bubbles in the middle of the abdomen and near the terminal ileum. Suspecting perforation, we performed an emergency laparotomy. However, there was no perforation to be found in the background of the purulent peritonitis. We initiated empirical broad-spectrum antimicrobial therapy which we later adjusted. Septic shock and complications were treated successfully. We could not find the source of the primary peritonitis. Since hospital discharge, the child has been asymptomatic. In primary peritonitis, due to the nonspecific, rapidly progressing symptoms, an emergency surgery can not be avoided. With proper antibiotics and supportive therapy, the prognosis is favourable. Orv Hetil. 2020; 161(23): 977-979.
