Symptomatic splenic hamartoma: case report and literature review.

An 11-year-old girl with low-grade fever, night sweats, thrombocytopenia, and an 8-year history of progressive splenomegaly underwent an elective splenectomy. Pathologic diagnosis was multiple splenic hamartoma. The patient's symptoms resolved after the splenectomy. Since first described by Rokitansky in 1861, approximately 140 cases of splenic hamartoma have been described in the literature. Most of the splenic hamartomas were discovered incidentally. A minority of these lesions were associated with hematologic symptoms such as pancytopenia, anemia, and thrombocytopenia. Only 20 of the reported cases of splenic hamartoma occurred in pediatric patients. However, compared with the adult patients, nearly half of these cases in pediatric patients was associated with symptoms. Splenectomy and partial splenectomy have relieved these symptoms. With advances in imaging, splenic hamartomas are being discovered with increasing frequency. A multimodal radiologic work-up has enabled some cases of splenic hamartoma to be diagnosed preoperatively. Inclusion of this benign entity in the differential diagnoses of symptomatic splenomegaly in a pediatric patient is important in the preoperative management and counseling of the patient and family. In patients who have discrete lesions, consideration of this entity preoperatively may avoid total splenectomy.

Neuroblastoma of the thoracic inlet.

The case of a 5-month-old girl with a large neuroblastoma of the thoracic inlet, an unusual location for this tumor, is presented. The patient had marked airway compromise due to tumor compression, with extension of the mass through the thoracic inlet into the base of the neck, also incorporating the right subclavian artery. The highly unusual location of this tumor is presented, and challenging technical aspects of its management are discussed.

A technique of airway management in children with obstructed airway due to tumor.

Airway management of patients with tracheobronchial compression due to mediastinal masses poses a difficult problem. A new technique of direct vision endotracheal intubation is described, and other adjunctive measures are reviewed.

Continual catheter administration of an elemental diet in infants and children.

Elemental diet offers a safe, simple, widely applicable technique for providing nutritional support in infants and children, thus protecting them against the hazards of malnutrition. Continual catheter administration of elemental diet provides an avenue of nutritional support free of many of the complications associated with total parenteral nutrition. Although mechanical and metabolic complications were avoided by rigid protocol compliance in our group of over 150 patients, further metabolic studies may suggest minor compositional changes providing a more optimal diet for premature and newborn infants.

Splenectomy in children. A correlative review of indications and complications in fifty patients.

We have reported our experience with splenectomy in fifty patients less than fourteen years old. The indications, results, and complications were enumerated. These data were then correlated with the recent literature regarding pediatric splenctomy. Of special note is the problem of immunologic incompetency associated with splenectomy in the patients less than five years old.

Gallbladder disease in children and adolescents.

Seventy-nine patients, twenty years old or younger, with cholecystitis underwent cholecystectomy during a five year period at Santa Rosa Medical Center. There was a considerable delay in diagnosis in many cases. Etiologic factors differed with race and age; however, the disease appears to be quite similar in adolescents and adults. Hemolytic disease was present in all five blacks but in none of the remaining seventy-four patients. Patients younger than ten years of age are more likely to have congenital anomalies or infectious etiologies for the gallbladder disease. Cholecystectomy was associated with minimal morbidity and no mortality in this series. Cholecystitis should be considered early in the child or adolescent with unexplained abdominal pain, and oral cholecystograms proved to be a safe and reliable method of diagnosis.

Gallbladder disease in the young male.

Eighteen of 2,614 patients undergoing cholecystectomy in two large general hospitals were males between the ages of two and twenty years. The great majority presented with a typical symptoms of cholecystitis. Ten of the eighteen had idiopathic cholelithiasis, with no predisposing factors generally associated with an increased incidence of this disease. This diagnosis must be kept in mind in dealing with patients of this age group.