[Neonatal intestinal obstruction due to cecal duplication]. / Obstrucción intestinal neonatal secundaria a duplicación cecal.

INTRODUCTION: Cecal duplications are rare, representing 0.4% of all gastrointestinal duplications, with few cases reported in the literature. CLINICAL CASE: A 48 hours-old newborn presented with bilious vomiting and abdominal distension; the ultrasound revealed a cystic mass in the right abdomen; ileocolic resection was performed with end to end anastomosis. Microscopy confirmed cecal duplication cyst. COMMENTS: In patients with intestinal obstruction, contrast enema allows differential diagnosis with other colonic pathologies in the newborn; when the cecal duplication cyst is connected to the lumen of the colon, enema reveals a filling defect, and cecal duplication can be suspected. Although cystic lesions are asymptomatic, they should be excised when detected to prevent complications.

INTRODUCCION: Las duplicaciones de ciego son patologías poco frecuentes, representando el 0,4% de las duplicaciones intestinales, existiendo pocos casos publicados. CASO CLINICO: Presentamos un caso de una recién nacida de 48 horas de vida con vómitos biliosos y distensión abdominal; en las pruebas de imagen, se observa una masa quística de 30 mm de diámetro en flanco derecho; en la laparotomía se comprueba una tumoración quística localizada en ciego; se realiza resección ileocólica con anastomosis término-terminal. El estudio anatomopatológico confirma la existencia de un quiste de duplicación cecal. COMENTARIOS: En pacientes con obstrucción intestinal, el enema opaco permite realizar el diagnóstico diferencial con otras patologías cólicas del periodo neonatal; cuando el quiste de duplicación cecal no se encuentra comunicado con la luz del colon, se puede observar un defecto de repleción, lo que junto con otras pruebas y la clínica, nos puede hacer sospechar duplicación cecal. Se recomienda realizar una intervención quirúrgica temprana, incluso en pacientes asintomáticos, para disminuir la morbilidad.

Testículo no palpable: laparoscopia o inguinotomía / Nonpalpable testes: laparoscopy for inguinotomy

Introducción. El testículo no palpable hace referencia a la imposibilidad de objetivar el teste mediante maniobras exploratorias. Estos pacientes se han beneficiado del abordaje laparoscópico ya que anteriormente podían requerir incluso una laparotomía. El tratamiento definitivo del teste no palpable depende de los hallazgos laparoscópicos, estando en controversial a resolución en uno o en dos tiempos. El objetivo de este estudio es valorarla incidencia y los resultados tras la aplicación de la laparoscopia para el tratamiento del teste no palpable en nuestro Servicio. Pacientes y métodos. Se recogen los casos de testículo no palpable entre 2000-2009. Se analizan la edad de intervención, la lateralidad, los hallazgos operatorios, el tratamiento realizado y el tamaño de los (..) (AU)

Introduction. The nonpalpable testis refers to the inability to make objective the teste through exploratory maneuvers. These patients have benefited from the laparoscopic approach that previously they could require even a laparotomy. Definitive treatment of nonpalpable testis depends on the laparoscopic findings, being in dispute their resolution in one or two stages. The aim of this (..) (AU)

[Nonpalpable testes: laparoscopy for inguinotomy]. / Testículo no palpable: laparoscopia o inguinotomía.

INTRODUCTION: The nonpalpable testis refers to the inability to make objective the teste through exploratory maneuvers. These patients have benefited from the laparoscopic approach that previously they could require even a laparotomy. Definitive treatment of nonpalpable testis depends on the laparoscopic findings, being in dispute their resolution in one or two stages. The aim of this study is to assess the incidence and the results after the application of laparoscopy for the treatment of nonpalpable testis in our department. PATIENTS AND METHODS: All the cases of nonpalpable testis between 2000-2009 are selected. The age of intervention, laterality, operative findings, treatment performed and the size of the testes in cases operated in two stages are analized. RESULTS: Fifty-eight children are reviewed with a total of 60 testis. Thirty-one cases are left (53.4%), 25 are rights (43.1%) and 2 are bilateral (3.5%). In 32 children the testis is absent or atrophic, in 10 the Fowler-Stephens technique is developed, 8 gonads are next to the internal inguinal ring, 5 are in the inguinal canal and 2 is so high and so hipoplasic that orchiectomy is decided. Of those operated in 2 stages, 9 testes survive after the first time and 7 of them have a normal size 6 months after the second surgery. CONCLUSIONS: Laparoscopy is an effective method for diagnosis and treatment of non palpable testis, however, there is still no consensus, for certain locations, to descend the testicle in 1 or 2 stages and if the way is by laparoscopy or inguinotomy.

[Labia minora hypertrophy in the puberty]. / Hipertrofia de labios menores en la pubertad.

The labia minora hypertrophy is a very low frequent entity, being probably at any age, but with more incidence in puberty. In some cases, the labia hypertrhophy is so big to provoke urinary and sexual-relationship problems, with theirs behaviour consequences. We present two cases in which an labioplasty was done, without any complications. Also from the aesthetic point of view the long term results have been excellent for our patients.

Catéter intrarrenal. Complicación post-pieloplastia / Intrakydney-catheter. post pielo-plasty complication

Las complicaciones urológicas yatrogénicas son excepcionales, siendo una de las más frecuentes el olvido de material dentro del campo quirúrgico, principalmente las gasas y compresas, que son el material más frecuente, el cual puede ser asintomático u originar diferentes complicaciones. Presentamos a un varón operado de una hidronefrosis izda, al que se le colocó una sonda de nefrostomía y un catéter transanastomótico retirado al 5º día. En la urografia descendente inmediata a la intervención y enla ecografía realizada al mes, no se observa ningún cuerpo extraño, pero en la urografía realizada al 6º mes de la intervención se comprueba un fragmento de catéter dentro de la pelvis renal que precisó nueva lumbotomía. Se realiza una revisión bibliográfica de las complicaciones urológicas y atrogénicas y se llama la atención sobre las pocas publicaciones existentes de yatrogenia urológica pediátrica, al contrario que los urólogos de adultos, que sí las publican. Esta falta de publicaciones repercute negativamente en la formación de los cirujanos pediátricos, especialmente, de los residentes (AU)

One of the more severe urology complications are the forgetfulness of surgical instruments or materials (compress, gauzes…), with different types of complications. We present a male, operated of left hydronephosis. The post surgical catheter was retired five days after the anterograde urography, being all normal. But, in the new urography, practised six month after, a little fragment of catheter was discover, being necessary to do a new lumbotomy and extraction. After revised the paediatric-urology bibliography, we note the very few articles about surgical complications, which is not the case of the adult’s urologist. And this is very negative to the resident training, and also to our patients (AU)

Hipertrofia de labios menores en la pubertad / Labia minora hypertrophy in the puberty

La hipertrofia de los labios menores es una patología muy poco frecuente, que puede aparecer a cualquier edad, aunque se ha observado con mayor incidencia durante la pubertad .En algunos casos, la hipertrofia es tan grande que, no solamente va a originar trastornos locales, sino que puede dificultar las relaciones sexuales, desencadenando problemas serios de comportamiento. Presentamos 2 casos a los que se les realizó una labioplastia, no teniendo ninguna complicación inmediata; desde el punto de vista esté-tico, a largo plazo, ha sido excelente el grado de satisfacción de nuestras pacientes y de los cirujanos (AU)

The labia minora hypertrophy is a very low frequent entity, being probably at any age, but with more incidence in puberty. In some cases, the labia hypertrhophy is so big to provoke urinary and sexual-relationship problems, with theirs behaviour consequences. We present two cases in which an labioplasty was done, without any complications. Also from the aesthetic point of view the long term results have been excellent for our patients (AU)

[Familial adenomatous polyposis: Gardner's syndrome]. / Poliposis adenomatosa familiar: síndrome de Gardner.

Familial adenomatous polyposis (PAF) associated to soft tissue tumors or osteomas constitutes the Gardner's syndrome of autosomal dominant inheritance. The risk of colorectal cancer in these patients is 100%. We present a patient with Gardner's syndrome who was had colectomy at early age. An eleven years old boy he was evaluated due to a family history of PAF and subcutaneous tumors (occipital and left thigh). Genetic profile shows a mutation in gene APC and the colonoscopy confirms the polyposis; the biopsy also suggested moderate dysplasia. When the patient reached the age of twelve, a total colectomy with colorectal mucosectomy was performed. Cystic subcutaneous lesions (epidermoid cysts) were also excised. In the postoperative period there were no complications. The prophylactic colectomy, is the only effective treatment to prevent the colorectal cancer. Gardner's syndrome patients requires periodic controls to rule out the appearance of new tumors or anomalies in the retine. The duodenoscopy is essential in the follow up of these patients because of the frequency of duodenal affectation.

Poliposis adenomatosa familiar: síndrome de Gardner / Familial adenomatous polyposis: Gardner´s syndrome

La asociación de poliposis adenomatosa familiar (PAF) con tumores de tejidos blandos u óseos constituye el síndrome de Gardner, de herencia autosómica dominante. Estos pacientes tienen un riesgo de cáncer de colon de un 100%. Se presenta un paciente con síndrome de Gardner al que se le practicó colectomía a una edad temprana. Niño de 11 años, remitido por antecedentes familiares de PAF y tumoraciones subcutáneas (occipital y en muslo izquierdo). El estudio genético demuestra mutación del gen APC y la colonoscopia confirma la poliposis, observando en la biopsia displasia moderada. A los 12 años se practica colectomía total con mucosectomía y exéresis de las lesiones subcutáneas (quistes epidermoides). El postoperatorio cursa sin complicaciones. La colectomía profiláctica es el único tratamiento eficaz para prevenir el cáncer de colon. Estos pacientes requieren controles periódicos para descartar la aparición de nuevas tumoraciones o anomalías en la retina. La duodenoscopia es imprescindible en el seguimiento de estos pacientes dada la frecuente afectación duodenal (AU)

Familial adenomatous polyposis (PAF) associated to soft tissue tumors or osteomas constitutes the Gardner´s syndrome of autosomal dominant inheritance. The risk of colorectal cancer in these patients is 100%. We present a patient with Gardner´s syndrome who was had colectomy at early age. An eleven years old boy he was evaluated due to a family history of PAF and subcutaneous tumors (occipital and left thigh).Genetic profile shows a mutation in gene APC and the colonoscopy confirms the polyposis; the biopsy also suggested moderate dysplasia. When the patient reached the age of twelve, a total colectomy with colorectal mucosectomy was performed. Cystic subcutaneous lesions (epidermoid cysts) were also excised. In the postoperative period there were no complications. The prophylactic colectomy, is the only effective treatment to prevent the colorectal cancer. Gardner’s syndrome patients requires periodic controls to rule out the appearance of new tumors or anomalies in the retine. The duodenoscopy is essential in the follow up of these patients because of the frequency of duodenal affectation (AU)

[Congenital colonic atresia. Surgery correction in one or two stages?]. / Atresia de sigma cierre quirúrgico primario o secundario?

Sigmoid atresia is rare, the recognzed prevalence is 1 per 15.000 to 60.000 live born. We present a 30 hours old boy with vomiting, abdominal distension and failure to pass meconium. Physical examination showed severe abdominal distension. An enema was performed and a gray mucus plug taken out. The abdominal plain XR showed bowel obstruction and in a barium enema only 5-7 cm of microcolon was seen. With the diagnosis of sigmoid atresia the patient underwent surgery, observing one atresia type I, with dilated proximal loop and distal microcolon. A colostomy was performed and few days later one end-to-end anastomosis was made.

Atresia de sigma ¿cierre quirúrgico primario o secundario? / Congenital colonic artesia. Surgery correction in one or two stages?

Las atresias de sigma son excepcionales, su incidencia se estima en un caso por cada 15.000-60.000 nacimientos. Suelen ser anomalías únicas; sin embargo, nuestro paciente presentaba varias anomalías asociadas. Presentamos un varón de 30 horas de vida, con vómitos alimentarios, gran distensión abdominal y ausencia de expulsión de meconio. Exploración: gran distensión abdominal. Se practica enema evacuando un tapón de moco gris. Radiografía de abdomen: patrón de obstrucción intestinal. Enema opaco: se observa 5-7 cm de microcolon. Con el diagnóstico de atresia de sigma, se realiza laparotomía, observando una atresia tipo I, con gran dilatación de cabo proximal y un microcolon distal. Se practica enterostomía de ambos cabos y unos días más tarde se realiza anastomosis termino-terminal. Se analizan las ventajas e inconvenientes de realizar un cierre quirúrgico primario o diferido en dos tiempos; así mismo, se aconseja descartar una enfermedad de Hirschsprung (AU)

Sigmoid atresia is rare, the recognzed prevalence is 1 per 15.000 to 60.000 live born. We present a 30 hours old boy with vomiting, abdominal distension and failure to pass meconium. Physical examination showed severe abdominal distension. An enema was performed and a gray mucus plug taken out. The abdominal plain XR showed bowel obstruction and in a barium enema only 5-7 cm of microcolon was seen. With the diagnosis of sigmoid atresia the patient underwent surgery, observing one atresia type I, with dilated proximal loop and distal microcolon. A colostomy was performed and few days later one end-toend anastomosis was made. Advantages and disavantages of correction in 1 or 2 times is discussed. In these cases Hirschsprung’s disease should be ruled out (AU)

[Congenital extraluminal duodenal diverticulum]. / Divertículo duodenal congénito extraluminal.

Congenital extraluminal duodenal diverticula are extremely rare. They usually present as repeated crisis of abdominal pain and most of the times their diagnosis is accidental because laboratory test performed by other cause. We report a girl with relapse crisis of abdominal pain since 2 years, the laboratory and radiographic findings are displayed. It is noteworthy that this disease can be life threatening sometime, when an acute abdomen is developed. Conversely of criteria followed in adults, surgery is adviced in children even without symptoms, to avoid further risks.

Divertículo duodenal congénito extraluminal / Congenital extraluminal duodenal diverticulum

Los divertículos duodenales extraduodenales congénitos (DEC)son excepcionales. Generalmente se presentan como dolores abdominales de repetición y su diagnóstico suelen ser fortuito al realizar exámenes complementarios. Presentamos una niña con dolor abdominal de repetición de 2 años de evolución, se analiza las diferentes pruebas utilizadas para su diagnostico, y se llama la atención que, además del síntoma citado, pueden originar cuadros de abdomen agudo secundario a graves complicaciones que pueden poner en peligro la vida del paciente. Al contrario del criterio utilizado en adultos, recomendamos un tratamiento quirúrgico, incluso en pacientes asintomáticos, con el fin de evitar riesgos (AU)

[Epidermoid cyst of the mouth floor]. / Quiste epidermoide en el suelo de la boca.

The epidermoid cysts are frequent during childhood, however mouth floor location are very unusual, because of their more difficult diagnosis and therapeutic approach. We present a 5 years old male, symptoms free until a week before, when his parents noticed a well defined mass in the mouth floor. A physical examination leaded to the diagnosis of possible epidermoid cyst. The tumor was excised through an introral approach. A review of different diagnostic means and surgical management are undertaken.

[Acute abdomen secondary to intra-abdominal hibernoma]. / Abdomen agudo secundario a hibernoma intraabdominal.

The hibernoma is a rare benign tumor derived of embrionary fat seen in adult, which is usually localized in scapular and interscapular region. It express as a slowing growth bulk without symptoms. The authors present a 2 years old boy with acute abdomen requiring urgent laparotomy, that shows a tumor connected to mesocolon by a vascular pedicle that had undergone torsion. No other similar case published been found. The treatment is surgical resection although recurrences have been reported due to incomplete resection.

Abdomen agudo secundario a hibernoma intraabdominal / Acute abdomen secondary intra abdominal hibernoma

Los hibernomas son tumores benignos, derivados de la grasa embrionaria, infrecuentes, observados en adultos, suelen localizarse principalmente en la región escapular e interescapular, manifestándose como una masa asintomática de crecimiento lento. Los autores presentan un varón de 2 años de vida, con clínica de abdomen agudo que requiere laparotomía de urgencia, encontrando una tumoración unida al meso de colon ascendente, mediante un pedículo vascular, que presenta varias vueltas de torsión, no encontrando ningún caso similar en la bibliografía revisada. El tratamiento es quirúrgico, pero se han descrito casos de reaparición debido a resección incompleta (AU)

Quiste epidermoide en el suelo de la boca / Epidermoid cyst of the mouth floor

Los quistes epidermoides son una patología frecuente en la infancia, sin embargo, su localización sublingual es excepcional, lo cual origina dificultades diagnósticas y terapéuticas. Presentamos un varón, de 5 años de edad, asintomático, que desde una semana antes, los padres le han observado una tumoración situada en el suelo de la boca, bien delimitada y mediante una exploración detenida se sospecha la existencia de un posible quiste que se extrae mediante un abordaje oral, confirmando el estudio histológico el diagnostico de quiste epidermoide. Se analiza los diferentes medios diagnósticos y las posibles vías de abordaje quirúrgico utilizadas (AU)

[Perineal canal]. / Canal perineal.

The malformation, perineal canal, is a rare condition accounting for the 4% of all anorectal malformations. We report a 15 months old female that presented passage of feces per vagina during a diarrheal disease. Former physical exam did not show any fistulous opening, another exam under sedation and radiological study with barium leaded to the diagnose of perineal canal. The fistula was excised without preceding colostomy. After surgery the patient did well without complications. Several diagnostic techniques and surgical approaches are analyzed. The authors believe that the surgical procedure used in this patient have had good outcome and the advantage of no needing of preceding colostomy.

Canal Perineal / Perineal canal

La malformación anorectal denominada «canal perineal» es muy poco frecuente, representa el 4% de este tipo de malformaciones. Presentamos una mujer de 15 meses que coincidiendo con un episodio de diarrea presenta heces semilíquida en vagina. A la exploración no se observa ningún orificio pero se confirma mediante estudio baritado y posterior exploración con sedación. Se realiza extirpación de la fístula sin colostomía previa, no obteniendo ninguna complicación. Se analiza los diferentes medios diagnósticos utilizados, así como, los múltiples tratamientos quirúrgicos empleados. Los autores consideran que la técnica empleada ha dado un excelente resultado, no teniendo ninguna complicación, y tiene la ventajas de no precisar colostomía previa (AU)

[Hypospadias: results and psychologic impact]. / Hipospadias: resultados y repercusiones psicológicas.

UNLABELLED: Twenty adults who had undergone operations in their childhood for hypospadias using Cloutier's technique, were studied. The parameters analized were 1) clinical data. On a escale 0 to 10, the following aspects were considered: 2) patient's evaluation of their genitals; 3) patient's evaluation of their sexual activity; 4) exploration of patient's genitals by the surgeon; 5) psychological aspects and repercussions. RESULTS: 1) 68 operations were carried on 19 fistules, 2 meatotomies, 6 preputioplasties. 2) Penis sizes: 7.15; glans: 7.5; urethral meatus caliber: 8.9; scrotum: 8.95; prepuce: 5. Average final evaluation: 7.75. 3) Average age first masturbation: 13.5 years; average age first sexual relation: 18 years; degree of satisfaction in sexual relations: 8.45. 4) Average penis length: 8.45; penis perimeter: 8 cm; micturition flow: 8; glans: 7.8; scrotum: 9; prepuce: 5; average evaluation: 7.42. 5) Fear before operation, fear and axiety before sexual relations 100%; withdrawn character, complexes and shyness: 70%. CONCLUSIONS: Anatomical, aesthetic and functional results were very good in spite of the high degree of complications. Patient's and the surgeon's evaluation were very similar. In some cases, psychological support may be necessary.

[Traumatic diaphragmatic hernia of late onset]. / Hernia diafragmática traumática de aparición tardía.

The diaphragmatic hernia usually appears in neonatal period. The late onset, due to diafragmatic tear after blunt trauma, is exceptional. We report the case of a boy aged 13, who was studied for epigastric pain since two months. Contrast gastrointestinal study showed bowel loops in left hemithorax. The patient had a blunt abdominal trauma due to a fallen from a horse, when he was 6 year old. It was performed a thoracotomy with reinsertion of intestinal structures into the abdomen and closure of the anterolateral tear of left hemidiaphragm. Postoperative progress was without event and the boy was discharged home well. We emphasize the lack of symptoms during seven years after trauma and we point out that diaphragm rupture may occur. Symptoms could be no specific, only light respiratory or digestive alterations.