Retroperitoneal teratomas--potential for surgical misadventure.

BACKGROUND: Retroperitoneal teratoma (RPT) is a relatively uncommon tumor in children. This study concerns 6 children with RPT that involved surrounding structures and required rather extensive operative procedures to successfully excise the lesions. METHODS: A review of RPT in children encountered at a single institution over an 8-year period by a single surgeon was carried out. Age at presentation, sex, operative findings, surgical management, and outcomes were evaluated. RESULTS: Four of the 6 patients were girls, and 5 were younger than 6 months at diagnosis. All of the tumors enveloped and displaced the aorta and vena cava, 1 involved the stomach wall, 2 others displaced the renal vessels, and 1 the portal vein. Extensive resection including major vessel ligation was necessary for complete excision. All the tumors were benign, but 1 recurred. There were no deaths; however, 2 children have persistent hypertension. CONCLUSIONS: The operative management of RPTs may be complex and challenging. Despite their benign nature, the lesions can attenuate and surround major vessels, making resection difficult. Ligation of major vessels when necessary is tolerated well and may be required for complete tumor excision.

The value of anal endosonography compared with magnetic resonance imaging following the repair of anorectal malformations.

BACKGROUND: Surgery for anorectal malformations (ARMs) attempts to position the neo-anus anatomically within the anal sphincter complex. Currently, MRI is the imaging modality of choice in determining the position of the neo-anus after reconstructive surgery. OBJECTIVE: The aim of this study was to compare the accuracy of anal endosonography (AES) with conventional MRI in demonstrating the anatomy of the neo-anus following repair of ARMs. MATERIALS AND METHODS: Fourteen children (ten girls, four boys), born with ARMs (four low, ten high) underwent both AES and pelvic MRI following anorectoplasty. The results of both investigations were compared with muscle stimulation and were reported blindly by a clinician and a radiologist. RESULTS: AES findings were comparable with MRI in 9 of the 14 cases. In four cases, MRI and AES findings differed, with nerve stimulation supporting AES but not MRI. CONCLUSIONS: AES is an accurate alternative to MRI in the assessment of anorectoplasty. It provides more detailed information and can be performed under anaesthesia in combination with a surgical procedure.