RESUMO
PURPOSE: We report the natural history and prognosis of tumors after augmentation enterocystoplasty, with a molecular analysis using an oncogene panel to search for potential targeted therapies. MATERIALS AND METHODS: This multicenter, nationwide, retrospective study included 16 patients. A panel of 21 clinically relevant oncogenes was tested on archival tumor specimens using next-generation sequencing. Survival rate was the main clinical outcome and sequences were compared to the reference genome for the genetic outcome. RESULTS: Augmentation enterocystoplasties were performed mainly for congenital neurogenic bladder and bladder exstrophy at a median patient age of 17 years (range 4 months to 45 years). Most of the malignancies were diagnosed because of clinical manifestations, with a median latency period of 20 years. Adenocarcinomas were mainly found after gastrocystoplasty, whereas urothelial cell carcinomas were typically found after colocystoplasty. Of the 16 patients 13 were diagnosed at an advanced stage of the disease (positive lymph nodes in 7, distant metastases in 6). The overall 1-year survival rate was 56%. Only 3 patients remained disease-free at a median followup of 70 months. Of the 9 tumors with analyzable DNA 4 were wild-type and 5 harbored missense mutations (KIT-p.Pro573Ser, PDGFRA-p.Glu587Lys, KRAS-p.Gly12Asp, ERBB4p.Arg484Lys, CTNNB1-p.Ser37Phe and p.Ser47Asn). CONCLUSIONS: Malignancy after augmentation enterocystoplasty is diagnosed late with frequent metastases and a very low 1-year survival rate. More than half the tested samples harbored missense mutations in oncogenes accessible to targeted therapies. An international collaboration to enlarge the genetic panel analysis of these tumors may offer new therapeutic hope to patients.
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Oncogenes/genética , Neoplasias da Bexiga Urinária/mortalidade , Bexiga Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adolescente , Adulto , Extrofia Vesical/cirurgia , Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Criança , Análise Mutacional de DNA , Feminino , França , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Mutação de Sentido Incorreto , Metástase Neoplásica , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/patologia , Bexiga Urinaria Neurogênica/congênito , Bexiga Urinaria Neurogênica/cirurgia , Adulto JovemRESUMO
OBJECTIVE: To report our experience of the unique scrotal incision for the redo cases of orchiopexy after previous inguinal surgery or orchiopexy for undescended testis with a special attention regarding the place of the single scrotal approach. PATIENTS AND METHODS: Thirty-six patients operated between January 2003 and September 2015 in our surgical unit for secondary orchiopexy after previous inguinal surgery or orchiopexy for undescended testis (UDT) were included in a retrospective study. The secondary surgical procedure was initiated by a scrotal incision (Bianchi). In cases of difficulty by the scrotal incision an inguinal approach by the prior skin inguinal incision was performed. Patients were divided in two groups a group 1 of 10 patients with reascending testis following inguinal hernia repair and a group 2 of 26 patients with reascending testis after previous orchiopexy for UDT. A good result was defined as testis in scrotal position without evidence of atrophy. RESULTS: All the patients of group 1 were treated by a unique scrotal incision. In group 2, seven patients required a complementary inguinal approach. One hematoma complicated a scrotal procedure leading to a testicular atrophy. A good result was achieved in 35/36 patients (97%). CONCLUSION: Single scrotal incision is an efficient and easy way to perform secondary orchiopexy after hernia repair. After surgery for UDT, as for primary cases, it cannot be an exclusive approach, higher testis need a combined or an inguinal approach. LEVEL OF EVIDENCE: 5.
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Criptorquidismo/cirurgia , Orquidopexia/métodos , Escroto/cirurgia , Adolescente , Criança , Pré-Escolar , Virilha , Humanos , Lactente , Masculino , Recidiva , Reoperação , Estudos RetrospectivosRESUMO
INTRODUCTION: Practical training of the surgery resident is based on the companionship currently hampered in particular by the increase of the number of residents in training. We created a teaching tool to promote learning and validation of a technique of classic urologic surgery, inguinal orchidopexy. The objective is to evaluate the applicability and the relevance of this tool. MATERIAL AND METHODS: The tool is a technical evaluation sheet made from reference documentation. The trainers evaluated the residents at 3 times of the semester (hetero-evaluation at 0, 3 and 6 months). Residents evaluated themselves monthly on the same items. RESULTS: Three trainers and 6 residents in surgery participated in the study between May and November 2013. The initial evaluation confirmed that the theoretical knowledge was acquired prior to the practical learning. The level of residents was very uneven at the beginning of the study but not at the end of the semester. The monthly evaluations gave a progressive and significant increase of notes. The notes of the intermediate and final hetero-evaluations rose gradually and they were always superior to those previous self-assessments (P<0.05). The tool was considered simple and useful for the participants. CONCLUSION: This tool is applicable and relevant to the technical teaching of inguinal orchidopexy in this population. A larger study would be helpful to confirm it. This type of tool could be applied to the simple and common surgery techniques to enrich the educational tools used in the training. LEVEL OF EVIDENCE: 4.
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Avaliação Educacional , Orquidopexia/educação , Adulto , Feminino , França , Humanos , Internato e Residência , MasculinoRESUMO
PURPOSE: Outpatient surgery is a very well adapted practice to the pediatric population. Our goal was to evaluate its actual development in the field of the pediatric urology. MATERIALS AND METHODS: A questionnaire was addressed to all the French pediatric surgery centers in which at least one surgeon was member of the French Section of Pediatric Urology. The questionnaire concerned the organization and the outpatient urology procedures performed during the years 2011 and 2012. RESULTS: Thirty of the 34 approached centers returned the questionnaire. The total number of patients concerned in this study was of 33,166. The practices were very variable among centers: the inferior limit of age for anesthesia ranged from 2 to 12 months and type of surgery was also heterogeneous. Foreskin surgery, orchiopexy for undescended testis, inguinal hernia, and endoscopic treatment of vesico-ureteral reflux were the only procedures performed for more than 60% of cases as outpatient surgery. Outpatient surgery is not well developed in hypospadias repair. Only five centers raised 60% of ambulatory procedures for distal cases. No serious complication related to the outpatient approach was reported. CONCLUSION: This survey demonstrated very heterogeneous practices among French pediatric urologic centers. According to the French guidelines about outpatient pediatric surgery, this type of care could be more developed if anesthesiologists and surgeons accepted to evolve in their practice.
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Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Pediatria , Padrões de Prática Médica , Urologia , Criança , França , Humanos , Inquéritos e QuestionáriosRESUMO
PURPOSE: The clinical benefit of sacral neuromodulation is unclear due to the paucity of randomized trial data. The purpose of this study was to evaluate sacral neuromodulation for management of urinary and fecal incontinence in a pediatric population. MATERIALS AND METHODS: This multicenter, open label, randomized, crossover study included children older than 5 years. After trial stimulation of the S3 root a neuromodulator (InterStim) was implanted on the S3 foramen. Clinical examinations, voiding and bowel diaries, and urodynamic and manometric evaluations were performed at the beginning (t1) and end (t2) of the first period, and at the beginning (t3) and end (t4) of the second period. RESULTS: A total of 33 patients (24 boys) with a mean +/- SD age of 12.22 +/- 5.09 years were randomized. Etiologies were mainly of neurological origin. Incontinence was mixed urinary and fecal in 19 cases, urinary only in 9 and fecal only in 5. Cystometric bladder capacity increased during sacral neuromodulation (delta +24.27 ml vs -37.45 ml, p = 0.01). There was no significant change in other urodynamic or manometric parameters. Overall positive response rate was more than 75% for urinary (81%) and bowel (78%) function. Crossover analysis indicated that sacral neuromodulation is more effective than conservative treatment for both types of incontinence (p = 0.001). CONCLUSIONS: In a pediatric population sacral neuromodulation is effective for bladder and bowel dysfunction and should be considered before irreversible surgery.
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Terapia por Estimulação Elétrica , Incontinência Fecal/terapia , Incontinência Urinária/terapia , Criança , Estudos Cross-Over , Feminino , Humanos , Plexo Lombossacral , Masculino , Estudos ProspectivosRESUMO
INTRODUCTION: Surgery for undescended testis is now commonly recommended before the age of one year. However, the risk of testicular atrophy or miss location after surgery at a young age has not been clearly evaluated. OBJECTIVE: The objective of this study is to evaluate the rate of testicular atrophy after surgery for non-palpable testis before the age of one year. MATERIALS: Fifty-five patients operated between 2005 and 2014 for non-palpable testes were reviewed for clinical and ultrasound (US) evaluation. Median follow-up after surgery was of 68.5 months (range 26-130 months). The median age at surgery was of months (5-12 months). Eight patients (14.5%) had bilateral non-palpable testis; thus, 63 testes were evaluated. At surgery, 38 (60%) testes were located in the high inguinal canal; 25 (40%), in the abdominal cavity. Orchiopexy was performed with preservation of the testicular vessels for 58 testes. Fowler-Stephens (FS) procedure was performed for 5 testes. Testicular location was clinically evaluated, and testicular volume was measured using a standard sonogram technique in our pediatric radiology department. Ratio comparing the volume of the descended testis to the spontaneously scrotal located testis was calculated in unilateral forms. RESULTS: After surgery, testes had scrotal location in 62 cases and inguinal location in one case. Seven cases of atrophy were confirmed after US control (11%), more frequently (odds ratio, OR 11.68 [1.9-72.5]) in abdominal testis (24%) than in inguinal testis (2.6%). Atrophy testicular was more frequent with FS technique (OR 7.1 [1.3-40.1]), but the population was weak (N = 5). Median volume ratio for unilateral form was 0.88 [0-1.8]; 14 patients presented a ratio greater than 1. DISCUSSION: The influence of the young age at surgery and the risk of post operative testicular atrophy had not been clearly evaluated. The term of 'no palpable testis' supports an heterogeneous group mixing abdominal and extra-abdominal testis sharing a uniform clinical presentation. Our rate of atrophy in the group of abdominal testes (24%) and inguinal testes (2.6%) is similar to the literature, which concerns older patients. The long-term sonogram assessment demonstrated a good development of the testis after surgery, especially in inguinal cases. CONCLUSION: Surgery for no palpable testis before the age of one year does not lead to a superior risk of testicular atrophy compared with surgery at an older age and allows a good development of the testis.
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Criptorquidismo/diagnóstico , Criptorquidismo/cirurgia , Orquidopexia/efeitos adversos , Complicações Pós-Operatórias/patologia , Testículo/patologia , Fatores Etários , Atrofia/etiologia , Atrofia/patologia , Biópsia por Agulha , Estudos de Coortes , Seguimentos , França , Hospitais Universitários , Humanos , Imuno-Histoquímica , Lactente , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Razão de Chances , Orquidopexia/métodos , Segurança do Paciente , Exame Físico/métodos , Complicações Pós-Operatórias/epidemiologia , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler/métodosRESUMO
In haemodynamically stable children with splenic trauma, conservative treatment is recommended to preserve the spleen and prevent potentially lethal post-splenectomy infectious complications. We report on the case of a 11-year-old child who suffered a fistula of a huge subcapsular splenic hematoma into the colon, 16 days after the traumatism. Decision to sustain the non-operative treatment allowed the preservation of the spleen without complications.
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Baço/lesões , Esplenopatias/terapia , Criança , Fístula/complicações , Fístula/terapia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Hematoma/complicações , Hematoma/terapia , Humanos , Masculino , Esplenopatias/complicaçõesRESUMO
UNLABELLED: Pediatric non hypertrophic pyloric stenosis (NHPS) are uncommon. Their causes and treatments are debated. MATERIAL AND METHOD: Retrospective review of all cases of NHPS from 3 pediatric surgery services during the period 1984-2002. RESULTS: Six children, aged 17 months to 15 years, underwent surgery for NHPS. Clinical symptoms, food vomiting and loss of weight, were present for several weeks before the diagnosis of NHPS was made. The diagnosis was peptic stenosis in 3 cases and has not been established in 3 cases. Search for Helicobacter pylori was negative in all cases. Failure of specific medical treatment and endoscopic dilatations led to pyloric resection in 3 cases and pyloroplasty in 3 cases. Post operative course was uneventful with normal oral feeding and normalisation of weight status. Histologic data were aspecific. No recurrence was observed. DISCUSSION: We discuss the origin of the pyloric stenosis, regarding clinical, operative and pathological data: were the stenosis the cause or consequence of peptic ulcer? Peptic disease is always advocated, but difficult to prove and may be excessively incriminated. Late symptomatic congenital and acquired idiopathic pyloric stenosis should be recalled. In all cases of proved pyloric stenosis, after failure of medical and endoscopic treatment, a simple surgical procedure (pyloroplasty) associated with medical treatment seems to be effective. CONCLUSION: The diagnosis of NHPS should be suspected in a child with food vomiting and loss of weight if his age is not concordant with hypertrophic pyloric stenosis. Upper gastro-intestinal series and endoscopy are diagnostic. The precise cause of the stenosis is more difficult to asses. When the medical treatment fails, a pyloroplasty is usually curative.
Assuntos
Estenose Pilórica/etiologia , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Diagnóstico Diferencial , Dilatação , Feminino , Seguimentos , Gastroscopia , Humanos , Lactente , Masculino , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/cirurgia , Estenose Pilórica/diagnóstico , Estenose Pilórica/cirurgia , Retratamento , Estudos Retrospectivos , Vômito/etiologiaRESUMO
OBJECTIVE: To evaluate the accuracy of ultrasonographic examination in boys with an undescended testis. MATERIAL AND METHODS: All patients who were referred to the paediatric surgeon after detection of an undescended testis were evaluated prospectively between November 2001 and November 2004. Among these 377 patients, 87 were referred with an ultrasonogram previously prescribed by the referring primary physician. The results of the ultrasonogram were compared to the results of the clinical examination of the paediatric surgeon and, in cases of no palpable testis, to the surgical findings. RESULTS: Ultrasonography did not detect the retractile testes. Ultrasonography detected 67% of the palpable undescended testes. In cases of no palpable testis, the ultrasonographic examination missed the abdominal testes and sometimes other structures were falsely interpreted as a testis. CONCLUSION: Sonography has no place in the diagnosis of undescended testis.
Assuntos
Criptorquidismo/diagnóstico por imagem , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , UltrassonografiaRESUMO
PURPOSE: The undescended testis (UT) is the most common congenital malformation of the genital apparatus in male infants. The main objective of the management of these patients is to reduce the risk of infertility and cancer. Since these risks increase with age of operation, learned societies have recommended earlier intervention. Following the publication in 2007 of the Nordic consensus that called for an intervention between 6 and 12 months of age, we issued this message to medical students in the Lower Normandy region of France. The aim of this study was to evaluate the implementation of this teaching through the evolution of the number of children operated between 6 and 12 months for a congenital UT in our center. MATERIAL AND METHODS: Between 2005 and 2014, we evaluated the yearly percentage of children operated for UT between 6 and 12 months compared to the percentage of children operated on between 12 and 24 months. A statistical study using the Chi(2) test was used to compare the 2005-2008 and 2009-2012 periods. RESULTS: The percentage of children operated on between 6 and 12 months of age increased from 13.7 % between 2005 and 2008 to 17.2 % between 2009 and 2014. From 2012 on, the number of children operated on between 6 and 12 months was consistently higher than the number of children operated on between 12 and 24 months. The proportion of children operated beyond 2 years remained stable over the study period. CONCLUSION: Since we implemented teaching of early surgery for children with UT, we have observed a gradual increase in the number of children operated between 6 and 12 months of age. Nevertheless, there are still many children operated between 12 and 24 months and beyond.
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Criptorquidismo/epidemiologia , Criptorquidismo/cirurgia , Pré-Escolar , França/epidemiologia , Humanos , Lactente , Masculino , Orquidopexia/estatística & dados numéricos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Retroperitoneoscopy is gradually gaining in importance in pediatric urology, especially for renal and adrenal diseases. Direct retroperitoneal pelvic access seems interesting in children when low urinary tract malformations are concerned. We report a case of a 12-year-old boy with a blind ectopic ureter managed by pelvic retroperitoneoscopy. We describe the surgical technique, focusing on the difficulty in the pediatric population. Nevertheless, retroperitoneoscopy is an excellent alternate way to manage such ureteral malformations.
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Ureter/anormalidades , Ureter/cirurgia , Ureteroscopia/métodos , Criança , Humanos , Masculino , Radiografia , Espaço Retroperitoneal/cirurgia , Ultrassonografia , Ureter/diagnóstico por imagemRESUMO
Sigmoid volvulus is an unusual cause of intestinal obstruction in children. We report two cases of sigmoid volvulus as a complication of segmental dilatation of the colon occurring in two girls (5 years old and 9 years old) previously treated for chronic constipation. In both cases the constipation had been recognised since the neonatal period mimicking a Hirschsprung's disease, a diagnosis which has been excluded after rectal biopsy. The delayed diagnosis of segmental dilatation of the sigmoid colon followed the volvulus. Segmental colonic resection resulted in both cases in the cure of the constipation.
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Colo , Obstrução Intestinal/etiologia , Intubação/instrumentação , Doenças do Colo Sigmoide/etiologia , Criança , Pré-Escolar , Colo/patologia , Colo Sigmoide/patologia , Diagnóstico Diferencial , Feminino , Humanos , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Doenças do Colo Sigmoide/patologia , Doenças do Colo Sigmoide/cirurgiaRESUMO
Although orchidopexy for an undescended testis is generally a satisfactory operation, high undescended testis is often a problem. Management of such testicles remains controversial and since 1984 the authors have used spermatic vessels division (Fowler Stephens procedure) in 29 cases with satisfactory results. Although the Fowler-Stephens procedure carries a certain risk of testicular atrophy, the results are equivalent to those achieved by the two stage orchidopexy if careful attention is paid to details of the procedure and selection of cases.
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Criptorquidismo/cirurgia , Testículo/irrigação sanguínea , Artérias/cirurgia , Criança , Pré-Escolar , Humanos , Lactente , Masculino , Testículo/cirurgiaRESUMO
Duplications of the alimentary tract are rare congenital anomalies and vermiform appendix duplication is exceptional. The aim of this study was to report a case of cystic appendiceal duplication in a 4 years old child, unusual in its anatomic type, its clinical presentation and its way of management.
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Apendicectomia , Apêndice/anormalidades , Laparoscopia , Apêndice/diagnóstico por imagem , Pré-Escolar , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
UNLABELLED: Abdominoscrotal hydrocele is a very rare condition, different from the majority of cases of hydroceles related to the persistence of the processus vaginalis. The anomaly consists of a large scrotal hydrocele which communicates in an hour-glass fashion with a large abdominal component through the inguinal canal. We report two cases observed in infants. CASE REPORTS: 1. A nine-month-old infant was referred because of a large bilateral hydrocele. On clinical examination on the right side in the lower quadrant of the abdomen was found a mass which communicated with the right scrotal pouch. Diagnosis of abdominoscrotal hydrocele was established by ultrasonography. During the surgical exploration the right testis was found to be dysmorphic, fusiform and ectopic in the inguinal canal. Surgical treatment comprised hydrocelectomy and right orchidectomy. 2. A six-month-old infant presented with a large right hydrocele in communication with an abdominal pouch located in the right lower quadrant, in association with a lymphoedema of the right limb. Diagnosis of abdominoscrotal hydrocele was confirmed by ultrasonography. During the surgical procedure the pouch was opened and everted. The testis was dysmorphic as in the first case, in normal scrotal position and was preserved. COMMENTS: Abdominoscrotal hydrocele is a rare condition reported in adult population and also in the infant. The exact mechanism by which it develops is unknown. The diagnosis can be suspected on clinical examination if an abdominal mass in a lower quadrant is palpable just above the inguinoscrotal pouch. The diagnosis relies on ultrasonography. Complications sometimes occur due to the pressure on adjacent structures (ureters, iliac vessels). Testicular dysmorphism has been reported in some patients. In any case, as spontaneous resolution of abdominoscrotal hydrocele has never been reported, surgical treatment is indicated.
Assuntos
Abdome , Espaço Retroperitoneal , Escroto , Hidrocele Testicular/diagnóstico , Hidrocele Testicular/cirurgia , Testículo/anormalidades , Diagnóstico Diferencial , Humanos , Lactente , Linfedema/etiologia , Masculino , Orquiectomia , Exame Físico , Hidrocele Testicular/classificação , Hidrocele Testicular/complicações , Hidrocele Testicular/epidemiologia , Resultado do TratamentoRESUMO
BACKGROUND--Familial cases of gastroschisis are exceptional. CASE REPORT NO. 1--A boy was admitted at birth suffering from gastroschisis. Surgical repair was done but the patient died on day 24 with septicemia. CASE REPORT NO 2--Fifteen years later, gastroschisis was discovered by ultrasonography in a male fetus (GA = 26 weeks). Successful surgical repair was done just after the birth at a normal term. Mothers of both cases were sisters. CONCLUSIONS--The rare familial cases of gastroschisis have been seen in sibships. This is the first familial case seen in first cousins.
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Músculos Abdominais/anormalidades , Doenças Genéticas Inatas/diagnóstico , Doenças Genéticas Inatas/genética , Humanos , Recém-Nascido , MasculinoRESUMO
UNLABELLED: Rectovestibular fistula without anorectal malformation is a rare anomaly. OBSERVATION: A six-week-old baby was hospitalized for a greater labium abscess. Stools leakage was secondary noted in the vagina and in abscess area. Clinical examination under anesthesia concluded to a congenital rectovestibular fistula with secondary drainage in the greater labium. Surgical treatment without colostomy led to recovery. COMMENTS: Congenital recto-vestibular fistula is a difficult diagnosis. It should be evoked when vaginal fecal leakage occurs in the absence of anorectal malformation or perineal injury. Fistula location is often confirmed by clinical examination under anesthesia. Treatment is surgical and allowed recovery without any functional damage.
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Genitália Feminina/patologia , Fístula Retovaginal/congênito , Abscesso/etiologia , Abscesso/patologia , Diagnóstico Diferencial , Fezes , Feminino , Humanos , Lactente , Procedimentos de Cirurgia Plástica , Fístula Retovaginal/diagnóstico , Fístula Retovaginal/cirurgiaRESUMO
BACKGROUND: Cystic retroperitoneal lymphangioma is a rare benign tumor with varied clinical presentation. CASE REPORTS: Case 1. A girl was born at term after ultrasonography had shown a cystic abdominal mass by 31 weeks of GA. This mass, clinically palpable at birth, was found again by ultrasonography. Surgical excision on day 3 was incomplete, requiring a second excision at the age of 2 months, followed by persistence of the cyst near the bladder; the patient was asymptomatic at the age of 2 years. Case 2. This full-term female newborn was admitted because of jaundice and pallor. Examination showed a firm mass of the left flank that was confirmed by X-rays and ultrasonography. Despite blood transfusion, anemia persisted, requiring surgery that showed a cystic hemorrhagic mass that was voided. A second partial excision was performed a few weeks later and, at the age of 7 months, ultrasonography showed a few small cystic masses behind the left kidney. Case 3. A 16-month-old boy was operated on for right inguinal hernia. The hernial sac contained fluid and its wall was thick. Ultrasonography and CT scan performed 3 days later were normal. The child was examined again 28 months later because he suffered from abdominal pain; a large mass was palpable in the right flank that appeared cystic at ultrasonography and CT scan. A retroperitoneal lymphangioma was completely excised. CONCLUSION: Because the risk of complications is apparently high, surgical treatment is always necessary. In the newborn period, complete excision is difficult, requiring delayed surgery.
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Linfangioma Cístico/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Feminino , Humanos , Lactente , Recém-Nascido , Linfangioma Cístico/cirurgia , Masculino , Neoplasias Retroperitoneais/cirurgiaRESUMO
Two patients, aged four and six months, with congenital diaphragmatic hernias, and who presented outside of the neonatal period, are reported. Clinical presentation was a progressive respiratory failure, and radiographic findings showed a consolidation of the left lung, associated with a pneumothorax in one and an ascites in the other. One had previous normal chest X-rays. All cases with herniated bowel showed connecting bowel segments passing through the diaphragmatic defect. All were repaired via an abdominal approach. Delay in presentation of congenital diaphragmatic hernias is not uncommon. Long-term prognosis is favourable and postoperative morbidity is minimal, despite late presentation and undesirable time delay between first sign and surgery.