Multiple cutaneous granular cell tumors involving the shoulder and foot in a child; a rare case report.

Granular cell tumors are rare soft tissue neoplasms derived from Schwann cells and are characterized by their infiltrative, non-encapsulated nests and sheets of polygonal cells with fine eosinophilic cytoplasmic granules on histology. Herin, we report a case of a 10-year-old Saudi female who presented to the hospital with multiple asymptomatic skin lesions, the largest located on the right shoulder and left foot. Preoperative workup revealed the absence of liver metastasis, and the patient underwent complete surgical excision successfully. Histopathology revealed ill-defined proliferation of large bland cells with prominent eosinophilic granular cytoplasm and mild epithelial hyperplasia consistent with granular cell tumors. Granular cell tumors are a rare entity that represent only 0.5% of all soft tissue tumors. They have characteristic histological features and can present with both malignant and being features. Due to the rarity of this disease, further research is needed to enhance our understanding and improve recognition in future practice.

Bile Duct Injury in Children: Is There a Role for Early Endoscopic Retrograde Cholangiopancreatography?

Introduction Liver injury is common among pediatric abdominal trauma. Nonoperative management is the standard of care in isolated stable liver injuries. Bile leak is not an uncommon complication in moderate- and high-grade injuries. Case series Three pediatric patients (age: 10-15 years) suffered grade IV liver injuries secondary to blunt abdominal trauma. All developed significant bile leak treated nonoperatively with endoscopic retrograde cholangiopancreatography (ERCP), and patients 1 and 2 were treated with bile duct stent alone. Patient 3 required laparotomy for bile peritonitis and abdominal compartment syndrome followed by interval ERCP and bile duct stent. Conclusion Traumatic bile leaks if not recognized and managed early can result in significant morbidity. This paper describes the presentation and treatment of three pediatric patients with blunt liver trauma complicated by significant bile leaks that were managed successfully with ERCP and bile duct stent. This paper demonstrates the importance of early detection of bile leak to prevent bile peritonitis. Abdominal imaging 4 to 5 days postinjury can help in detecting bile accumulation. We believe that ERCP and bile duct stent are becoming the standard of care in diagnosing and treating traumatic bile leak. This paper confirms the safety and feasibility of this technique in the pediatric population.

Staged closure of a giant omphalocele with amnion preservation, modified technique.

Closure of a giant omphalocele can be challenging. Preservation of the amnion in staged closure is not commonly practiced. Here, we describe 2 cases of giant omphalocele treated with a modified amnion preservation, staged closure technique. This paper demonstrates the feasibility and safety of this technique, and the versatility of amnion to adapt to an escharization strategy if closure is not achievable.

Effect of timing of enteral feeding on outcome in gastroschisis.

BACKGROUND: Timely initiation of enteral nutrition is pivotal to outcome optimization in gastroschisis (GS). The purpose of our study was to analyze the effect of timing of first feeds on outcome. METHOD: GS cases accrued between May 2005 and August 2011 were abstracted from a national database. Risk variables evaluated included GA, illness severity, bowel injury severity, and post-closure days to first feed (DTF). The outcomes analyzed included duration of TPN, LOS, and infectious complications. Descriptive, univariate, and multivariate regression analyses were conducted. RESULTS: The study cohort comprised 570 cases (16% with "high risk" bowel injury). Group distribution by DTF was: 0-7 days (12%), 8-14 days (44%), 15-21 days (26%), and >21 days (17%), with a mean DTF of 17 ± 15 days. Mean durations of TPN and LOS were 44 ± 56 and 112 ± 71 days, respectively. DTF subgroups were comparable, except for a greater proportion of "high risk bowel injury" in DTF>21 days. Initiation of feeds between 8 and 21 days was associated with fewer TPN days and reduced LOS. Multivariate analyses revealed that TPN duration, LOS, and infectious complications were independently predicted by DTF. CONCLUSIONS: Post-closure DTF predicts outcome in GS, with best outcomes observed when feeds are started 7 days post-closure.

Gastric hamartoma of the pylorus in an infant.

Gastric hamartomata, alternatively called adenomyomata, are rare, benign lesions of the gastric wall. They can present with a wide spectrum of symptomatology. Pure pyloric adenomyomata are exceedingly rare. We are reporting a 13-day-old infant with a gastric hamartoma at the pylorus presenting with gastric outlet obstruction mimicking infantile hypertrophic pyloric stenosis.