Late presentation of congenital type IV esophageal hiatus hernia in a 9-year-old boy: a case report.

BACKGROUND: Congenital diaphragmatic hernia affects 1 in every 2000-5000 live births. The mediastinum shifts to the opposite side, the lungs are hypoplastic, and the arterioles are abnormal, resulting in pulmonary hypertension. Respiratory and cardiovascular functions are severely impaired at birth, resulting in significant mortality and morbidity as a result of the associated malformations. CASE PRESENTATION: A 9-year-old persian boy was referred with complaint of intermittent abdominal pain in the left lower quadrant and an episode of vomiting. The patient was tachypneic, and the abdomen was nontender on examination. Lung sounds on the left side were considerably decreased, whereas heart sounds on the right side were louder. There was no history of underlying disease in the patient. Initial laboratory blood tests, chest x-ray, spiral computed tomography scan, and chest sonography were requested. Blood tests were normal, and chest x-ray revealed a round-shaped lesion with relatively clear boundaries containing air-fluid level and shift of the heart and mediastinum to the right. A spiral computed tomography scan of the lungs demonstrated the shift of the heart and mediastinum to the right side was due to dilated stomach and colon pressure, and chest sonography revealed that half of the stomach was inside the thorax. Laparotomy surgery was performed. The patient had no complications following surgery. CONCLUSIONS: Herniation of abdominal contents through the diaphragmatic hiatus should be suspected in patients with tachypnea and mediastinal shift to the right side. Rapid diagnosis and early surgical treatment are necessary to avert any potentially life-threatening complications.

Omental torsion mimicking acute appendicitis in a 7-year-old boy: a case report.

BACKGROUND: Torsion of the greater omentum is an uncommon cause of acute abdominal pain. Omental torsion can be divided into primary and secondary. Owing to its nonspecific abdominal pain, preoperative diagnosis is difficult. Ultrasound sonography and abdominal computed tomography scans do not have a major role in preoperative diagnosis. The definite diagnosis is usually made during operation. CASE PRESENTATION: A 7-year-old Persian boy was referred with right lower quadrant pain associated with nausea and vomiting. Laboratory blood tests and urinalysis were requested that revealed normal values. Ultrasonography was performed, revealing inflammatory changes with mild free fluid collection in the interloop. The patient underwent an open appendectomy, confirming a normal appendix with omental torsion. Two days later, he was discharged home without postoperative complications. CONCLUSIONS: In patients with acute abdomen, particularly those with acute appendicitis symptoms, omental torsion should be considered in the differential diagnosis.

Pediatric Vaginal Leech Infestation with Severe Bleeding: A Case Report and Review Article.

BACKGROUND: Vaginal leech infestation is a rare event with vaginal bleeding being its prominent sign. Few cases have been reported in young children. CASE: In this article, we present a case of vaginal leech infestation in a 2-year-old girl who presented with significant vaginal bleeding that caused severe acute anemia, prompting transfusion. On examination, she appeared anemic, but healthy, without any signs of pubertal development. The leech was seen during examination with the patient under anesthesia and was removed. With removal of the leech, bleeding decreased significantly and stopped completely after 2 hours. She was discharged the next day in good condition. SUMMARY AND CONCLUSION: The important concern in vaginal leech infestation is early diagnosis to prevent severe acute anemia and shock.