Voluminous perinatal pelvic mass: a case of congenital hydrometrocolpos.

Imperforate hymen is the most frequent congenital malformation of the female genital tract; it usually does not show symptoms until puberty. Only rarely, imperforate hymen manifests itself as an abdominal mass detectable in the prenatal period. We describe a rare case of voluminous hydrometrocolpos, antenatally diagnosed and successfully treated immediately after birth.

[Enema-induced intestinal perforation. A case report]. / Perforazione intestinale da clisma di pulizia. Descrizione di un caso clinico.

Constipation is a frequent clinical condition in pediatric age, with a low frequency of evacuation and emission of voluminous and hardened stools. In the most serious cases enemas became necessary, and are usually carried out without trouble. Nevertheless, traumatic events of great importance can take place, leading the patient to urgent surgical observation. The clinical case of a girl suffering from birth from chronic constipation is reported. The girl underwent a colostomy according to Mikulitz's technique on the descending colon, due to a rectal perforation induced during an enema. After the re-canalisation and the contemporaneous resection of 18 cm of the dolicho-sigmoid colon (which was most likely the cause of chronic constipation) the girl presented a normal defecatory rhythm.

[Treatment of varicocele in the pediatric age: videolaparoscopic versus "traditional" open techniques]. / Trattamento del varicocele in età pediatrica: tecnica VLS vs open.

AIM: Varicocele is determined by an ectasia of the veins of the pampinous plexus, and its incidence ranges from 2% to 16% in the different ages. Etiology and pathogenic mechanism are not clear; on the other hand it is absolutely certain that an early onset of varicocele in the pre-puberal age can heavily condition testicular development and function, with a condition of hypo-infertility which will be irreversible in the adult age. Up to date, there are not clear data allowing to state a "gold standard" therapy, although there is a general goodwill in affirming the usefulness of an early operation to prevent a gonadic damage. The aim of our study was to carry out an accurate analysis of post-operative clinical and instrumental data and to point out advantages and disadvantages of the traditional surgical technique versus the more recent videolaparoscopic technique (VLS). METHODS: Twenty-eight patients were consecutively treated for hydiopathic, III Horner degree, I Coolsaet degree left varicocele. In the first 15 patients an "open" operation was performed, while in the other 13 VLS technique according to Palomo was used. RESULTS: Follow-up, based on 9 different parameters, such as duration of hospitalisation and postoperative recovery was continued for a mean period of 18,67 months. CONCLUSIONS: An analysis of the results showed that both techniques are effective, although VLS can offer advantages as far as reduction of hospitalisation, reduction of duration of operation and postoperative recovery are concerned, as well as an increasing of compliance due to a better cosmetic result.

Laparoscopic diagnostic exploration of the vaginal processus in the pediatric age. Preliminary experiences.

BACKGROUND: Laparoscopic surgical procedures, employed even in the paediatric age, bearing both diagnostic and therapeutic value, are currently used in the evaluation of peritoneal-vaginal duct patency during surgery for controlateral inguinal hernia or other diseases requiring opening of abdominal wall. METHODS: From January 1996 to December 2000, at the Department of Pediatric Surgery of the University of Siena a prospective study protocol has been performed to evaluate the effectiveness of laparoscopy versus traditional surgery in showing patency of peritoneal-vaginal duct. RESULTS: From our study we have been able to see how this laparoscopic procedure is well tolerated by children and parents, and is lacking in clinical complications. Patency of peritoneal-vaginal duct has been pointed out in 21.73% of cases. This result is in line with the international literature; in fact, the majority of authors have found a negative controlateral exploration in 50-80% of patients examined, thus confirming the uselessness of routine surgical controlateral inguinal exploration in hernia cases. CONCLUSIONS: The use of diagnostic laparoscopy in the study of peritoneal duct patency is a rapid and relatively easy technique, practically without intra- and peri operative risks. It allows an easy solution of the diagnostic doubt, without the need to necessarily perform a traditional explorative surgical procedure.

Relapsing acute pancreatitis due to duodenal duplication in an 8-year-old child. Case report.

The authors present the diagnostic and therapeutic evolution of a case of duodenal duplication complicated by acute recurring pancreatitis in a eight-year-old boy. Abdominal pain and vomiting represented important clinical signs associated with a previous history of inexplicable episodes of acute pancreatitis. Abdominal US scan and NMR were able to diagnose the duodenal duplication preoperatively. Initial treatment was conservative in the attempt to resolve the acute pancreatitis episode. Partial exeresis and derivation of the duplication in the duodenal lumen was subsequently performed. Diagnosis was confirmed by histological examination. Currently, at 6 months after intervention, the patient is clinically asymptomatic and negative at US scan follow-up.

[Epididymal anomalies in cryptorchism and in persistent peritoneo-vaginal duct]. / Anomalie dell'epididimo nel criptorchidismo e nella persistenza del dotto peritoneo-vaginale.

BACKGROUND: Various percentage incidences (36-75%) of the duct system morphologic alterations in cryptorchidism syndrome have been reported in the literature. Etiopathogenic factors, responsible for this syndrome, are yet to be specified, as is their correlation with testicular descent in the scrotum and peritoneal-vaginal duct regression. METHODS: In a prospective multicentric study we have documented seminal duct anatomy in 566 children, undergoing inguinal or scrotal surgical exploration due to acute scrotal syndrome (group A, "control group"), cryptorchidism (group B), and peritoneal-vaginal duct patency syndromes (group C), for a total of 726 testicles. On the basis of anatomical configurations, explored testicles have been subdivided into three groups: normal testicles (type I), suspension anomalies (type II), obstruction anomalies (type III). Prevalence of the above anatomical configurations in the various groups has been statistically evaluated by the chi 2 test. RESULTS: Results have highlighted a significant prevalence (p < or = 0.01) of severe duct system obstructive anomalies (type III) in children with cryptorchidism (group B) and in children with vaginal duct patency (group C). These results can justify the hypothesis of a close correlation between testicle embryologic migration process in the scrotal sac and seminal duct development; this latter seems furthermore correlated with peritoneal duct regression. CONCLUSIONS: The drawn conclusion is that duct system morphologic alterations in cryptorchidism, due to their seriousness and incidence, can condition final fertility capability.

[Cervical lymphadenitis caused by mycobacteria. Our experience]. / Linfoadeniti cervicali da micobatteri. Nostra esperienza.

BACKGROUND: Mycobacterial infections are extremely complex diseases, either due to the various clinical manifestations, or to the various involved kind of mycobacteria, or to the different sensibility to antibiotics. The authors review retrospectively their series, evaluating the management of pediatric cervical lymphadenitis due to mycobacterical etiology. METHODS: From 1975 to 1998, at the Department of Pediatric Surgery of the university of Siena, 88 children were evaluated for laterocervical lymphadenopathy. Among these, 29 children, aged from 14 months to 13 years, were diagnosed as affected with lymphoadenopathy due to mycobacteria. Therapy of choice was the association of surgery and antibiotics. This behaviour allowed us to approach both advanced lesions, in active colliquation, and progressive ones. RESULTS: Results were unquestionably positive, with a complete resolution and good esthetical results in 93.2% of cases. In 6.8% of cases there was a recurrence, which required reintervention. CONCLUSIONS: On the basis of our series, we agree with the international literature in affirming that, in cases of mycobacterial lymphadenopathy, a combined antibiotic and surgical therapy is necessary. However, controversy about such a complex and difficult pathology is opened and unsolved.