Aggressive angiomyxoma as a rare cause of scrotum enlargement in a 10-month-old boy: a case report.

BACKGROUND: Aggressive angiomyxoma (AAM) is a locally infiltrative mesenchymal tumour that most commonly affects the pelvis and/or perineum in adult women. AAM is very rare in males, especially in infancy. CASE PRESENTATION: A 10-month-old fulani (African) male infant was referred to our department for a large painless mass in the right testicule. The mass was detected during the neonatal period and gradually increased in size. Ultrasound examination revealed a large heterogeneous lesion; computed tomography results led to the conclusion that the mass was a mesenteric hernia. An inguinal and scrotal surgical approach was adopted. Exploratory surgery found a normal right testicle displaced upwardly and a large scrotal mass. Radical excision of the mass and orchidopexy were performed. Subsequent histology and immunohistochemstry studies indicated that the mass was a scrotal angiomyxoma. The postoperative course was uneventful. No recurrence occurred during the 6-month follow-up. CONCLUSION: To the best of our knowledge, this is the youngest patient with AAM reported to date. Angiomyxoma should be included in the differential diagnosis of scrotal masses, for which radical excision is justifiable to prevent recurrence.

[Female inguinal herniain Niger : diagnostic, therapeutic and evolutionary aspects]. / La hernie inguinale de la fille au Niger : aspects diagnostique, therapeutique et evolutifs.

AIM: The aim of this study was to evaluate the diagnostic, therapeutic and evolutionary aspects of female inguinal hernia (ovarian hernia). PATIENTS AND METHODS: This was a prospective and descriptive study lasting 6 years (1st January 2014 to 31st December 2019). It included all girls aged 0 to 15 years old with ovarian hernia, received in the pediatric surgery department of the Hôpital National AmirouBoubacar Diallo in Niamey. The variables studied were the socio-demographic characteristics of the patients, personal and family history, and those related to diagnostic, therapeutic and evolutionary aspects. RESULTS: With 23 recorded cases, ovarian hernia had a hospital frequency of 8.7%. The average age of the patients was 5.6 years (range: 4 months and 11 years). The average duration of evolution before diagnosis was 8 months (range: 0 days and 36 months). The hernia was mainly located on the right side: 14 cases (60.85%). The hernial sac during the operation was most often empty: 11 cases (47.85%). It contained at least the ovary for 10 patients (43.5%). There were 2 cases of strangulated hernia (8.6%). All the patients benefited from a herniotomy. The average operating time was 26.7 days (range: 0 days and 146 days). No deaths and no postoperative complications were recorded after a 3-month follow-up. CONCLUSION: Ovarian hernia in this study is a rare condition often encountered in young girls. In spite of a late treatment, the therapeutic results were satisfactory.

BUT: Le but de cette étude était d'évaluer les aspects diagnostiques, thérapeutiques et évolutifs de la hernie inguinale de la fille (hernie de l'ovaire). PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective et descriptive portant sur une période de 6 ans (1er janvier 2014 au 31 décembre 2019). Elle incluait toutes les filles âgées de 0 à 15 ans présentant une hernie de l'ovaire reçus dans le service de chirurgie pédiatrique de l'Hôpital National Amirou Boubacar Diallo de Niamey. Les variables étudiées étaient les caractéristiques sociodémographiques des patientes, les antécédents personnels et familiaux et celles liées aux aspects diagnostiques, thérapeutiques et évolutifs. RÉSULTATS: Avec 23 cas recensés, la hernie de l'ovaire avait une fréquence hospitalière de 8,7%. Les patientes étaient en moyenne âgé de 5,6 ans (extrêmes : 4 mois et 11 ans). La durée moyenne d'évolution avant le diagnostic était de 8 mois (extrêmes : 0 jours et 36 mois). La hernie était principalement située à droite : 14 cas (60,85%). Le sac herniaire au cours de l'intervention était le plus souvent vide : 11 cas (47,85%). Il contenait au moins l'ovaire chez 10 patientes (43,5%). Il y avait 2 cas de hernie étranglée (8,6%). Toutes les patientes bénéficièrent d'une herniotomie. Le délai opératoire moyen était de 26,7 jours (extrêmes : 0 jours et 146 jours). Aucun décès et aucune complication postopératoire après un suivi de 3 mois n'avaient été enregistrés. CONCLUSION: La hernie de l'ovaire est dans cette étude une affection rare rencontrée souvent chez la petite fille. Malgré une prise en charge tardive les résultats thérapeutiques étaient satisfaisants.

Diagnosis and surgical management of children with oesophageal achalasia: A 10-year single-centre experience in Morocco.

INTRODUCTION: Achalasia is a primary oesophageal motility disorder with unknown aetiology. The aim of this study was to evaluate our 10-year experience in the diagnostic process and surgical management of oesophageal achalasia (OA) in children. METHODS: A retrospective review of all children (age: 0-15 years) treated for achalasia at the department of paediatric surgery from 2007 to 2016 was conducted. The demographics, presenting symptoms, associated diseases, diagnostic process, outcomes and complications were analysed. RESULTS: Fourteen patients were identified, with a mean age of 5.2 years. There were eight female and six male patients. The most common symptom was chronic vomiting, in all patients (100%), followed by weight loss in 10 (71.4%), cough in 6 (42.9%), dysphagia in 5 (35.7%) and chest pain in 3 (21.4%). The mean duration of symptoms until diagnosis was 36.3 ± 29.1 months. Three patients underwent an open Heller myotomy (HM) and 11 laparoscopic HM (LHM) including three conversions. The reasons for conversion were mucosal perforation in two cases and liver bleeding in one patient. The mean operating time and the average length of postoperative stay in the patients of LHM group were, respectively, 2.0 ± 0.7 h and 4 ± 1.5 days. The mean follow-up was 43.2 months. CONCLUSION: : The diagnosis of OA in children is based on clinical arguments and especially on the barium oesophagram findings. Laparoscopic myotomy is the most effective surgical approach in children.

Langerhans cell histiocytosis presenting as eosinophilic granuloma of the bilateral forearms in an 8-year-old girl: a case report.

BACKGROUND: Langerhans cell histiocytosis previously known as histiocytosis X is a rare disease of children and young adults with a very broad clinical spectrum. In children, its annual incidence is estimated between 0.2-0.5 per 100,000. CASE REPRESENTATION: An 8-year-old Moroccan girl with no known personal or family history presented to our institution with painful swelling of both forearms. An X-ray and magnetic resonance imaging were inconclusive. We then performed a biopsy curettage (of her left forearm). Microscopic analysis followed by immunohistochemical analysis disclosed a diagnosis of Langerhans cell histiocytosis. No chemotherapy was necessary. Clinical and radiological improvement was achieved after 6 months. CONCLUSION: The particularity of this observation is the bilaterality of the lesion on both forearms and it has not previously been reported. Langerhans cell histiocytosis should be included in the differential diagnosis of osteomyelitis and Ewing's sarcoma.

[Acute appendicitis due to Claudius Amyand's hernia in a newborn with intestinal obstruction]. / Appendicite aigue sur hernie de Claudius Amyand chez un nouveau-né dans un tableau d'occlusion neonatale.

Claudius Amyand's hernia is defined as the incarceration of the vermiform appendix in the hernia sac. The first reported appendicectomy was performed in 1735. It is very rare among children, hence its frequency is not yet established. We report the case of a 22-day old new born with untreated simple inguinoscrotal hernia who had an urgent admission to the Emergency Department due to occlusive syndrome with no evacuation of faeces and no passing of flatus, inflammatory inguinoscrotal swelling and bilious vomiting persisting for 2 days. Treatment was based on the restoration to good health and on preanesthetic assessment. Intraoperative exploration showed necrotic bulging appendix in its distal half with false membranes. Appendectomy was performed with closure of the hernia sac. Patient's evolution was marked by resumption of intestinal transit 24h after surgery.

Unusual cause of acute scrotum in children: a case report.

A 13-year-old boy was presented in the pediatric emergency with a 2-week history of swelling of the right scrotal contents of simple evolution, which was worsened by the appearance of an acute scrotal pain 48 h prior to his consultation. The doppler ultrasound and computed tomography (CT) scan revealed an incarceration of the omentum in an inguinal hernia. Acute scrotal pain and swelling is a common reason for surgical consultation in the emergency department of children. However, omentum is a rare content of inguinal hernia in children and infarct is exceptional. It should be included in the differential diagnosis of an acute scrotum.

Multifocal rib osteomyelitis in children: a case report and literature review.

Rib osteomyelitis is a rare disease, occurring in ~1% or less of all cases of haematogenous osteomyelitis. During the last century, 58 cases of rib osteomyelitis were reported in the literature, of which, multiple ribs were involved in only five patients. Because of its rarity and non-specific clinical signs, diagnostic of rib osteomyelitis may be delayed. We report a case of multifocal rib osteomyelitis revealed by a dorsal mass in a healthy 13-year-old female child.