Outcomes of pneumatic dilation in pediatric caustic esophageal strictures: a descriptive and analytic study from a developing country.

OBJECTIVES: Corrosive substance ingestion in children represents a significant public health issue due to its long-term health sequelae. Esophageal stricture, main complication of this dangerous condition, is treated by pneumatic dilation and eventually by esophageal replacement. We aimed, through this study, to report the outcomes of esophageal pneumatic dilation complicating corrosive substance ingestion in children in a developing country. METHODS: This cross-sectional study was performed on the population of pediatric patients with caustic esophageal stenosis between January 2005 and December 2020. All patients underwent pneumatic balloon dilation. A logistic regression model was built to predict the probability of the occurrence of the event (success/failure) of the dilation. The ROC curve is used to evaluate the performance of the logistic regression model to discriminate between positive and negative values of the dependent variable. RESULTS: The success rate of pneumatic balloon dilation was 80.4%. The median duration of overall management was 11 months. The severity of caustic stricture observed during endoscopy was significantly linked to worse outcomes (p = 0.001). Multivariate analysis indicated that the severity of stenosis and the number of dilation sessions were independent risk factors for failure of dilation. ROC curve analysis showed that the area under the curve was 71.7%. A Cut-Off point value of 7 provided the best sensitivity and specificity. CONCLUSION: Pneumatic balloon dilation has been proven to be efficacious in infants with caustic esophageal stricture. Pediatric surgeons should take into account factors to promptly switch to replacement surgery and avoid unnecessary and time-consuming serial dilations.

Bilateral pheochromocytoma revealed by acute abdominal pain in a child. A case report.

Pheochromocytoma is a rare tumor during childhood, originating from the chromafine tissue. The clinical presentation can be variable and assembling many other diseases. This tumor submits specific care problems. We report the case of a 7-year-old boy who presented with headache, fever, abdominal pain and vomiting evolving for 3 days. The physical examination revealed a painful abdomen, a high blood pressure and profuse sweating. As an acute appendicitis was suspected, abdominal ultrasound then abdominal CT were performed, revealing multiple bilateral adrenal masses. Measurement of 24-hour urinary catecholamines showed a marked increase in normetanephrines: 7,18 mg/24 h (normal range: 0.07-0.46 mg/24 h). The MIBG scintigraphy revealed a bilateral fixation in the two adrenals. During the next weeks, the patient developed close peaks of threatening hypertension, controlled with difficulty through the concomitant use of three anti hypertensive treatments. He underwent surgery two months after the first consultation, and had a total adrenalectomy on the right side and subtotal on the left side. The pathological examination concluded with multiple and bilateral pheochromocytomas with a PASS score between 2 and 6. The patient was treated with hormone replacement therapy immediately after the surgery. The subsequent course with a 10-month follow-up was favorable with disappearance of functional signs, correct blood pressure, good general condition, normal growth and a normal biological balance.

Familial Near-Total Intestinal Aganglionosis.

Near total aganglionosis represents the most extreme and rare form of Hirschsprung's disease. It can affect more than one member of family. We report three cases of near total intestinal aganglionosis in a family presenting with intestinal obstruction at birth. All of them were operated and a jejunostomy was performed. Outcome was dismal.

Mesenteric cyst in infancy: presentation and management.

Mesenteric cysts are documented as a rare entity in pediatric population. They are considered as benign intra-abdominal tumors with an unknown etiology. Symptoms are not specific and knowledge of such condition is essential in order to establish a proper management. We report three pediatrics cases of mesenteric cysts managed between 2000 and 2009 in the pediatric surgery Department of Monastir College Hospital. We described the clinical, radiological and operative findings. Two males and a female were managed (age range: 10 days-5years, mean age: 6,3years). Two patients were presented with an intestinal obstruction. A preoperative diagnosis was made basing on imaging. Thus, abdominal ultrasonography was performed in all of our reported cases and showed a cystic mass in all cases. The cystic nature of the mass, its margins and its extension were better described on tomographic images. The mesenteric cyst was completely and successfully removed in all cases. The histopathological report confirmed the diagnosis and showed a multiloculated cyst with columnar mesothelial lining, without any defined muscular layer or cellular atypia and without any evidence of malignancy. The children were evaluated post-operatively with a mean follow-up of 2 years and a half. No recurrence was noted in our patients during the follow-up period. It is known that clinical features are not specific of such anomaly but once the diagnosis is made, the complete surgical removal of the cyst remains the treatment of choice with excellent outcomes.

Thoracoscopic treatment of pulmonary hydatid cyst in children: a report of 25 cases.

BACKGROUND: Open surgery is the standard option for the treatment of hydatid pulmonary cysts. Surgeons are able to replicate the principles of conventional surgery using minimally invasive techniques ,in particular thoracoscopy. However, there are few reports about this subject in children. To our knowledge, this is one of the biggest pediatric series ever reported in the literature. aim: the purpose of this study was to determine the best indications of the thoracospic surgery for the treatment of the pulmonary hydatid cysts in children. methods: We report a series of 25 cases with pulmonary hydatid cysts treated using the thoracoscopic approach from 2005 to 2009. We retrospectively analyzed the patients' sex, age, symptoms, biological data, characteristics of hydatid cysts (location, number and size) and the medical treatments. Pulmonary hydatid cyst diagnosis was performed on Chest x-ray, abdominal ultrasound and biological data in all the cases. Tomography was not systematic. All patients underwent video-assisted surgery. A conversion to thoracotomy was conducteded in 2 cases. All the patients had a chest tube and received an antibio-prophylaxy , without Albendazol . A concurrent hydatid cyst at the opposite lung or in the peritoneal cavity was treated later. results: There were 25 cases with a sex ratio of 2.1 and a mean age of 8 years. All the patients underwent a video-assisted surgery. A conversion to thoracotomy was performed in 2 cases because hydatid cysts were large (size > 8 cm). The average duration of the procedure was 75 minutes. In the post-operative course, one patient presented an air leak which required a prolonged chest drainage for 16 days and a second one was treated for lung infection. In all the other cases, the follow-up was uneventful. CONCLUSION: The thoracoscopic approach for pulmonary hydatid cysts in children is feasible. For better results, it is recommended for cysts smaller than 5 cm.