A case of penetrating axillary trauma.

INTRODUCTION: Deep penetrating traumas of the axilla extending to the neck are rare and potentially dangerous. OBSERVATION: An 11-year-old child presented with an impressive penetrating axillary injury extending to the neck after falling on a tree branch. The wound was explored in the operating room (OR). A fragment of the branch was removed without injuring any vascular structure. The only lesion concerned the hypopharynx. DISCUSSION: Cervical wounds may have an axillary origin. These wounds must be systematically explored in the OR, given the risk of upper airway obstruction and vascular lesion.

Systemic Lupus Erythematosus-Related Pancreatitis in Children: Severe and Lethal Form.

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease of unknown cause, characterized by multisystemic involvement. Its occurrence in children is rare, and acute pancreatitis is exceptional in this matter. Its diagnosis is clinical, biological, and radiological. Its treatment is based on corticosteroid therapy, and its progress is generally lethal. We report two cases of acute pancreatitis in the course of SLE, highlighting its life-threatening severity despite well-conducted treatment. Case 1: 14-year-old patient, admitted to the pediatric ICU for altered state of consciousness. This child, an outpatient since 2009 for chronic arthralgia, was hospitalized five days previously in the pediatric ward for suspicion of severe SLE, before presenting abdominal pain and vomiting. Hyperlipasemia was found, and an abdominal CT scan confirmed the diagnosis of acute pancreatitis. The patient was put under immunosuppressive therapy composed of high-dosage of corticosteroid and cyclophosphamide cures. She died 20 days after her hospitalization by severe lupus flare with multiorgan failure. Case 2: 14-year-old child, admitted to the Pediatric ward for prolonged fever associated with polyarthralgia (nondeforming, immovable, and additive) that had been progressing since 6 months with altered general state; his symptoms got worst 15 days before his hospitalization by having behavioral disorders and epigastralgia with vomiting. Pancreatitis was strongly suspected in the absence of improvement on symptomatic treatment and confirmed by hyperlipasemia 6 times the normal value and a swollen pancreas on the abdominal CT scan. The child was treated with Solumedrol and cyclophosphamide without improvement and then died after one month of hospitalization by a septic shock.

Upper airway obstruction and hemoptysis due to a leech infestation in a child.

This paper presents the case of a 12-year-old child who presented with an 8-day history of cough, respiratory distress, and hemoptysis. He was admitted first to the pediatric intensive care unit to reestablish hemodynamic and respiratory stability. The chest X-ray showed a bilateral alveolar-interstitial syndrome. Four hours after admission, he had a coughing fit, moderately abundant hemoptysis, and a leech appeared in his mouth, which was removed by the mother. Symptoms completely disappeared afterwards. Endoscopy and ear-throat-laryngeal examination done thereafter were normal. The presence of a leech in the larynx has been rarely described in children, but is not a rare cause of hemoptysis. Extraction is imperative and should be performed as soon as the diagnosis is made to avoid a fatal progression. Prevention remains the best treatment.

[Catheter fracture and pulmonary embolization of the distal fragment: a rare complication of the totally implantable venous access port]. / Rupture du cathéter et migration du fragment distal vers les artères pulmonaires : une complication rare des chambres à cathéter implantables.

INTRODUCTION: Totally implantable venous access port plays a crucial role in the treatment of patients in oncology. However, its use can result sporadically in catheter fracture with catheter tip embolization into pulmonary arteries. CASE REPORTS: We report this unusual but potentially serious complication in four patients. In these patients, the port had been inserted percutaneously into the subclavian vein using the infra-clavicular approach. This side effect occurred late in three patients. In all patients, the catheter fracture was asymptomatic or pauci-symptomatic and was caused by the pinch-off syndrome. The retrieval of the embolized fragments was successfully performed by transcatheter procedure in the cardiac catheterisation laboratory. CONCLUSION: We reviewed the literature and the newest guidelines and recommendations to detail the clinico-radiological features, the possible causes of this complication and discussed means to recognize, manage and prevent it.

[Haemocholecyst: a rare complication of anticoagulant treatment]. / Hémocholécyste: complication rare du traitement antithrombotique.

We report a case of a 50-year-old woman, taking antivitamin K for double mitro-aortic valvular replacement, having presented a clinical picture of acute cholecystitis with marked hypotension. The radiological and biologic exams showed a deep hypocoagulability, vesicular gallstones, a haemoperitoneum and retroperitoneal haematoma. After correction of biological anomalies, the patient was operated. The gallbladder was distended containing large clots and four stones without any evidence of perforation. One of the gallstones led to cystic duct obstruction. Haemocholecyst is a rare complication of anticoagulant therapy, which may occur in the setting of gallbladder stones. The usual complication was the vesicular perforation. In spite of its rarity, haemocholecyst should be suspected when an anticoagulant treated patient presents symptoms of acute cholecystis with or without haemorrhagic shock.

[Traumatic thrombosis of the inferior vena cava]. / Thrombose post-traumatique de la veine cave inférieure.

Traumatic thrombosis of vena cava is rare. Thrombosis of the inferior vena cava diagnosed by uroscanner after blunt abdominal trauma involving the kidney is reported. The Doppler exam confirmed the floating character of the clot. Three days after the initiation of anticoagulant therapy, the thrombus disappeared without any clinical or radiological signs of pulmonary embolism. Fifteen cases of traumatic thrombosis of the inferior vena cava have been described in the literature. Mechanisms, clinical pictures and the management are discussed.

Chickenpox complicated by pneumococcal meningitis: a rare coinfection.

Bacterial complications, particularly skin superinfections, are common during chickenpox. However, reports of acute bacterial meningitis associated with chickenpox are unusual and amount to only a very few observations. For the most part, they are caused by Neisseria meningitidis or Streptococcus pyogenes. We report an infrequent occurrence of pneumococcal meningitis 2 days after the onset of a chickenpox rash in a 7-year-old previously healthy boy. Based on data from the literature, we attempt to understand the possible mechanisms resulting in bacterial complications, particularly meningitis, during chickenpox and to determine the means to prevent it.

[Fatal poisoning by Atractylis gummifera L.: a case report]. / Intoxication mortelle au chardon à glu : à propos d'un cas.

We report the case of a 13-year-old child admitted to the ICU because of Atractylis gummifera poisoning. This plant is poisonous, with a liver tropism and is a public health problem in the pediatric population. Beyond this observation, we review this intoxication, whose diagnosis is clinical, treatment is symptomatic and prevention is crucial.

[Bacteriology of community-acquired peritonitis in children treated in the university hospital of Marrakech]. / Profil bactériologique des péritonites communautaires de l'enfant prises en charge au CHU de Marrakech.

INTRODUCTION: The available microbiological data on community-acquired peritonitis in children are inadequate, and antibiotic therapy is not consensual. Our work aims to study the bacteriology of peritonitis in children in our region and discuss the appropriate antibiotherapy. PATIENTS AND METHODS: A descriptive study spread over one year. We collected cases of peritonitis in which a microbiological study of peritoneal fluid was performed. RESULTS: Of 38 cases, the most frequently isolated bacteria is Escherichia coli (E. coli) (50%). Its sensitivity was 64% to amoxicillin-clavulanate, 93.33% to third generation cephalosporins (C3G) and 100% to ertapenem and aminozides. CONCLUSION: We find a high rate of resistance of E. coli to amoxicillin-clavulanic acid. This prompts us to reconsider our therapeutic approach. We believe that the association C3G+aminoglycoside+metronidazole should be used first-line in the pediatric peritonitis in our context.

Chylothorax complicating closure of the ductus arteriosus: the second case.

Chylothorax is a possible complication of intrathoracic surgery. The diagnosis of postoperative chylothorax is easy; however, the treatment can cause problems of management because of the lack of consensus. In children, the most common causes of postoperative chylothorax are the cures for congenital heart diseases. We report the case of a two-year-old child, presenting with a chylothorax following surgery of the ductus arteriosus. Our case illustrates the treatment that must first include medical measures without delaying the surgery. The risk is the installation of nutritional and immune deficiency.

[Unusual presentation of hypertriglyceridemic acute pancreatitis in a child]. / Présentation inhabituelle d'une pancréatite aiguë hypertriglycéridémique chez un enfant.

Acute pancreatitis in children is rare and is characterized by clinical, biological, and etiological polymorphism. We report the case of a 6-year-old child who underwent surgery for intestinal obstruction. The diagnosis of acute pancreatitis was made after the surgical exploration. Initial laboratory tests showed hyperlipasemia and mild hypertriglyceridemia. After 2 weeks of hospitalization, we found severe hypertriglyceridemia, which was considered the cause of acute pancreatitis. Based on a review of the literature, we emphasize the importance of considering acute pancreatitis in the diagnosis of abdominal pain in children. Hypertriglyceridemia is one of its rare causes and must be detected because specific treatments are needed. Blood triglyceride concentration in the initial phase can be misleading and the assay should be repeated after the acute episode.