Ovarian Sertoli-Leydig Cell Tumors in a Three-Year-Old Child.

Ovarian Sertoli-Leydig cell tumors (SLCT) are extremely rare malignant tumors deriving from the sex cord stroma. An abdominal mass and a virilization syndrome dominate the clinical symptoms. This particular tumor poses diagnostic and therapeutic problems. Prognosis depends on staging (the International Federation of Gynecology and Obstetrics (FIGO)/tumor, node, metastasis (TNM)) and differentiation. The treatment is surgical, combined with adjuvant chemotherapy in certain cases. We report the case of a three-year-old girl admitted to our department for signs of virilization with an abdominal mass. The literature does not contain any reports of a younger case. Ovarian SLCTs should be considered in every girl presenting with signs of virilization and a lower abdominal mass. The prognosis and management depend on the results of the histological analysis and extension evaluation in order to define therapeutic management.

Retrospective Comparative Study between Duplay and Koff Methods in Repair of Distal Hypospadias.

BACKGROUND: Hypospadias repair is a complicated surgery even in the best of hands. To date, there is a lack of consensus on which surgical technique offers more favourable post-operative outcomes. The present work was undertaken to evaluate and compare the outcomes and complications rates of two single-stage techniques widely used to repair primary anterior hypospadias, namely Thiersch-Duplay Tubularized Plate Urethroplasty and Koff Urethral Mobilisation and Advancement. MATERIALS AND METHODS: Data from the medical records of 120 patients operated on for primary anterior hypospadias were retrospectively analysed and compared. The patients were divided into two groups: 60 patients underwent Thiersch-Duplay procedure (Group A) and 60 patients underwent Koff procedure (Group B). They were compared using the Chi-squared or Fisher's exact test to assess the relationship between the adopted surgical technique and the complications' development with a P < 0.05. RESULTS: Neither intraoperative complications nor acute post-operative complications occurred, whereas 28.3% ( n = 34/120) cases have exhibited at least one late post-operative surgical complication, including 38.3% ( n = 23/60) in Group A and 18.3% ( n = 11/60) in Group B, revealing a better outcome of the Koff procedure despite the statistical insignificance ( P = 0.102). We did not objectify any other complication besides meatal stenosis (MS), urethro-cutaneous fistula (UCF) and wound dehiscence. CONCLUSION: Overall, our study could not demonstrate the superiority of one technique above another. At the same time, it established the versatility, satisfactory cosmetic and functional results, low MS and UCF rates of Koff urethral mobilization and advancement technique in primary anterior hypospadias repair.

Left-sided appendicitis revealing a common mesentery: A Case Report.

Intestinal malrotation is a congenital rotational anomaly that results of abnormal rotation of the gut, said to occur in 1 in 6000 live births. Common mesentery predisposes to volvulus of the midgut and internal hernias due to the left position of the cecum and appendix. The association of this anomaly with acute left appendicitis is rarely reported in the literature. Occurrence of acute appendicitis on common mesentery is a source of diagnosis difficulties, which may lead to a surgical management delay. We report a case of a 10-year-old boy, admitted for a left-sided iliac pain whose radiological investigations confirmed a left acute appendicitis associated with complete common mesentery. The child underwent laparoscopic surgery with simple post-operative follow-up.

Posterior mediastinal teratoma presenting as an abdominal mass in a child: A case report.

We report the case of a 2.5-year-old child admitted for abdominal distension, whose imaging revealed a large posterior mediastinal cystic mass, with a tissue component, a calcification, and a minimal fat component. The ultrasound- guided biopsy led to the diagnosis of a benign extragonadal germ cell tumor, also called mature teratoma or dermoid cyst, whose mediastinal localization is rare, often localized in the anterior mediastinum, and rarely in the posterior mediastinum. The mainstay of treatment is complete surgical excision.

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.

Huge omental lymphangioma with haemorrhage in children: case report.

Omental cystic lymphangioma is a rare benign intraabdominal anomaly with uncertain etiology, predominantly occurring in children. Most cases of abdominal lymphangioma are asymptomatic. However, patients may occasionally present with acute abdomen because of an intestinal obstruction or peritonitis caused by infected cysts, hemorrhaging, and/or torsion. This report describes a case of omental cystic lymphangioma with acute intracystic haemorrhage. Ultrasonography and computed tomography (CT) scan confirmed the diagnosis. Complete excision of the cyst along without omentectomy done with no clinical or radiological evidence of recurrence till 17 months.

Falciform ligament abscess secondary to a ruptured liver abscess in a child: a case report.

Abscess of the liver ligaments is extremely rare, and abscess of the falciform ligament has been sporadically reported. We report the case of a 3 years old male who presented with a three days history of right upper quadrant abdominal pain, fever and nausea. The ultrasound and computed tomography (CT) scan showed an abdominal wall abscess located anterior to the liver. The patient underwent surgery. Abscess of the falciform ligament secondary to a ruptured liver abscess was found. Excision of the falciform ligament including the abscess was performed. Although pathology of the falciform ligament is rare, it should be included in the differential diagnosis of acute abdomen.

[Long-term evolution of vesicoureteral reflux in children]. / L'évolution à long terme du reflux vésico-rénal chez l'enfant.

Vesicoureteral reflux is very common in children, requiring a long follow-up period to reduce its progression toward chronic renal failure. This study aims to analyze the epidemiological diagnostic features, the management of vesicoureteral reflux and long term course of patients with this disease. We conducted a retrospective study of 42 patients with suspected vesicoureteral reflux hospitalized in the Department of Visceral Paediatric Surgery at the Hassan II University Hospital of Fez over a period of 6 years from January 2010 to December 2015. Mean age of patients at diagnosis was 3 years and 2 months. The boy is to girl sex ratio was 1.8. Vesicoureteral reflux was isolated in 81% of patients and secondary or associated in 19% of patients. The most common initial manifestation was urinary tract infection (90.4%). Renal function was impaired in 54.8% of children. The treatment was based on antibiotics against diagnosed UTI (90.4%), antibiotic prophylaxis in the case of recurrence and Cohen reimplantation (97.62%). Surgical indication readily concerned all patients with grades IV and V vesicoureteral reflux (73.9%) as well as patients with impaired kidneys and 26.1% of patients after medical treatment. Early and late postoperative course was in general satisfactory: disappearance of vesicoureteral reflux in 92.68% of cases. Upper urinary tract regressed except for 9.52% of patients; 95.23% of patients had complete recovery of renal function. There was a reduction in UTI recurrence (in 19.04% of cases after surgery). The majority of parents judged positively the clinical course of their children (54.76%) after surgery.

[Complications of Meckel's diverticulum in children: about 18 cases]. / Les complications du diverticule de Meckel chez l'enfant: à propos de 18 cas.

Meckel's diverticulum (MD) is a remnant of omphalomesenteric channel. It is often asymptomatic but it can be responsible for various clinical complications and variable clinical status especially in children. We conducted a retrospective study on complications of MD among children hospitalized in the division of Paediatric Surgery at the University Hospital Hassan II, Fez, Morocco. The study aimed to describe the clinical, radiological and therapeutic features of MD. The study was conducted over a period of 10 years (January 2009 - December 2018) and involved 18 children (15 boys and 3 girls) aged 1 day - 15 years (with an average age of 5 years) who had undergone surgery for complications of MD. Acute intussusception and intestinal occlusion were the most frequent complications. Other complications included: infection of the MD (1 case) and digestive hemorrhage (2 cases). Two rare types of neonatal Meckel's diverticulum were described (neonatal occlusion and fistula associated with omphalocele). In no case, abdominal X-ray without treatment, ultrasound and CT scan showed MD. Scintigraphy was performed in 2 patients with hematochezia and it helped to make the diagnosis of MD in one case. Three patients underwent laparoscopic surgery with resection of the MD and intestinal anastomosis with laparoscopy. The other patients underwent laparotomy. Ileostomy was performed in one case, followed by secondary recovery. Patient's outcome was good, except for one case of anastomotic leakage. Anatomopathological examination showed two cases of heterotopia.

[Pancreatic pseudocyst in children: about 7 cases]. / Le pseudokyste du pancréas chez l'enfant: à propos de 7 cas.

Pancreatic pseudocyst is a rare benign condition, in particular among children. It is an intra or extra pancreatic juice collection lacking of an epithelial lining. We conducted a retrospective study of 7 children whose medical record data were collected in the Department of Paediatric Surgery at the University Hospital Hassan II in Fez, over a period of 11 years, from 1 January 2005 to 31 December 2016. All children were male, their average age was 6.6 years (15 months - 12 years). An history of abdominal trauma was found in 4 cases, abdominal bloating, pain, vomiting and transit disorders were the primary reason for consultation. Clinical examination showed epigastric tenderness and an alteration of the general state in all cases. Abdominal ultrasound as well as abdominal CT scan helped to diagnose pancreatic pseudocyst before surgery. Six patients, out of a total of seven, underwent surgery; we opted for internal bypass (gastro-cystic anastomosis) in 4 cases, external bypass in 2 cases and therapeutic abstention in one case. Pancreatic pseudocysts are rare. Nevertheless, they are the most frequent (80% of pancreatic cystic lesions are pseudocysts and due to acute and/or chronic pancreatitis, pancreatic trauma or pancreatic ductal obstruction).

[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.

Caecal duplication cyst: a rare cause of neonatal intestinal obstruction.

We report a rare case of duplication cyst of the caecum responsible for an intestinal obstruction in a 5-day-old newborn. Preoperatively, we suspected the diagnosis of enteric duplication as ultrasonography demonstrated a cystic mass in the right iliac fossa, and laparotomy confirmed an obstructive caecal mass which was resected and an end-to-end anastomosis was performed. The neonate completely recovered with an uneventful follow-up.

[Neonatal caecal perforation revealing congenital megacolon]. / Perforation cæcale néonatale inaugurale du diagnostic d'un mégacôlon congénital.

Spontaneous intestinal perforations are rare in a full term new-born. We report the case of an infant born at 41 weeks' gestation who, three days after birth, had pneumoperitoneum revealing congenital megacolon. Surgical exploration showed diastatic perforation of the cecum associated with a disparity in rectosigmoid caliber. The patient underwent emergency caecostomy after peritoneal washing. Histological examination of the biopsy specimens confirmed the diagnosis of congenital megacolon. The postoperative course was simple and radical treatment was performed six months later.

Hernia of the bladder through the broad ligament with renal agenesis and ipsilateral ureter blind ending.

Hernia through a defect of the broad ligament is extremely rare in children. These defects can result from a developmental defect or a spontaneous rupture of cystic formations remnants of mesonephric ducts or Müller. Genital anomalies associated with unilateral renal agenesis are more common in females. We report the case of a 13 months girl allowed for assessment of recurrent urinary tract infection; abdominal examination did not objectified palpable mass, the external genitalia were without abnormalities. Abdominal ultrasound revealed a left renal space is empty with a retrovesical cyst. Cystography was requested that objectified a large pelvic cystic mass retrovesical communicating with the bladder, there was also a left vesicoureteral reflux. Uro- MRI showed a cystic formation retrovesical communicating with the bladder, the right pelvic kidney; uterus is normal size for age. DMSA scintigraphy confirmed the absence of the left kidney with the right kidney that ensures 100% of total renal function. To surgical exploration we found a hernia of the bladder through the left broad ligament, the uterus was dislocated on the right side; left ovary was hypoplasic; the ipsilateral ureter was blind with renal agenesis, we performed by reduction of the bladder then closing the hernial orifice, dissection of the ureter with its ligation and section at the vesical stoma. The postoperative course was uneventful. Evolution is favorable. This observation illustrates a hernia of the bladder through the broad ligament associated with ovarian hypoplasia, renal agenesis and ipsilateral ureter blind ending; this association was not described to our knowledge in the literature.