Computed tomography diagnosis of symptomatic right paraduodenal hernia associated with enteric duplication cyst.

Paraduodenal hernias rarely present with symptoms in children. We report a case of a right paraduodenal hernia associated with enteric duplication cyst that caused intestinal suboclussion in a 9-month-old female infant. Paraduodenal hernia was detected by contrast-enhanced computed tomography. In a review of the English-published literature, we have not found other reports of the association of paraduodenal hernia and enteric duplication cyst. A high index of suspicion is required for detecting paraduodenal hernias in children, and abdominal computed tomography is the most specific imaging study for their preoperative diagnosis.

Selective splenic artery embolization or use of polyglycolic acid mesh in children with severe splenic trauma.

Children with splenic trauma are managed conservatively in most circumstances, and the need for surgical intervention is very rare. When surgical exploration in mandatory, splenic preservation is a worthwhile objective, using various suture methods, biomaterials, or resorbable prostheses. We present our experience over the past year with 5 severe splenic injuries. Three of these patients were treated operatively with a resorbable mesh, while the other two were managed percutaneously by selective embolization of the splenic artery under fluoroscopic control. We describe the embolization technique with its advantages, good outcome with low morbidity, and low economic and social cost.

[Surgical treatment of laryngotracheal stenosis in childhood]. / Tratamiento quirúrgico de las estenosis laringotraqueales en la infancia.

Acquired or congenital laryngotracheal stenosis is uncommon in children although premature infants with respiratory distress syndrome (SDR) requiring ventilatory support with prolonged intubation are at great risk. The different treatments used in the past show high rates of morbidity and mortality. Following the technique described by Cotton in 1980, anterior cricoid slit procedure in the upper two tracheal rings has been used as a primary treatment on five patients since 1991, four by intrinsic stenosis and one by extrinsic. Extubation failed in four of them, checking trough bronchoscopy different grades of laryngotracheal stenosis and in the fifth due to respiratory distress, secondary to subcricoid stenosis. Anterior cricoid split procedure with intubation with conventional endotracheal tube (SET) or Montgomery tube (TTM) was performed on infants whose ages ranged from 4 to 18 months old (averaged 8 months). They were extubated between the 5th and 340th days after surgery. Two of them underwent complications: a skin-tracheal fistula and a paresis of the left vocal cord, the two are asymptomatic after four and eighteen months of the procedure. All patients discharged without signs of upper airway obstruction, except one who developed a granuloma which diminished with cortisone. Anterior cricoid split with prolonged intubation is a safe and useful technique for the treatment of laryngotracheal stenosis.

[Surgical options in the treatment of short bowel syndrome with loss of the ileocecal valve. Intestinal valve, intestinal duplication]. / Opciones quirúrgicas en el tratamiento del síndrome de intestino corto con pérdida de la válvula ileocecal. Válvula intestinal, desdoblamiento intestinal.

Morbidity and mortality are especially increased in pediatric patients affected of short bowel syndrome in whom ileocecal valve was resected. This report concerns 13 infants and children with short gut syndrome with ileocecal valve resected treated in the last 4 years. In two of them we performed intestinal duplication and in seven an antireflux intestinal valve with a segment of bowel. With that procedure we achieved a significant shortening of the hospital stay as well as reduction in time and quantity of total parenteral nutrition. The rest of the patients were treated with conservative management.

[Renal volumetric echography in the newborn infant with an agenetic, dysplastic or obstructive contralateral kidney]. / Volumetría ecográfica renal en el recién nacido con riñón contralateral agenésico, displásico u obstructivo.

In newborn babies with congenital renal pathology type agenesia, dysplasia or obstruction is very important to know if there is intrautero vicariant growing of the contralateral kidney. To find out that we have proceeded to be ultrasound volume measurement of the normal renal unit, as this is a valuable parameter related to compensatory mechanisms. We have studied by ultrasounds 28 renal units (16 right, 12 left) in newborns with contralateral pathology: pyeloureteral stenosis in 10 cases, multicystic kidney in 13 cases, renal agenesia in 3 cases, obstructive ureterocele in 1 case and another one with ureterovesical stenosis. We considered renal function, length of the larger renal axis width and depth of the kidney mass. Renal function was normal in all cases. Analysis of objectives results show a clear difference between the volume of normal Kidneys in children with contralateral pathology and the control group constituted by 42 renal unit in normal newborns without urological pathology. We conclude with the real evidence of compensatory growing of the normal contralateral kidney during intrautero periods.

[Cantrell's pentalogy: complete treatment, step by step]. / Pentalogía de Cantrell: tratamiento completo, paso a paso.

Since MAYOR and CANTRELL described in 1953 and in 1958 the ectopia cordis associated to other four anomalies, few cases have been reported, and only a small part of them have survived. We report the case of a neonate who presented with the features of the pentalogy. On the 3rd day we found at operation the heart laying over the left hepatic lobe, no pericardium could be identified and diaphragm was absent at its anterior edge. We made an "isolating sac" with duramadre fixed to the anterior thoracic wall, to both sides and to the posterior diaphragmatic defect. The initial management of the ventral defect is described. At the age of two years we initiated the definitive treatment aiming to: 1. To protect the heart. 2. To correct the huge abdominal eventration following the closure of the omphalocele. We described in details the technic employed to cover the precordial defect, to reconstruct the diaphragm, and finally as we treated in three consecutives stages the huge abdominal eventration.

[Ectopic gastric mucosa in the proximal esophagus]. / Mucosa gástrica ectópica en esófago proximal.

Gastric mucosa is not found often in the proximal and medial esophagus. Hematemesis and dysphagia are the most frequent symptoms. We report a six year-old child who complained of difficulty in swallowing. A filling defect was detect in the esophagogram. We biopsied the suspected area, through an endoscopy and the pathological examination informed of ectopic gastric mucosa. We performed a 99Tc isotopic study. The child is on ambulatory controls and at the moment is asymptomatic.