Adenocarcinoma de colon en un niño de 10 años / Colonic adenocarcinoma in a ten-years old boy

Se presenta un caso de adenocarcinoma de colon en un varón de 10 años, sin factores predisponentes. Clinicámente se manifestó con obstrucción intestinal, consecuencia un avanzado estadío local. La terapeútica quirúrgica y en quimioterapia no modificó por la rápida progresión tumoral por lo que el niño falleció a los 5 meses del diagnóstico.Se comentan los aspectos clinicos,patológicos y evolutivos del cáncer de colon en la edad pediátrica...

Bilateral and multilobar cystic adenomatoid malformation of the lung.

We report a case of bilateral and multilobar congenital cystic adenomatoid malformation (CCAM) in a four-months-old child with good clinical results after resections of the lesions. This is a relatively rare form of pulmonary disease. The final prognosis in these patients depends on the type of malformation, the presence or absence of fetal hydrops and on the extent of affected lung. Few cases of multiple involvement have been reported. We will consider the physiopathological aspects of the case, late clinical presentation and treatment and the positive surgical response based on the findings of the functional and anatomic imaging studies.

Torsion of vermiform appendix: value of ultrasonographic findings.

A case of torsion of the vermiform appendix is described in a five-year-old boy with a two-day history of right-sided abdominal pain. No associated abdominal tenderness was reported, no vomiting nor fever. The pain was localized in the same place for 24 hours and became more severe and constant. Blood film showed a normal white cell count. After two ultrasonographic examinations in the course of 24 hours, the sign of a distended intestinal loop became constant. With the diagnosis of mucous-producing appendicular lesions or appendicular torsion, a laparotomy was performed. The appendix was severely congested and gangrenous; there was a 360-degree anticlockwise twist in its base. The related literature is reviewed and the value of the ultrasound scanner images and the possible mechanism involved is discussed.

Segmental cecal dilatation with absent appendix: a case of failure of appendiceal regression?

A rare intestinal malformation is reported in a boy 11 years old with a 3-year history of abdominal pain and chronic anemia. Laparotomy revealed a large cecal mass extending beyond the ileocecal valve in the place of the appendix, with bleeding mucosal ulcers.

[Intrahepatic biloma. Conservative management with external drainage]. / Bilioma intrahepático. Tratamiento conservador mediante drenaje externo.

A seven year old boy, one week after surgical intervention for blunt liver trauma, presents an intrahepatic bilioma. Under ultrasonografic guidance, an external drainage is inserted. Contrast injection shows billiary fistula. Three weeks later, after a new contrast injection, billiary fistula resolution is proved, and dranaige tube is withdrawn. Ultrasonografic and CT Scan studies showed total resolution of intrahepatic collection. Intrahepatic billiary collections are a rare complication of the hepatic traumatism. Conservative management with external drainage, should be keept in mind like a first choice terapeutic option.

[Neonatal treatment of Hirschsprung disease using the Duhamel-Martin technique]. / Tratamiento neonatal de la enfermedad de hirschsprung mediante la técnica de Duhamel-Martin.

The definitive surgical treatment in the first months of life without colostomy are essential principles at present in the management of Hirschsprung's disease. The appearing of little size stapling devices like EndoGIA, from the development of laparoscopic surgery, make possible the application of the classical surgicall procedures on early age patients. The experience in five patients operated under two months of life with the Duhamel-Martin procedure is reported. Only in one case previous colostomy was performed for one episode of enterocolitis at age of fifthteen days. The stapling of both pouches was performed with EndoGIA. The agartglionic pouch was closed with TA Roticulator. That provides a reduction in the high of the aganglionic pouch at minimum. Follow-up varied from 3 months to 2 years, without any complication.

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.

Imperforate anus, malrotation and Hirschsprung's disease: a rare association.

The association of imperforate anus with anomalies of rectal innervation is very rare. Moreover, malrotation only rarely accompanies these malformations. We report 2 patients with this unusual triple association and its impact on their management. Retrospectively both patients presented at birth with the same radiological picture of distended distal colon and right-sided small bowel location. We discuss the importance of a systematic search for associated intestinal malformations in cases of imperforate anus in order to avoid serious complications and to choose the optimal operative strategy.

[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.

Minimally conjoined omphalopagi: a consistent spectrum of anomalies.

Omphalapagus twins constitute less than one third of all siamese twins. Most omphalopagi are attached by a skin bridge that often contains hepatic tissue. Only four cases of omphalopagi attached by an intestinal bridge have been reported. The authors present two additional cases of conjoined twins minimally attached by a small bowel and bladder bridge. In both instances, the spectrum of anomalies included a ruptured omphalocele and imperforate anus with cloacal anomalies. The attachment consisted of an open urachal remnant joining the two bladders, and the short small bowel of twin A attached to the terminal ileum of twin B. Separation was uneventful. For one set of twins, the case part of the proximal colon of twin B was used to lengthen the bowel of twin A. Three of the twins survived and underwent additional procedures for repair of the cloacal anomalies. All four previously reported cases of minimally conjoined omphalopagi presented with a remarkably similar spectrum of anomalies. All had ruptured omphaloceles, imperforate anus with cloacal anomalies, and urachal anomalies. Intestinal connection was consistently at a point corresponding to the Meckel diverticulum site of twin B, with blood supply to the small bowel of twin A, probably via the vitelline artery. The consistent spectrum of anomalies encountered with minimally conjoined omphalopagi allows planning of separation. Caution is required to avoid overlooking the patent urachus, and intestinal lengthening procedures based on the vitelline artery become an important consideration.

[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.