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Foreign body ingestion is a frequent issue in paediatrician's practice. Foreign bodies often pass the gastro-intestinal tract spontaneously but can sometimes generate complications (1% of the cases). The migration of ingested foreign bodies is rare, but their spontaneous extrusion through the skin is even rarer and was previously described only in the neck. We report an unusual case of a spontaneous extrusion of an ingested foreign body through the skin of the lower abdomen. Observation: A 2 year-old boy, presented with a 2cm inflammatory swelling of the hypogastric region. Laboratory analysis showed hyperleukocytosis (16 7770 /mm3) and high C reactive protein level at 12mg/L. Ultrasonography and computed tomography allowed us to diagnose a parietal foreign body extruding through the skin and to eliminate associated complication (perforation, vascular fistula ). The foreign body was extracted by a surgical incision. This observation is very rare but it is also uncommon because of the nature of the ingested foreign body which was a wooden piece. Its ingestion was explained by a paediatric mental disorder.
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Corpos Estranhos/complicações , Migração de Corpo Estranho/diagnóstico por imagem , Pele/diagnóstico por imagem , Abdome , Pré-Escolar , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
We report a case of urethral cystic lymphangioma. Hematuria is the revealing symptom. Im our knowledge, is the third case described in literature.
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Hematúria/etiologia , Linfangioma Cístico/complicações , Neoplasias Uretrais/complicações , Pré-Escolar , Hematúria/patologia , Humanos , Linfangioma Cístico/patologia , Masculino , Neoplasias Uretrais/patologiaRESUMO
We report a rare case of a thoracic lipoblastoma in a 7-month-old infant who presented with respiratory infection, dyspnea, and a right-sided chest wall swelling. Imaging revealed a predominantly fatty mass, and biopsy confirmed the diagnosis. A right thoracotomy was performed, resulting in subtotal excision due to the tumor's friability. Two months later, a recurrent tumor was detected and was successfully treated with total excision. This case emphasizes the importance of complete surgical resection and regular follow-up to prevent local recurrence of thoracic lipoblastoma.
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We report the case of a 10-year-old child who presented with a renitent lesion on the left abdominal wall. Clinical, radiological, and intraoperative findings concluded to a cutaneous fistulization of a hydatid cyst of the left lobe of the liver. The diagnosis was confirmed by histopathological examination. The child was successfully treated with acombination of medical and surgical management. Complicated hydatid disease should be considered in the differential diagnoses of patients presenting with cutaneous fistulization, particularly in regions where hydatid disease is endemic.
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INTRODUCTION: Magnetic foreign body (FB) ingestion represents a significant health hazard among children. The increasing use of small attractive magnets as toys or parts of various household accessories makes it easily accessible to children. The aim of this report is to raise awareness of public authorities and parents around exposing children to magnetic toys. CASE PRESENTATION: We report a case of multiple FB ingestion in a 3-year-old child. Radiological imaging revealed multiple round objects arranged in a circular shape resembling a ring. Surgical exploration showed multiple intestinal perforations attributed to the magnetic attraction between the objects. CLINICAL DISCUSSION: Although more than 99 % of ingested FB pass without surgical intervention, ingestion of multiple magnetic FB provides a substantially higher risk of injury due to self-association and therefore requires a more aggressive clinical approach. A stable or clinically benign condition, though common, does not necessarily mean a safe situation in the abdomen. Literature review suggests that emergency surgical intervention should be pursued to avoid potentially life-threatening complications; perforation and peritonitis. CONCLUSION: Multiple magnet ingestion is rare, but can result in serious complications. We recommend early surgical intervention before gastrointestinal complications develop.
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INTRODUCTION: Peritoneal dialysis (PD) is the method of choice for extra-renal replacement therapy (ERT) for children with end-stage renal disease (ESRD), because of its various advantages. However, it presents different infectious and non-infectious complications, causes of important morbidity and mortality. AIM: To determine the mechanical complications of PD in our center and to identify risk factors of their occurrence. METHODS: We retrospectively collected the records of 99 patients who were treated with PD within the past eleven years in the department of pediatrics of the University Hospital Charles Nicolle of Tunis. Analysis examining possible risque factors were performed using parametric and non-parametric tests. RESULTS: A total of 63 patients had mechanical complications with an incidence of peritoneal dialysis catheter revision of 1 procedure every 38 months. The causes were dominated by catheter migration (27.5%) and obstruction by fibrin or blood clotting (19.8%). A history of peritonitis (p=0.046) and the presence of comorbidity (p=0.008) were the two independent risk factors for catheter revision. Inguinal hernia was noted in six patients. No patient presented with a hydrothorax. Seven patients presented an episode of hemoperitoneum. CONCLUSION: Our results lead us to focus our efforts on preventing peritonitis and controlling morbidity. Prospective studies will enable us to confirm our results.
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Falência Renal Crônica , Diálise Peritoneal , Peritonite , Humanos , Criança , Estudos Retrospectivos , Estudos Prospectivos , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/métodos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Falência Renal Crônica/complicaçõesRESUMO
BACKGROUND: Trauma remains the leading cause of mortality in the pediatric population. Liver injuries occur commonly in blunt abdominal trauma. AIM: To assess the selective non-operative management of liver injuries in children. METHODS: A retrospective review of 51 patients with a discharge diagnosis of traumatic liver injuries at Tunis Children's Hospital, over a 14-year period from 1996 to 2009. RESULTS: We identified 51 patients with liver trauma. The median age was 7 years. Boys accounted for 58% (n= 30), and the most common cause was traffic accident. Head injuries were the most common associated injuries. Forty-nine patients (96%) required non-operative management without complications. The mean in-hospital stay was 10 days in this group. The ultrasound demonstrated complete resolution and healing after 3-6 months. Two patients underwent surgery for hemodynamic instability. The mortality rate was 0.2 %. CONCLUSION: Safe, non-operative management involves careful serial examination, a CT scanning facility and close monitoring of the patient in a fully equipped high-dependency unit with trained staff to run it. Even though most patients can be treated non-operatively the challenge is to identify the severely injured child early and institute aggressive resuscitation and expedite laparotomy.
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Fígado/lesões , Acidentes/estatística & dados numéricos , Adolescente , Transfusão de Sangue/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Escala de Gravidade do Ferimento , Fígado/cirurgia , Masculino , Estudos Retrospectivos , Ferimentos e Lesões/classificação , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapiaRESUMO
Gastric volvulus is a rare mode of revelation of congenital diaphragmatic hernia. This is an uncommon condition that may be difficult to diagnose in the paediatric population. We here report the case of a three-month-old infant presenting with a rapid worsening of acute dyspnoea. Chest X-ray showed image clarity and ascending gastric air sac. Thoraco-abdominal CT scan showed gastric volvulus complicating left congenital diaphragmatic hernia. Surgical treatment consisted of gastric devolvulation followed by complete reduction of the herniated viscera and closure of the diaphragmatic defect. Patient´s outcome was favourable. Congenital diaphragmatic hernia complicated by gastric volvulus should be considered as a diagnostic and therapeutic emergency due to the risk of life-threatening gastric necrosis.
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Hérnias Diafragmáticas Congênitas , Volvo Gástrico , Criança , Lactente , Humanos , Hérnias Diafragmáticas Congênitas/diagnóstico , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico , Volvo Gástrico/cirurgia , Radiografia , Tomografia Computadorizada por Raios X , Dispneia/etiologia , Doença AgudaRESUMO
AIM: To report a rare case of a left paraduodenal hernia presenting as volvulus of the small intestine associated to an intestinal malrotation. CASE REPORT: A 2 months-old girl presented with history of bilious vomiting, sonography showed signs of volvulus and emergency laparotomy was performed and confirmed left paraduodenal hernia containing a part of the ileon, coecum with right colon and volvulus of the small intestine out of the hernia sac. CONCLUSION: Paraduodenal hernia is an uncommon cause of small bowel volvulus. It can be suspected by clinical and radiological findings, surgery is always required to prevent small bowel necrosis and to repair the defect.
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Hérnia/diagnóstico , Enteropatias/diagnóstico , Volvo Intestinal/diagnóstico , Feminino , Hérnia/congênito , Herniorrafia , Humanos , Lactente , Enteropatias/cirurgia , Volvo Intestinal/etiologia , Volvo Intestinal/cirurgiaRESUMO
BACKGROUND: Perineal ectopic testis (PET) is a rare congenital anomaly in which the testis is abnormally situated between the penoscrotal raphe and the genitofemoral fold. AIM: we report six patients treated for PET. The epidemiological, clinical, radiological and therapeutic aspects of this rare entity are discussed in light of data of the literature. RESULTS: Between 2000 and 2009, six patients (0, 2%) treated for PET were diagnosed among 2156 patients operated upon for undescended testes in unity of paediatric surgery in Tunis children's hospital. The mean age was 21+/- 25 months. The abnormality was associated with an inguinal hernia in two cases. The diagnosis was based on the presence of an empty scrotum or perineal swelling. In all, orchidopexy in a dartos pouch was easily performed through an inguinal skin crease incision.The length of the testicular vessels and vas deferens was adequate with a favourable course in every case. Although the complications of undescended testes are the same as for PET, the timing of surgery should be different. CONCLUSION: It is generally accepted that children must not be below 6 months of age for surgical correction of undescended testes, but there is no need to delay surgery in PET, which can easily be diagnosed by physical examination in the neonatal period. Surgery is indicated even if there is no hernia present. The functional prognosis, always difficult to define, appears to be identical to that of other sites.
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Testículo/anormalidades , Testículo/cirurgia , Pré-Escolar , Hérnia Inguinal/complicações , Humanos , Lactente , MasculinoAssuntos
Doenças do Cabelo/complicações , Recidiva Local de Neoplasia/complicações , Pilomatrixoma/complicações , Neoplasias Cutâneas/complicações , Calcinose/complicações , Criança , Cicatriz/complicações , Feminino , Doenças do Cabelo/patologia , Doenças do Cabelo/cirurgia , Humanos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Pilomatrixoma/patologia , Pilomatrixoma/cirurgia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
BACKGROUND: The last decade has witnessed significant refinements in preoperative diagnostic evaluation and an improvement in surgical techniques and postoperative management for paediatric patients. There has been an improvement in our understanding of the natural history of some congenital renal anomalies which has caused some changes in management approach. AIM: To review the indications for nephrectomy in children between 1996 and 2008, at the departement of paediatric surgery, children's hospital in Tunis. METHODS: There were 80 nephrectomies. A retrospective review of the patients' notes was performed. The 13-year period was divided into two halves (1996-2000 and 2001-2008) which were then compared. RESULTS: The total number of nephrectomies per year significantly increased over the period of the study (4, 6 and 8 nephrectomies per year for 1996-2000 and 2001-2008, respectively; P < 0.05), as did the number of nephrectomies for Multicystic dysplastic kidney (MCDK) (zero and 5 for 1996-2000 and 2001-2008, respectively) and wilms'tumour (8.3% and 29,16% for 1996 - 2000 and 2001 - 2008, respectively). Wilms' tumour, vesico-ureteric reflux (VUR) and pelvi-ureteric junction (PUJ) obstruction accounted for more than half of the nephrectomies (80% and 58% for 1996-2000 and 2001-2008, respectively). The proportion of nephrectomies performed for VUR did not change (15% and 12% for 1996-2000 and 2001-2008, respectively) but fewer nephrectomies were performed for pelvi-ureteric junction (PUJ) obstruction in the second half of the study period (44% and 4,16% for 1996-2000 and 2001-2008, respectively ; P < 0.05). CONCLUSION: The total number of nephrectomies, including partial nephrectomies, has increased significantly. The decrease in nephrectomies for PUJ obstruction could be accounted for by a more aggressive approach in the management and follow up of prenatally diagnosed hydronephrosis. Of note is that there was no significant change in the proportion of nephrectomies performed for VUR. On the contrary, the proportion of nephrectomies increased for neoplastic lesions and MCDK.
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Nefropatias/cirurgia , Nefrectomia/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Nefropatias/epidemiologia , Masculino , Nefrectomia/tendências , Estudos Retrospectivos , Tunísia/epidemiologiaRESUMO
INTRODUCTION: Congenital urethrocele is a rare disease in children. The diagnosis is often easy but the management remain difficult due to the risk of urethral stenosis form. CASE PRESENTATION: We report a case of a 19-month-old child presenting with a penoscrotal mass. Cystourethroscopy confirmed the diagnosis of an urethrocele of the anterior urethra. Urethrocele repair was performed with good results. We propose to discuss clinical, paraclinical and therapeutic characteristics of congenital urethrocele in children. CONCLUSION: An early, precise diagnosis and awareness of the anterior urethral diverticulum in boys with obstructive symptoms can reduce incidence of advanced uropathies.
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INTRODUCTION: In contrast with the usual idiopathic intussusception appearing in infants, neonatal intussusception in full-term newborns is a rare entity and usually due to an organic lead point lesion. It has a misleading and variable presentation. This manuscript reports a very rare case of neonatal idiopathic intussusception in a full-term male newborn in order to highlight the difï¬culties in establishing an early diagnosis. PRESENTATION OF CASE: We present a full-term male newborn who was referred to our department at day 7 of life with fecaloid vomiting, distended abdomen and absence of intestinal transit. No bloody stool was identified. The newborn was in poor condition, dehydrated and hypothermic. He was promptly resuscitated and an abdominal ultrasound was quickly performed, it showed an ileocecal intussusception located in the right hypochondriac region. An emergency laparotomy was performed confirming the ultrasound findings. The pathological exam of the resected bowel confirmed the presence of an intussusception with areas of hemorrhagic rearrangements but no lead point was detected. The patient died from septicemia. CONCLUSION: Intussusception occurring in the neonate is still difficult to assess, because of its rarity and its uncommon mode of presentation. This case report underlines the importance to make early diagnosis, because once a critical condition develops, the mortality rate is likely to rise.
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BACKGROUND: Hypertrophic pyloric stenosis (HPS) is a common condition affecting infants before the first three months of life. AIM: Analysis of our results and comparison with literature to determine particularities of HPS in our country. METHODS: We conducted a retrospective review of 142 patients presenting HPS, between 1990 and 2003. RESULTS: In this study male sex was predominant, with a sex-ratio of 3.8/1. The classical symptom of projectile vomiting was always present, a pyloric tumor was palpated in 19.7% of the cases, metabolic disturbance was noted in 44.3% of patients. The diagnosis was confirmed by ultrasonography and sometimes contrast upper gastrointestinal study. All the infants were treated surgically unless three patients dying before operation, because of a late diagnosis. Postoperative courses were uneventful in 87.4% of cases. Three patients were dead after operation, because of medical complication. CONCLUSION: The cause of HPS is unknown. The diagnosis is suggested by clinic features and confirmed by imaging. Early diagnosis prevents from metabolic complications due to vomiting. Surgical treatment allows early feeding and is associated with a low complication rate and a good long-term outcome.
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Estenose Pilórica Hipertrófica/diagnóstico , Estenose Pilórica Hipertrófica/cirurgia , Constipação Intestinal/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Vômito/etiologiaRESUMO
BACKGROUND: Adnexal torsion is the most frequent gynaecological emergency in children. It requires an early diagnosis and an urgent surgical treatment. PURPOSE: to study the clinical, paraclinical and therapeutic aspect of adnexal torsion in paediatric population. METHODS: This is a retrospective review of nine girls with the diagnosis of ovarian torsion observed over a 7 years period (January 1999 to December 2005). RESULTS: The average age is 9 years (extreme 6 to 13 years). This pathology was located in 5 cases on the right side and in 3 cases on the left side; a case of bilateral torsion of poly-cystic ovary was encountered in a girl with down syndrome. Clinical presentation is made in all the cases by abdominal pains and vomiting. The disorders of the transit and the urinary signs are associated in 3 and 2 cases respectively, the clinical examination objectified a pelvic defense in all the cases and an abdominal mass in 2 cases. Pelvic ultra-sonography was made in 6 observations and give the diagnosis of torsion of the ovary in 4 cases, whereas it was doubtful in the 2 remaining cases when an ovarian mass was observed. In the 3 remaining cases, this examination was not performed since one the diagnosis of acute appendicitis was retained and the patient operated in emergency. All the children of our series were operated; in 1/3 of the cases we found a necrosis of the ovary. 4 cases out of 9 present a torsion on pathologic ovary (cyst, dysplasia), whereas in the 5 remaining cases, we noted a torsion on healthy ovary. 4 young girls have undergoes a annexectomy, of which one was bilateral. The evolution was favorable in all the cases. CONCLUSION: Adnexal torsion is a surgical emergency that need an early diagnosis and management to preserve ovarian function in girls and Doppler sonography every must be done every time there is a pelvic pain without fever in girls