Lymphatic malformations in children: retrospective review of surgical and interventional management.

PURPOSE: Lymphatic malformations (LMs) are classified as macrocystic, microcystic or mixed. Treatment depends on their characteristics: surgery, sclerotherapy, both combined, systemic treatment or observation. This study aims to analyze the surgical and interventional management of LMs in children over the last two decades in our university hospital. METHODS: Management of children born with LMs between 2000 and 2019 was reviewed. Parameters collected were: malformation characteristics, type of treatment, symptoms, imaging, timing of diagnosis and first treatment, number of interventions, recovery rate, complications and length of stay. RESULTS: Files of 48 children were reviewed: 27 with macrocystic and 21 with microcystic LMs. There was no statistically significant difference in type of treatment except for combined treatment, more performed in microcystic LMs (p = 0.04). Symptoms, imaging, timing of diagnosis and first treatment, number of interventions and complications were not statistically significant. Overall, the number of surgeries was lower than sclerotherapies (p = 0.04). Recovery rate after surgery was higher in macrocystic LMs (p = 0.01). Complications and length of stay were not statistically significant. CONCLUSION: A good rate of recovery was observed when surgery was performed, with no significant increase in complications and length of stay. A prospective study will be determinant to create a decisional algorithm for children with LMs.

Gallbladder mucocele caused by intestinal metaplasia in lithiasic cholecystitis: A case report and literature review of a rare association.

INTRODUCTION: Mucin hypersecretion promoted by intestinal metaplasia can lead to gallstone formation. The presence of large amounts of mucin induced by a change in biliary epithelium structure is called a mucocele, a usually benign condition studied among animals but rarely described in humans. This entity must be distinguished from hydrops, a condition secondary to an impacted gallstone in the cystic duct leading to an outlet obstruction and distension of the gallbladder. PRESENTATION OF CASE: We report a case of a 51-year-old female with lithiasic cholecystitis showing areas of intestinal metaplasia associated with a mucocele. Laparoscopic cholecystectomy was performed with an uneventful postoperative course. Macroscopic findings revealed a dilated gallbladder filled with mucoid fluid. Signs of chronic and focally acute cholecystitis with areas of intestinal metaplasia were observed microscopically. DISCUSSION: Lithiasic gallbladders can bear a gene that is found in goblet cells of intestinal metaplasia, leading to mucin hypersecretion. Metaplasia - a benign lesion often encountered on cholecystectomy specimens - can be the precursor of carcinoma. Mucin-producing gallbladder carcinoma is a very aggressive tumor that can appear as a mucocele. Consequently, preoperative computed tomography or magnetic resonance cholangiopancreatography should be performed in the presence of an unusual aspect on sonography. CONCLUSION: Metaplastic changes in gallbladder epithelium associated with an overproduction of mucin and lithiasic cholecystitis reported in this case is a rarity. Malignancy is an alternative diagnosis of gallbladder mucocele that must be suspected whenever preoperative imaging of the gallbladder is atypical.

Impact of the COVID-19 pandemic on the severity and management of acute appendicitis.

Background: The literature seems to indicate that the number of appendectomies dropped at the beginning of the coronavirus disease in 2019 (COVID-19 pandemic), while the number of complicated appendicitis increased due to late presentation. In addition, a longer delay before surgical treatment resulted in a higher morbidity. This study aims to compare the number of appendectomies, the severity, and the management of acute appendicitis during the first two pandemic peaks of COVID-19 with those observed during the same seasonal periods in the previous 2 years in a regional hospital in Switzerland. Methods: We retrospectively reviewed and compared the number of appendectomies, rate of complicated appendicitis, delay to consultation and to surgery, distribution of appendectomies over a 24-h schedule, postoperative outcomes, and rates of overall complications in 177 patients, that is, 66 during the COVID-19 pandemic and 111 before the pandemic. Results: No statistical difference was found in the number of appendectomies, duration of symptoms before consultation, median time to surgery, number of appendectomies performed outside the usual scheduled time for non-urgent surgery, length of postoperative stay, or the rates of overall complications. However, there was a trend in the rate of complicated appendicitis (p = .05). Conclusion: In spite of a high incidence rate of COVID-19 in our canton, the impact of COVID-19 on our population did not follow the pattern observed elsewhere. The reasons for this might be that people would still present to the emergency department due to less strict social distancing measures. Great availability of emergency operating room may also account for the unchanged delay preceding surgical treatment and complication rates.