Methicillin-resistant Staphylococcus aureus-associated empyema necessitans in a child: A case report and a literature review.

Introduction: Empyema is a known complication of severe pleuropneumonia. In rare cases, if poorly treated, it could result in dissemination and fistulization and transformation into empyema necessitans. The manifestation may appear as a superficial abscess. However, as management highly differs, the recognition of potentially severe phenomenon is required. Case Presentation: We describe a case of empyema necessitans on a 4-year-old girl secondary to methicillin-resistant Staphylococcus aureus. It represents the sixth pediatric case reported in the literature. It was managed by open drainage and prolonged antibiotherapy. The outcome was favorable as guidelines were extracted from similar reported cases. Conclusion: Empyema necessitans remains a rare complication with significant morbidity. Prompt diagnosis and adapted management have relied on limited literature. As such, further reports are necessary to establish proper guidelines.

Methicillin-resistant Staphylococcus aureus-associated empyema necessitans in a child: A case report and a literature review.

Introduction: Empyema is a known complication of severe pleuropneumonia. In rare cases, if poorly treated, it could result in dissemination and fistulization and transformation into empyema necessitans. The manifestation may appear as a superficial abscess. However, as management highly differs, the recognition of potentially severe phenomenon is required. Case Presentation: We describe a case of empyema necessitans on a 4-year-old girl secondary to methicillin-resistant Staphylococcus aureus. It represents the sixth pediatric case reported in the literature. It was managed by open drainage and prolonged antibiotherapy. The outcome was favorable as guidelines were extracted from similar reported cases. Conclusion: Empyema necessitans remains a rare complication with significant morbidity. Prompt diagnosis and adapted management have relied on limited literature. As such, further reports are necessary to establish proper guidelines.

Accessory Scrotum.

Introduction: An accessory scrotum is characterized by a characteristic skin appearance in addition to a normal scrotum in the anatomically normal position. Case report: We report an accessory inguinal left hemiscrotum in a 15-day-old male infant. There was a normal scrotum and penis. The testes were descended and normally located within the normal scrotum. Additional scrotal skin was located anterior and lateral to the normal scrotum. Conclusion: The accessory ectopic scrotum is readily observed by physical examination. Cosmetic excision is the treatment of choice.

Acute peritonitis secondary to post-traumatic appendicitis: A case report and literature review.

BACKGROUND: Blunt abdominal trauma has rarely been reported as a cause of acute appendicitis in the literature. However, the coexistence of the two conditions can cause issues for the patient. We present here a systematic review of cases of traumatic appendicitis as well as our own experience with a 12-year-old male patient. CASE SUMMARY: A 12-year-old male was admitted 3 d after abdominal trauma, experiencing peritoneal syndrome. A pelvic formation was discovered during abdominal ultrasound, and surgical exploration revealed a perforated appendix. A literature review was conducted applying the keywords "appendicitis," "abdominal," and "trauma" to the PubMed, Embase, and Medline databases. Our initial search included 529 papers published between 1991 and 2022, of which 33 papers were finally included. They revealed 51 reported cases. The trauma mechanisms included road traffic accidents, falls, assaults, ball accidents, a horse kick, and a colonoscopy. Eight patients underwent surgical exploration with no prior radiological investigation, and twenty-six patients underwent an initial radiological examination. All reports indicated a perforated appendix. CONCLUSION: Acute traumatic appendicitis represents a diagnostic quandary that can be misdiagnosed resulting in significant morbidity and potential mortality. A high level of suspicion combined with radiological examination may aid in the diagnosis and treatment of this condition.

Mechanical complications of peritoneal dialysis in Tunisian children.

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.

Thoraco-abdominal duplications in children: Two case reports.

INTRODUCTION: Thoraco-abdominal duplication is rare congenital malformations of the notochord that occurs in only 2% of cases of alimentary tract duplications. We report two rare cases of thoraco-abdominal duplication, emphasizing the value of radiological assessment and discussing the place of diagnostic and therapeutic laparoscopy. PRESENTATION OF CASE: It was a 12-year-old girl and an 8-month-old boy, admitted for epigastralgia and dysphagia with respiratory distress respectively. Imaging was in favor of pancreatic duplication with intra-thoracic extension for the first patient and gastro-esophageal duplication for the second. A mass excision was done laparoscopically for the first and by a thoracotomy for the second. The aftermath of the surgery was simple in both cases. CLINICAL DISCUSSION: Thoraco-abdominal duplications are rare congenital malformations that account for only 2% of cases of gastrointestinal duplications. Their diagnosis is difficult since the revealing symptomatology is not common. The treatment is only surgical is facilitated by the laparoscopy which has a diagnostic and therapeutic interest. CONCLUSION: Our case reports focused on the difficulty of the diagnosis that is done by imaging and is confirmed by surgery with anatomopathological examination of the excised mass. Diagnostic and therapeutic minimally invasive approach should be used whenever possible.

Presternal giant epidermal cyst: 2 cases.

BACKGROUND: Epidermal cysts are a common benign lesion, occurring often above the shoulder and within the face and the scalp. Presternal site and huge volume are quite rare, especially in children. AIM: The authors report on two paediatric cases, discuss etiopathogenesis and diagnostic difficulties. CASES: A 2, 5 and 3-year-old boys were admitted for voluminous subcutaneous tumour of the chest. The lesions had appeared since neonatal period with rapid growth after a minimal trauma for the last year. The physical examination found a great presternal cystic mass of 70 mm in diameter which is painless round and mobile. Ultrasonography and magnetic resonance imaging, showed a subcutaneous cystic mass with no mediastinal involvement or other localization in both. Complete surgical excision including the overlying skin with direct cutaneous closure was performed in both cases. The histological examinations confirmed the diagnosis of epidermal cyst. Postoperative courses were uneventful with no recurrence during respectively 18 months and 5 years follow-up periods. CONCLUSIONS: Giant presternal epidermal cyst is uncommon and can raise diagnostic problems. Imaging investigations facilitate accurate diagnosis. Because of malignant degeneration, surgical excision should be mandatory.

Xanthogranulomatous pyelonephritis in childhood: diagnosis difficulties and success of conservative treatment.

BACKGROUND: Xanthogranulomatous pyelonephritis is an uncommon form of chronic pyelonephritis rarely seen in children. Preoperative diagnosis is difficult and management is still obscure. AIM: The authors report on a focal pseudotumoral case and discuss therapeutic modalities. CASE: A 2-year-old boy was admitted for a 2-weeks history of fever and right flank pain. Physical examination revealed a right lumbar mass. White blood cell count was 12.800/mm3 and C reactive protein elevated (50 mg/l). The urine culture was negative. Ultrasonography and computerized tomography demonstrated a focal multilocular cystic mass of the lower polar of right kidney, measuring 80 millimeters, with peripheral enhancement and perirenal involvement. At surgical exploration, a huge abscess of the lower polar of the kidney with dense adhesions to adjacent structures were noted. Excision of the collection and local drainage were performed. Pathologic examination of biopsy specimen confirmed the diagnosis of xanthogranulomatous pyelonephritis. Intraoperative culture was positive for Escherichia coli. Successful treatment of the lesion was achieved with adjunctive antibiotic therapy. The postoperative course was uneventful over a follow-up period of 2 years. CONCLUSION: Xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass. A first-line conservative treatment must be strongly recommended in pediatric focal cases.

Pyelonephritis xanthogranulomatous in childhood: case report and literature review.

BACKGROUND: Xanthogranulomatous pyelonephritis (XGP) is a specific form of chronic inflammatory kidney disease rarely seen in children. The Symptoms are often vague and non-specific AIM: the aim of this paper is to return the particularities of imaging features in xanthogranulomatous pyelonephritis, insisting on differential diagnosis with renal tumors, especially in case of no renal stone or tract obstruction evidence. CASE: We report a case of xanthogranulomatous pyelonephritis in a 2-year-old boy involving the lower renal pole which demonstrates the diagnostic difficulties encountered in this disease CONCLUSION: Xanthogranulomatous pyelonephritis is a rare condition in children and should be included in the differential diagnosis of a child presenting a renal mass.

Evidence of metabolic imbalance and oxidative stress among patients suffering from pressure ulcers.

Background: Pressure ulcers (PU) are serious medical problems that involve several factors. Recent studies suggest that oxidative stress along with chronic inflammation may cause and develop PU. However, the metabolic disturbances underlying PU are not totally known. The purpose of this study is to evaluate biochemical oxidative stress markers in Tunisian patients suffering from PU. Methods: A total of 100 adult patients with PU and 213 healthy adult controls were selected for the study. Biochemical parameters related to immune profiles, and biomarkers of the liver, kidney, and inflammatory proteins were evaluated using recently developed automated measurement methods. Oxidant-antioxidant system markers (malondialdehyde (MDA), carbonyl proteins, total antioxidant potential, total oxidant status (TOS), catalase, and glutathione-S-transferase) were studied using appropriate methods. Results: Patients with PU showed, remarkably, abnormal levels of biochemical markers and relatively higher systemic oxidative stress compared to healthy subjects. This provides the first evidence that alterations in biochemical parameters and oxidative stress are features of PU. Conclusions: Understanding the signaling pathways involved in the development of PU will provide experts with additional knowledge for therapeutic strategies aimed at limiting the oxidative and inflammatory reactions in affected patients. ClinicalTrials.gov ID: NCT0257800.

[Acute cholangitis revealing a primary pancreatic hydatid cyst in a child]. / Une angiocholite aiguë révélant un kyste hydatique du pancréas chez l'enfant.

Pancreatic hydatid cysts represent 0.1 to 1% of all hydatidoses. A 12 year-old-boy, with a previous history of abdominal pain, was admitted for acute cholangitis. Laboratory investigations showed cholestasis, cytolysis and eosinophilia. Serum amylase levels were normal. Abdominal ultrasound and CT scan revealed a 100 mm hydatid cyst, located in the head of the pancreas. The biliary and pancreatic ducts were markedly dilated. Exploratory laparotomy confirmed the diagnosis. A pancreatic fistula was discovered. Subtotal excision of the cyst and external drainage of the pancreatic fistula were performed. Laboratory tests were normal post-operatively. The pancreatic fistulae persisted for two months. Hypercaloric and hyperprotidic feeding resulted in occlusion in three weeks. The rest of the postoperative course was uneventful and the size of the biliary and pancreatic ducts was normal. The authors discuss the diagnostic features of pancreatic hydatid cyst and discuss therapeutic modalities.

A Rare Cause of Recurrent Vaginal Hydrocele: Herniating Mesenteric Hydatid Cyst.

Echinococcosis is a multisystem disease and has propensity to involve any organ, an unusual anatomical site, and can mimic any disease process. The hydatid cyst of the mesenteries known to occur secondary to hepatic involvement but occasional cases of his primitive form has also been reported. We report here one such case of primitive mesenteric hydatid cyst herniated through inguinal canal in a 5-yr-old boy, admitted to our Pediatric Surgery Department of Children's Hospital in Tunis, Tunisia in 2015.

[Glans reimplantation after circumcision accident]. / Réimplantation balanique après accident de circoncision.

INTRODUCTION: Circumcision, the most frequent operation in boys, is performed by various persons and is responsible for a considerable number of documented or non-documented complications. CASE REPORT: The authors report a case of accidental traumatic amputation of the glans during ritual circumcision performed by a nurse on a 5-year-old boy. Reimplantation was successfully performed after suture of the glans. In the light of this case and a review of the literature, the authors describe the treatment and prevention of this type of lesion. CONCLUSION: Circumcision is not a completely benign operation. Iatrogenic lesions are frequent but rarely serious. The best treatment is prevention, which requires education of the population about the importance of medicalized circumcision.

[Laparoscopic treatment of choledocolithiasis]. / Le traitement laparoscopique de la lithiase choledocienne.

In a period of five years we operated 52 patients affected by choledocolithiasis. 38 patients had a laparoscopic approach, 10 patients had directly a laparotomy and 4 patients benefit of a sequential treatment. The conversion rate was 39% because we don't select candidates to laparoscopy, including even patients with acute cholangitis. Main causes of conversion were wedged calculi in the papilla, multiple stones and high inflammation of the common bile duct. Mortality and morbidity were nil. Duration of laparoscopic operation was in a mean of 165 minutes with 8.8 days of hospital stay. Two residual stones were successfully removed by endoscopic sphincterotomy. Laparoscopic treatment of choledocolithiasis is an effective, safe method; it seems to be the best therapeutic alternative. This technique needs an additional and costly instrumentation and good laparoscopic skills. In order to reduce the conversion rate it is recommended to avoid the laparoscopic approach for patients with acute cholangitis and multiple common bile duct stones.