Chronic constipation leading to sigmoid colon volvulus in an adolescent

We report a case of one of the rare complications of constipation in an adolescent. The patient presented with acute abdominal symptoms and the radiographic images revealed a dilated twisted sigmoid colon. Rectal tube reduction was successful and subsequently, the patient underwent sigmoidectomy and uneventful recovery

Acute pancreatitis due to ascaris lumbricoides worm

We present a case of obstructive acute pancreatitis due to infestation with ascaris worm in a very young child. The child had an acute abdominal presentation. The investigations showed high serum amylase; the CT scan showed a hypoechoic tubular shadow in the jejunum with evidence for severe pancreatic necrosis. The child was managed conservatively, and received anthelmintic medication. She passed the worm in the stool and recovered completely

Stage III atypical cellular mesoblastic nephroma

A six-week-old female infant presented with acute progression of abdominal distension and sudden pallor. Abdominal CT scan revealed large renal mass. The patient underwent total nephrectomy. The pathologic features and immune staining confirmed the presence of atypical cellular congenital mesoblastic nephroma. The patient died two months later because of chemotherapy toxicity

Laparoscopic splenectomy in children with sickle cell disease

Background: Many children with Sickle Cell Disease [SCD] might experience severe sickle cell crises due to splenic complications. These include hypersplenism, acute splenic sequestration, splenic abscess and massive splenic infarction. Splenectomy is indicated to decrease the rate of recurrence of complications and the associated morbidity and mortality. The laparoscopic approach has proved to be associated with a better outcome. Many laparoscopic techniques were implemented for the removal of the spleen, especially when it is enlarged and fragile

Objective: To evaluate laparoscopic assisted splenectomy technique and outcome in 51 children with SCD

Design: A Retrospective Review

Setting: Department of Pediatric Surgery, Salmaniya Medical Complex, Bahrain

Method: Fifty-one children who had laparoscopic assisted splenectomy with a small inguinal incision from January 2002 to December 2014 were reviewed

Result: Fifty-one children had laparoscopic assisted splenectomy for either hypersplenism 42 [82.4%] or acute splenic sequestration 9 [17.6%]; 32 [63%] males and 19 [37%] females. The age range was 6 to 14 years, a mean age of 9.8. Only one [1.9%] case required conversion to open procedure due to excessive bleeding. Only 7 [13.7%] were admitted in the ICU following the procedure. The mean length of hospital stay was four days; the measured decrease in the HBS was 38%, preoperative fever was seen in 16 [31%], and there was no mortality

Conclusion: Laparoscopic splenectomy with a left inguinal incision is a safe and effective approach in children with SCD

Idiopathic perforated appendicitis in neonates and infants

Background: Neonatal appendicitis is a very rare condition and has a high mortality rate in premature babies. The diagnosis of acute appendicitis is mainly clinical and the accuracy of clinical diagnosis approach 90%. Although acute appendicitis is a common diagnosis in the pediatric population, it is rare in neonates and infants

Objective: To present the clinical picture of three cases of acute appendicitis in neonate and infants. Design: A Retrospective Study. Setting: Pediatric Surgical Unit, Salmaniya Medical Complex, Bahrain

Method: Two neonates and one infant with acute perforated appendicitis were managed in our unit. The first was ten days old; the second was one month of age and the third was five months of age. The clinical presentations were different

Result: The first case was a female term baby, a product of Caesarean section. On the ninth postnatal day, the patient developed abdominal distention. Abdominal plain X-ray showed a pneumoperitoneum, but no pneumatosis or bowel thickening. During laparotomy, the appendix was noted to have perforated at the base. Appendicectomy was performed and the patient was treated with intravenous antibiotic and supportive measures postoperatively. The second case was a 5-month-old male term baby. The patient had abdominal distension. A plain abdominal X-ray revealed dilated bowel loops. Laparotomy revealed a perforated appendix. Appendicectomy was performed and patient was treated with intravenous antibiotic for one week postoperatively. The third case was a 29-day-old male term baby presented with abdominal distension, constipation and bile stained vomiting. Plain abdominal radiograph revealed dilated bowel loops with absent air in the rectum. Laparotomy revealed a perforated appendix with segmental ileal loop volvulus. Appendicectomy and ileostomy were performed

Conclusion: Vascular insufficiency secondary to cardiac defect or perinatal hypoxia was the most likely cause in our first and third cases. The second case could possibly may have been idiopathic

Atypical presentation of mesenchymal hamartoma of the chest wall in a one-month-old infant

A one-month-old infant had an unusual presentation of Mesenchymal Hamartoma of the Chest Wall [MHCW]. The patient presented with excessive crying. Chest X-ray revealed a large chest mass. The CT and MRI scans revealed heterogeneous mass originating from the posterior aspect of the fifth rib. The patient developed severe respiratory distress and required resection of the mass. The histologic study on the specimen confirmed the diagnosis of mesenchymal hamartoma of the chest wall

Medical Quiz

A nine-month-old male patient presented with abdominal swelling on the left flank region since birth. The patient is known to have meningomyelocele which was repaired soon after birth. Look at the picture below and answer the following questions. Ql. Describe the findings in this patient and mention the most likely content of this swelling. Q2. What is the diagnosis? Answers on page No 276

Left hepatic lobe infarction in a ten year old girl

Hepatic infarction is rare, probably due to the dual blood supply by portal vein and hepatic artery. The causes of hepatic artery occlusion include: atherosclerotic, embolus, arteritis, aneurysm, neoplasia, sepsis, shock, general anesthesia and transcatheter embolization for treatment of malignant hepatic tumors. Abdominal trauma rarely leads to hepatic infarction, causing significant morbidity and may require emergency intervention. We are reporting a case of left hepatic lobe infarction developed after blunt abdominal trauma in a ten year-old girl. It was managed successfully by conservative treatment. The sequela of hepatic infarction, in this case, was evaluated by ultrasound

Medical Quiz

A full term male infant presented with severe respiratory distress, developed immediately after birth. The general condition of the infant deteriorated rapidly requiring ventilator support. The pregnancy was uneventful. His blood tests including complete blood count, arterial blood gas and septic work up were all normal apart from mild acidosis. CT scan of the chest performed as shown below Q.I. Describe the abnormal findings in this CT scan. Q.2. Mention three differential diagnoses