Thoracoscopic treatment of pulmonary hydatid cyst in children: a report of 25 cases

Open surgery is the standard option for the treatment of hydatid pulmonary cysts. Surgeons are able to replicate the principles of conventional surgery using minimally invasive techniques ,in particular thoracoscopy. However, there are few reports about this subject in children. To our knowledge, this is one of the biggest pediatric series ever reported in the literature.The purpose of this study was to determine the best indications of the thoracospic surgery for the treatment of the pulmonary hydatid cysts in children. We report a series of 25 cases with pulmonary hydatid cysts treated using the thoracoscopic approach from 2005 to 2009. We retrospectively analyzed the patients' sex, age, symptoms, biological data, characteristics of hydatid cysts [location, number and size] and the medical treatments. Pulmonary hydatid cyst diagnosis was performed on Chest x-ray, abdominal ultrasound and biological data in all the cases. Tomography was not systematic. All patients underwent video-assisted surgery. A conversion to thoracotomy was conducteded in 2 cases. All the patients had a chest tube and received an antibio-prophylaxy, without Albendazol . A concurrent hydatid cyst at the opposite lung or in the peritoneal cavity was treated later

[Persistent hyperinsulinemic hypoglycemia [HHI] of infancy: about 3 cases]

Hyperinsulinaemic hypoglycaemia [HHI] is the most frequent aetiology of recurrent severe hypoglycaemia in newborn and infant. This pathology arises the problem of early medical and surgical management to prevent brain damage. The aim of this work is to stress on the treatment emergency, to underline difficulties to distinguish damage. The aim of this work is to stress on the treatment emergency, to underline difficulties to distinguish between focal forms and diffuse forms, and to discuss our results with literature data. Our work is a retrospective study of 3 observations of symptomatic newborn HHI. Due to failure of glucose supplementation and medical treatment based on diazoxide and hydrocortisone, the 3 patients were operated between 50 and 107 days of life. Surgical exploration did not find any macroscopic pancreatic abnormality and intervention consisted of subtotal pancreatectomy [90-95 percent]. Anatomopathological study showed diffuse form in 2 cases and focal form in one case. After a follow up of 3 months to 2 years and a half the 3 patients have a normal glycaemia with no need to medical treatment. Yet 2 patients present brain damages .HHI is an emergency which needs a rapid medical management. Medical treatment failure should lead quickly to surgery to prevent neurological complications

[Ileal prolapse through patent omphalomesenteric duct. A review of six cases]

Meal prolapse through the umbilicus is a severe complication of patent omphalomesenteric duct which exposes to the risk of intestinal necrosis in case of diagnostic or therapeutic delay. This is a retrospective study of six cases of ileal prolapse complicating a patent omphalomesenteric duct observed between 1986 and 2004 in the pediatric surgery department of Monastir. The mean age of the six patients was 67 days. The diagnosis was performed on the observation of an out-f low of intestinal liquid or stools through the umbilicus associated to an ileal prolapse. Five patients were treated by intestinal resection and anastomosis and the sixth had a wedge-shaped resection of the omphalomesenteric duct. One patient died from a severe sepsis. The evolution was favourable for the other patients. The ileal prolapse complicates 50 to 80 per cent of the umbilical enteric fistula. It exposes to the risk of occlusion and intestinal necrosis. So, the treatment must be urgent and consists on the resection of omphalomesenteric duct with ileal anastomosis.This treatment can be done by classic surgery or, more recently, by coelioscopy. The mortality can reach 33 per cent in the event of diagnostic or therapeutic delay. The ileal prolapse is a rare form of the patent omphalomesenteric duct which must be diagnosed and treated quickly to ovoid complications

[Primary peritonitis in children]

Background: Primary peritonitis is rare in children. It raise problems of aetiology diagnosis, and therapy. The aim of this study is to review the particularities of this pathology by emphasizing these difficulties of the treatment

Methods: Its a retrospective study of 14 cases of primary peritonitis treated in the infant surgery unit of Monastir hospital in the period between January 1984 and December 2003.The mean age was 2 years ;the sex ratio was 1/6.The beginning of the clinical symptoms were usually acute

Results: The diagnosis was done by surgical exploration in 13 cases/14; in only one case the diagnosis was highly suspected because of the results of the peritoneal drainage. The post operative course was uneventful for 11 patients; two died probably because of liver failure and presented a residual peritonitis

Conclusion: primary peritonitis of the child is rare. until now, it is still a controversial pathology. Its treatment can be only medical but the surgical treatment which can be laparoscopic must be indicated if there is a doubt

[Rectal duplications. Report of two cases and literature review]

Rectal duplications are very rare and pose sometimes diagnostic problems. We report 2 cases of rectal duplication among 32 alimentary tract duplications [6%] observed over 17 years period. The 2 patients were female and were hospitalized respectively at the age of 20 days and one month. In the first case the diagnosis was early in front of a mass prolapsed to the anus. In the second case, the diagnosis was posed at age the 6 months after iterative interventions for perished abscess and anal dents. The treatment consisted on a subtotal resection of the malformation in the first case and a lowering of the colon after iterative interventions for recidivant anal dents. Evolution was favorable in the two cases with a follow up of 4 and 10 year. Although it's rare, the diagnosis of rectal duplication must be evoked in front of any crowned pre sacral mass. Only an early diagnosis and treatment make it possible to prevent the complications and the later evolution towards the degeneration