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.

Urachal rhabdomyosarcoma: A case report of an extremely rare localisation.

Urachus is a tubular structure connecting the allatois to the bladder's apex, in the embryonic development. We report a rare case of a 5-year-old boy, with no past medical history, complaining of secondary enuresis, pollakiuria and urgent incontinence. Physical exam revealed a hypogastric mass. Echo guided percutaneous biopsy followed by a histological analysis showed embryonal RMS. The remainder of the staging ruled out metastasis. The patient received neoadjuvant chemotherapy before proceeding to complete tumor excision. Surgical exploration revealed that the tumor was primitively related to the urachus. Total resection was performed. The one year follow-up was uneventful.

Splenogonadal fusion misdiagnosed as spermatic cord cyst: a case report.

INTRODUCTION: Splenogonadal fusion is a rare congenital anomaly. The aim of this study was to report a case of splenogonadal fusion mimicking a spermatic cord cyst, and discuss therapeutic management of this rare congenital malformation. OBSERVATION: An eight-years old patient was presented with an asymptomatic three-centimeter oval scrotal mass mistaken for a spermatic cord cyst. Surgical exploration has revealed tow purple-red, firm encapsulated masses. The first mass was two cm long and adherent to the upper pole of the left testis with a cleavage plane. The second mass was four cm long, attached to the first by a fibrous cord and drawn on its superior pole by a serpiginous vascular structure that extended inside the abdomen. The spermatic cord was individualized. Extemporaneous anatomopathological examination of the first mass, totally excised, has concluded to benign lesion. Therefore, the peritoneum was opened, and the superior mass was excised as high as it could be reached without orchiectomy. Definitive Anatomopathological examination concluded to an ectopic splenic tissue. The final diagnosis was a continuous splenogonadal fusion. CONCLUSION: This case highlights the clinical characteristics of this condition, with a special focus on the signs and findings that might help prevent unnecessary orchiectomy. Consequently, it is essential to include this malformation in the differential diagnosis of scrotal masses in children.

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.

Ovarian inflammatory myofibroblastic tumor in children.

Inflammatory myofibroblastic tumors or inflammatory pseudotumors are uncommon solid tumors that are highly vascularized, have an intermediate prognosis, and are associated with local recurrence, and rare metastasis. Inflammatory myofibroblastic tumors (IMT) most often are seen in the lung of young adults, but there have been reports of these tumors occurring in children, in various sites. The authors report a case of an ovarian IMT arising in a six-year-old girl (third case reported in the literature), treated by a right adnexectomy with uneventful postoperative course, and discuss recent reports.

[Urolithiasis in children in Tunisia: current features based on a series of 104 cases]. / La lithiase urinaire de l'enfant en Tunisie. Aspects actuels a propos de 104 cas.

UNLABELLED: The clinical and laboratory characteristics of urolithiasis in Tunisian children have evolved continuously since the 1980s. This retrospective study defines the current status of urolithiasis in children in Tunisia. PATIENTS AND METHODS: All 104 children (age: 8-192 months) of our series were hospitalized for urolithiasis. A first-line metabolic, urine and plasma work-up was performed in 96 patients. Physical and chemical analysis of the stones was performed by stereomicroscopy and infrared spectroscopy, respectively. Statistical analysis of the results was performed with SPSS 11.0 software. The Chi-square test was used for comparison of percentages. RESULTS: Our study shows a male predominance of urolithiasis with a sex ratio of 1.53. The clinical features were dominated by urinary tract infections (28.8%). Stones were situated in the upper tract in 75% of cases and the lower tract in 25% of cases. Urine culture was positive in 15 patients. Identification of the crystalline composition showed that whewellite was the most frequent crystalline species in children (80.0%) and infants (57.1%). Ammonium acid urate was more frequent in infants. CONCLUSION: In this study, we observed changes in the epidemiological characteristics (bladder stones and infection stones) of urolithiasis in children over the last decade in Tunisia. The patient's age is an important factor that must be taken into account during aetiopathogenic work-up.

[Giant ureteric stones: report of two cases]. / La lithiase urinaire géante: à propos de deux cas.

Ureteric stones are generally solitary and less than 2 cm long. Exceptionally, ureteric stones can be longer than 5 cm and/or weigh more than 50 grams, and are referred to as giant ureteric stones. In the light of two personal cases and a review of the literature, the authors review the epidemiological, aetiopathogenic, clinical and therapeutic aspects of this disease with particular emphasis on the importance of the aetiological work-up. These two cases concerned two boys, aged 10 years and 4 and a half years, respectively, with no particular medical history, who presented an acute episode of pyelonephritis. The KUB plain film, renal ultrasound and IVU demonstrated a huge stone filling the right ureter in one case and the left ureter in the other case. The stones were treated surgically in both cases. The aetiopathogenesis of these large ureteric stones remains unclear. A urinary tract malformation (megaureter, ureterocele, stricture, etc.), either alone or associated with a metabolic predisposition plays an important role in the pathogenesis of these large stones. The aetiological work-up of these large stones is essential. Morpho-constitutional stone analysis provides extremely useful and even decisive information in some cases for the aetiological diagnosis. Despite the development of extracorporeal lithotripsy and endourological techniques, the treatment of giant ureteric stones often remains surgical.

[Pyelogenic cyst in children]. / Le kyste pyélogénique chez l'enfant.

Pyelogenic cyst is an intraparenchymal renal cavity lined by transitional cell epithelium which communicates with a calyx via a neck. It is a rare disease, often discovered incidentally. The diagnosis is based on imaging. Asymptomatic forms require simple surveillance and surgical management is only indicated in forms complicated by urinary tract infections or stones. In the light of a case of pyelogenic cyst revealed by upper urinary tract infection in a 12-year-old girl, the authors recall the clinical, histological and therapeutic features of this rare disease.

[Treatment of urinary stones in infants]. / Traitement de la lithiase urinaire du nourrisson.

Up until the beginning of the 1990s, surgery was the only available modality for the treatment of renal and ureteric stones in infants. From 1990 onwards, two new minimally invasive techniques were developed, leading to a real revolution in the management of these patients. The first and most spectacular breakthrough was extension of the application of ESWL to this age-group and the second breakthrough was ureteroscopy following the enormous technological progress in the manufacture of endoscopes. This technique is increasingly useful when lithotripsy is impossible or insufficient. Surgery is still indicated in the case of contraindications to minimally invasive methods or after failure of these methods. It is the method of choice for bladder stones. Medical treatment or watchful waiting have valuable indications, at the cost of regular clinical and radiological follow-up of patients. The choice of treatment modality depends on the size of the stone, its site, its composition, the anatomy of the urinary tract and the availability of the various techniques.

[Intra-abdominal desmoplastic small round cell tumor in childhood: case report and review of the literature]. / Tumeur desmoplastique à petites cellules rondes intra-abdominale de l'enfant : à propos d'une observation et revue de la littérature.

Desmoplastic small round cell tumor (DSRCT) correspond to a recent clinicopathological entity, individualized in 1989 into the group of tumors with small round cells. This pathology puts ethiopathogenic, diagnostic, therapeutic and prognosis problems. Indeed, the ethiopathogenic is still unknown, diagnosis is asserted only by immuno-histochimic and cytogenetic study because of the big number of differential diagnoses and the anatomopathologic polymorphism. Its treatment is not well codified and its outcome remains dark in spite of therapeutic progress. The objective of this work is to report a personal observation of a DSRCT and to proceed to a review of the literature to clarify the epidemiological, clinical, paraclinical and therapeutic aspects of this rare tumor.

[Urinary stones in Tunisian infants, based on a series of 64 cases]. / Particularités de la lithiase urinaire du nourrisson en Tunisie. A propos de 64 observations.

OBJECTIVE: To define the epidemiological and clinical characteristics of urinary stones in infants, to study the role of stone chemical analysis in the aetiological assessment of urinary stones and to define the various treatment modalities adapted to this age-group. PATIENTS AND METHODS: Between 1984 and 2002, 64 infants (age: 5-24 months) were hospitalised for urinary stones. Urine culture was performed in all patients and metabolic assessment was performed in 24 patients. Physicochemical stone analysis was performed by infrared spectrophotometry in 37 patients. RESULTS: Upper tract and lower tract stones were equally prevalent. Urine culture was positive in 48 cases. The micro-organism most frequently isolated was Proteus mirabilis (19 cases). The metabolic assessment was normal in 15 patients and pathological in 9 patients. Infrared spectrophotometry showed that 17 stones were pure. 60 patients were treated surgically, 2 were treated by endoscopy associated with intracorporeal lithotripsy. One patient was treated medically and another patient passed the stone spontaneously while in hospital. No intraoperative or postoperative complication was observed. No recurrence was observed in this series. The mean follow-up is 16 months (range: 6 months to 94 months). CONCLUSION: The epidemiological profile of urinary stones in infants in Tunisia is situated between that observed in developed countries and that observed in developing countries. In our study, the incidence of metabolic abnormalities appears to be low despite a high rate of consanguinity in Tunisia. This can be largely explained by the absence of an aetiological survey and/or an inadequate survey when it is performed.

[Rhabdoid tumour of the kidney in children]. / Tumeur rhabdoïde du rein chez l'enfant.

Rhabdoid tumour of the kidney is an extremely rare cancer in children, which raises aetiopathogenic, diagnostic and therapeutic problems. Treatment of this tumour is not well defined and its prognosis remains poor despite progress in paediatric oncology. The authors report a new case of neonatal rhabdoid tumour of the kidney, with a rapidly fatal outcome and present a review of the literature.

[Nephroblastoma and Wilms tumor: report of 2 cases]. / Néphroblastomatose et néphroblastome: à propos de 2 cas.

Nephroblastomatosis is a rare disease, considered to be a precursor of Wilms tumour. When it is isolated, recommended treatment consists of chemotherapy followed by surveillance. In the presence of associated Wilms tumour, treatment consists of preoperative chemotherapy followed by partial nephrectomy (when possible), followed by postoperative chemotherapy and surveillance.

[Congenital mesoblastic nephroma]. / Le néphrome mésoblastique congénital.

Mesoblastic nephroma is a rare renal tumour mainly observed in neonates and young infants. The authors report a case in a 5-day-old new-born infant presenting with an isolated abdominal mass occupying the left hypochondrium and flank. Ultrasonography demonstrated a 4 cm heterogeneous mass in the lower pole and middle of the left kidney. CT showed an intensely contrast-enhanced heterogeneous mass. The patient was treated by left radical nephrectomy with an uneventful postoperative course. The outcome was favourable without recurrence with a follow-up of one year. Mesoblastic nephroma is considered to be a benign tumour. The diagnosis is suggested by clinical, ultrasonographic and CT findings. Treatment is based on radical nephrectomy. In the light of this case, the authors discuss the clinical, radiological and therapeutic aspects of this tumour.