[Malrotated kidney causing prenatal giant hydronephrosis]. / Anomalie de rotation rénale entraînant une hydronéphrose géante prénatale.

We report the case of a malrotated right kidney associated with giant prenatal hydronephrosis due to a non vascular extrinsic ureteropelvic compression. The kidney presented an hyper-rotation of 180° in relation to the original fetal position, with the renal hilum backward looking. At neonatal surgery we discover that the inferior pole of the kidney pushes laterally the ureteropelvic junction like a violin bridge. The simple uncrossing of the ureteropelvic junction from the inferior renal pole relieves the extrinsic ureteral obstacle and the giant hydronephrosis. The authors summarize the morphogenesis of the upper urinary tract which allowed to understand this rare anatomical variation.

Emergency management and conservative surgery of ovarian torsion in children: a report of 40 cases.

INTRODUCTION: The authors describe and discuss the clinical and therapeutic features of 40 ovarian torsions (OT) in children with its urgent treatment that has advanced in recent years. MATERIALS AND METHODS: A retrospective study of 40 cases of OT in 38 children under 16 years of age, excluding adnexal torsions in neonates. RESULTS: Abdominal and/or pelvic pain was the presenting symptom ; 8 of these children had pain between 2 to 9 months prior to surgery and 27/40 (67.5%) had associated vomiting. Before the procedure, ultrasound (US) diagnosed 29 ovarian lesions, related to 14 mature teratomas (MTE) and 10 cystadenomas (CA), one association of MTE and CA in the same ovary, 2 functional cysts and 2 malignant neoplasms. 19/40 torsions could benefit from conservative management. Eleven torsions occurred, 10/11 of these ovaries had an increased volume, and 5/11 had US evidence of small subcortical cysts. Three detorsions with incomplete removal of CA were followed by enlargement of the tumor and re-torsion in 2 of them. Five children had bilateral ovarian pathology which led to unilateral ovariectomy, while the other benefited from conservative treatment. CONCLUSIONS: In any girl presenting with abdominal pain, the diagnosis of an ovarian torsion must be considered. US is performed emergently, but only surgery, most often a laparoscopic procedure, assures diagnosis. The treatment of the torsion is an emergency and must be as conservative as possible in order to preserve the ovarian function. Bilateral torsions are not unusual.

[Acute carpal tunnel syndrome secondary to prolonged pressure on the wrist during enolic coma]. / Syndrome du canal carpien aigu après compression prolongée dans un contexte de coma éthylique.

We report a case of acute carpal tunnel syndrome caused by prolonged compression. A 40-year-old man was admitted for an acute carpal tunnel syndrome secondary to direct compression of the wrist which was blocked in supination under his thorax for ten hours during a period of alcoholic coma. Total sensorial anesthesia of the median nerve territory was noted. The emergency procedure consisted in simple opening of the carpal tunnel without nerve exploration due to the risk of bacterial contamination resulting from skin lesions, devascularization and postoperative fibrosis. Initially, the skin on the volar aspect of the wrist had the aspect of a second degree burn. The patient recovered nerve function the next day and the skin wound healed within 15 days. The patient was seen at consultation at 13 months and exhibited complete recovery of wrist and hand motion with normal thumb opposition and no signs of sensorial or motor deficit. The retinaculum of the flexor system must be opened to guarantee full nervous recovery.

Antenatal isolated hydronephrosis associated with urinoma.

Two cases of prenatally identified urinoma associated with an isolated hydronephrosis are presented, and the pathophysiology and prognosis of this rare condition are discussed. The presence in utero of a peri-renal collection associated with an isolated hydronephrosis seems to be a sign of significant renal dysplasia. These urinomas disappear spontaneously, thus drainage is not necessary, except in the case of compression of surrounding structures. The functional prognosis of these kidneys seems to be most unfavourable.

[Traumatic rupture of the tibialis posterior tendon after ankle fracture: three cases and a review of the literature]. / Rupture du tendon du tibial postérieur lors des fractures de la cheville: à propos de trois cas et revue de la littérature.

We report three cases of complete traumatic tibialis posterior tendon rupture which occurred after ankle fracture. Diagnosis was established at surgery. Repair of the non-degenerative tendon was achieved during the procedure for osteosynthesis of the malleolar fracture. Fractures healed a few months after surgery. The posterior tibialis muscle tendon functioned plantar arch was normal, except in one patient with multiple injuries who died in intensive care thirteen days after the accident. Although exceptional, injury of the tibialis posterior tendon should not be overlooked after ankle fracture. These injuries become apparent only at surgery for the malleolar fracture since pain hinders clinical examination. Primary suture best guarantees a good functional outcome. Residual pain, deficit in active inversion of the foot, modified medial longitudinal arch, or progression to planovalgus are retrospective diagnostic signs.

Dorsal trans-scaphoid perilunate dislocation in a 9-year-old child.

The authors reported on the surgical management of a trans-scaphoid retrolunate dislocation of the carpus associated with a stable styloid fracture of the radius and a displaced fracture of the triquetrum in a nine-year-old child. An open reduction of the dislocation and fixation using a screw inserted disto-proximally in the scaphoid were quickly carried out using a palmar approach. X-ray showed a good union nine months later. At 29 months the motion of the wrist was normal and pain-free, the strength was graded at 80 % in comparison to the contralateral side and the X-ray examination showed no carpal instability nor growth trouble. The authors discuss the mechanism of production and the therapeutic strategy.

Stingray injury to the ankle.

We are reporting on a case of traumatic ankle penetration by the sting of a stingray that occurred in the West Indies. Clinical presentation, management and revue of the literature are also presented.

Cystic rectal duplication: a rare cause of neonatal intestinal obstruction.

A case of cystic rectal duplication revealed on day 2 of life by a low intestinal occluding syndrome is reported. Radiologic imaging (ultrasonography, cystography, rectography) showed a large, retrorectal liquid formation in the pelvis and abdomen, with pelvic compression of the terminal alimentary canal and lower urinary tract. Magnetic resonance imaging demonstrated a liquid formation with clearly defined edges and no medullary involvement, thus ruling out the possibility of a previous meningeal hernia. Biological markers were within normal limits. On day 4, a 9 x 6-cm cystic rectal duplication was removed, followed by a temporary colostomy. Pathologic examination demonstrated typical rectal architecture with ciliated cells. Radiologic and clinical findings at 2-month follow-up were reassuring. This case report is exceptional for the following reasons: (1) As a rule, rectal duplications are relatively rare (70 cases reported in the literature); (2) The means of disclosing a neonatal rectal duplication is unusual (4 cases reported in the literature); (3) The volume of the malformation was considerable; and (4) Heterotopic ciliated epithelium was present.

Localized esophageal leiomyoma and hypertrophic osteoarthropathy.

The authors report the case study of a 13-year-old girl, suffering from epigastric pain related to an important infectious syndrome and from marked hypertrophic pneumosteopathy (clubbed fingers, diffuse cortical hyperostosis). Radiological examination (chest x-ray and computed tomography scan) showed a partly calcified right posterior mediastinal mass. The esophagoscopy showed a fistular emanation from the esophagus to the tumor. The biopsy results were of no diagnostic significance, and the samples demonstrated a bacterial and fungal colonization. An endoscopic sonogram showed an inhomogeneous mass with hyperechoic structures developed between the mucosa and the outer muscular coat of the esophagus. The patient underwent surgery, which showed a large intraparietal tumor of the esophagus, which, through pathological examination, was confirmed to be a benign leiomyoma. Postoperative follow-up was simple and the pneumosteopathic symptoms regressed rapidly. This disease is rare in children under 15 years of age. It is only exceptionally associated with a hypertrophic pneumosteopathy. This pathology is diagnostically challenging to the surgeon. The endoscopic ultrasonography is the best procedure in the assessment of subepithelial tumor and extrinsic compressions of the oesophagus.

Antenatal finding of intestinal obstruction caused by isolated segmental jejunal dilatation: a case report.

The authors report a case of segmental jejunal dilatation that was discovered antenatally and manifested clinically as lower obstruction in a newborn boy. The antenatal ultrasound findings at 29, 30, and 31 weeks' gestation showed a constant hypoechogenic image (6 x 3 cm in diameter) localized to the right flank of the fetal abdomen, thought to be situated in the right colon. A prenatal diagnosis of incomplete right colonic stenosis was considered. In the immediate postnatal period, there were clinical manifestations of intestinal obstruction; however, results of a contrast enema and rectal biopsies were normal. An upper gastrointestinal contrast study showed a dilated jejunal loop situated approximately 15 cm from the ligament of Treitz. During surgery, a large dilated jejunal loop (7 cm in diameter, 15 cm in length) was found and resected. Histopathologic examination confirmed the diagnosis of segmental jejunal dilatation. This is the first antenatal illustration of this rare pathology, and it supports the hypothesis of a congenital origin for this anomaly.

[Pregnancy in the uterine horn after total salpingectomy]. / Grossesse de la corne utérine après salpingectomie totale.

The authors report a case of pregnancy of the uterine horn occurring after total salpingectomy, i.e. including resection of the intramural portion of the tube. They identify the epidemiological, pathophysiological and clinical features of this complication with the help of a review of the literature of cases occurring after partial salpingectomy and total salpingectomy. They discuss the usefulness of resection of the interstitial portion of the tube and feel that prophylactic cesarean section is justified in patients who have remained fertile.