[Von Meyenburg disease found during laparoscopic surgery: report of two cases]. / Maladie des complexes de von Meyenburg (micro-hamartomes biliaires) découverte lors d'une chirurgie laparoscopique: à propos de deux observations.

The authors report two cases of von Meyenburg complexes disease found during laparoscopic surgical procedures. The first patient (41 years old) had multiple gallbladder stones with recurrent hepatic colics. The second patient (45 years old) had gastroesophageal reflux with recurrent peptic esophagitis. In both cases, multiple millimetric and superficial hepatic lesions were found during the exploration of the abdominal cavity. Then, an hepatic biopsy was done because the macroscopic aspect should suspect secondary metastatic lesions. Histological result made the diagnosis of von Meyenburg complexes disease (biliary microhamartomas). It seems to be important to know this anomaly of the ductal plate development and to do a liver biopsy during laparoscopy to affirm the diagnosis and cancel the diagnosis of multiple hepatic metastasis. In fact, this congenital pathology could be associated with increased risk of cholangiocarcinoma of the liver. The modality of radiological monitoring still remains to be defined.

[Jejunal perforation by a fish bone diagnosed by CT-Scan: report of two cases]. / Perforation jéjunale par arête de poisson diagnostiquée par la tomodensitométrie abdominale : à propos de deux observations.

The authors relate two cases of peritonitis secondary to jejunal perforation by a fish bone. Clinically, the first patient presented signs and symptoms of acute diverticulitis and the second had signs of duodenal perforation. In both cases, the diagnosis was made by the CT-scan revealing a linear radio-opaque object suggestive of a fish bone perforating the jejunum. At laparotomy of the first case, we found a perforation located above several loops of small bowel densely adhered to the nonabsorbable intra-abdominal mesh. Removal of the fish bone, suture of the jejunal perforation, washing and drainage of the abdominal cavity were performed. The mesh was removed and replaced by a polyglycolic acid mesh. In the second case, jejunal perforation occurred in an unaltered small bowel loop and a short intestinal resection was performed. The postoperative course was uneventful for both patients. These clinical cases allow us to discuss the several fish bone perforation site and our patients precipitating factors.

Cystography after the Cohen ureterovesical reimplantation: is it necessary at a training center?

PURPOSE: Reimplantation by the Cohen procedure has a low rate of recurrent reflux, although postoperative cystography is done routinely at most centers. According to the French training program for pediatric surgery and urology residents, reimplantation is the main pediatric urology procedure performed during residency. We determine whether it is necessary to perform postoperative cystography routinely and whether the fact that the procedure is done by a junior surgeon modifies management. MATERIALS AND METHODS: A total of 268 children with primary vesicoureteral reflux underwent ureteral reimplantation by the Cohen transtrigonal technique. Bilateral reimplantation was done in 97% of the cases. Reimplantation was performed by a surgery resident assisted by a clinical fellow or senior consultant surgeon in 37% of the cases. Routine cystography and renal ultrasound were done in all patients postoperatively. Followup ranged from 6 months to 5 years (mean 10 months). RESULTS: In 2 children (0.7%) with recurrent reflux surgery was not performed by a resident. One of the 2 children had asymptomatic persistent reflux and no further surgery was done. In the other child postoperative cystography was normal at 6 months. One year later she had acute pyelonephritis with recurrent unilateral reflux and underwent repeat reimplantation. CONCLUSIONS: Routine cystography is not necessary after bilateral Cohen reimplantation. Reflux recurrence is low even at a training center where surgery may be performed by junior surgeons.

[Ureteropyelostomy for obstructed duplicated ureter an easy and reliable operation in infants]. / La place de l'anastomose urétéro-pyélique dans le traitement des duplications urétérales pathogènes.

AIM: Ureteropyelostomy is one of the surgical options to treat obstructed duplicated ureter. We retrospectively analysed the results of this procedure in a group of young children with prenatal diagnosis. MATERIAL AND METHODS: Between 1992 and 1996, 11 children underwent ureteropyelostomy for obstructed functioning duplicated ureter using the following procedures. 7 cases were revealed by prenatal ultrasound and 4 by acute pyelonephritis; an ureterocele was identified in 7 cases. The mean age at surgery was 6 months for the whole group (3-46 weeks), while in the subgroup of prenatal diagnosis, it was 8 weeks (3-9 weeks). The follow-up ranged from 6 months to 4 years. RESULTS: There were no postoperative complications. None of the anastomoses needed revision, and the conserved segments maintained their functioning appearance, on follow-up. 3 children needed a subsequent ureterovesical reimplantation for urinary tract infections due to reflux in the lower segment ureter. DISCUSSION: Ureteropyelostomy is of great interest for the management of the obstructed dilated upper pole ureter revealed by prenatal diagnosis. This specific group of children needs early management to avoid septic complications and ureteropyelostomy is an easy and reliable method at this young age.