Suprasternal dermoid sinus: A case report.

INTRODUCTION: Congenital anomalies in the neck region, such as dermoid sinuses, pose diagnostic challenges in pediatrics. Surgical excisions are vital to prevent complications. PRESENTATION OF CASE: A 7-month-old male infant had presented with a congenital suprasternal dermoid sinus, which had been evident since birth. Imaging confirmed the diagnosis, prompting surgical intervention under general anesthesia. A delicate excision was performed, guided by a methylene blue dye injection, followed by histopathological confirmation. DISCUSSION: Dermoid sinuses typically manifest as cutaneous pits or sinus tracts, with a left-sided predominance and a female predilection. An accurate diagnosis relies on clinical examination and imaging studies to delineate the anomaly. Surgical excision remains crucial to prevent recurrence and complications. CONCLUSION: This case reaffirms the necessity of prompt and accurate diagnosis followed by surgical intervention for managing congenital dermoid sinuses. Ongoing research and collaborative studies are needed to further refine management strategies and improve outcomes for patients with these anomalies, particularly when presenting in atypical locations.

Mesocolic hernia, a case series.

INTRODUCTION AND IMPORTANCE: Paraduodenal hernias are difficult to diagnose due to their unusual presentation. Herein, five new cases are added to the literature. CASE PRESENTATION: Four male and one female child complained of paraduodenal hernias, two on the right side and three on the left side. The intestinal part that herniated inside the hernia sac was also malrotated in four patients. One patient had Meckel's diverticulum with a herniated intestine. One infant had extrahepatic biliary disease, a single atrium, polysplenia, intestinal malrotation, and a left paraduodenal hernia. Exploratory labarotomy was done for reduction of the intestine, reorientation, and repair of hernia orifices. CLINICAL DISCUSSION: Paraduodenal hernia is a component of malrotation. Cautious dissection of the hernia orifice is required to keep away from injuries to the inferior mesenteric vein or left colic artery in the course of the restoration of the left paraduodenal hernia. Also, the superior mesenteric vessels may be injured in the course of the restoration of the right paraduodenal hernia. CONCLUSION: There is a correlation between the occurrence of PDH with malrotation. The diagnosis of malrotation can be made with an ultrasound abdomen; however, it is true that ultrasound cannot make a confirmed diagnosis in all patients. Once the diagnosis of a mesocolic hernia has occurred, surgical repair is mandatory by closure of the defect.

Safety and Efficacy of Hook Diathermy in the Dissection of the Mesocolorectum During Laparoscopic-Assisted Pull-Through for Hirschsprung Disease in Low-Resource Settings.

Background: Surgical correction is the main line of treatment for the congenital disorder Hirschsprung's disease (HD). Laparoscopic techniques proved their safety and efficacy in previous studies. LigaSure™ is the gold standard for colorectal dissection. However, other sealing methods could be used during the unavailability of LigaSure. Purpose: This study aimed to assess the safety profile of the hook diathermy technique compared to LigaSure in colorectal dissection during laparoscopic-assisted pull-through for HD. Materials and Methods: This case-control study was held in the pediatric surgery department at Assiut University Hospitals between September 2017 and January 2023. The study included 57 HD patients who were surgically operated on during a laparoscopic-assisted pull-through. They were divided into 2 groups according to the sealing methods: the ligasure group included 25 patients, and the hook diathermy group included 32 patients. Results: Both groups had no statistically significant differences regarding age, sex, or weight. The transition zone was present in all patients, and most transition zones were rectosigmoid. No cases reported intraoperative blood transfusion or conversion to an open or transanal approach. Minimum intraoperative blood loss was reported in both groups, with no significant differences. As regards postoperative complications, including bleeding, leakage, perianal excoriation, and enterocolitis, no significant differences between both groups were found. Conclusion: The LigaSure and hook diathermy techniques are safe and effective sealing methods for colorectal dissection during laparoscopic-assisted pull-through for HD.

Painful knee.

INTRODUCTION: A bipartite patella is a rare anatomical variant of the patella. A patella bipartite is often asymptomatic and is often an incidental finding on radiological imaging. The patella remains bipartite when secondary ossification centers fail to fuse. Herein, a case of bipartite patella improved after knee arthroscopy and surgical removal. PRESENTATION OF THE CASE: A 57-year-old male with a history of polytrauma. He complained of progressive pain in the right knee area. A radiological investigation reported a right bipartite patella. The condition improved after the open removal of the accessory patella. DISCUSSION: This case is considered type III according to Saupe's classification. Due to its location and radiological appearance, it is a painful synchondrosis of a bipartite patella. CONCLUSION: After the failure of conservative management, the removal of the bipartite patella was necessary and unavoidable to restore everyday activities.

Management of penile post-circumcision ischemia by pentoxifylline infusion and hyperbaric oxygen therapy.

BACKGROUND: Post-circumcision penile ischemia is a devastating complication. We will present our experience in managing children with various forms of penile ischemia. MATERIALS AND METHODS: This cohort prospective observational and interventional study was performed on all male children with post-circumcision penile ischemia between April 2017 and October 2021. A designed and approved protocol includes a combination of early pentoxifylline infusion, hyperbaric oxygen inhalation, early catheterization, and appropriate surgical debridement were applied for patients with deep ischemia 11/23, mainly the necrotic skin and subcutaneous tissues. Data of patient age, anesthesia method, monopolar diathermy usage, early presentation and positive wound culture were collected and analyzed statistically. RESULTS: During the study period 3,382 children were circumcised for non-medical reasons; 23 children were diagnosed with penile ischemia (0.7%), among other complications (9%). Most of the penile ischemia is associated with the use of monopolar diathermy (74%). The use of compressive wound dressing to control post-circumcision bleeding and infections is also responsible for ischemia in 52.2% and 43.5% of the cases. Inexperienced physicians were commonly responsible for ischemia (73.9%). Patients managed at first 24 h had better outcomes than those who were presented later (p = 0.001). CONCLUSION: In children with post-circumcision penile ischemia, a combination of hyperbaric oxygen therapy and pentoxifylline is especially effective for patients with skin and facial necrosis, this management reduces penile tissue loss.

Post-cesarean section laparoscopic cholecystectomy: a case report.

BACKGROUND: Laparoscopic cholecystectomy at the time of cesarean section is novel in medicine. It is safe, feasible, and cost-effective. CASE PRESENTATION: A 29-year-old G3P2 + 0 woman had two previous cesarean sections. She was pregnant at 32 weeks. The fetus had anencephaly. She had acute cholecystitis. Laparoscopic cholecystectomy done at the time of termination of pregnancy by cesarean section. CONCLUSIONS: In a critical period, such as acute cholecystitis, the combination of laparoscopic cholecystectomy immediately post cesarean section is effective if the surgeon is highly qualified and experienced.

Surgical correction of epispadias associated with buried penis.

INTRODUCTION AND IMPORTANCE: Isolated male epispadias is a rare entity with incidence of approximately 1 in 120,000 live births. Epispadias usually presents with a phimotic preputial orifice where glans is not visible and hence is also known as concealed epispadias. Buried penis in children is defined as a congenital insufficient penile skin with an unretractable foreskin that keeps the penis deep inside the pre-pubic fat. This congenital malformation of the penile envelopes is usually isolated. However, in some cases the concealed penis hides an underlying penile anomaly. We present surgical repair of a very rare case with concealed epispadias. CASE PRESENTATION: A nine-month-old infant had buried his penis, and his mother was seeking his circumcision. Local examination revealed concealed penopubic epispadias. A pediatric surgeon operated on this patient using the modified partial penile disassembly technique. The patient was doing well at follow-up visits at one, three, and six months. There were no urethral stricture or obstructive urinary symptoms. The parents were satisfied with the cosmetic outcome. CLINICAL DISCUSSION: The embryogenesis and development of the urethra and the prepuce are linked. Urethral development defects (as in hypospadias or epispadias) are frequently coupled with faulty prepuce on the same side. The goal of surgical management for epispadias is to correct the dorsal chordee and reconstruct the epispadiac urethra and glans. Based on the cosmesis of the penis reconstruction, preservation of erectile function, and achieving urine continence, the outcome is evaluated. CONCLUSION: Concealed epispadias is frequently ignored because patients appear with buried penis, non-retractile prepuce, and a normal urine stream. Preoperative diagnosis and parent counseling are critical for the effective treatment of this uncommon entity. The modified partial penile disassembly procedure, in which the tunica albuginea is stitched to the pubic periosteum at 3 and 9 o'clock, can be used to correct buried epispadias.

Perforated gallbladder in neonates with review of literature.

INTRODUCTION: Neonatal perforated gallbladder is a rare and implausible surgical emergency. Pneumoperitonium and neonatal intestinal obstruction are the main clinical presentations. Many cases of neonatal perforated gallbladder had no clear pathology. Most proper treatment is cholecystectomy during formal exploration. CASE PRESENTATION: We reported a case of male neonate in his first days of life, presented with abdominal distention and pneumoperitonium and so, surgical exploration revealed perforated gallbladder for which cholecystectomy done. CLINICAL DISCUSSION: Idiopathic gallbladder perforation is seldom condition and is hard to discover before exploration. Besides, pathogenesis remains unknown. In our presented case, the real cause of perforation was unknown and main presentation was pneumoperitonium. CONCLUSION: Although perforated gallbladder is a rare entity and in most of cases does not cause pneumoperitonium, but perforated gallbladder should be taken in account of all cases of pneumoperitonium.

The effects of curcumin as dietary supplement for patients with COVID-19: A systematic review of randomized clinical trials.

Accumulating evidence has been reported regarding the effect of curcumin as a dietary antiviral on patients with COVID-19; however, findings are controversial. Our systematic review aimed to evaluate the effects of curcumin in patients with COVID-19. Electronic databases (PubMed, EMBASE, Scopus, Web of Science, Cochrane Central, and Google Scholar) were systematically searched to identify only randomized clinical trials (RCTs) that assessed curcumin in patients with COVID-19 from inception to September 23, 2021 relevant keywords. The Cochrane risk-of-bias tool for randomized trials was used to evaluate the risk of bias. After a critical review of 1,098 search hits, only six RCTs were selected for discussion. A total of 480 patients were included, with 240 amongst the curcumin groups and 240 in the control group. The lymphocyte count was significantly higher in the curcumin group compared to the placebo group. Curcumin was found to decrease the number of T-helper 17 cells, downregulate T-helper-17 cell-related factors, reduce levels of T-helper-17 cell-related cytokines, yet increase the gene expression of Treg transcription factor forkhead box P3 (FOXP3), and decrease T-Box transcription factor 21 (TBX21). Our review revealed that curcumin might have a positive effect on relieving COVID-19 related inflammatory response due to its powerful immune-modulatory effects on cytokines production, T-cell responses, and gene expression. These findings suggest that curcumin confers clinical benefits in patients with COVID-19. However, due to the limited number of the included studies, further high-quality studies are needed to establish the clinical efficacy of the curcumin.

An ileo-ileal intussusception secondary to polypoid lipoma in a child, a case report and review of the literature.

BACKGROUND: Intramuscular intestinal lipoma is one of the rare benign tumours of the small intestine in children and acts as a lead point of intussusception. PRESENTATION OF CASE: We describe a case in which a 4-year-old boy presented with recurrent attacks of colicky abdominal pain and non-bilious vomiting. Abdominal examination was irrelevant. Per rectum (PR) examination indicated an empty rectum without red currant jelly stool and non-palpable mass. Abdominal ultrasonography revealed a target sign of intussusception. After a period of conservative treatment, the child passed normal coloured and well-formed stool. Exploratory laparotomy referred to a long segment ileo-ileal intussusception with a polypoid lipoma as a lead point. Microscopic examination showed a benign non-capsulated intramuscular ileal lipoma. DISCUSSION: Small bowel lipoma produces symptoms of intermittent bowel obstruction. Herein, the child presented with non- bilious vomiting, we attribute this to reflex sympathetic stimulation of the pylorus leading to pylorospasm. CONCLUSION: Small intestinal lipoma is a rare finding in children that may cause intussusception which does not resolve spontaneously.

Idiopathic neonatal pneumoperitoneum, a case report.

INTRODUCTION: There have been non-surgical conditions secondary to neonatal pneumoperitoneum (e.g., mechanical ventilation, pulmonary diseases and pneumatosis cystoides intestinalis) that neonates were able to overcome without the need for abdominal exploration. Idiopathic pneumoperitoneum, although similar to perforation of the alimentary tract and the previously mentioned non-surgical conditions, is a rare and benign condition that does not yet have a definite cause. The criteria by which a surgeon decides on which abdomen to open and which one to observe, is ill-defined. Thus, increasing the awareness of neonatologists and surgeons about this condition will help decrease complications due to unnecessary procedures. PRESENTATION OF THE CASE: We report a case of a neonate with a massive pneumoperitoneum who obtained a surgical intervention with negative finding. We had noted that the bag of the abdominal drain was expanded with gas every 2days, we replace the bag by new one every 2days for 10days postoperative. Nonetheless, the cause of pneumoperitoneum remains unclear. DISCUSSION: There are five main nonsurgical causes of free air in the peritoneal cavity. These are categorized as follow: pseudopneumoperitoneum, thoracic, abdominal, gynecological and idiopathic. This is a condition in which imaging shows free air in the peritoneal cavity that can either be managed with observation and supportive care alone or results in a negative laparotomy. CONCLUSION: This case demonstrated that laparotomy is not a true routine in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established. Future research is still necessary to understand the source of the free gas in the abdomen, as well as the underlying causes of delayed postoperative gas underdiaphragm and postoperative abdominal drain bag gas expansion.