Gastrointestinal stromal tumor: a very rare cause of jejunoileal intussusception in a 6-year-old girl.

A 6-year-old girl was admitted to the emergency department with abdominal pain and bilious vomiting of 3 days in duration. Abdominal ultrasound examination showed an 8-cm-long intussuscepted intestinal segment with a target sign. There was a 26 × 28 × 23 mm nonperistaltic anechoic cystic mass suggestive of a duplication cyst. At laparotomy, the ileocecal region was normal with many enlarged lymph nodes from which biopsies were taken. There was a 20-cm-long intussuscepted segment at the proximal ileum close to the jejunum. After manual reduction, a 2-cm-long edematous segment resembling a duplication cyst served as the lead point. The segment was excised, and a primary bowel anastomosis was performed. She was discharged on the fifth postoperative day. The histopathologic examination revealed that the excised segment contained a gastrointestinal stromal tumor measuring 2.5 cm, with a mitotic rate of 2 to 3 mitoses per 50 high-power fields (low-risk group) showing an infiltrative growth pattern. On immunohistochemistry assay, some of the tumor cells were CD117 and CD34 positive, whereas all of them were smooth muscle actin and S-100 positive but CD10 negative. Staining index with Ki-67 was 5%. Surgical margins were free of tumor. The lymph nodes showed reactive hyperplasia. She was referred to the pediatric oncology department for further evaluation. Gastrointestinal stromal tumors are common in adults and may lead to intussusception. To the best of our knowledge, this is the first childhood case of gastrointestinal stromal tumor causing jejunoileal intussusception in the literature.

Gastric serosal tear due to congenital pyloric atresia: a rare anomaly, a rare complication.

Congenital pyloric atresia (CPA) is a very rare malformation with unknown aetiology. It has has numerous complications including gastric perforation, aspiration pneumonia. Gastric perforations in newborns occur by three mechanisms: trauma, ischaemia, or spontaneous. Here, we report a newborn with CPA presenting with gastric serosal tearing without full-cut gastric perforation. The diagnosis was confirmed with the help of plain abdominal radiograph, ultrasound, contrast-study, and at operation. Treatment of CPA is surgery irrespective of the type of atresia. We performed serosa repair and then the solid, cord-like atretic pylorus was excised with accompanying gastroduodenostomy. Our patient had an uneventful course and was discharged at the end of the second postoperative week.

Two cases of fetus in fetu.

Fetus in fetu (FIF) is a rare cause of abdominal mass in children. One of the malformed monozygotic diamniotic twins is located in the body of other twin. It is differentiated from teratoma by the presence of vertebral organization with limb buds and other organ systems. Diagnosis is based on radiologic findings. Surgical excision is the treatment of choice, leading to the complete removal of the mass. To our knowledge, less than 200 cases have been described in the literature. Herein, we report 2 cases of FIF, a newborn who was diagnosed antenatally and a three-and-half-year- old boy diagnosed with mediastinal FIF after admission for recurrent respiratory tract infections.