[Cantrell's pentalogy. Four cases reported]. / Pentalogía de Cantrell. Informe de cuatro casos.

BACKGROUND: In 1958, Cantrell etal. described a rare syndrome in neonates. The description of the syndrome was characterized by a midline supraumbilical defect encompassing a thoracoabdominal omphalocele and ectopia cordis, a defect of the lower sternum, ventral diaphragmatic and pericardial defects, and other congenital cardiac anomalies. CLINICAL CASES: 4 neonates with the uncommon Cantrell's pentalogy were seen in our hospital within a 5-year period without having any apparent factor in common. This paper describes the clinical course and surgical correction. CONCLUSIONS: Early detection of these anomalies is very important for the diagnosis and surgical planning, and subsequently for prognostic implications.

[Appendicitis in a two-months old infant with a peritoneovaginal duct]. / Apendicitis en un lactante de dos meses con conducto peritoneovaginal permeable.

Acute appendicitis in infants is a very unusual disease, but associated to structural defects like patent peritoneovaginal duct, Meckel's diverticulum, clubfeet, and Moebius syndrome is extremely rare. Case report. A male of two months-old with this association is presented. Left inguinal swelling and acute abdomen syndrome were identified. In laparotomy, iguinal defect and a gangrenous appendicitis were observed. Appendectomy was performed and postoperative recovery was unevenful.

Apendicitis en un lactante de dos meses con conducto peritoneovaginal permeable / Appendicitis in a two-months old infant with a peritoneovaginal duct

La apendicitis en lactantes menores es una enfermedad poco frecuente, y más aún cuando está asociada a defectos estructurales como conducto peritoneo vaginal permeable, divertículo de Meckel, pie equinovaro bilateral y síndrome de Moebius. El presente caso corresponde a un lactante varón de dos meses de edad con aumento de volumen de la región inguinal izquierda y síndrome abdominal agudo. En la cirugía se encontró defecto inguinal y apendicitis gangrenada. Se realizó apendicectomía con evolución favorable.

Acute appendicitis in infants is a very unusual disease, but associated to structural defects like patent peritoneovaginal duct, Meckel diverticulum, clubfeet, and Moebius syndrome is extremely rare. Case report. A male of two months old with this association is presented. Left inguinal swelling and acute abdomen syndrome were identified. In laparotomy, iguinal defect and a gangrenous appendicitis were observed. Appendectomy was performed and postoperative recovery was unevenful.

[Enterocutaneous fistula in the pediatric population. Clinical experience]. / Fistula enterocutánea en la edad pediátrica. Experiencia clínica.

BACKGROUND: The presence of fistulous communications between the small bowel and the skin continues to be one of the most perplexing and challenging problems facing the surgeon today. Their occurrence is a major catastophe of surgical practice because are frequently a result of technical failure or errors in surgical judgement. MATERIAL, METHOD AND RESULTS: Thirty four patients with high-output enterocutaneous fistulae arising from the small intestine are reported. Fourteen were due to appendicitis and sixteen were infants. Fistula resection were performed in six patients. Spontaneous fistula closure occurred in twenty-eight. Six died. The treatment program included parenteral nutritition thorugh central venous line, local care and antibiotics. CONCLUSIONS: In recent years, more aggressive therapy accompanied by the development of high caloric parenteral alimentation shows promise of reducing the mortality and morbidity rates associated with these fistulas.

Surgical aspects of intussusception secondary to Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome (PJS) is a familial condition characterized by the presence of pigmented mucocutaneous spots and intestinal polyposis. Intussusception is the most frequent abdominal complication, but it is very rare. In our country, this is the second known report. In this article we present four cases of PJS associated with intussusception. All the patients were female and all underwent a surgical procedure. The intussusception was located in the ileum and colon. There are no more than 20 reported cases in the world where these two entities are associated. Children with PJS have a high risk of suffering from ileo-ileal or jejuno-ileal intussusception that will frequently require a special surgical procedure.

[Traumatic perforation of the anorectal canal]. / Perforación traumática del conducto anorrectal.

INTRODUCTION: Traumatic perforation of the anorectal canal in children is relatively uncommon. There may be difficulties in recognizing or properly treating such injuries because their severity may not be reflected accurately by the external appearance of the perineum. MATERIAL AND METHODS: This was a retrospective survey of 19 children with anorectal rupture injuries secondary to blunt trauma and perforating mechanisms. RESULT: Sixteen (89.4%) were male and 15 (77.0%)suffered perforation after al fall on a sharp tool. All were admitted more than 12 hours after accident. Twelve (63.0%) had transanal extra-peritoneal injuries and 13 (68.4%) patients underwent colostomy. CONCLUSIONS: The majority of these perforations are caused by falls at play. The current standard principles in the treatment of anorectal injuries in children and wound drainage, broad-spectrum antibiotics and frequently fecal diversion.

[Intrauterine necrosis in closed gastroschisis]. / Necrosis intestinal in utero por gastrosquisis.

INTRODUCTION: Strangulation of the intestine as the result of compression of its blood supply in a tightly closed gastroschisis defect is a very rare occurrence. CLINICAL CASES: We present the cases of two newborn patients who had extra-abdominal infarcted bowel and intra-abdominal jejunal atresia due to vascular compression for gastroschisis defect. One was associated with colonic, probably acquired aganglionosis. Both had similar clinical courses. CONCLUSIONS: This association is very uncommon. Prognosis of this complex is very poor.

[Testicular necrosis resulting from torsion in children. Perspective of a second level hospital]. / Necrosis testicular por torsión en niños. Perspectiva de un hospital de segundo nivel.

INTRODUCTION: The disaster of a testicular torsion leading to the possible loss of a gonad within a few hours is a well known occurrence and it is discouraging. Clinical examples emphasizing torsion of the testis as the most important differential diagnosis in children with acute scrotal pain and swelling, as well as the need for early exploration, have been reported with increasing frequency. MATERIAL AND METHODS: Seventy cases of clinically diagnosed unilateral torsion of the testis have been admitted to our pediatric surgical unit over a period of 8 years. There were 46 cases between 13 and 15 years of age; 34 were admitted after 24 ho and 25 after 3 days of multilating disease. Left side was involved in 46 cases and 61 testicles were removed. CONCLUSIONS: In order to avoid initiation procedures, early diagnosis is very important.

[Renal trauma in childhood. Second-level hospital experience]. / Trauma renal en la edad pediátrica. Experiencia de un hospital de segundo nivel.

UNLABELLED: The leading cause of death in children is accidents. Severe craniocerebral trauma and injuries to the heart or major vessels are mainly responsible for immediate death. This phenomenon is also reflected in the increasing number of pediatric admissions for renal trauma. MATERIAL AND METHODS: From 1990 to 2000, the charts of 132 patients with renal injuries secondary to blunt and penetrating trauma in childhood are reviewed. RESULTS: A total of 88 were male patients and 126 sustained blunt trauma (motor accidents, falls, etc.). Gross and microscopic hematuria were the most important finding at the time of presentation, and correlated with severe renal injury, and both were present in 122 cases. Intravenous pyelography and CT scan were the most useful diagnosis tools. Only 27 patients were managed operatively, the majority because of associated intra-abdominal injury. CONCLUSIONS: Intravenous pyelography remains the most cost-effective means of investigating renal injuries in a second-level hospital. Renal contusion and most laceration should be managed conservatively. Only few a renal transactions should be managed operatively.

Trauma renal en la edad pediátrica. Experiencia de un hospital de segundo nivel / Renal trauma in childhood. Second-level hospital experience

The leading cause of death in children is accidents. Severe craniocerebral trauma and injuries to the heart or major vessels are mainly responsible for immediate death. This phenomenon is also reflected in the increasing number of pediatric admissions for renal trauma. MATERIAL AND METHODS: From 1990 to 2000, the charts of 132 patients with renal injuries secondary to blunt and penetrating trauma in childhood are reviewed. RESULTS: A total of 88 were male patients and 126 sustained blunt trauma (motor accidents, falls, etc.). Gross and microscopic hematuria were the most important finding at the time of presentation, and correlated with severe renal injury, and both were present in 122 cases. Intravenous pyelography and CT scan were the most useful diagnosis tools. Only 27 patients were managed operatively, the majority because of associated intra-abdominal injury. CONCLUSIONS: Intravenous pyelography remains the most cost-effective means of investigating renal injuries in a second-level hospital. Renal contusion and most laceration should be managed conservatively. Only few a renal transactions should be managed operatively.

Trauma en pediatría / Trauma in the pediatric age

El artículo hace una descripción somera sobre la historia del trauma en la edad pediátrica. Asimismo, hace hincapié en cuán relevante es este fenómeno con relación a la morbilidad y mortalidad y el efecto que tiene sobre la economía y desarrollo en general. Se analizan a profundidad las peculiaridades anatómicas que detenta el individuo en crecimiento y desarrollo, especialmente cuando se compara con el adulto, y las variedades de lesiones traumáticas que se pueden observar. Se detalla con mayor profundidad, lo que corresponde al manejo intrahospitalario del niño accidentado, haciendo énfasis en la evaluación clínica, en el criterio de asignación de gravedad y el manejo sistematizado según lo propuesto por ATLS (advanced trauma life support).

Extracción de monedas alojadas en el esófago: un método inocuo, efectivo y sencillo / A simple, cheap, and safe method to extrac swallowed coins in the upper esophagus

Introducción. La ingestión de cuerpos extraños (monedas, etc.) es una condición muy común y se han publicado diversos estudios en los que se analiza la manera de hacer el diagnóstico y los métodos de extracción. El diagnóstico es usualmente sencillo, pero extraerlos resulta problemático. La esofagoscopia es un procedimiento potencialmente peligroso en manos inexpertas y no debe realizarse sin los márgenes de seguridad correspondientes. Material y métodos. Se propone un método alternativo de extracción de monedas. El catéter de Foley es introducido en el esófago y el globo es utilizado para extraer la moneda sin ayuda de la anestesia general y fluoroscopia. Resultados. Fueron estudiados 99 niños que habían tragado una moneda y que fue extraída mediante la técnica de la sonda de Foley. La edad osciló entre los 7 meses y 12 años. La mayoría de los cuerpos extraños se alojaron en el espacio cricofaríngeo. En 93 del total, el procedimiento fue efectivo y sólo se observaron complicaciones no graves. Conclusiones. Este estudio ha permitido concluir que la técnica del tubo de Foley para la extracción de monedas del esófago es fácilmente reproducible, e inocua.

Malformación en "árbol de navidad" asociada a otro tipo de atresia y malformación intestinal / Christmas tree deformity associated to other type of intestinal atresia and malrotation

Introducción. La atresia del intestino delgado es la causa más común de obstrucción intestinal en el recién nacido. De todas las atresias la deformidad en "árbol de navidad" es la variedad menos frecuente; asociada a otra atresia es todavía más rara, especialmente cuando la sociación es con la tipo IV (variedad en "salchicha"). Casos clínicos. Durante un período de 3 años fueron operados 53 niños con atresia íleo-yeyunal en el Hospital Pediátrico Moctezuma. Se describe en detalle los hallazgos clínicos y quirúrgicos de 3 pacientes que sufrieron atresia yeyunal variedad "árbol de navidad" asociada, en un recién nacido, a atresia tipo I; en otro a la tipo IV (atresia múltiple). El caso más reciente se catalogó como "no clasificable" debido a que existía un segmento intestinal independiente localizado entre ambos extremos de la atresia. En todos los casos había malrotación intestinal y la base de implantación del mesenterio era muy breve. Conclusiones. Esta asociación es muy rara, de mal pronóstico y sin duda alguna es la que mayor morbilidad y mortalidad ocasiona

Duplicación intestinal tóraco-abdominal / Thoraco-abdominal duplication

Introducción. Es bien conocido que la duplicación intestinal intraabdominal es una malformación congénita poco frecuente; la torácica es aún menos; y la tóraco-abdominal es excepcional. Presentamos el caso de un niño que sufrió este último defecto y estudiamos en detalle los hallazgos clínicos, radiológicos y quirúrgicos. Caso clínico. Lactante masculino de 11 meses de edad que fue hospitalizado por infección de vías respiratorias y palidez cutánea. el día de su ingreso se le efectuo estudio radiológico de tórax, que revelo la presencia de un nivel hidroaéro en el hemitórax izquierdo y hemivértebras. La tomografía axial computada mostró la presencia de tumoración en mediastino posterior. Fue intervenido quirúrgicamente encontrándose duplicación tóraco-abdominal. Esta fue extirpada y el extremo diafragmático fue suturado. Como externo, se le efectuó tránsito intestinal y gamagrafía abdominal, refiriéndose posible comunicación con el tubo digestivo proximal y mucosa gástrica ectópica. En la laparotomía exploradora se encontró conexión del yeyuno con el residuo de la duplicación Se efectuó resección intestinal y entero-enteroanastomosis. Conclusiones: este es un defecto raro que requiere de intervención quirúrgica