Acute gastric volvulus secondary to H-type tracheo-oesophageal fistula.

H-type tracheo-oesophageal fistula is an uncommon type of tracheo-oesophageal malformation. Acute gastric volvulus is another infrequent pathology in children. They rarely present together.We report the case of a toddler with acute gastric volvulus possibly secondary to an undiagnosed H-type tracheo-oesophageal fistula. The fistula was suspected due to persistent gastric distention observed during volvulus detorsion. This kind of tracheo-oesophageal fistula often presents with subtle symptoms making early diagnosis difficult.Acute gastric volvulus is a life-threatening condition. Gastric distension caused by the passage of air into the stomach through the fistula could be a triggering factor for gastric volvulus.

Three-Dimensional Printed Model and Virtual Reconstruction: An Extra Tool for Pediatric Solid Tumors Surgery.

Introduction Three-dimensional (3D) technology is increasingly applied for planning challenging surgical interventions. We report our experience using 3D printing and virtual reconstruction for surgical planning of complex tumor resections in children. Methods Data were obtained from preoperative magnetic resonance. imaging analysis and 3D virtual recreations were performed using specialized computer software. 3D real-scale geometry models, including tumor, adjacent organs, and relevant vascularization, were printed in colorimetric scale and different materials for optimal structures discrimination. Results Four complex cases were selected. The first case was a bilateral Wilms tumor. The volumetric reconstruction proved the presence of enough healthy renal tissue, allowing bilateral nephron-sparing surgery. In the second case, reconstruction contributed to the location of pulmonary metastases. The third case was an abdominal neuroblastoma stage L2. The 3D model was of high value for planning and as a reference during the intervention. The last case is a cervico-thoracic neuroblastoma with an anatomopathological diagnosis of ganglioneuroma, located at the cervico-mediastinal juncture, in close relationship with the cervical vessels. Conclusions 3D reconstruction and the full-scale printing models are a useful tool in cases of complex tumor resections as they contribute to a better understanding of the relationships between the tumor and adjacent organs, helping to anticipate certain surgical complications. They also provide additional information to conventional imaging tests, being able to influence therapeutic decisions and facilitate the understanding by the family, improving doctor-patient communication.

Correlación entre el neumoperitoneo y los hallazgos quirúrgicos y morbimortalidad en recién nacidos con enterocolitis necrosante / Correlation between pneumoperitoneum and surgical findings and morbidity and mortality in newborns with necrotising enterocolitis

INTRODUCCIÓN: La intervención quirúrgica en las enterocolitis necrosantes (EN) es precisa cuando existe gangrena intestinal, hecho evidente cuando produce perforación y neumoperitoneo, siendo este la única indicación radiológica aceptada universalmente para la intervención quirúrgica. OBJETIVO: Analizar a los pacientes intervenidos de EN, saber por qué se les intervino, cómo evolucionan y si los pacientes perforados presentan neumoperitoneo. MÉTODO: Estudio retrospectivo de una cohorte de recién nacidos con EN intervenidos durante un periodo de 10 años (2006-2015). Se analizan los hallazgos radiológicos preoperatorios y se correlacionan con los quirúrgicos y con la morbimortalidad, dependiendo de la presencia de neumoperitoneo (N+) o no (N-). Se evaluó la concordancia interobservador con radiólogo pediátrico enmascarado a la clínica mediante el índice de acuerdo kappa. RESULTADOS: Se analizó a 53 pacientes. El 36% se intervino tras la visualización de neumoperitoneo; en el resto, la indicación fue deterioro clínico y metabólico, junto con hallazgos radiológicos asociados. En el 39% del grupo N- se objetivó perforación. No se encontraron diferencias significativas en ambos grupos con respecto a longitud intestinal resecada, días de intubación, día de inicio de nutrición enteral y mortalidad. La comparación entre duración de síntomas y estancia hospitalaria total en ambos grupos (N-/N+) fue significativa (7 vs. 2 días, p = 0,008; 127 vs. 79 días, p = 0,003 respectivamente), siendo más favorable en el grupo N+. Estas diferencias se mantuvieron al ajustar por peso. CONCLUSIONES: La indicación quirúrgica ha de basarse en un conjunto de datos clínicos y radiológicos, ya que el 39% de los pacientes sin neumoperitoneo presentaron perforación. En nuestro estudio la presencia de neumoperitoneo no se correlaciona con peor pronóstico

INTRODUCTION: Surgical intervention in necrotising enterocolitis (NEC) is correct when there is intestinal gangrene. This is evident when gangrene produces perforation and pneumoperitoneum, with this being the only universally accepted radiological indication for the surgical intervention of NEC. OBJECTIVE: To perform an analysis on patients with surgically managed NEC, including determining how the decision to intervene is reached, the outcomes, and if patients with perforation had a pneumoperitoneum. METHODS: Retrospective review of neonates with surgical NEC over a period of 10years (2006-2015). An analysis was made of pre-surgical x-ray findings, which were compared with surgical ones, in addition to the morbidity and mortality, depending on the presence (N+) or absence (N-) of pneumoperitoneum. An evaluation was also made of the interobserver concordance with a paediatric radiologist blinded to the clinical reason using the kappa agreement index. RESULTS: A total of 53 neonates were included in the study. Surgical treatment was indicated after observing pneumoperitoneum in 36%. In the remaining neonates, the surgical decision was made after noting a clinical and metabolic deterioration with classical x-ray findings. Intestinal perforation was observed in 39% of the N- neonates. There were no statistical differences between either group on analysing the excised intestinal length, days of intubation, starting of enteral nutrition, and the mortality rate. Comparisons in terms of duration of symptoms and total hospital stay were statistically significant (7 vs. 2 days, P = .008; 127 vs. 79 days, P = .003, respectively), with both being more favourable in the N+ group. These differences remained when the groups were adjusted by birthweight. CONCLUSIONS: Surgical indication has to be done on an ensemble of clinical and radiological evidence, as 39% of the neonates in the N- groups were perforated. In our study, the presence of a pneumoperitoneum did not correlate with a worse prognosis

[Correlation between pneumoperitoneum and surgical findings and morbidity and mortality in newborns with necrotising enterocolitis]. / Correlación entre el neumoperitoneo y los hallazgos quirúrgicos y morbimortalidad en recién nacidos con enterocolitis necrosante.

INTRODUCTION: Surgical intervention in necrotising enterocolitis (NEC) is correct when there is intestinal gangrene. This is evident when gangrene produces perforation and pneumoperitoneum, with this being the only universally accepted radiological indication for the surgical intervention of NEC. OBJECTIVE: To perform an analysis on patients with surgically managed NEC, including determining how the decision to intervene is reached, the outcomes, and if patients with perforation had a pneumoperitoneum. METHODS: Retrospective review of neonates with surgical NEC over a period of 10years (2006-2015). An analysis was made of pre-surgical x-ray findings, which were compared with surgical ones, in addition to the morbidity and mortality, depending on the presence (N+) or absence (N-) of pneumoperitoneum. An evaluation was also made of the interobserver concordance with a paediatric radiologist blinded to the clinical reason using the kappa agreement index. RESULTS: A total of 53 neonates were included in the study. Surgical treatment was indicated after observing pneumoperitoneum in 36%. In the remaining neonates, the surgical decision was made after noting a clinical and metabolic deterioration with classical x-ray findings. Intestinal perforation was observed in 39% of the N- neonates. There were no statistical differences between either group on analysing the excised intestinal length, days of intubation, starting of enteral nutrition, and the mortality rate. Comparisons in terms of duration of symptoms and total hospital stay were statistically significant (7 vs. 2 days, P=.008; 127 vs. 79 days, P=.003, respectively), with both being more favourable in the N+ group. These differences remained when the groups were adjusted by birthweight. CONCLUSIONS: Surgical indication has to be done on an ensemble of clinical and radiological evidence, as 39% of the neonates in the N- groups were perforated. In our study, the presence of a pneumoperitoneum did not correlate with a worse prognosis.

Evaluación funcional y estética de los teratomas sacrococcígeos. No todo termina con la cirugía / Functional and aesthetic evaluation of sacrococcygeal teratomas. Not everything ends with surgery

Introducción: El teratoma sacrococcígeo es el tumor neonatal sólido más frecuente. El aumento de la supervivencia de estos pacientes ha permitido diagnosticar y tratar secuelas posquirúrgicas. Evaluamos el resultado funcional y estético a largo plazo de los pacientes intervenidos en nuestro centro. Material y método: Estudio retrospectivo de los teratomas sacrococcígeos intervenidos en nuestro hospital desde 1977 hasta 2014. Se recogieron datos personales de los pacientes y se realizó encuesta telefónica sobre hábito intestinal, urinario y autoevaluación estética y social. Resultados: En el período de estudio se intervino a 14 pacientes, 11 mujeres y 3 varones, con una edad mediana en el momento de la encuesta de 17 años (8 meses-37 años). Se encuestó a 8 pacientes (57,1%). La edad mediana de esos 8 pacientes fue de 23 años (4-37 años). El 37,5% se intervino por un teratoma sacrococcígeo tipo I, 25% tipo II, 25% tipo III y 12,5% tipo IV. De los pacientes estudiados, 2 (25%) presentan estreñimiento y uno (12,5%) incontinencia fecal. Dos pacientes (25%) presentan infecciones urinarias recurrentes y 3 (37,5%) incontinencia urinaria. Cinco pacientes (62,5%) presentan alterada su percepción física con limitación en su vida social. Conclusiones: En nuestra serie, se ha encontrado un porcentaje similar a la literatura en la incidencia de estreñimiento. La incontinencia fecal está levemente disminuida respecto a series publicadas. Sin embargo, la frecuencia de infecciones y de incontinencia urinarias es mayor en nuestra serie. Cinco pacientes presentan problemas psicosociales según el cuestionario DAS-59. Los pacientes con teratoma sacrococcígeo requieren asesoramiento urológico, digestivo y psicológico, para poder adquirir un completo desarrollo funcional y emocional (AU)

Introduction: Sacrococcygeal teratoma is the most common solid neonatal tumour. The improvement in survival has meant that postoperative sequelae can be diagnosed and treated. The aim of this article is to evaluate the long-term outcomes of patients treated in our centre. Material and methods: Records of patients treated for a sacrococcygeal teratoma in our hospital from 1977 to 2014 were retrospectively reviewed. Personal data was collected and a telephone questionnaire was used to assess long-term bowel and urinary habits, as well as an aesthetic and functional self-assessment. Results: A total of 14 patients were treated during the study period, of whom 11 were females and 3 males, with a mean age at the time of the survey of 17 years (8 months-37 years). Eight patients completed the questionnaire (57.1%). The mean age of the 8 patients was 23 years (4-37 years), of whom 37.5% were operated on due to a sacrococcygeal teratoma type I, 25% type II, 25% type III, and 12.5% type IV. Two of them (25%) had constipation, and one (12.5%) had faecal incontinence. Two (25%) patients suffered from recurrent urinary tract infections, and 3 (37.5%) patients had urinary incontinence. Five patients (62.5%) had a perception of being physically impaired, with limitation of their social life. Conclusions: The incidence of constipation does not differ from that found in the literature. Faecal incontinence is slightly improved compared to what has been published. However, urinary tract infections and incontinence are more prevalent in our series. Five patients out of the eight that responded suffered from psychosocial problems, according to DAS-59 questionnaire. Patients with SCT require urological, bowel, and psychological counselling, until they have a complete functional and emotional development (AU)

Three-dimensional printed model of bilateral Wilms tumor: A useful tool for planning nephron sparing surgery.

Nephron sparing surgery (NSS) is increasingly utilized to treat patients with bilateral Wilms tumor. We present a case of NSS planning using a three-dimensional computerized and printed model of both kidneys with anatomical structures of interest (parenchyma, renal pelvis, major calyx, renal artery, renal vein, and tumor). This model allowed a better understanding of the anatomic relation between the tumor and the normal kidney on each side, improving the surgical planning and the preoperative discussion with the patient's family.

[Functional and aesthetic evaluation of sacrococcygeal teratomas. Not everything ends with surgery]. / Evaluación funcional y estética de los teratomas sacrococcígeos. No todo termina con la cirugía.

INTRODUCTION: Sacrococcygeal teratoma is the most common solid neonatal tumour. The improvement in survival has meant that postoperative sequelae can be diagnosed and treated. The aim of this article is to evaluate the long-term outcomes of patients treated in our centre. MATERIAL AND METHODS: Records of patients treated for a sacrococcygeal teratoma in our hospital from 1977 to 2014 were retrospectively reviewed. Personal data was collected and a telephone questionnaire was used to assess long-term bowel and urinary habits, as well as an aesthetic and functional self-assessment. RESULTS: A total of 14 patients were treated during the study period, of whom 11 were females and 3 males, with a mean age at the time of the survey of 17 years (8 months-37 years). Eight patients completed the questionnaire (57.1%). The mean age of the 8 patients was 23 years (4-37 years), of whom 37.5% were operated on due to a sacrococcygeal teratoma type i, 25% type ii, 25% type iii, and 12.5% type iv. Two of them (25%) had constipation, and one (12.5%) had faecal incontinence. Two (25%) patients suffered from recurrent urinary tract infections, and 3 (37.5%) patients had urinary incontinence. Five patients (62.5%) had a perception of being physically impaired, with limitation of their social life. CONCLUSIONS: The incidence of constipation does not differ from that found in the literature. Faecal incontinence is slightly improved compared to what has been published. However, urinary tract infections and incontinence are more prevalent in our series. Five patients out of the eight that responded suffered from psychosocial problems, according to DAS-59 questionnaire. Patients with SCT require urological, bowel, and psychological counselling, until they have a complete functional and emotional development.

Risk factors of non-tuberculous mycobacterial lymphadenitis in children: a case-control study.

The aim of the present study is to clarify the association between environmental exposures and non-tuberculous mycobacterial (NTM) lymphadenitis, during the last decade, in a population of children. In children up to 14 years of age in a pediatric tertiary hospital, all cases of NTM lymphadenopathy with a specific microbiological diagnosis, from January 2004 to January 2015, were reviewed. This is a case-control study (1:5 proportion), in which the prevalence of environmental factors between cases and controls was compared by means of a multivariate logistic regression analysis. A total of 24 cases were diagnosed in the aforementioned period, and 18 of them included in the case-control study. Mycobacterium avium-intracellulare was the predominant mycobacterium species isolated (83.3%). Exposure to hens showed a clear trend to be significantly associated with the disease (OR = 4.33; IC95% 0.97-19.41, p = 0.055), with no significant differences for the rest of the risk factors studied. CONCLUSION: M. avium is still the predominant bacteria causing NTM lymphadenitis in children of our region. Contact with hens has been the only risk factor for NTM lymphadenitis detected in the present study. What is Known: • M. avium is the predominant bacteria causing NTM lymphadenitis in children of our region. • There is no consensus on which environmental factors are associated with NTM lymphadenitis in children. What is New: • The only risk factor for NTM lymphadenitis found in the present study was regular contact with hens. Contact with other farm animals was not associated to NTM lymphadenitis.

Piocele como complicación de peritonitis en un preescolar / Pyocele as a complication peritonitis in an preschooler

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Retrocaval ureter in children. Case report and bibliographic review.

OBJECTIVE: Retrocaval ureter is a rare disease which is due to a abnormal development of the inferior cava vein. It usually presents with ureteral obstruction, and surgery is needed for symptomatic cases. METHOD: We present a case of retrocaval ureter and a revision of the literature. RESULTS: A 9 year-old boy who had consulted for macroscopic hematuria. The intravenous urography (IVU) suggested the diagnosis of retrocaval right ureter, which is confirmed by magnetic resonance imaging (MR). Make us resection of the retrocaval segment and relocation of the ureter anterior to the inferior vena cava. Follow-up IVU showed good resolution of hydronephrosis. CONCLUSIONS: Retrocaval ureter is a rare disease, with easy diagnostic and effective treatment. Other associated anomalies could be associated.

Uréter retrocavo en el niño: a propósito de un caso y revisión de la literatura / Retrocaval ureter in children. Case report and bibliographic review

OBJETIVO: El uréter retrocavo es una patología poco frecuente debida a una alteración en el desarrollo embriológico de la vena cava inferior. Se manifiesta normalmente con clínica de obstrucción ureteral y el tratamiento en los casos sintomáticos, es quirúrgico.MÉTODO: Presentamos un caso clínico de uréter retrocavo y realizamos una revisión de la literatura.Palabras clave: Uréter. Anomalías genitourinarias. Vena cava inferior. Ureteroureterostomía.RESULTADOS: Paciente de 9 años que consulta por hematuria macroscópica. La Urografía intravenosa (UIV) sugiere el diagnóstico de uréter retrocavo derecho, lo que se confirma con estudio de resonancia magnética nuclear (RMN). Realizamos ureteroureterostomía y decruzamiento de vena cava inferior con buena evolución, confirmada por UIV.CONCLUSIONES: El uréter retrocavo es una anomalía fácilmente diagnosticable y con posibilidad de tratamiento eficaz. Debe evaluarse la posibilidad de otras malformaciones asociadas(AU)

OBJECTIVE: Retrocaval ureter is a rare disease which is due to a abnormal development of the inferior cava vein. It usually presents with ureteral obstruction, and surgery is needed for symptomatic cases.METHOD: We present a case of retrocaval ureter and a revision of the literature.RESULTS: A 9 year-old boy who had consulted for macroscopic hematuria. The intravenous urography (IVU) suggested the diagnosis of retrocaval right ureter, which is confirmed by magnetic resonance imaging (MRI). Make us resection of the retrocaval segment and relocation of the ureter anterior to the inferior vena cava. Follow-up IVU showed good resolution of hydronephrosis.CONCLUSIONS: Retrocaval ureter is a rare disease, with easy diagnostic and effective treatment. Other associated anomalies could be associated(AU)