Acute peritonitis secondary to post-traumatic appendicitis: A case report and literature review.

BACKGROUND: Blunt abdominal trauma has rarely been reported as a cause of acute appendicitis in the literature. However, the coexistence of the two conditions can cause issues for the patient. We present here a systematic review of cases of traumatic appendicitis as well as our own experience with a 12-year-old male patient. CASE SUMMARY: A 12-year-old male was admitted 3 d after abdominal trauma, experiencing peritoneal syndrome. A pelvic formation was discovered during abdominal ultrasound, and surgical exploration revealed a perforated appendix. A literature review was conducted applying the keywords "appendicitis," "abdominal," and "trauma" to the PubMed, Embase, and Medline databases. Our initial search included 529 papers published between 1991 and 2022, of which 33 papers were finally included. They revealed 51 reported cases. The trauma mechanisms included road traffic accidents, falls, assaults, ball accidents, a horse kick, and a colonoscopy. Eight patients underwent surgical exploration with no prior radiological investigation, and twenty-six patients underwent an initial radiological examination. All reports indicated a perforated appendix. CONCLUSION: Acute traumatic appendicitis represents a diagnostic quandary that can be misdiagnosed resulting in significant morbidity and potential mortality. A high level of suspicion combined with radiological examination may aid in the diagnosis and treatment of this condition.

Mechanical complications of peritoneal dialysis in Tunisian children.

INTRODUCTION: Peritoneal dialysis (PD) is the method of choice for extra-renal replacement therapy (ERT) for children with end-stage renal disease (ESRD), because of its various advantages. However, it presents different infectious and non-infectious complications, causes of important morbidity and mortality. AIM: To determine the mechanical complications of PD in our center and to identify risk factors of their occurrence. METHODS: We retrospectively collected the records of 99 patients who were treated with PD within the past eleven years in the department of pediatrics of the University Hospital Charles Nicolle of Tunis. Analysis examining possible risque factors were performed using parametric and non-parametric tests. RESULTS: A total of 63 patients had mechanical complications with an incidence of peritoneal dialysis catheter revision of 1 procedure every 38 months. The causes were dominated by catheter migration (27.5%) and obstruction by fibrin or blood clotting (19.8%). A history of peritonitis (p=0.046) and the presence of comorbidity (p=0.008) were the two independent risk factors for catheter revision. Inguinal hernia was noted in six patients. No patient presented with a hydrothorax. Seven patients presented an episode of hemoperitoneum. CONCLUSION: Our results lead us to focus our efforts on preventing peritonitis and controlling morbidity. Prospective studies will enable us to confirm our results.

Splenogonadal fusion misdiagnosed as spermatic cord cyst: a case report.

INTRODUCTION: Splenogonadal fusion is a rare congenital anomaly. The aim of this study was to report a case of splenogonadal fusion mimicking a spermatic cord cyst, and discuss therapeutic management of this rare congenital malformation. OBSERVATION: An eight-years old patient was presented with an asymptomatic three-centimeter oval scrotal mass mistaken for a spermatic cord cyst. Surgical exploration has revealed tow purple-red, firm encapsulated masses. The first mass was two cm long and adherent to the upper pole of the left testis with a cleavage plane. The second mass was four cm long, attached to the first by a fibrous cord and drawn on its superior pole by a serpiginous vascular structure that extended inside the abdomen. The spermatic cord was individualized. Extemporaneous anatomopathological examination of the first mass, totally excised, has concluded to benign lesion. Therefore, the peritoneum was opened, and the superior mass was excised as high as it could be reached without orchiectomy. Definitive Anatomopathological examination concluded to an ectopic splenic tissue. The final diagnosis was a continuous splenogonadal fusion. CONCLUSION: This case highlights the clinical characteristics of this condition, with a special focus on the signs and findings that might help prevent unnecessary orchiectomy. Consequently, it is essential to include this malformation in the differential diagnosis of scrotal masses in children.

Urachal rhabdomyosarcoma: A case report of an extremely rare localisation.

Urachus is a tubular structure connecting the allatois to the bladder's apex, in the embryonic development. We report a rare case of a 5-year-old boy, with no past medical history, complaining of secondary enuresis, pollakiuria and urgent incontinence. Physical exam revealed a hypogastric mass. Echo guided percutaneous biopsy followed by a histological analysis showed embryonal RMS. The remainder of the staging ruled out metastasis. The patient received neoadjuvant chemotherapy before proceeding to complete tumor excision. Surgical exploration revealed that the tumor was primitively related to the urachus. Total resection was performed. The one year follow-up was uneventful.

Thoraco-abdominal duplications in children: Two case reports.

INTRODUCTION: Thoraco-abdominal duplication is rare congenital malformations of the notochord that occurs in only 2% of cases of alimentary tract duplications. We report two rare cases of thoraco-abdominal duplication, emphasizing the value of radiological assessment and discussing the place of diagnostic and therapeutic laparoscopy. PRESENTATION OF CASE: It was a 12-year-old girl and an 8-month-old boy, admitted for epigastralgia and dysphagia with respiratory distress respectively. Imaging was in favor of pancreatic duplication with intra-thoracic extension for the first patient and gastro-esophageal duplication for the second. A mass excision was done laparoscopically for the first and by a thoracotomy for the second. The aftermath of the surgery was simple in both cases. CLINICAL DISCUSSION: Thoraco-abdominal duplications are rare congenital malformations that account for only 2% of cases of gastrointestinal duplications. Their diagnosis is difficult since the revealing symptomatology is not common. The treatment is only surgical is facilitated by the laparoscopy which has a diagnostic and therapeutic interest. CONCLUSION: Our case reports focused on the difficulty of the diagnosis that is done by imaging and is confirmed by surgery with anatomopathological examination of the excised mass. Diagnostic and therapeutic minimally invasive approach should be used whenever possible.

Changes in urinary stone composition in the Tunisian population: a retrospective study of 1,301 cases.

BACKGROUND: Studies that evaluate the effect of age on stone composition are scarce. The aim of this study was to highlight the changes in epidemiological characteristics (stone composition and location) of urolithiasis according to patients' age. METHODS: We studied 1,301 urolithiasis patients with age ranging from 6 months to 92 yr (781 males and 520 females). Stone analysis was performed using a stereomicroscope and infrared spectroscopy to determine the morphological type and molecular composition of each stone. RESULTS: The annual average incidence of new stone formation was 31.7 per 100,000 persons. In 71.8% of cases, calculi were located in the upper urinary tract. Compared to other age groups, children and old men were more affected by bladder stones. Calcium oxalate monohydrate was the most frequent stone component, even though its frequency decreased with age (59.5% in young adults and 43.7% in the elderly, P<0.05) in favor of an increase in uric acid stones (11.5% in young adults and 36.4% in the elderly, P<0.05). Struvite stones were rare (3.8%) and more frequent in children than in adults. CONCLUSIONS: The analysis of these data showed that urinary stones in Tunisian patients are tending to evolve in the same direction as the stones in patients from industrialized countries.

Urinary lithiasis and urinary tract malformations in children: a retrospective study of 34 cases.

BACKGROUND: Although the association of urinary lithiasis and urinary tract malformation is not rare, their management poses challenges. The aim of this study was to evaluate the relationship between urolithiasis and malformations of the urinary system. There were 34 patients (19 males and 15 females) with a mean age of 4.8 years (range, 2 months to 14 years). All patients had urinary lithiasis with a urinary tract malformation. Abdominal pain was the most frequent clinical symptom (38%). Urinary infection was found in 7 patients (21%) and macroscopic haematuria was present in 10 patients (29%). The most frequent urinary tract malformations were megaureter (8 cases), uretero-pelvic junction obstruction (7 cases) and vesico-ureteric reflux (8 cases), but its malformative origin could not be confirmed. Treatment consisted of lithiasis extraction in 32 cases associated with specific treatment of the uropathy in 27 cases. Postoperative outcome was uneventful in all cases. In fact, urinary lithiasis and urinary tract malformation association is not rare. Indeed, 9-34% of urinary lithiasis are noted to be associated with urinary tract malformation. Positive diagnosis relies specifically on kidney ultrasound, intravenous urography, and urethrocystography. Treatment depends on the type of urinary tract malformation, localisation and size of the urinary lithiasis. CONCLUSION: In conclusion, urinary lithiasis and urinary tract malformation association is a frequent eventuality. Surgical intervention is the usual mode of treatment.

Benign intrascrotal lipoblastoma in a 4-month-old infant: a case report and review of literature.

Lipoblastomas are rare benign soft tissue tumors that occur primarily in young children. Most lipoblastomas occur in the extremities, trunk, head, and neck. An intrascrotal location is unusual. We describe a case of a 4-month-old infant with an intrascrotal lipoblastoma and discuss the differential diagnosis and review the literature.

Congenital bilobar emphysema.

Congenital bilobar emphysema is reported to be extremely rare. We describe 3 cases, and we review the diagnosis problems and treatment methods of this childhood respiratory tract pathologic condition.

Transverse testicular ectopia: a three-case report and review of the literature.

OBJECTIVES: To describe the embryologic, clinical, and therapeutic features of transverse testicular ectopia (TTE) and to review the literature on similar cases. METHODS: Three cases of TTE were discovered accidentally during surgery for inguinal hernia and undescended testes; a persistent Müllerian duct syndrome (PMDS) was associated in 1 case. We also performed a literature search for other reports of TTE. RESULTS: A conservative surgical approach was chosen: transseptal orchiopexy was preferred in 2 cases and the Müllerian remnant was preserved in the first case. CONCLUSIONS: TTE is a rare anomaly that usually presents as a unilateral cryptorchidism and a contralateral descendent testis with an associated hernia. In suspected cases, laparoscopy and ultrasonographic evaluation may be helpful in diagnosing this condition before surgery. Surgery, transseptal orchiopexy, is highly recommended to manage TTE especially when vasa deferentia are fused. In case of PMDS, the authors preferred preserving Müllerian remnants because of the risk of vas deferens and testicular blood supply damage. Recently, laparoscopy is useful for both diagnosing and management of TTE and associated anomalies.

Ovarian inflammatory myofibroblastic tumor in children.

Inflammatory myofibroblastic tumors or inflammatory pseudotumors are uncommon solid tumors that are highly vascularized, have an intermediate prognosis, and are associated with local recurrence, and rare metastasis. Inflammatory myofibroblastic tumors (IMT) most often are seen in the lung of young adults, but there have been reports of these tumors occurring in children, in various sites. The authors report a case of an ovarian IMT arising in a six-year-old girl (third case reported in the literature), treated by a right adnexectomy with uneventful postoperative course, and discuss recent reports.

Laparoscopic treatment of hydatid cyst of the liver in children. A report on 34 cases.

PURPOSE: This study evaluated the safety and efficiency of laparoscopically treated liver cysts in children. METHODS: From September 2001 to July 2004, 34 patients underwent laparoscopic treatment of hydatid cysts of the liver. All patients had chest x-ray, abdominal sonography, and hydatid serology. The different stages of the procedure were the same as in open surgery: puncture, aspiration, injection of scolicidal agent, reaspiration, removal of proligerous membrane, and resection of the dome. RESULTS: The patients' mean average age was 7 years and 7 months (range, 3-14 years). The number of cysts ranged from 1 to 10 with a diameter of 40 to 150 mm (mean diameter, 65.5 mm). One case had a mesenteric associated hydatid cyst, another splenic hydatid cyst. The average length of hospital stay was 5 days (range, 4-14 days). No per- or postoperative complications were reported. At 12 to 45 months follow-up, no recurrence has been reported. CONCLUSION: Laparoscopy represents an excellent approach for the treatment of hydatid cyst of the liver in children.

[Urolithiasis in children in Tunisia: current features based on a series of 104 cases]. / La lithiase urinaire de l'enfant en Tunisie. Aspects actuels a propos de 104 cas.

UNLABELLED: The clinical and laboratory characteristics of urolithiasis in Tunisian children have evolved continuously since the 1980s. This retrospective study defines the current status of urolithiasis in children in Tunisia. PATIENTS AND METHODS: All 104 children (age: 8-192 months) of our series were hospitalized for urolithiasis. A first-line metabolic, urine and plasma work-up was performed in 96 patients. Physical and chemical analysis of the stones was performed by stereomicroscopy and infrared spectroscopy, respectively. Statistical analysis of the results was performed with SPSS 11.0 software. The Chi-square test was used for comparison of percentages. RESULTS: Our study shows a male predominance of urolithiasis with a sex ratio of 1.53. The clinical features were dominated by urinary tract infections (28.8%). Stones were situated in the upper tract in 75% of cases and the lower tract in 25% of cases. Urine culture was positive in 15 patients. Identification of the crystalline composition showed that whewellite was the most frequent crystalline species in children (80.0%) and infants (57.1%). Ammonium acid urate was more frequent in infants. CONCLUSION: In this study, we observed changes in the epidemiological characteristics (bladder stones and infection stones) of urolithiasis in children over the last decade in Tunisia. The patient's age is an important factor that must be taken into account during aetiopathogenic work-up.