Ultrasonographic findings in the epididymis of pediatric patients with testicular torsion.

INTRODUCTION: Although grayscale ultrasound and color Doppler ultrasound characteristics of the torsed testis are well established in the literature, less is known about its anatomic partner: the epididymis. OBJECTIVE: The purpose of this study was to describe the ultrasound characteristics of the epididymis in pediatric patients with testicular torsion, and to describe their potential role as prognostic criteria for testicular salvage outcomes. STUDY DESIGN: During a retrospective review of 217 pediatric patients with acute testicular torsion during 2009-2016, morphological features of the epididymis from scrotal ultrasounds (size, parenchymal characteristics, and vascular flow of both epididymis heads), as well as patient demographics, time duration, surgical outcomes, histopathology results, and follow-up periods were analyzed. RESULTS: Mean epididymis size and twisting degree were significantly higher in the torsed testes than in the contralateral epididymis (P < 0.001) (Summary table). Cystic structures in the epididymis were identified: a higher number of cysts was associated with testicular non-viability (P = 0.025) and higher twisting degree (P = 0.017). Histopathologic examination showed that these spaces were infiltrated connective tissue most likely formed by venous congestion and vessel rupture. DISCUSSION: Scrotal ultrasound can provide information on testicular morphology and viability, as well as morphological changes in the epididymis over time in pediatric patients with testicular torsion. These findings may provide potential prognostic information regarding testicular viability, as a higher number of cystic spaces in the epididymis was associated with a higher rate of testicular non-viability and a higher twisting degree. In addition, the epididymis size (volume) can change during the time course of the ischemic state. CONCLUSIONS: This was the first study to describe and analyze epididymis ultrasound findings in pediatric patients with testicular torsion and to correlate them with testicular salvage outcomes. Further prospective studies are needed to determine the role of epididymis ultrasound findings as a potential pre-operative prognostic tool.

Treatment of Morgagni hernias by transabdominal approach / Tratamiento de las hernias de Morgagni mediante el abordaje transabdominal

BACKGROUND: Recently, the thoracic approach has been suggested in the surgical treatment of Morgagni hernias with some reported advantages over abdominal surgery. This manuscript reports the authors' experience with childhood Morgagni hernias repaired via laparotomy. SUBJECTS AND METHODS: Records of five cases of Morgagni hernias were evaluated with respect to age, presentation, operative data, complications, and outcome. RESULTS: The average age of four male and one female patients was 34 months (range 6 months to 8 years). Predominant presenting symptoms were related to the respiratory system. The diagnoses were made by posterior-anterior and lateral chest X-rays and confirmed by barium enema contrast radiographs. Associated anomalies were detected in three cases. All cases were managed by abdominal approach through upper midline incisions reducing the herniated viscera (transverse colon in all and including omentum in one patient) and excising the hernia sac which was present in all patients. The postoperative period was uneventful in this series and no recurrence was detected in an average of four years of follow-up. CONCLUSION: The transabdominal approach is appropriate in the surgical correction of paediatric Morgagni hernias.

Antecedentes: Recientemente, se ha sugerido el empleo del abordaje torácico en el tratamiento de las hernias de Morgagni, reportándose algunas ventajas del mismo sobre la cirugía abdominal. Este trabajo reporta la experiencia de los autores en relación con hernias de Morgagni en la infancia, reparadas mediante laparotomía. Sujetos y métodos: Las historias clínicas de cinco casos de hernias de Morgagni operadas en nuestro departamento, fueron evaluadas con respecto a edad, presentación, datos operatorios, complicaciones, y resultado. Resultados: La edad promedio de cuatro pacientes varones y una hembra fue de 34 meses (rango de 6 meses a 8 años). Los síntomas presentados estuvieron relacionados de forma predominante con el sistema respiratorio. Los diagnósticos se hicieron mediante rayos X posterior-anterior y lateral de tórax, y confirmados luego mediante estudio radiográfico de contraste con enema de bario. Se detectaron anomalías asociadas en tres casos. Todos los casos fueron manejados mediante abordaje abdominal a través de incisiones de la línea media superior, reduciendo así la víscera herniada (colon transversal en todos, incluyendo el omento en un paciente) y practicando la excisión del saco de la hernia, presente en todos los pacientes. El período post-operatorio no presento incidentes en esta serie, y no se detectó recurrencia durante el seguimiento, que duró un promedio de cuatro años. Conclusión: El abordaje transabdominal es apropiado en la corrección quirúrgica de las hernias pediátricas de Morgagni.

Treatment of Morgagni hernias by transabdominal approach.

BACKGROUND: Recently, the thoracic approach has been suggested in the surgical treatment of Morgagni hernias with some reported advantages over abdominal surgery. This manuscript reports the authors' experience with childhood Morgagni hernias repaired via laparotomy. SUBJECTS AND METHODS: Records of five cases of Morgagni hernias were evaluated with respect to age, presentation, operative data, complications, and outcome. RESULTS: The average age of four male and one female patients was 34 months (range 6 months to 8 years). Predominant presenting symptoms were related to the respiratory system. The diagnoses were made by posterior-anterior and lateral chest X-rays and confirmed by barium enema contrast radiographs. Associated anomalies were detected in three cases. All cases were managed by abdominal approach through upper midline incisions reducing the herniated viscera (transverse colon in all and including omentum in one patient) and excising the hernia sac which was present in all patients. The postoperative period was uneventful in this series and no recurrence was detected in an average of four years of follow-up. CONCLUSION: The transabdominal approach is appropriate in the surgical correction of paediatric Morgagni hernias.

Pancreas pseudocyst associated with L-asparaginase treatment: a case report.

A major complication of L-asparaginase used in the treatment of paediatric malignancies in children is pancreatitis (2%-16%). However, only seven paediatric cases of pancreatic pseudocyst caused by the utilization of the agent have been reported in literature. We present the case of a 5-year old girl who had abdominal pain and epigastric dullness after the third course of BMF-95 protocol with a diagnosis of ALL. A pancreatic pseudocyst of 10 x 10 cm size was found by abdominal tomography. The cyst was treated by percutaneous external drainage, total parenteral nutrition (TPN), administration of octreotide and antibiotherapy for one month. Percutaneous external drainage has proven to be an effective, noninvasive method in this special case with a systemic disorder and the high risk of mortality should a surgical intervention have been performed.