Laparoscopic Sac Excision as a Definitive Technique for Inguinal Hernia Management in Pediatric Females: A Prospective Study.

INTRODUCTION: The utilization of laparoscopic techniques in the management of inguinal hernias among pediatric patients has seen a rising trend. We aimed to assess the efficacy of laparoscopic excision of the hernial sac as a suitable approach for managing inguinal hernias specifically in female patients and conducted a prospective study to investigate this hypothesis. METHODS: Over a comprehensive four-year period, a total of 99 hernias in 69 female patients were surgically addressed using laparoscopic methods. The surgical procedure primarily involved the laparoscopic inversion and excision of the hernial sac without subsequent distal suturing. RESULTS: During the initial phase of the study, two cases encountered recurrences within 48 hours post-operation, potentially attributed to incomplete excision. However, in the subsequent period, no further recurrences were recorded. CONCLUSION: Our study findings support the contention that laparoscopic excision of the sac, without adjunctive closure of the peritoneum, suffices as an effective approach for managing inguinal hernias in female pediatric patients.

A Cosmetic Approach to Cheek and Nasal Hemangioma Utilizing Open Rhinoplasty in a 10-Year-Old Child: A Case Report.

Infantile hemangiomas are characterized as benign tumors of vascular tissue that arise from rapid endothelial cell proliferation followed by gradual involution, affecting 4% to 5% in infants and 2.6% to 9.9% in older children. Most of them resolve by the age of three years, negating the need for surgical intervention. However, intervention should be considered especially in cases with a high risk of recurrence. A female patient, aged 10 years, was referred to plastic surgery by her dermatologist due to the presence of a vascular mass in her face located at the junction between the nose and right cheek that had been present since infancy. The patient was diagnosed with infantile hemangioma based on MRI imaging of the face showing a benign vascular lesion measuring 9 x 12 mm. After the failure of multiple sclerotherapy sessions and informed discussion with the respective family, the patient underwent open rhinoplasty for surgical excision with no facial scarring other than the transcellular scar. This study presents a rare case of utilizing the open rhinoplasty technique in a relapsing facial hemangioma of a 10-year-old child. Results show a positive aesthetic outcome by minimizing facial scars. Considering the limited reported use of this technique, more clinical studies, especially comparing long-term effects across different age populations, are recommended to validate the efficiency and effectiveness of this technique.

A Challenging Surgical Decision in a Child With Bowel Obstruction Secondary to Abdominal Tuberculosis and a Literature Review.

Tuberculosis (TB) is an infectious disease and one of the top 10 causes of death worldwide. Abdominal TB (ATB) can involve the peritoneum, lymph nodes, luminal structures, and solid organs, with a predominance of intestinal and peritoneal forms of the disease. Most pediatric cases may present with peritoneal and lymph node disease. This case reports a five-year-old girl who is medically and surgically free. She had ATB complicated with a bowel obstruction that resulted in an eventful outcome of fistula formation. The family gave a travel history to Egypt two months prior to the emergency first presentation. ATB is considered a severe and challenging infectious disease that affects several systems. It is associated with high mortality and morbidity rates, specifically in the pediatric population. This case discusses the importance of considering the possible complications of ATB in pediatrics to overcome unfavorable outcomes.

Use of a Bipedicled Pericranial Flap and a Split Thickness Skin Graft for Reconstruction of a Traumatic Scalp Injury: A Case Report.

Reconstruction of a scalp defect should ensure the skull's protection, soft-tissue bulk, and contour maintenance. When calvaria is exposed, each reconstruction option has its own advantages and disadvantages. We report a 2-year-old Saudi boy, a road traffic accident (RTA) victim, otherwise medically stable who sustained partial to full-thickness defects of the scalp involving the left temporoparietal region, measuring 20 × 10 cm2 in size. After optimal debridement of the wound, a bipedicled pericranial flap with a split-thickness skin graft (STSG) was done. This case reports the satisfactory outcomes of using a bipedicled pericranial flap with STSG in traumatic scalp injuries, specifically in the pediatric age population without creating any secondary scalp skin defect and its associated morbidities. Being bipedicled the vascularity of the flap is more reliable and robust.

Index Digit Necrosis as a Complication of Radial Artery Cannulation.

Arterial access is therapeutically and diagnostically useful. Its clinical utility is vast, and associated complications are infrequent. However, some unfortunate patients progress to disastrous outcomes. Luckily, ischemic hand complications are rare. Hand ischemia threatens independence and quality of life, thus warranting vigilance. We present a case of index digit necrosis as a complication of arterial cannulation in a 30-year-old patient with end-stage renal disease admitted to an intensive care unit.

Multilocular Lipoma in the Middle and Index Fingers: A Case Report.

Lipomas are the most common type of soft tissue tumor, and 95% of them are benign. While lipomas can present anywhere on the body, 1% of them are found in the fingers. The ultimate goal of management is surgical excision of the mass with preservation of the neurovascular surroundings. Here, we present the case of a 24-year-old, morbidly obese Saudi female patient complaining of large non-tender lumps in the index and middle fingers involving the palmar and dorsal surfaces of the left non-dominant hand. The lumps were associated with paresthesia and tingling sensations. The article aims to report and highlight the satisfactory outcomes after total excision of such lipomas and restoring the function as well as the cosmetic results of the hand.

A Benign Rectal Polyp With Osseous Metaplasia: A Pediatric Case Report and Literature Review.

Osseous metaplasia is rarely detected in benign and malignant lesions in the gastrointestinal tract, especially in the pediatric population under the age of six. Here, we report the case of a four-year-old boy with a history of constipation associated with painless bleeding per rectum for six months which was excised successfully. Microscopically, there was osseous metaplasia with no malignant changes. Further reporting is needed due to the limited cases of osseous metaplasia in colorectal polyps, with unknown mechanisms of pathogenesis and prognostic factors, specifically in the pediatric population.

Lupus manifestations in children with primary immunodeficiency diseases: Comprehensive phenotypic and genetic features and outcome.

OBJECTIVES: To report the phenotypic, genetic findings and outcome of children with lupus manifestations associated with primary immunodeficiency diseases (PIDs). METHODS: Data are retrospectively collected on patients with lupus manifestations and PIDs seen between 1998 and 2019. Data comprised the clinical findings and genetic testing, the response to treatment and the accrual damage related to SLE. RESULTS: A total of 39 patients (22 female) were reviewed. Thirty-four patients had lupus manifestations and six patients with SLE-like manifestations. Genetic analysis was performed in 25 patients. Complement deficiency was the most frequent PIDs; 26 patients were C1q deficient, three patients had C3 deficiency, two patients had C4 deficiency and one patient with heterozygous C8b variant. The other seven patients had different PIDs genetic defects that include SCID caused by PNP deficiency, CGD, CVID (PIK3CD), IL-2RB mutation, DNase II deficiency, STAT1 mutation, ISG15 mutation and Griscelli syndrome type 3. Mucocutaneous lesions, arthritis and lung involvement were the main clinical features. 84.1% experienced recurrent infections. The mean accrual damage was 2.7 ± 2.2. There were five deaths because of infection. CONCLUSION: This study suggests that patients with lupus manifestations and early onset disease, family history of SLE or recurrent infections should undergo immunological work-up and genetic testing to rule out PIDs.

Lemmel Syndrome as a Rare Cause of Prolonged Right Hypochondrial Pain: A Case Report.

Lemmel syndrome is a rare cholestatic disease caused by a periampullary duodenal diverticulum (PAD) compressing the common bile duct (CBD) or pancreatic duct, which results in acute abdominal pain and/or obstructive jaundice in the absence of other pathology explaining the symptoms. It can be easily misdiagnosed unless carefully detected by abdominal ultrasound (US), barium studies, computed tomography (CT) scan, esophagogastroduodenoscopy (EGD), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiography (ERCP), which is also the treatment modality of choice. We herein report a case of a 62-year-old male presenting with prolonged hypochondrial pain. He was diagnosed with Lemmel syndrome after performing US, barium meal, CT scan, EGD, and MRCP that was managed successfully by ERCP with sphincterotomy and stent placement.