Hidrosálpinx en una niña prepuberal: un caso excepcional en la edad pediátrica / Hidrosalpinx in girl in pubertal age: An exceptional case in pediatric age

El hidrosálpinx consiste en una acumulación de líquido claro o seroso en la trompa de Falopio, debido a una obstrucción distal y a una dilatación de la misma. Es una entidad bien descrita, aunque infrecuente, sobre todo en mujeres sexualmente inactivas o prepúberes, puesto que la etiología principal del cuadro suele ser la enfermedad inflamatoria pélvica. Presentamos el caso de una niña de 11 años púber, en estadio II de Tanner, sin actividad sexual. En estas edades existen muy pocos casos descritos, y en la mayoría se encuentra una causa subyacente, aunque la patogenia es incierta. En el presente caso no encon-tramos ningún factor de riesgo para la aparición del hidrosálpinx, pero en revisiones de imagen posteriores, 3 meses después de la menarquia, se encontró un endometrioma. Lo excepcional del caso es precisamente la aparición de la malformación previa al endo-metrioma, si bien ambos procesos podrían estar condicionados por factores hormonales propios de la adolescencia

Hydrosalpinx consists of accumulation of clear or serous fluid in the fallopian tube, due to distal obstruction and dilatation of the same. It is a well-described but infrequent entity, especially in sexually inactive or prepubertal women, since the main etiology of the condition is usually pelvic inflammatory disease. We present the case of an 11-year-old pubertal girl (Tanner II) with no sexual activity. In these ages there are very few cases de-scribed and in all of them an underlying cause is found, although the pathogenesis is unclear. In our case, we did not find any risk factors for the appearance of hydrosalpinx, but in posterior image revisions, three months after menarche, an endometrioma was found, the exception being precisely the appearance of the malformation prior to the endometrioma, although both processes may be influenced by hormonal factors in adolescence

[Neutropenic enterocolitis in children with cancer]. / La enterocolitis neutropénica en el niño con cáncer.

OBJECTIVES: Neuropenic enterocolitis (NEC) is a destructive lesion of the ileocecal region occurring in cancer patients treated with chemotherapy. Its clinical picture is one of febrile acute abdominal extension with bloody diarrhea and low neutrophil counts. Our aim was to determine the incidence of NEC in children with cancer and to review the indications of surgery in these cases. MATERIAL AND METHODS: The records of children with cancer treated with chemotherapy in the last 6 years at Hospital Infantile La Paz were reviewed. We selected those patients who had abdominal pain and neutropenia and whose physical examination and radiological findings were consistent with NEC. RESULTS: Twelve cases of NEC were diagnosed during this period among 432 malignancies. The symptoms most frequently seen were abdominal pain and distension, nausea and vomiting. The neutrophil count was consistently below 500/ml. All patients were receiving chemotherapy before the onset of the clinical picture. Five children were operated upon. In three of these we found various ileocecal perforations, in one a gastric perforation and in the remaining one a diffuse inflammation of the ileocecal area. Two non-operated patients died from NEC. The remaining children recovered without problems with medical therapy. CONCLUSION: Pediatric surgeons treating neutropenic cancer patients should be familiar with this condition, that must be suspected early in granulocytopenic patients with acute abdominal extension. Aggressive surgical management is indicated in cases with severe peritonitis, bowel perforation or massive lower gastrointestinal bleeding, irrespective of the degree of neutropenia. Medical support should aim at reestablishing normal neutrophil counts.