Enterolito de sulfato de bario en una paciente con malformación anorrectal. Notas sobre el colostograma distal apropiado / Barium sulfate enterolith in a patient with anorectal malformation. Remarks on the appropriate distal colostogram

Resumen: Presentación del caso: Paciente femenino de 2 años de edad con malformación Anorrectal y fístula rectovestibular a quién se realizó colostograma distal con sulfato de bario provocando concreción lítica de bario en el fondo de saco del colon distal al no enjuagar el contenido. Ante la imposibilidad de retirar el enterolito a través del estoma disfuncional de la derivación intestinal decidimos realizar la extracción al momento de hacer la anorrectoplastía sagital posterior con riesgo aumentado de infección, dehiscencia de herida y lesión de estructuras adyacentes. Enfatizamos la necesidad de recordar a la comunidad médica radiológica y pediátrica de la adecuada realización de este tipo de estudios siempre con medio de contraste hidrosoluble, y aprovechamos para recapitular la técnica de realización del mismo.

Abstract: Case presentation: 2 year-old female patient with anorectal malformation with recto-vestibular fistula to whom a distal colostogram with barium sulfate was done, thus provoking lithic concretion in the distal sac. Since it was deemed impossible to extract the enterolith trough de distal stoma we decided to perform the anorectoplasty and extract the lit at that moment knowing the increased surgical risks such as infection, dehiscence and damage of adjacent structures. We stress the need to remind the radiological and pediatric medical communities to always perform this kind of imaging studies with water-soluble contrast agents and we also annotate the technique for doing so.

Vólvulo de vesícula biliar en un recién nacido / Gallbladder volvulus in a newborn

El vólvulo de la vesícula biliar es una enfermedad preponderante en las personas ancianas y del sexo femenino. En niños es extremadamente raro. El rango de edad ocurre entre los 6 y 13 años, predomina en el sexo masculino, con una relación de 4:1; el paciente más joven reportado en la literatura es de dos años. Es una enfermedad rara en la que el órgano gira a lo largo de su eje comprometiendo su irrigación vascular. Esta enfermedad fue descrita por primera vez en 1898 por Wendel. El primer caso en niños se describió en 1925 por Daux. A la fecha, 14 casos han sido reportados en la literatura inglesa y 38 casos en la literatura japonesa. En México no encontramos registro de casos. Se reporta el primer caso mundial de vólvulo de vesícula en un recién nacido como causa inusual de abdomen agudo. Caso clínico: recién nacido masculino de 24 días de vida con vólvulo de la vesícula biliar que ameritó colecistectomía convencional.

Gallbladder volvulus is a disease most frequently seen in elderly people or women, but its presence in children is extremely rare. Its incidence occurs between 6 to 13 years, it is predominant in males, 4:1. The youngest case described in the literature was a two-year-old. It is considered a rare disease in which the organ rotates along its axis, compromising its vascular irrigation. It was first described in 1898 by Wendel; in children, it was first reported in 1925 by Daux. To date, only 14 cases have been documented in the English literature and 38 in the Japanese. In Mexico we did not find any case recorded. We report the first world-wide case of gallbladder volvulus in a newborn as unusual cause of acute abdomen. Case report: 24-day-old male newborn with acute abdomen due to a gallbladder volvulus that required conventional cholecystectomy.

Onfalopileflebitis con absceso hepático en un neonato asociado con cateterización umbilical / Onfalopileflebitis with hepatic abscess associated with umbilical catheterization in a newborn

La onfalopileflebitis es la inflamación conjunta con trombosis séptica de la vena porta o de alguna de sus tributarias. Ésta se presenta como una complicación de la colocación del un catéter umbilical. El diagnóstico es difícil, debido a lo inespecífico del cuadro; los hallazgos de este padecimiento suelen realizarse durante una intervención quirúrgica o en forma incidental mediante estudios de imagen o estudios anatomopatológicos. Se reporta el caso de un neonato que tuvo un desenlace fatal por esta entidad con formación de absceso hepático, el cual requirió de un drenaje quirúrgico abierto y antibioticoterapia. Se discutió su condición rara y no comunicada, además de sus características etiopatogénicas, clínicas, diagnósticas y terapéuticas.

Omphalopylephlebitis is the inflammation with septic thrombosis of the portal vein or one of its tributaries as a complication of umbilical catheter placement. Diagnosis is difficult because of non specific findings of the picture and are usually performed during a surgery, or incidentally by imaging studies or pathology. We report the case of a newborn with fatal outcome for this entity with liver abscess formation which required open surgical drainage and antibiotic therapy. We discuss rare condition, besides unreported etiopathogenic characteristics, clinical, diagnostic and therapeutic.

[Volvulus of the vermiform appendix. A case report]. / Vólvulos del apéndice vermiforme. Presentación de un caso.

BACKGROUND: Vermiform appendix torsion is a very rare condition, with only 25 cases recorded in the international literature. This patient is the second case registered in our country. CLINICAL CASE: A seven year-old female patient suddenly developed crampy central abdominal pain that gradually localized in the right lower quadrant. She had vomiting, but no fever. On examination there were acute abdominal signs and during surgical exploration vermiform appendix torsion was founded. The patient underwent appendectomy with an uneventful recovery.

[Is the risk of death real among home accidents?]. / Es real el riesgo de muerte por accidentes en el hogar?

Descriptive study on damage to children's health caused by accidents. The literature has mainly focused on the analysis of severe trauma. The main objective was to assess the morbidity and mortality based on the authors experience and to propose special measures to prevent this type of trauma. Home accidents are a frequent form of pediatric trauma, yet reports in the literature are not always consistent with its real prevalence. We believe that home traumatic events have been underestimated and neglected mainly because they are generally not a cause of death, especially among infants. We analyzed 21 patients who underwent a traumatic lesion at home.

[Total duodenal section. A reliable indicator of severe physical abuse]. / Sección duodenal total. Indicador confiable de maltrato fisico severo.

BACKGROUND: Rupture of the hollow viscera due to battered child syndrome is an unusual clinical finding and it is even less likely when we encounter total duodenum section. The literature on child abuse does not include visceral lesions as part of the spectrum. The aim of this study was to analize if complete duodenal section is a reliable indicator of severe physical abuse. Data were statistically analyzed using chi-square tests, likelihood ratios and the Cochran-Mantel-Haentzel test. CLINICAL CASES: Four children were admitted with a battered child syndrome diagnosis. RESULTS: All participants were surgically treated and the finding was total section of the duodenum. The postoperative course was normal. Statistical tests were p<0.0001 and the likelihood ratio 18.7 CONCLUSION: Duodenal rupture is a statistically reliable indicator of a severe form of physical abuse in children.

Es real el riesgo de muerte por accidentes en el hogar? / Is the risk of death real among home accidents?", "_i": "en

El presente es un estudio descriptivo acerca del daño que sufren los niños como consecuencia de accidentes. Los objetivos de este estudio son explorar la morbilidad y mortalidad a través de la experiencia de los autores y proponer formas especiales de prevención. Los accidentes en el hogar son comunes, pero los informes de la literatura no son consistentes con la realidad. Los eventos traumáticos que suceden en el hogar han sido menospreciados, sin embargo, no es raro que sean causa de muerte, en especial en niños pequeños. Analizamos los hallazgos en 21 niños que sufrieron percance traumático en el hogar.

Descriptive study on damage to children's health caused by accidents. The literature has mainly focused on the analysis of severe trauma. The main objective was to assess the morbidity and mortality based on the authors experience and to propose special measures to prevent this type of trauma. Home accidents are a frequent form of pediatric trauma, yet reports in the literature are not always consistent with its real prevalence. We believe that home traumatic events have been underestimated and neglected mainly because they are generally not a cause of death, especially among infants. We analyzed 21 patients who underwent a traumatic lesion at home.

[Inguinal impalement. Report of two cases]. / Empalamiento inguinal. Presentación de dos casos clínicos.

BACKGROUND: Traumatic inguinal lesions in children are relatively unusual and those caused by impalement are less common. The purpose of this paper is to demonstrate the clinical course of two similar cases. CLINICAL CASES: A 13-year-old male and a 7-year-old female are presented in this report. During an accidental fall, they sustained an inguinal wound. In the emergency room, a wooden stake and a metallic bar were seen in the inguinal region. The surgical procedure shows absence of vascular, neurological, visceral and testicular damage. Both wounds caused by foreign bodies were subcutaneous and removed without complications. CONCLUSIONS: These types of accidents are uncommon and the absence of damage is the most relevant issue.

Sección duodenal total: indicador confiable de maltrato fisico severo / Total duodenal section: a reliable indicator of severe physical abuse

Antecedentes: No es común que como consecuencia de abuso físico haya perforación de víscera hueca y mucho menos que la rotura sea de magnitud tal que seccione el duodeno en la totalidad de su circunferencia. De acuerdo con la literatura, se ha establecido que es poco probable que una lesión visceral sea causada por maltrato. El objetivo de este análisis es investigar si la sección duodenal total puede ser un indicador seguro de agresión física intencional. Las variables fueron sometidas a χ2, probabilidad de riesgo y prueba de homogeneidad de Cochran-Mantel-Haenzel. Casos clínicos: Fueron estudiados cuatro niños que sufrieron maltrato físico y cuya complicación más importante fue la sección duodenal completa. Resultados: Los niños fueron operados y la evolución fue satisfactoria; el análisis estadístico mostró p<0.0001 y probabilidad de riesgo de 18.7. Conclusiones: De acuerdo con los resultados estadísticos, la rotura duodenal en toda su circunferencia debe ser considerada un indicador de maltrato físico severo.

BACKGROUND: Rupture of the hollow viscera due to battered child syndrome is an unusual clinical finding and it is even less likely when we encounter total duodenum section. The literature on child abuse does not include visceral lesions as part of the spectrum. The aim of this study was to analize if complete duodenal section is a reliable indicator of severe physical abuse. Data were statistically analyzed using chi-square tests, likelihood ratios and the Cochran-Mantel-Haentzel test. CLINICAL CASES: Four children were admitted with a battered child syndrome diagnosis. RESULTS: All participants were surgically treated and the finding was total section of the duodenum. The postoperative course was normal. Statistical tests were p<0.0001 and the likelihood ratio 18.7 CONCLUSION: Duodenal rupture is a statistically reliable indicator of a severe form of physical abuse in children.

Empalamiento inguinal: presentación de dos casos clínicos / Inguinal impalement: report of two cases

BACKGROUND: Traumatic inguinal lesions in children are relatively unusual and those caused by impalement are less common. The purpose of this paper is to demonstrate the clinical course of two similar cases. CLINICAL CASES: A 13-year-old male and a 7-year-old female are presented in this report. During an accidental fall, they sustained an inguinal wound. In the emergency room, a wooden stake and a metallic bar were seen in the inguinal region. The surgical procedure shows absence of vascular, neurological, visceral and testicular damage. Both wounds caused by foreign bodies were subcutaneous and removed without complications. CONCLUSIONS: These types of accidents are uncommon and the absence of damage is the most relevant issue.

[Cantrell's pentalogy. Four cases reported]. / Pentalogía de Cantrell. Informe de cuatro casos.

BACKGROUND: In 1958, Cantrell etal. described a rare syndrome in neonates. The description of the syndrome was characterized by a midline supraumbilical defect encompassing a thoracoabdominal omphalocele and ectopia cordis, a defect of the lower sternum, ventral diaphragmatic and pericardial defects, and other congenital cardiac anomalies. CLINICAL CASES: 4 neonates with the uncommon Cantrell's pentalogy were seen in our hospital within a 5-year period without having any apparent factor in common. This paper describes the clinical course and surgical correction. CONCLUSIONS: Early detection of these anomalies is very important for the diagnosis and surgical planning, and subsequently for prognostic implications.

Amputación y expulsión rectal de catéter de derivación subaracnoideo-peritoneal / Spontaneous disconnection and expulsion per rectum of a subarachnoid-peritoneal shunt catheter

Introducción. Las complicaciones abdominales de las derivaciones ventrículo-peritoneales por hidrocefalia aparecen de manera infrecuente. Han sido reportados pseudoquistes, peritonitis, ascitis, pseudo-tumores, volvulus, perforación vaginal, umbilical e intestinal. Sin embargo, la migración espontánea del catéter distal hacia la cavidad peritoneal y perforación subsecuente y asintomática del colon y expulsión completa por el recto es un evento muy raro. Caso clínico. Femenino de 4 años de edad con antecedentes de higroma subdural fronto-parietal bilateral, a la que se le efectuó derivación subaracnoideo-peritoneal con catéter de silastic, evolucionando desfavorablemente, presentando convulsiones tónico clónicas generalizadas; se le realizó radiografía simple de abdomen encontrando como hallazgo migración casi completa del catéter hacia la cavidad peritoneal. Conclusiones. Esta entidad es poco usual; la paciente se encuentra asintomática a seis meses de haber expulsado por vía rectal el tubo de derivación.

Introduction. Abdominal complications of peritoneal shunts for hydrocephalus occur infrequently. Pseudocysts, peritonitis, ascites, pseudotumors, volvulus, vaginal, umbilical and bowel perforation have been reported. However, spontaneous migration of the distal catheter into peritoneal cavity and subsequent asymptomatic perforation of the colon and total expulsion by rectum is a very uncommon event. Case report. We are presenting the second registered patient who developed this complication in the literature. Conclusions. This event is very uncommon.

[Fibromatosis infantile. Report of an aggressive disease]. / Miofibromatosis infantil. Relato de una enfermedad desesperante.

This rare entity is characterized by multiple nodular lesions largely composed of collagen-forming spindle cells and involving the subcutis, skeletal muscle, bone and viscera of newborns and infants that occurs in either a solitary or multicentric form. The clinical course of a case is presented. The patient is a 2-year-old male who was brought to our hospital because of a large cervical mass. On physical examination a firm, subcutaneous, immobile painless mass measuring 4.5x6 cm was palpated at right side of neck. After the first admission, 13 complete surgical resections were performed. This patient is the eleventh familial case in the literature. The patient died 10 years after the first surgery.

Torsión del apéndice cecal asociada a invaginación intestinal / Torsion of the vermiform appendix associated with intussusception

La torsión del apéndice vermiforme es muy rara; en la literatura sólo han sido referidos 25 casos. El aquí informado es el primero asociado a invaginación intestinal. Se trató de una niña de dos meses de edad quien súbitamente dio muestras de dolor. En la exploración quirúrgica se encontró invaginación ileocecal apretada, que fue corregida. Cuatro días después fue necesario reoperar, encontrando torsión y perforación del apéndice cecal; se practicó apendicectomía. Por datos de obstrucción y peritonitis se requirió nueva exploración quirúrgica en la que se encontró dehiscencia del muñón y perforación cecal. Una vez corregidas estas complicaciones, la paciente evolucionó satisfactoriamente y fue dada de alta en buenas condiciones.

BACKGROUND: Vermiform appendix torsion is a rare condition, with only 25 cases recorded in the international literature. Our patient is the first case associated with intussusception. CASE REPORT: A 2-month-old female infant suddenly developed severe abdominal pain due to ileoceal intussusception. During surgical exploration, a tight intussusception was reduced. Three days later, a new laparotomy was required and we found torsion and perforation of the vermiform appendix. The patient underwent appendectomy, but there was dehiscence of the appendiceal stump and cecal perforation requiring a new surgical exploration. The patient had an uneventful recovery.

Miofibromatosis infantil: relato de una enfermedad desesperante / Fibromatosis infantile: report of an aggressive disease

La miofibromatosis es una enfermedad tumoral que afecta casi exclusivamente a lactantes y preescolares. Se caracteriza por múltiples lesiones nodulares compuestas de tejido colágeno y células fusiformes que afectan piel, huesos, tejidos blandos e incluso las vísceras; puede ser solitaria o multicéntrica. Presentamos la evolución clínica de un niño que a los dos años de edad fue llevado por primera vez a consulta por una masa cervical derecha de 4.5 x 6 cm, subcutánea, inmóvil e indolora. Fue intervenido quirúrgicamente en 13 ocasiones; en la última falleció. El caso corresponde al número once reportado con patrón familiar.

This rare entity is characterized by multiple nodular lesions largely composed of collagen-forming spindle cells and involving the subcutis, skeletal muscle, bone and viscera of newborns and infants that occurs in either a solitary or multicentric form. The clinical course of a case is presented. The patient is a 2-year-old male who was brought to our hospital because of a large cervical mass. On physical examination a firm, subcutaneous, immobile painless mass measuring 4.5x6 cm was palpated at right side of neck. After the first admission, 13 complete surgical resections were performed. This patient is the eleventh familial case in the literature. The patient died 10 years after the first surgery.

[Oral cholangiography and duodenal atresia]. / Colangiografía oral y la atresia duodenal.

A newborn male patient with trisomy-21 presented with bilious hemesis. The patient was icteric with slight hepatomegaly. Simple abdominal X-ray and upper gastrointestinal series with barium showed a dilated duodenal loop and inflammatory changes involving the duodenal mucosa. This image known as "double bubble" is characteristic of congenital duodenal obstruction. Simultaneously the gallbladder and choledochus were visualized. The former X-ray finding is very unusual. An uneventful Kimura procedure was performed.

Colangiografía oral y la atresia duodenal / Oral cholangiography and duodenal atresia

Se presenta el caso de un recién nacido masculino con síndrome de Down, que presentó al nacimiento vómito biliar y al examen físico ictericia y hepatomegalia leve. Los estudios radiológicos simple de abdomen y la serie gastrointestinal mostraron al duodeno dilatado y cambios inflamatorios de la mucosa. Esta imagen es conocida como la imagen en “doble burbuja” y es común en la obstrucción duodenal congénita. Simultáneamente fueron visualizados la vesícula biliar y el colédoco, siendo este hallazgo poco usual. Se le efectuó corrección del defecto mediante el procedimiento de Kimura.

A newborn male patient with trisomy-21 presented with bilious hemesis. The patient was icteric with slight hepatomegaly. Simple abdominal X-ray and upper gastrointestinal series with barium showed a dilated duodenal loop and inflammatory changes involving the duodenal mucosa. This image known as [quot ]double bubble[quot ] is characteristic of congenital duodenal obstruction. Simultaneously the gallbladder and choledochus were visualized. The former X-ray finding is very unusual. An uneventful Kimura procedure was performed.