[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.

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.

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.

[A pancreatobiliary malformation causing spontaneous perforation of the extrahepatic bile duct]. / Malformación del sistema pancreático-biliar como causa de perforación espontánea de la vía biliar extrahepática.

Biliaryascitis usually results from a spontaneous or traumatic perforation of the common bile duct, usually at the junction with the cystic duct. Distal duct obstruction, pancreatic fluid reflux up the common bile duct, congenital weakness or a localized mural malformation of the wall of the common duct have been proposed as possible causes. We present an 11-months-old infant girl who developed a biliary ascitis as a consequence of biliary rupture. Perforation was due to malformation of the pancreatico-biliary junction. An uneventful external derivation by tube was performed.

Malformación del sistema pancreático-biliar como causa de perforación espontánea de la vía biliar extrahepática / A pancreatobiliary malformation causing spontaneous perforation of the extrahepatic bile duct

La ascitis biliar usualmente resulta de la perforación espontánea o traumática del conducto biliar principal, usualmente en la unión con el conducto cístico. La obstrucción ductal distal, el reflujo hacia la vía biliar común, la debilidad o una muy localizada malformación mural de la pared del conducto común han sido propuestas como causas probables. Presentamos el caso de una niña de 11 meses de edad quien sufrió ascitis biliar como consecuencia de la ruptura del colédoco. La perforación probablemente se debió a una malformación de la unión pancreático-biliar. Se le derivó la bilis hacia el exterior mediante una sonda.

Biliaryascitis usually results from a spontaneous or traumatic perforation of the common bile duct, usually at the junction with the cystic duct. Distal duct obstruction, pancreatic fluid reflux up the common bile duct, congenital weakness or a localized mural malformation of the wall of the common duct have been proposed as possible causes. We present an 11-months-old infant girl who developed a biliary ascitis as a consequence of biliary rupture. Perforation was due to malformation of the pancreatico-biliary junction. An uneventful external derivation by tube was performed.

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

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.

[Pulmonary contusion and hemothorax due to explosion]. / Contusión pulmonar y hemotórax por explosión.

Folklore and "uses and customs" in countries such as Mexico, under certain circumstances, have direct influences on risks for traumatic injuries. Such is the case of gunpowder explosive objects used during celebration holidays. We present a 14-year-old male who suffered a pulmonary contusion as a consequence of an explosion of "huevo de codorniz." A pleurostomy tube was required to resolve symptomatic hemothorax. The patient was discharged 5 days after admission.

Surgical aspects of intussusception secondary to Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome (PJS) is a familial condition characterized by the presence of pigmented mucocutaneous spots and intestinal polyposis. Intussusception is the most frequent abdominal complication, but it is very rare. In our country, this is the second known report. In this article we present four cases of PJS associated with intussusception. All the patients were female and all underwent a surgical procedure. The intussusception was located in the ileum and colon. There are no more than 20 reported cases in the world where these two entities are associated. Children with PJS have a high risk of suffering from ileo-ileal or jejuno-ileal intussusception that will frequently require a special surgical procedure.

[Intrauterine necrosis in closed gastroschisis]. / Necrosis intestinal in utero por gastrosquisis.

INTRODUCTION: Strangulation of the intestine as the result of compression of its blood supply in a tightly closed gastroschisis defect is a very rare occurrence. CLINICAL CASES: We present the cases of two newborn patients who had extra-abdominal infarcted bowel and intra-abdominal jejunal atresia due to vascular compression for gastroschisis defect. One was associated with colonic, probably acquired aganglionosis. Both had similar clinical courses. CONCLUSIONS: This association is very uncommon. Prognosis of this complex is very poor.

[Congenital transmesenteric hernia]. / Hernia transmesentérica congénita.

INTRODUCTION: Acute intestinal obstruction due to congenital defects in the mesentery of the small bowel are quite uncommon. The most frequent location of the defect is the mesentery of the terminal ileum. MATERIAL AND METHODS: Five cases of small bowel obstruction caused by congenital transmesenteric hernia was reviewed. RESULTS: Four were male and all patients had an intestinal obstructive disease, small bowel gangrene and peritonitis. Two patients died. DISCUSSION AND CONCLUSIONS: Diagnosis is difficult and most cases recorded until today are incidental findings on laparotomy and surgical treatment is mandatory.

[Intestinal ischemia resulting from previous laparotomy]. / Isquemia intestinal por laparotomía previa.

INTRODUCTION: Acute adhesive obstruction of the small intestine is a surgical emergency in which there is a risk of intestinal ischemia. By delaying diagnosis and institution of appropriate treatment for ischemic obstruction, morbidity and mortality increase. MATERIAL, METHOD AND RESULTS: The hospital records of 63 patients with diagnosis of intestinal obstruction and regional ischemia due to fibroadhesive peritonitis were reviewed in an attempt to identify criteria that could be used to separate patients who would require an emergency operation; 39 (61.9%) were male and three (4.7%) newborn. This complication was seen after 3 years of age in 39 patients (69.1%). Appendicitis was first cause with 26 cases (41.2%). Range of time of appearance after operation was from 1 week to 15 years (median 10 months). In 87% of patients the operation was a second procedure. All had gangrene and an enterostomy was constructed. General morbidity rate was 80%. Four children died. CONCLUSION: It is mandatory to identify which patients require non conservative management.

[Testicular necrosis resulting from torsion in children. Perspective of a second level hospital]. / Necrosis testicular por torsión en niños. Perspectiva de un hospital de segundo nivel.

INTRODUCTION: The disaster of a testicular torsion leading to the possible loss of a gonad within a few hours is a well known occurrence and it is discouraging. Clinical examples emphasizing torsion of the testis as the most important differential diagnosis in children with acute scrotal pain and swelling, as well as the need for early exploration, have been reported with increasing frequency. MATERIAL AND METHODS: Seventy cases of clinically diagnosed unilateral torsion of the testis have been admitted to our pediatric surgical unit over a period of 8 years. There were 46 cases between 13 and 15 years of age; 34 were admitted after 24 ho and 25 after 3 days of multilating disease. Left side was involved in 46 cases and 61 testicles were removed. CONCLUSIONS: In order to avoid initiation procedures, early diagnosis is very important.