[A case of abdominal internal hernia through the foramen of Winslow in a pediatric emergency department].

Abdominal internal hernia is a rare cause of intestinal obstruction in pediatric emergency departments, being the herniation through the foramen of Winslow an exceptional entity (less than 0.5% of the herniae). We report the case of a 15-year-old adolescent male without previous surgical interventions who presented with abdominal pain and vomiting; computed tomography scans showed intestinal obstruction due to an internal hernia through the foramen of Winslow. To reduce the herniated ileum, the patient required surgical intervention with diagnostic laparoscopy, which, due to bad visualization, was changed to supraumbilical midline laparotomy. There was no need to resect the affected ileum as it appeared healthy. We did not perform a preventive technique to reduce the risk of recurrence. Postoperative pelvic collection was conservatively managed with antibiotics. The patient undergoes regular follow-up in the pediatric surgery department.

Caso de hernia interna abdominal a través del hiato de Winslow en urgencias de pediatría / A case of abdominal internal hernia through the foramen of Winslow in a pediatric emergency department

Las hernias internas abdominales son una causa poco frecuente de obstrucción intestinal en las urgencias de pediatría, siendo excepcional la herniación a través del hiato de Winslow (menos del 0,5% de las hernias).Presentamos el caso clínico de un varón adolescente de 15 años sin antecedentes quirúrgicos previos, con clínica de dolor abdominal y vómitos, en el que la tomografía computarizada sugería un cuadro de obstrucción intestinal a causa de hernia interna a nivel del hiato de Winslow. Precisó de intervención quirúrgica mediante laparoscopia explora-dora, reconvertida por mala visualización a laparotomía media supraumbilical, para reducción del asa de íleon herniada. Esta presentaba buen aspecto y no fue necesaria la resección intestinal. No se realizó ninguna técnica preventiva para disminuir el riesgo de recidiva. Postoperatoriamente, el paciente presentó una colección pélvica manejada de manera conservadora con antibióticos. Actualmente se encuentra en seguimiento en consultas externas de cirugía pediátrica. (AU)

Abdominal internal hernia is a rare cause of intestinal obstruction in pediatric emergency departments, being the herniation through the foramen of Winslow an exceptional entity (less than 0.5% of the herniae). We report the case of a 15-year-old adolescent male without previous surgical interventions who presented with abdominal pain and vomiting; computed tomography scans showed intestinal obstruction due to an internal hernia through the foramen of Winslow. To reduce the herniated ileum, the patient required surgical intervention with diagnostic laparoscopy, which, due to bad visualization, was changed to supraumbilical midline laparotomy. There was no need to resect the affected ileum as it appeared healthy. We did not perform a preventive technique to re-duce the risk of recurrence. Postoperative pelvic collection was conservatively managed with antibiotics. The patient undergoes regular follow-up in the pediatric surgery department. (AU)

Capillary-lymphatic malformation, kaposiform hemangioendothelioma and delayed Kasabach-Merritt phenomenon.

According to International Society for the Study of Vascular Anomalies classification, vascular anomalies are mainly divided into two groups: vascular tumors and vascular malformations. Nevertheless, a small group of patients present clinical and/or histopathologic overlapping features. We report a case of a 4-month-old boy that presented a vascular lesion on his right buttock with involvement of abdominal wall muscles, abdominal cavity and drainage to primitive iliac by a tortuous drainage vein. Surgery was performed and histopathology demonstrated a combined vascular malformation. Six months later he developed a thrombocytopenia and repeat magnetic resonance imaging revealed a new solid mass involving the majority of the abdominal cavity. At 18 months of age the patient developed a Kasabach-Merrit phenomenon and treatment with vincristine, interferon and then acetyl-salicilic acid and dypiridamol was started. No response in platelet counts was obtained and one more surgery was perfomed. On this occasion a histopathologic study revealed vascular malformation areas intermingled with areas of kaposiform hemangioendothelioma. This patient demonstrates the Kasabach-Merritt phenomenon with kaposiform hemangioendothelioma arising within a pre-existing combined vascular malformation.

[Use of a urethral plate in surgery for incurving hypospadias]. / Utilización de la placa uretral en la cirugía de los hipospadias con incurvación.

OBJECTIVE: To describe a new procedure for surgical correction of primary hypospadias with chordee. METHODS: The design of the urethral plate divide it in two flaps. Chordee must be resected in order to straighten the penis. Ventral side of neourethra is made with preputial skin or Mathieu procedure. This method has been used in 10 pediatric patients diagnosed of primary hypospadias with chordee. RESULTS: Medium follow-up was 6 months. Only 2 patients developed urethro-cutaneous fistulae and required a new surgical procedure. No reports of meatal stenosis, urethral dilatation or residual curvature were made. 8 patients have excellent cosmetic results and 2 cases were classified as acceptable. CONCLUSIONS: This procedure is a new surgical method for correction of primary hypospadias with chordee.

Utilización de la placa uretral en la cirugía de los hipospadias con incurvación / Use of urethral plate for surgical repair of hypospadias with penile curvature

OBJETIVO: Describir una nueva técnica para la corrección en un sólo tiempo quirúrgico de los hipospadias primarios que presentan incurvación moderada-severa (>30º) por presencia de marcada "chorda". MÉTODOS: La placa uretral se divide en dos flaps mediante una sección oblicua en su tercio medio. El enderazamiento del pene se consigue resecando la "chorda" expuesta tras el despegamiento de la placa uretral dividida. La cara ventral de la neouretra creada se obtiene bien de piel prepucial ("Onlay island flap"), bien de piel del pene (Técnica "flip-flap" de Mathieu). Esta técnica se ha llevado a cabo en 10 pacientes pediátricos con hipospadias con incurvación. RESULTADOS: Tras un seguimiento postoperatorio de, al menos, 6 meses, sólo 2 pacientes presentaron fístula y requirieron reintervención para su corrección. Ninguno presenta, clínicamente, estenosis meatal ni saculaciones uretrales. Desde el punto de vista estético, el resultado fue satisfactorio en 8 pacientes y aceptable en 2. CONCLUSIONES: Creemos que esta nueva técnica quirúrgica es una opción válida para el tratamiento de los hipospadias con severa incurvación cuando se observe que la placa uretral supone una traba para el adecuado enderezamiento del pene (AU)