Pediatric Rectosigmoid Atypical Juvenile Polyps Presenting With Rectal Prolapse and Acute Bleeding: A Case Report and a Comprehensive Literature Review.

Rectosigmoid solitary juvenile polyps are benign lesions, relatively frequent in childhood. The clinical debut of a pediatric polyp with bleeding is relatively frequent, but there are very few reports of rectal prolapse of polyps. We present the case of a 7-year-old female patient with no previous history who presented with rectal prolapse of a polyp with acute bleeding. An urgent endoscopic examination was performed and 2 rectosigmoid polypoid lesions were found and resected. The anatomopathological study showed that these were 2 hamartomatous polyps with mild dysplasia. The patient is asymptomatic and is being followed up. The literature concerning rectal prolapse of polyps in the pediatric population is scarce. In a pediatric patient with a rectal prolapse, this entity should be considered in the differential diagnosis.

Congenital Meatal Urethral Stenosis in a Female Patient: A Case Report.

We present the case of a 6-year-old girl who presented with alterations in the voiding stream. On physical examination, a very small urethral meatus was identified at the expense of a membrane. The renovesical ultrasound showed no alterations. An uroflowmetric study was performed, showing a bladder outlet obstruction pattern. The urethral meatus was calibrated and a ventral meatotomy was performed. The histological study of the resected membrane showed a transitional urethral mucosa with chronic focal inflammation and discrete hyperplasia. The patient evolved favorably, with resolution of the symptoms and no notable complications. This is, to the best of our knowledge, the first reported case with a histological study of a congenital meatal urethral stenosis. In the presence of lower urinary tract obstruction, this entity should be considered in the differential diagnosis. Surgical treatment is curative.

Desarrollo y aplicación clínica de nuevo sistema de tracción cenital esternal en la toracoplastia percutánea videoasistida / Development and clinical application of a new sternal zenithal traction system in video-assisted percutaneous thoracoplasty

Introducción: La toracoplastia percutánea videoasistida implica un acceso quirúrgico complejo y con riesgo de dañar estructuras vitales durante el procedimiento. Históricamente se han aplicado distintos sistemas de tracción y elevación esternal durante la intervención con el fin de minimizar el riesgo asociado al paso del instrumental entre el esternón y el pericardio. Métodos: Se presenta mediante una descripción ilustrada un nuevo sistema de tracción esternal. Se extrajeron los datos clínicos y sociodemográficos de los 36 pacientes intervenidos en nuestro centro de Pectus Excavatum entre julio 2017 y agosto 2021. Todos los pacientes fueron intervenidos por el mismo cirujano. Se clasificó a los pacientes en función de si se había empleado el sistema de tracción esternal (TE) o no (ST). La asignación a uno u otro grupo de intervención se hizo siguiendo un criterio cronológico, sin aplicar el índice de Haller u otro índice. El análisis estadístico de los datos recogidos se realizó con STATA, versión 15.0 (StataCorp). Resultados: La distribución de las variables sociodemográficas muestra que no había diferencias significativas entre los grupos. En 25 de los pacientes se empleó el sistema TE y en 11 no se utilizó ningún ST. El Índice de Haller fue de 4,19±0,7 para el grupo TE y de 3,79±0,3 para el ST. El tiempo quirúrgico medio en minutos fue 88,13±18,1 para el grupo TE y 97,73±46,2 para el grupo ST (p=0,87). La media de días de ingreso fue 7,67±0,8 y 7,73±1,3 para el grupo TE y ST respectivamente. La media de días de PCA intravenosa fue 6,08±0,7 para el grupo TE y 5,89±1,5 para el ST. La media de días de PCA epidural fue 3,79±0,5 y de 3,36±0,5 para el grupo TE y ST respectivamente (p=0,01). Todos los pacientes presentaron una evolución postoperatoria favorable. Ninguno de los pacientes presentó molestias a nivel de las heridas esternales durante el ingreso en hospitalización. La evolución cosmética fue favorable en todos los pacientes. (AU)

Introduction: Video-assisted percutaneous thoracoplasty involves a complex surgical access with risk of damaging vital structures during the procedure. Historically, different traction and sternal elevation systems have been applied during the intervention to minimize the risk associated with the passage of the instruments between the sternum and the pericardium. Methods: A new sternal traction system is presented by means of an illustrated description. Clinical and sociodemographic data were extracted from the 36 patients operated in our center for Pectus Excavatum between July 2017 and August 2021. The Haller index was not applied as a criterion to determine the use or not of the sternal traction system. Patients were classified according to whether the sternal traction system (TE) or not (ST) had been employed. Statistical analysis of the data collected was performed with STATA, version 15.0 (StataCorp). Results: Both groups were comparable. In 25 of the patients the described traction system was used, and in 11 no traction system was used. Haller's index was 4.19±0.7 for the TE group and 3.79±0.3 for the ST group. All patients were operated on by the same surgeon. The mean operative time in minutes was 97.73±46.2 for the ST group and 88.13±18.1 for the TE group (P=.87). The mean total days of admission was 7.67±0.82 (TE) and 7.73±1.35 (ST). Mean days of intravenous PCA was 6.08±0.72 (TE) and 5.89±1.45 (ST). The mean number of epidural PCA days was 3.79±0.5 (TE) and 3.36±0.5 (ST) (P=.01). All patients presented a favorable postoperative evolution. None of the patients presented discomfort at the level of the sternal wounds during hospitalization. Cosmetic evolution was favorable in all patients. (AU)

Development and clinical application of a new sternal zenithal traction system in video-assisted percutaneous thoracoplasty.

INTRODUCTION: Video-assisted percutaneous thoracoplasty involves a complex surgical access with risk of damaging vital structures during the procedure. Historically, different traction and sternal elevation systems have been applied during the intervention to minimize the risk associated with the passage of the instruments between the sternum and the pericardium. MATERIAL AND METHODS: A new sternal traction system is presented by means of an illustrated description. Clinical and sociodemographic data were extracted from the 36 patients operated in our center for Pectus Excavatum between July 2017 and August 2021. The Haller index was not applied as a criterion to determine the use or not of the sternal traction system. Patients were classified according to whether the sternal traction system (TE) or not (ST) had been employed. Statistical analysis of the data collected was performed with STATA, version 15.0 (StataCorp). RESULTS: Both groups were comparable. Haller's Index was 4.19 ± 0.7 for the sternal traction (TE) group and 3.79 ± 0.3 for the no sternal traction (ST) group. In 25 of the patients the described traction system was used, and in 11 no traction system was used. All patients were operated on by the same surgeon. The mean operative time in minutes was 97.73 ± 46.2 for the ST group and 88.13 ± 18.1 for the TE group (p = 0.87). The mean total days of admission was 7.67 ± 0.82 (TE) and 7.73 ± 1.35 (ST). Mean days of intravenous PCA was 6.08 ± 0.72 (TE) and 5.89 ± 1.45 (ST). The mean number of epidural PCA days was 3.79 ± 0.5 (TE) and 3.36 ± 0.5 (ST) (p = 0.01). All patients presented a favorable postoperative evolution. None of the patients presented discomfort at the level of the sternal wounds during hospitalization. Cosmetic evolution was favorable in all patients. CONCLUSIONS: The sternal traction system presented provides safety when performing retrosternal dissection and placement of the thoracoplasty bar, leading to a decrease in surgical time in cases with a Haller Index higher than 3.5. There have been no complications associated with its use, nor has there been an increase in the number of days of hospitalization or analgesic requirements. There are no aesthetic sequelae for the patients.

Congenital Prepubic Sinus as a Variant of Incomplete Urethral Dorsal Duplication: A Case Report with New Insights into its Immunohistochemical Characterization and a Comprehensive Literature Review.

Congenital prepubic sinus (PS) is an extremely infrequent malformation consisting of a prepubic fistulous tract that classically does not communicate with the genitourinary system. Previous studies centered on its immunohistochemical characterization have shown inconsistent results, and the etiology has not been clarified. We present the case of a 2-year-old male who presented since birth with a fistulous orifice on the dorsum of the penis. He had no associated symptoms. Under general anesthesia, the fistulous tract was explored, and methylene blue was instilled through it. After cystoscopically verifying the absence of communication with the urethra, a complete resection of the lesion was performed. The immunohistochemical study showed positivity for low and high molecular weight keratins and a transitional pattern for keratin 7 and GATA3, with positivity at cul de sac level and negativity at proximal level. These findings suggest that this lesion is an incomplete dorsal duplication variant.

Pediatric Vulvar Superficial Angiomyxoma: A Case Report With Clinical, Radiological, and Anatomopathological Characterization and a Comprehensive Review of the Literature.

Superficial angiomyxoma is characterized as a benign, slow-growing vascular cutaneous myxoma. A 6-year-old Arab girl with no medical history presented with a vulvar tumor located on the left labia majora. The lesion was present since birth, but it had significantly increased over the last 6 months. She did not have any associated symptoms. Physical examination revealed an exophytic tumor of the left labia majora, which measured 5 cm in its major axis. Doppler ultrasound study showed a mass with abundant arterial and venous vascularization, and magnetic resonance imaging showed a highly vascular contrast-enhanced mass with well-delimited margins, which depended on the labia majora. A macroscopically complete resection was performed, achieving a tension-free primary closure. Histologically, the lesion was characterized as a well-demarcated superficial tumor with thin-walled vessels and myxoid stroma, S100 (-), CD34 (+), vimentin (+), and actin (+). The final histopathological diagnosis was superficial angiomyxoma. The literature review of this entity in the pediatric population shows a predominance of this lesion in the vulvar location. Local recurrence has been described. Loss of PRKAR1A expression may be involved in the pathogenesis of superficial angiomyxoma.

[Solitary dorsal paravertebral tumor: radiological and histopathological characterization of a pediatric case of nodular fasciitis].

Nodular fasciitis is a benign soft tissue lesion with rapid fibroblastic or myofibroblastic proliferation, rarely observed in pediatric patients. Here, we present the case of a seven-year-old boy with no relevant medical records, in whom an asymptomatic dorsal tumor was incidentally identified. Magnetic resonance imaging showed a left dorsal paravertebral lesion with hypointensity on T1, hyperintensity on T2, peripheral contrast enhancement, and the so-called fascial tail sign. Complete surgical resection of the lesion was achieved. The histopathological study showed a proliferation of spindle or stellate cells with nuclei without atypia in a myxoid or collagenized stroma. The immunohistochemical profile showed positivity for smooth muscle actin, muscle-specific actin antibody HHF35, and calponin. The lesion was diagnosed as nodular fasciitis, an entity with broad and complex differential diagnosis. Presence of specific radiological signs and adequate immunohistochemical characterization of the lesion help perform an accurate diagnosis.

[Urachal remnant and acute abdomen: when it's not what it seems].

Among the causes of acute surgical abdomen, infection of a urachal remnant may go unnoticed despite routine complementary studies. We present three cases in boys aged 11, 6, and 4 years who were brought to the emergency department for right iliac fossa pain, fever, and urinary symptoms. Examination and complementary tests results were compatible with acute complicated appendicitis and were sent to surgery. While in the operating room, appendicitis was excluded and inflammatory changes suggestive of infection of the urachal remnant were documented. Complications of urachal remnants should be considered in the differential diagnosis of acute surgical abdomen, since advanced infection of the urachus may be a cause of confusion. A more accurate presumptive diagnosis can change the therapeutic/surgical approach and follow-up.

Tumor paravertebral dorsal solitario: caracterización radiológica e histopatológica de un caso pediátrico de fascitis nodular / Solitary dorsal paravertebral tumor: radiological and histopathological characterization of a pediatric case of nodular fasciitis

La fascitis nodular es una lesión benigna de tejidos blandos de rápida proliferación fibroblástica o miofibroblástica, excepcional en pediatría. Presentamos el caso de un varón de siete años, sin antecedentes, que debutó con una tumoración dorsal asintomática identificada incidentalmente. La resonancia magnética mostró una lesión paravertebral dorsal izquierda con hipointensidad en T1, hiperintensidad en T2, captación periférica de contraste y el denominado signo de la cola fascial. Se realizó una resección quirúrgica completa de la lesión. El estudio histopatológico mostró una proliferación de células fusiformes o estrelladas con núcleos sin atipia en un estroma mixoide o colagenizado. El perfil inmunohistoquímico mostró positividad para actina de músculo liso SMA, actina músculo específica HHF35 y calponina. Se diagnosticó fascitis nodular, entidad que presenta un diagnóstico diferencial amplio y complejo. La presencia de signos radiológicos específicos y la adecuada caracterización inmunohistoquímica de la lesión contribuyen a realizar un diagnóstico preciso.(AU)

Nodular fasciitis is a benign soft tissue lesion with rapid fibroblastic or myofibroblastic proliferation, rarely observed in pediatric patients. Here, we present the case of a seven-year-old boy with no relevant medical records, in whom an asymptomatic dorsal tumor was incidentally identified. Magnetic resonance imaging showed a left dorsal paravertebral lesion with hypointensity on T1, hyperintensity on T2, peripheral contrast enhancement, and the so-called fascial tail sign. Complete surgical resection of the lesion was achieved. The histopathological study showed a proliferation of spindle or stellate cells with nuclei without atypia in a myxoid or collagenized stroma. The immunohistochemical profile showed positivity for smooth muscle actin, muscle-specific actin antibody HHF35, and calponin. The lesion was diagnosed as nodular fasciitis, an entity with broad and complex differential diagnosis. Presence of specific radiological signs and adequate immunohistochemical characterization of the lesion help perform an accurate diagnosis.(AU)

Remanentes uracales y abdomen agudo: cuando no es lo que parece / Urachal remnant and acute abdomen: when it's not what it seems

Dentro de las causas de abdomen agudo quirúrgico, la infección de un remanente uracal puede pasar desapercibida en cuadros evolucionados a pesar de las pruebas complemetarias habituales.Presentamos tres casos de varones de 11, 6 y 4 años llevados a urgencias por dolor en fosa iliaca derecha, fiebre y síntomas urinarios. La exploración y las pruebas complementarias eran compatibles con patología apendicular aguda evolucionada y fueron intervenidos con dicha sospecha. En el quirófano se descartó apendicitis y se documentaron cambios inflamatorios sugestivos de infección de remanente uracal. Las complicaciones de los remanentes uracales deben ser tenidas en cuenta en el diagnóstico diferencial del abdomen agudo quirúrgico, ya que la infección evolucionada de estos puede confundirnos. Un diagnóstico de presunción más certero puede cambiar nuestra actitud terapéutica, quirúrgica y el seguimiento.(AU)

Among the causes of acute surgical abdomen, infection of a urachal remnant may go unnoticed despite routine complementary studies.We present three cases in boys aged 11, 6, and 4 years who were brought to the emergency department for right iliac fossa pain, fever, and urinary symptoms. Examination and complementary tests results were compatible with acute complicated appendicitis and were sent to surgery. While in the operating room, appendicitis was excluded and inflammatory changes suggestive of infection of the urachal remnant were documented. Complications of urachal remnants should be considered in the differential diagnosis of acute surgical abdomen, since advanced infection of the urachus may be a cause of confusion. A more accurate presumptive diagnosis can change the therapeutic/surgical approach and follow-up.(AU)

Crossed Testicular Ectopia: Report of Two Cases in Children of Consanguineous Parents.

Crossed testicular ectopia (CTE) is an extremely rare anomaly of urogenital development. The etiopathogenic mechanism is unknown. Medical records of two biological siblings with a confirmed diagnosis of CTE being managed at our center were collected. The first patient was born with a non-palpable left testis. An exploratory laparoscopy was performed and a CTE was found. The second patient had an incarcerated left inguinal hernia and a mesopenile hypospadias. During surgery a CTE was observed. The parents were consanguineous. This is the first reported case of CTE in siblings.

Ectopia renal intratorácica / Intrathoracic ectopic kidney

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Transumbilical laparoscopic-assisted appendectomy in children: is it worth it?

INTRODUCTION: Transumbilical laparoscopic-assisted appendectomy (TULAA) is the technique of choice for all types of appendicitis in our Department. It combines the advantages of laparoscopy (global vision and minimally invasion) and open surgery (lower cost). The objective was to assess the results of our TULAA series and compare them to the results of standard laparoscopic appendectomies (SLA) performed during the same period. METHODS: Retrospective review of total appendectomies performed since TULAA introduction (September 2003 to December 2015) with statistic analysis of the results. RESULTS: A total of 1309 patients underwent TULAA approach, but 126 (9.6%) needed reconversion to open appendectomy, 1 (0.08%) to SLA, and 9 (0.7%) introduction of a second port. Mean age and weight of patients was 121.5 ± 36 months and 37.6 ± 14 kg, respectively. Mean operative time was 40.9 ± 15.5 min, ranging from 11 to 110. All types of appendicitis were present, with 394 being complicated (29.9%). Postoperative complications were seen in 168 patients (14.3%), 37 being readmitted (3.2%), and only five needing reintervention (Two intestinal occlusions and three abscess debridement). When comparing TULAA and SLA, there were no significant differences in the length of hospitalization, time to tolerate soft diet, analgesic requirements, and complications depending on the type of appendicitis, but TULAA was significantly faster and cheaper (average 900€). CONCLUSIONS: In our hands, TULAA has shown to be effective, easy to learn, and fast to perform. Low surgical cost is probably its principal advantage, which might be encouraging in times of crisis.