A Rare Case of Iatrogenic Urinary Bladder Injury During Inguinal Hernia Repair: Management Tips, Tricks and Pitfalls.

Iatrogenic injury of the bladder is a rare incidence during inguinal hernia repair in children, with serious consequences for such patients. Due to the scarcity of information on this matter, it is our goal to share our experience regarding the therapeutic approach to such a rare occurrence. Specifically, a 22-month-old male was admitted to our department with the complaint of vomiting, abdominal pain and anuria, two days after inguinal hernia repair. The child had distention of the inguinal hernia region and was lethargic. The diagnostic investigation did not reveal any significant findings. During surgical exploration, we discovered an injury to the bladder, while a large part of the dome of the bladder was ligated and subsequently became necrotic. After a reoperation and an enduring postoperative course, the patient finally recovered. Currently, the child is under observation. Therefore, it is of paramount importance for pediatric surgeons to be acquainted with the potential for bladder injury during inguinal hernia repair, ways to manage this complication, and various issues that may emerge during the therapeutic process.

Endovascular Treatment With a Balloon-Expandable Covered Stent in a Polytrauma 12-Year-Old Patient With Traumatic Abdominal Aortic Rupture.

Βlunt trauma is a common injury in children; however, blunt abdominal aortic trauma is extremely rare and is accompanied by high rates of morbidity and mortality. We report our initial experience with the endovascular management of an abdominal aortic rupture in a 12-year-old boy after he was involved in a motor vehicle accident. The patient was a backseat-restrained passenger. Upon admission, he had a Glasgow Coma Scale of 15, was hemodynamically stable, and complained of abdominal pain. The computed tomography revealed a rupture in the abdominal aorta along with a distally extending pseudoaneurysm, free fluid in the peritoneal cavity, and a large retroperitoneal hematoma. The rest associated injuries were a Grade III splenic injury, a retroclival epidural hematoma in the first cervical vertebra level, a right clavicle fracture, a bilateral minor pneumothorax, along with bilateral pulmonary lacerations and contusions in the thoracic vertebrae. Given the extent of the intraabdominal injuries and the risk for open laparotomy, the decision to proceed with endovascular stenting instead of open surgical repair was made. The patient tolerated the procedure well and an angiography confirmed the result. The postoperative period was uneventful and the associated injuries were treated conservatively without complications. Although blunt abdominal aortic trauma is extremely rare in children, endovascular management seems to be a new and feasible therapeutic approach.

Maternal Preeclampsia and a Preterm Neonate With Small Bowel Stenosis, Volvulus, and Severe Intrauterine Growth Restriction.

Preeclampsia is a human-specific hypertensive disorder of gestation. It is associated with short-term adverse effects in the fetus and long-term complications in the neonate, mainly due to disrupted blood flow during critical periods of intrauterine development. An ischemic event in the uterus can affect many systems of the fetus, including a small bowel involvement. We present a case of a preterm, small for gestational age neonate with severe intrauterine growth restriction, small bowel stenosis, and volvulus without malrotation, born to a mother with severe preeclampsia.

Surgical Management of Arteriovenous Malformation of the Penis in an Adolescent Boy: A Case Report and Review of the Literature.

Arteriovenous malformations (AVMs) are common benign lesions, present at birth. Although they may occur anywhere in the body, usually they are found on the head, the neck, and the extremities. AVMs of the glans penis are very rare. Only a few have been reported in the literature, and thus, a definitive treatment does not exist. We herein report our experience of treating an AVM of the glans penis with surgical excision and plastic reconstruction of the glans, with the application of transplant tissue from the inner skin of the prepuce.

Laparoscopic-Assisted Anorectoplasty for Anorectal Malformation With Recto-Prostatic Urethral Fistula: A Case Report and Review of the Literature.

Congenital recto-urethral fistula is the most common form of anorectal malformation found in boys. The final repair includes the ligation of the fistula and the anorectoplasty, and can be achieved either way: posterior sagitally or laparoscopically. We present a case of a term male infant diagnosed with anorectal malformation and recto-prostatic urethral fistula, that underwent a laparoscopic-assisted posterior sagittal anorectoplasty in our department.

A well-hidden esophageal foreign body in an 11-year-old boy treated for gastroesophageal reflux disease: a case report.

Symptoms of gastroesophageal reflux disease (GERD) in children with developmental disorders could be often confusing. Especially when considering accidental foreign body ingestion, with no acute signs or symptoms of choking. We hereby present a case of an 11-year-old male with a well-hidden esophageal foreign body who was already treated for GERD and finally diagnosed with a hidden foreign esophageal object, ingested 12 months ago. Ingestion of objects of any kind, especially in certain groups of children, must always raise high suspicion for the clinical pediatric specialties, regardless of the presence or absence of classic symptoms.

Partial epididymal rupture and spermatic cord haematoma with an associated secondary testicular torsion due to blunt scrotal injury, in a 12-year-old boy.

Scrotal injuries are not very common in children and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. Traumatic testicular torsion in children has been also infrequently reported in the literature. To ensure testicular salvage, an urgent and specialised diagnosis and management are necessary. We present a case of a partial epididymal rupture and spermatic cord haematoma with an associated secondary testicular torsion due to blunt scrotal injury, in a 12-year-old boy.

Asymptomatic autoamputation of ovary and fallopian tube in a 2 days newborn: a case report.

Automatic amputation of the ovary represents a rather uncommon condition. Especially asymptomatic autoamputation is an even more unusual laparoscopic finding. We hereby present a case of a 2-days´-old infant with a prenatal ultrasound (US) diagnosis of a cystic mass, laparoscopically proved as an amputated right adnexa. The female infant was asymptomatic and had normal laboratory exams, including hormone levels, according to her age. The infant was managed surgically, as the size of the cystic lesion, both prenatally and postnatally was indicative of surgical intervention. Careful monitoring is critical for the management of cystic lesions diagnosed prenatally. Although rare, the suspicion of an auto-amputated ovary has to be risen during diagnostic approach of infants with adnexal cysts, especially when these lesions are supposed to "wander" during imaging examinations, and also taking into account the size of the lesion in order for a final approach and management to be established.

Right sided Bochdalek diaphragmatic hernia appeared as a life-threatening event in an infant: a case report.

We report a case of a 5-month-old female infant who presented with a cardiorespiratory distress and shock. After thoracic computed tomography (CT) scan, a right sided Bochdalek hernia was diagnosed with massive herniation of the abdominal viscera causing mediastinal shift. The girl underwent emergency laparotomy, which confirmed the right sided diaphragmatic hernia with herniation of small bowel and colon. After reduction of herniated contents, the defect in the diaphragm was closed. The patient had an uneventful post-operative cause. This case demonstrates that an undiagnosed Bochdalek hernia can appear with such a severe, life-threatening and misleading presentation.

Frontal bone fibrous dysplasia in a 6-months-old boy: A distinctive entity.

Fibrous Dysplasia (FD) is a non-malignant condition caused by post-zygotic, activating mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and woven bone. The clinical behavior and progression of FD is variable. The management of this condition is difficult and in every case is strictly individualized. We report a case of frontal fibrous dysplasia in a 6month's old boy who underwent a successfully resection of the lesion with an excellent cosmetic effect.

Laparoscopic-assisted excision of a huge polycystic omental lymphangioma in a 3 year old patient presenting with acute abdomen: case report and review.

Lymphangioma is a rare benign neoplasm affecting mainly children. In this report we present a complicated case of polycystic omental lymphangioma in a 3 year old female presenting with acute abdomen. The patient underwent a laparoscopic-assisted excision of the lesion and had an excellent postoperative course. We discuss the effectiveness and advantages of this laparoscopic surgical approach in children and elaborate on the current literature.

Crush syndrome in a case of severe infant physical abuse: a case report.

Crush syndrome, also known as traumatic rhabdomyolysis, is the result of the disruption of skeletal muscle fibers with the release of intracellular contents into the bloodstream. Although trauma is the main trigger for rhabdomyolysis in adults, in the pediatric population viral infections and inherited disorders seem to be the most frequent causes. Only a few reports in the literature mention rhabdomyolysis secondary to non-accidental pediatric trauma. We herein report an unusual case of traumatic rhabdomyolysis, following significant physical abuse in an infant. Rhabdomyolysis should be suspected in children presenting with a history of excessive blunt trauma, because a prompt diagnosis and treatment prevent from the potential life-threatening consequences.

Sigmoid volvulus in a 10-year-old male: A case report and review of the literature.

Sigmoid volvulus in children is a potentially disastrous situation, still remaining rare in terms of occurrence. We hereby present a case report of a 10-year-old male, having admitted in our department complaining about abdominal pain, who finally proved to suffer from sigmoid volvulus.

Incarcerated Umbilical Hernia in a 14-Month-Old Female: A Rare Case of Bowel Strangulation.

An umbilical hernia, although considered a benign condition of childhood, may rarely manifest with serious complications such as incarceration and viscous organ strangulation. One such case is presented in this report in an attempt to enrich the current literature, due to the relative lack of data in regard to complicated umbilical hernias in children and definite guidelines regarding the monitoring and management of uncomplicated cases. In addition, we discuss some of the latest advancements concerning the matter at issue.

Endoscopic treatment of obstructive ureterohydronephrosis in children.

Obstructive ureterohydronephrosis in childhood population is a matter of debate between paediatric surgeons and paediatricians, as far as the therapeutic protocol that should be applied. Close observation, chemoprophylaxis, endoscopic and surgical approaches are the universally used techniques that provide quality of life in the paediatric patients. Undoubtedly, "the less is more" even when we have to encounter obstructive ureterohydronephrosis in children. Herein, we present a short case series where the endoscopic management of obstructive uropathies proved to be therapeutic without any need of surgical intervention.

Testis-Sparing Surgery for Non-Palpable Leydig Cell Tumors in Prepubertal Children.

Leydig cell tumor (LCT) is an infrequent stromal neoplasm of the testis with an incidence of less than 3% of all gonadal tumors in the general male population. Only 25% is found in prepubertal children, where Leydig cell tumors are always reported benign. The hospital records of two prepubertal male children, who underwent organ sparing surgery for testicular LCT the last five years, were retrospectively reviewed. In both of them, the lesion was incidentally found during a scrotal ultrasonography for testicular pain. The diagnosis of a benign LCT was based on the pre-operative physical examination and imaging (Ultrasound-US, Magnetic Resonance Imaging-MRI) as well as the negative tumor markers. A testicle-sparing procedure was decided and the pathologic examination of the surgical specimen confirmed the diagnosis. No tumor recurrence was noted on follow-up. Testis-sparing surgery provides the possibility of complete excision of such lesions and should be considered as the treatment of choice.

Injury of the external genitalia in 10-year-old boy.

Degloving injury of penis and scrotum is very rare in child population and requires early reconstructive surgery for good outcomes. We report a 10-year-old boy with complete avulsion of the scrotum and partial of the penis caused by a bicycle chain due to off-road bicycling. The patient has been treated successfully with a single-staged surgery.

Proliferative Fasciitis in Childhood: A Review of Clinical Data Apropos of a Case.

Proliferative Fasciitis (PF) is a benign lesion with histologic and clinical features overlapping with those of malignant soft tissue tumours. Its occurrence in children is considered very rare. We present a case of PF appearing as a painful, red, gradually increasing in size lesion, during a period of a few weeks, on the finger of a five-year-old boy compromising the dermis and subcutaneous tissue. We were able to locate literature on 20 paediatric PF cases, which we review. Only five of these focus on the clinical data, the rest describing mainly histological findings. It is the first reported paediatric case appearing on the finger.

Tubular Intestinal Duplication Harboring Gastric Ectopia Accurately Diagnosed by Tc-99m Pertechnetate Single-photon Emission Computed Tomography/Computed Tomography Meckel's Scan.

A 7-year-old girl with an episode of hematochezia and melena, suspicious for bleeding Meckel's diverticulum, was referred for a Tc-99m pertechnetate Meckel's scan. On dynamic planar scan, apart from prompt gastric visualization an oval-shaped, area of inhomogeneous tracer uptake was observed in the left lower quadrant of the abdomen. Subsequent single-photon emission computed tomography/computed tomography localized this to intestinal lumen, thus establishing the diagnosis of intestinal duplication (ID) with functional gastric mucosa. Surgical exploration confirmed the presence of a tubular ID in a distance of 1.5 m from the ileocecal valve and pathologic examination showed gastric mucosa lining the lumen of the duplication.

Intercostal leiomyoma in a child: review of the literature.

Leiomyomas of the chest wall are very rare. In a review of the current literature twelve cases were found, of which only one concerns of an intercostal leiomyoma of the chest wall. We report a case of 1 year old male child with intercostal leiomyoma who presented with a painless rigid swelling of the right chest wall. The radiological control revealed a solid mass in the right anterior sixth intercostal space. En-bloc excision of the mass by abrading of the sixth rib through right anterior thoracotomy was performed. Histopatological analysis showed a localized intercostal leiomyoma. The patient has a close follow-up for 6 months without evidence of recurrence. This is the first case of a primary intercostal leiomyoma in a child which was excised totally without reconstruction of the chest wall.