[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[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.

[Enterocutaneous fistula in the pediatric population. Clinical experience]. / Fistula enterocutánea en la edad pediátrica. Experiencia clínica.

BACKGROUND: The presence of fistulous communications between the small bowel and the skin continues to be one of the most perplexing and challenging problems facing the surgeon today. Their occurrence is a major catastophe of surgical practice because are frequently a result of technical failure or errors in surgical judgement. MATERIAL, METHOD AND RESULTS: Thirty four patients with high-output enterocutaneous fistulae arising from the small intestine are reported. Fourteen were due to appendicitis and sixteen were infants. Fistula resection were performed in six patients. Spontaneous fistula closure occurred in twenty-eight. Six died. The treatment program included parenteral nutritition thorugh central venous line, local care and antibiotics. CONCLUSIONS: In recent years, more aggressive therapy accompanied by the development of high caloric parenteral alimentation shows promise of reducing the mortality and morbidity rates associated with these fistulas.

[Appendicitis in a two-months old infant with a peritoneovaginal duct]. / Apendicitis en un lactante de dos meses con conducto peritoneovaginal permeable.

Acute appendicitis in infants is a very unusual disease, but associated to structural defects like patent peritoneovaginal duct, Meckel's diverticulum, clubfeet, and Moebius syndrome is extremely rare. Case report. A male of two months-old with this association is presented. Left inguinal swelling and acute abdomen syndrome were identified. In laparotomy, iguinal defect and a gangrenous appendicitis were observed. Appendectomy was performed and postoperative recovery was unevenful.

[Esophageal atresia: a second-level hospital experience]. / Atresia esofágica: experiencia de un hospital de segundo nivel de atención.

INTRODUCTION: In recent years, surgical correction of esophageal atresia with distal tracheoesophageal fistula has become increasingly successful. However, there is still a group of high-risk patients with specific factors in whom the mortality remains appreciable. These associated factors include weight, gestational age, associated malformations and respiratory distress. MATERIAL AND METHODS: This report analyzes the mortality in 80 newborn infants with variants of esophageal atresia with or without tracheoesophageal fistula who were treated from 1999 to 2003. Data were collected restrospectively from hospital and office records. RESULTS: We observed 42 male patients, 69 patients were C variety, all had more than 12 h of postnatal life, 34 were preterm newborn, 41 were classified A or B according to Waterston, and 41 died. A logistic regression analysis and chi2 of the influence of each risk factor on mortality was performed. Relevant statistical significance was found in the studied variables. CONCLUSIONS: Morbidity and mortality of esophageal atresia was higher due to identified risk factors.

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.

[Henoch-Schönlein purpura and intestinal perforation]. / Púrpura de Henoch-Schönlein y perforación intestinal.

Schönlein-Henoch purpura is one of the most common forms of vasculitis in childhood, and intestinal perforation, necrosis and intussusception constitute the major surgical conditions. We present one recent case of spontaneous small bowel perforation without intussusception. An intestinal resection and ileostomy were performed. Perforation, usually ileal, frequently is accompanied by intussusception. We believe the the perforation is secondary to deep ischemic phenomenon of the bowel.

[Traumatic perforation of the anorectal canal]. / Perforación traumática del conducto anorrectal.

INTRODUCTION: Traumatic perforation of the anorectal canal in children is relatively uncommon. There may be difficulties in recognizing or properly treating such injuries because their severity may not be reflected accurately by the external appearance of the perineum. MATERIAL AND METHODS: This was a retrospective survey of 19 children with anorectal rupture injuries secondary to blunt trauma and perforating mechanisms. RESULT: Sixteen (89.4%) were male and 15 (77.0%)suffered perforation after al fall on a sharp tool. All were admitted more than 12 hours after accident. Twelve (63.0%) had transanal extra-peritoneal injuries and 13 (68.4%) patients underwent colostomy. CONCLUSIONS: The majority of these perforations are caused by falls at play. The current standard principles in the treatment of anorectal injuries in children and wound drainage, broad-spectrum antibiotics and frequently fecal diversion.

[Hirschsprung in children over 6 years of age]. / Hirschsprung en niños mayores de seis años.

INTRODUCTION: Hirschsprung's disease or colonic agangliosis is a rare condition in schoolchildren and adolescents. It is common in infants and chronic constipation is the usual symptom. MATERIALS, METHODS, AND RESULTS: In a period of 5 years, 11-years-old patients were diagnosed and treated for Hirschsprung's disease. We studied six male patients; mean age was 8.6 years. All patients had classic disease and nine, severe chronic constipation, and two were admitted with encopresis. One had 10 kg of feces in 40 cm of colon. Diagnosis was established with barium enema and tissue biopsy. All patients had colostomy. In eight patients, Duhamel procedure was performed with good results. CONCLUSIONS: This disease is a rare condition in older patients and Duhamel procedure is a good surgical option.

[Retroperitoneal hematoma in children]. / Hematoma retroperitoneal en niños.

INTRODUCTION: Retroperitoneal hematoma is frequently due lo blunt trauma and is a challenging problem. Incidence of this complication in adults is high, but in childhood is uncommon. MATERIALS AND METHODS: Analysis of 30 cases is presented. PTS was found between 10 and 12 points, zone II, 12, zone III, 17, and zone I, only one. We observed 33 associated injuries: 17 were pelvic fractures and nine, ureteral rupture. Three patients underwent hepatic or splenic laceration. Seventy-three percent of patients had exploratory laparotomy, but did not have exploration of retroperitoneum. CONCLUSIONS: Retroperitoneal hematoma in infancy should be treated conservatively.

[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.

[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.

[Renal trauma in childhood. Second-level hospital experience]. / Trauma renal en la edad pediátrica. Experiencia de un hospital de segundo nivel.

UNLABELLED: The leading cause of death in children is accidents. Severe craniocerebral trauma and injuries to the heart or major vessels are mainly responsible for immediate death. This phenomenon is also reflected in the increasing number of pediatric admissions for renal trauma. MATERIAL AND METHODS: From 1990 to 2000, the charts of 132 patients with renal injuries secondary to blunt and penetrating trauma in childhood are reviewed. RESULTS: A total of 88 were male patients and 126 sustained blunt trauma (motor accidents, falls, etc.). Gross and microscopic hematuria were the most important finding at the time of presentation, and correlated with severe renal injury, and both were present in 122 cases. Intravenous pyelography and CT scan were the most useful diagnosis tools. Only 27 patients were managed operatively, the majority because of associated intra-abdominal injury. CONCLUSIONS: Intravenous pyelography remains the most cost-effective means of investigating renal injuries in a second-level hospital. Renal contusion and most laceration should be managed conservatively. Only few a renal transactions should be managed operatively.