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Ascaris lumbricoides is one of the most common helminthic diseases worldwide and it can cause various complications. The presence of this worm in the biliary tree, however, is a rare condition, especially in children. We describe a child with biliary ascariasis who was presenting clinical symptoms mimicking surgical acute abdomen. The diagnosis was made by ultrasound. The child was successfully treated with mebendazole and anti-spasmolytic. Biliary ascariasis should be added to the differential diagnosis of acute abdominal pain in patients, even in children, from endemic areas.

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OBJECTIVE: To report a translocation between chromosomes 3 and 4: 46,XY,t(3;4)(p25;q31.3) in a male infant with a disorder of sexual development. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 1-year-old infant who presented with abnormal location of the urethral meatus. INTERVENTION(S): Cytogenetic analysis, fluorescence in situ hybridization (FISH), and serum concentrations measurement (using peripheral blood), and clinical examination. MAIN OUTCOME MEASURE(S): Karyotype and clinical findings. RESULT(S): On clinical examination, bilateral testicular volume and phallus were determined to be undersized. Serum concentrations of T and DHEAS were low. G-banding of his chromosomes showed that the patient had a balanced translocation involving chromosomes 3 and 4: 46,XY,t(3;4)(p25;q31.3). This karyotype finding was confirmed by FISH. The FISH analysis revealed the presence of sex-determining region (SRY). The proband inherited this translocation from his father. His sister had the same translocation. However, the father and sister of the proband were clinically normal. CONCLUSION(S): The presence of this chromosomal anomaly and hypospadias was unique to our patient compared with others with the 46,XY,t(3;4) translocation. Although no such association has been reported to date, we think that the severe hypospadias in our case might be associated with this translocation.

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OBJECTIVE: To determine contemporary patterns of presentation and trends in the management and outcome of 51 newborn infants with intestinal atresia. METHODS: We retrospectively reviewed 51 cases of intestinal atresia between January 1983 and February 2003. Clinical data included antenatal history, age, gender, weight, presenting symptoms and signs, diagnostic procedures, location and type of atresia, associated abnormalities, surgical treatment, associated problems, morbidity, mortality and plans of treatment. RESULTS: Twenty children had duodenal obstruction, 24 had jejunoileal atresia, and 7 had colonic atresia. Approximately one-fourth of patients associated with duodenal atresia had preterm delivery and all patients with jejunoileal and colonic atresia were full term. Clinical features such as vomiting, abdominal distention, delayed meconium passage and jaundice were more frequent in jejunoileal atresia patients. Other associated organ anomalies particularly Down's syndrome were more frequent in duodenal atresia patients. A duodeno-duodenostomy was preferred in most of the patients with duodenal atresia and annular pancreas; duodenotomy and web excision for those with duodenal webs; and resection with end-to-end anastomosis for those with jejunoileal atresia. In all patients with colonic atresia, colostomy procedure was performed as the first step of surgery. CONCLUSION: Experienced neonatal care and prompt total parenteral nutrition by placing central line during surgery may improve the outcome of such patients.

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Heteropagous conjoined twins are rare and umbilical heteropagous conjoined twins are extremely rare. We present a case with umbilical heteropagous conjoined twins and discuss the diagnosis and management. The parasitic component of heteropagous can be separated and treated successfully in the majority of cases.

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The purpose of this study was to determine the morbidity, mortality and possible risk factors in children who underwent colostomy. A total of 473 children who underwent colostomy in our clinic between 1983 and 2005 were retrospectively reviewed. Of these patients, 278 were boys and 195 were girls. The major indications for colostomy were anorectal malformation (252 patients), Hirschsprung's disease (117), and trauma (66). The patients' age ranged from 1 day to 15 years. Of the 473 patients, 254 (53.6%) were < 1 month of age, 97 (20.5%) were 1-12 months of age, and 122 (25.7%) were > 12 months of age. The side of colostomy was transverse in 341 (72%) patients and sigmoid in 132 (28%). The type of colostomy was loop in 364 (77%) patients and diverting in 109 (23%). Postoperative complication was observed in 80.5% of patients; excoriation (46.5%), prolapse (20.5%), stomal obstruction/stenosis (6.1%), and stomal bleeding (2.1%). A stomal revision was required for 26 (5.5%) patients. Overall, 50 (10.5%) patients died; 37 were related directly to major congenital anomalies, while 13 (2.7%) patients had a colostomy complication. The age of patients who died was < 1 month in 46 (92%) patients. The incidence of morbidity and mortality in children with colostomy is significantly high, particularly in neonates. Prompt colostomy procedure by an experienced hand, prompt stomal care under the supervision of a trained and experienced stomal care giver and early closure of the colostomy may increase the survival of these patients.

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Postoperative abdominal evisceration may lead to high morbidity and mortality. The purpose of the present study was to determine possible risk factors, morbidity and mortality associated with abdominal evisceration in children. A total of 3,591 children underwent abdominal exploration in our clinic between 1983 and 2005. In this study, we retrospectively reviewed 29 patients who developed abdominal evisceration after abdominal exploration. The incidence for abdominal evisceration was found to be 0.8%. The mean age was 16 months (range 1 day-13 years), while 48.2% of the patients were younger than 1 month. The incidence of abdominal evisceration was significantly higher in patients younger than 1 month (2.5%) compared to older ones (0.4%) (P < 0.0001). The mean time interval between primary abdominal exploration and development of abdominal evisceration was 7 days (2-21 days). The risk for development of evisceration was significantly higher in patients who underwent colonic or small bowel surgery compared to those underwent laparotomy alone (P < 0.0001, P < 0.01, respectively). Absorbable suture was used in 15 patients for closure of abdominal fascia, while a silk suture material was used in 14 patients (P > 0.05). The age-weight percentile was lower than 3% in 41.3% of patients. At the follow-up period, 19 patients recovered completely whereas 10 (34.5%) died. As a result, the age (neonates), primary surgery (colo-rectal), type of incision (median), and emergency surgery were significant risk factors for development of abdominal evisceration in children.

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The purpose of the present study was to investigate whether mibefradil can reduce oxidative stress and histologic damage in the rat small bowel subjected to mesenteric ischemia and reperfusion injury. Thirty Sprague-Dawley rats weighing between 210 and 220 g were divided into three groups, each containing 10 rats: group 1, sham operation; group 2, untreated ischemia-reperfusion; and group 3, ischemia-reperfusion plus mibefradil treatment group. Intestinal ischemia for 45 min and reperfusion for 60 min were applied. Ileal specimens were obtained to determine the tissue levels of MDA, CAT, SOD, and GSH-Px and histologic changes. In group 2, MDA values were significantly increased compared to those in groups 1 and 3. In addition, SOD, CAT, and GSH-Px values decreased significantly in group 2 compared to groups 1 and 3. The intestinal injury score increased significantly in group 2 and 3 rats compared to group 1 rats. However, this increase was reduced in group 3 rats compared to group 2. Histopathologically, the rats in group 1 had essentially normal testicular architecture. In group 2 rats, the lesions varied between grade 3 and grade 5. In contrast, most of the specimens in the mibefradil-treated group 3 showed grade 1 injury. Mibefradil plays a role in attenuating reperfusion injury of the small intestine by depressing free radical production and mucosal injury score and regulating postischemic intestinal perfusion while restoring intestinal microcirculatory blood flow and encountered histologic injury.

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