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Sternal clefts are infrequent congenital malformations, particularly in their complete presentation. There are less than 100 descriptions of these defects published in the literature worldwide. We report a clinical case of lower sternal cleft associated with congenital laparoschisis in a 2-year-old boy. Surgery was performed because of recurrent pneumopathy and the risk of cardiorespiratory decompensation in the midterm. A semi-resorbable prosthesis was used for sternal closure. We have not observed any complications with this sternal closure system in our patient. This approach is easy, safe, effective and not harmful to a child's growth.

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If acute or severe infectious are know that risk factors for venous thromboembolism (VTE), the role active tuberculosis is ill defined, despite different case reports and many small case series have proposed an association between VTE and chronic infectious such as tuberculosis. We are highlighting an exceptional phenomenon correlation between intra-cardiac thromboembolism and pulmonary tuberculosis and concluded that active tuberculosis should include in the physician's evaluation of intra-cardiac thromboembolism risk.

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The pseudosyndrome of Meigs is caracterised by a triad, which associates a solid benign tumor of the ovary, an ascitis and a pleural effusion. Surgical extraction of the tumor entails disappearance of the symptomatology. The authors report in this study a case of an ovarian goitre revealed by this syndrom.

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Osteosarcoma is a malignant neoplasm characterized by local lytic or plastic processes. We observed a case of radius osteosarcoma in a 10-year-old boy 3 months after intramedullary osteosynthesis in the ipsilateral distal radius. Treatment consisted of amputation of the distal humerus and adjuvant chemotherapy; no complications were observed.

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OBJECTIVE: To evaluate the frequency of urinary peritonitis in children and to highlight its terms of management in a country with limited resources. PATIENTS AND METHODS: We retrospectively observed nine case reports of urinary peritonitis collected in surgical reanimation service at the CHU of Antananarivo, from 1st January 2009 to 31 December 2012. RESULTS: Urinary peritonitis accounts 0.5% of all pediatric abdominal emergencies and 5% of pediatric urological emergencies collected in our service during study period. Three etiologies were traumatic bladder rupture, one bladder iatrogenic rupture, four secondary to obstructive uropathy and one other after cystolithotomy. We found a new case of posttraumatic transverse rupture of the bladder neck. Among obstructive uropathy observed, there were two cases of posterior urethral valves and two cases of ureteralpelvic junction obstruction. Clinical expression was dominated by fever, with abdominal distention and defense. In majority of cases, etiological diagnosis was made intraoperatively. The surgical treatment by laparotomy was performed under cover of systemic antibiotic therapy. Evolution was complicated with sepsis in three cases and acute renal failure in both cases. Surgical follow-up without complication were observed in four cases. A child has died to septic shock and multivisceral failure. CONCLUSION: Unlike urinary ascites resulting a transperitoneal extravasation of urine, uroperitoneum was a fistula between adominal cavity and content of the urinary tract. Urinary ascites was a rare cause of peritonitis. In contrast, uroperitoneum caused peritonitis quickly. Urinary peritonitis was a rare entity but severe prognosis in children. In majority of cases, etiological diagnosis was made intraoperatively.

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A Petit lumbar hernia is an uncommon hernia. Congenital forms are seen in children. Incarceration may occur as an unreducible lumbar mass, associated with bilious vomiting and abdominal distention. Abdominal X-ray shows sided-wall bowel gas. In this case, reduction and primary closure must be performed as emergency repair.

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Cavernous sinus thrombophlebitis is a serious disease. We report herein a case seen in a 9-year-old boy hospitalized for an acute pneumopathy. Clinical signs were made of a diffuse edema of the upper two-thirds of the face, eyelid edema, chemosis, exophthalmia, meningeal syndrome, and infections syndromes associated with alteration of consciousness. A CT scan revealed a heterogenous enhancement and enlargement of the left cavernous sinus and homogenous opacity of the sphenoidal sinuses. Therapeutic management was complicated due to allergy to ß-lactams and the multidrug resistance of Staphylococcus aureus.

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Omphalomesenteric fistula is a complete persistence of the omphalomesenteric duct communicating between the umbilicus and the intestine. The presence of intestinal contents suggests the diagnosis in its typical form. We report a case of omphalomesenteric fistula in a 3-year-old boy to show that intestinal parasitic infection associated with ascariasis expulsion through the umbilicus can be the incidental finding of the omphalomesenteric fistula. This case needs no paraclinical investigation and treatment consists in partial transumbilical resection followed by umbilicus restitution.

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Objectif: Determiner les facteurs de mortalite post-chirurgicale en periode neonatale au service des Urgences et de faire ressortir les difficultes de prise en charge. Methodes: C'est une etude retrospective et analytique allant du mois d'Aout 2008 au mois d'Aout 2009 sur tous les nouveaux-nes recus au service des urgences du Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona Antananarivo Madagascar. Resultats: Soixante quinze nouveaux nes ont ete releves. L'occlusion intestinale et la malformation ano-rectale etaient le motif de reference dans presque la moitie des cas; avec une predominance masculine. Douze nouveaux-nes etaient decedes en post-operatoire immediat. L'absence de diagnostic prenatal; la prematurite; l'absence de transport medicalise; le retard de consultation; le manque de moyen de reanimation et les associations malformatives graves ont ete les principaux facteurs de mortalite dans notre serie. Conclusion: Des consultations prenatales regulieres; l'accouchement dans un hopital disposant d'une ambulance medicalisee et l'equipement en materiaux et en personnels de l'Unite de Soin Intensif Neo-natal devrait ameliorer le resultat

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Isolated testicular tuberculosis is rare. The authors report 2 cases in children. The clinical features had no specificity: one case of hydrocele and 1 case of acute scrotum inflammation. Surgical exploration showed testicular nodules in both cases. Only histological examination provided the definitive diagnosis. The details of diagnosis and treatment are discussed and compared to the information available in the literature.

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Myopericytoma is a ubiquitous, benign tumor that is likely to be found in the muscular-cutaneous system. Symptoms are related to its location and to the mass effect it may cause on surrounding organs. Diagnosis is usually made by the pathologist and treatment is surgical. We report herein a rare thoracic location in a 4-year-old girl.

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Pheochromocytoma is uncommon in children. We report herein a case in a 6-year-old boy whose pheochromocytoma was revealed by cerebral ischemia as a consequence of acute-cardiac failure. Twenty-four-hour urinary catecholamines were markedly increased. Abdominal ultrasonography and computed tomography located the tumor on the left adrenal gland. After surgical excision, hypertension disappeared. Diagnosis and treatment of pheochromocytoma in children are discussed.

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Polyorchidism is a rare congenital anomaly. We report 1 case in a Malagasy young man revealed by left scrotal mass. The diagnostic was suspected by clinical examination and confirmed by testicular sonography. Management is conservative, based on clinical and sonography surveillance of supernumerary testicle.

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Lymphoma is an uncommon tumor of bladder. We report herein one case in a 58 year-old man aiming to show diagnosis and treatment difficulties in our practice. This patient had medical history of nephritic colic, haematuria and cystitis. Imagery revealed tissular mass with orange-like dimension in the right bladder corn. There was no kidney function alteration. Complete mass excision was performed and histological examination diagnosed low grade lymphoma with lymphoplasmocytary type. After chemotherapy, complete remission was obtained after 10 months follow-up.

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Mesenteric cystic lymphangioma is an uncommon benign tumor. The purpose of this report is to present a case involving a 7-year-old girl who presented hemoperitoneum due to traumatic rupture of a mesenteric lymphangioma cyst. The patient who had a huge preexisting tumor mass presented with hemorrhagic shock symptoms following a severe fall. Peritoneum puncture lavage confirmed hemoperitoneum. Exploratory laparotomy revealed a large bleeding cyst-like mesenteric tumor. Total extirpation was difficult but successful. Histological examination of the surgical specimen demonstrated mesenteric lymphangioma. In developing countries like Madagascar, rupture of parasitic splenic cysts is the most frequent underlying etiology in children presenting hemorrhagic syndrome after falls. This case shows that mesenteric cystic lymphangioma rupture can be a rare cause.

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Les pseudotumeurs fibreuses inflammatoires du cordon spermatique observe chez l'enfant sont rares. Les auteurs rapportent un cas observe chez un garcon de 9 ans presentant une tumefaction paratesticulaire gauche. L'examen echographique du scrotum revele un nodule hypoechogene du cordon spermatique gauche. A partir de cette observation et d'une revue de la litterature; nous discutons les aspects diagnostiques et therapeutiques de ces tumeurs

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La decouverte d'une hernie de Spieghel compliquee d'une fasciite necrosante de la paroi abdominale est exceptionnelle. Un homme de 36 ans avait presente une tumefaction inflammatoire de la fosse iliaque gauche diagnostiquee comme une fasciite necrosante. Cette tumefaction decouverte quatre mois plus tot avait fait l'objet de plusieurs seances de massage traditionnel. Au cours du traitement chirurgical; une anse grele necrosee et perforee passant a travers une hernie de Spieghel etait retrouvee; a l'origine de la fasciite necrosante. Les difficultes diagnostiques et therapeutiques sont discutees a travers une revue de la litterature

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L'invagination intestinale aigue de l'adulte est rare et souvent secondaire. La symptomatologie clinique est polymorphe. Nous en rapportons un cas lie a un lipome de l'intestin grele et se manifestant de maniere subaigue dans un tableau de douleur abdominale chronique associee a un syndrome subocclusif. Les differents aspects de la prise en charge sont discutes a travers une revue de la litterature

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L'hematome retroperitoneal est habituellement secondaire a un traumatisme. La forme spontanee idiopathique est rare surtout quand il survient chez la femme enceinte. Nous rapportons le cas d'une femme de 29 ans enceinte de 20 semaines d'amenorrhee; qui a presente une douleur abdominale aigue avec instabilite hemodynamique et deglobulisation. La difficulte est d'affirmer le diagnostic de cet hematome afin d'evaluer le retentissement foto-maternel et d'adapter la prise en charge therapeutique

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