RESUMO
Choledochal cysts are cystic dilatation of the common bile duct managed by excision and hepatico-intestinal reconstruction. The gold standard after choledochal cyst excision is reconstruction using the jejunum. With the advent of laparoscopy the pendulum has changed toward hepaticoduodenostomy reconstruction. We review the classification, diagnosis and recent management of choledochal cyst.
Assuntos
Cisto do Colédoco/cirurgia , Duodenostomia/métodos , Jejunostomia/métodos , Cisto do Colédoco/diagnóstico , Cisto do Colédoco/patologia , Humanos , Laparoscopia/métodosRESUMO
Handlebar hernia is a rare traumatic abdominal wall hernia occurring after blunt trauma. We report a case of an adolescent patient with a traumatic rectus muscle abdominal wall hernia produced by injury with the bicycle handlebar. The skin abrasion caused by the trauma and a swelling reproduced after a Valsalva maneuver suggested the diagnosis. Traumatic wall hernias after blunt trauma should be repaired primarily to avoid complications.
Assuntos
Traumatismos Abdominais/complicações , Ciclismo/lesões , Hérnia Abdominal/etiologia , Ferimentos não Penetrantes/patologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/etiologia , Parede Abdominal/patologia , Adolescente , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/patologia , Humanos , Masculino , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/etiologiaRESUMO
Cancer of the thyroid gland in pediatric patients is rare and if left untreated spreads and become lethal. Thyroid nodules in pediatric patients are four times more likely being malignant than adult nodules. The incidence of thyroid cancer in children increases with age, sex, race and nodule size. Exposures to low level of head and neck irradiation at young age, cancer survivors, family history of thyroid cancer and iodine deficiency are specific risk factors to develop thyroid cancer. Thyroid cancer is subdivided into papillary, follicular and medullary thyroid cancer varying in histological characteristics. Children who present with thyroid nodules should undergo ultrasound and fine needle aspiration biopsy to evaluate malignant potential. If biopsy results are positive for malignancy best option is complete surgical resection of the thyroid gland with central lymph node dissection followed by radioactive iodine treatment. Surgeons need to take certain precaution to avoid postoperative complications like hypoparathyroidism or recurrent laryngeal nerve damage. Follow-up is essential in order to evaluate remission or recurrence. An excellent prognosis in pediatric patients is the result of such an aggressive approach that can be supported by the low complications rate and low recurrence rate following surgery.
Assuntos
Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Adulto , Fatores Etários , Biópsia por Agulha , Criança , Humanos , Excisão de Linfonodo , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Fatores de Risco , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/terapiaRESUMO
Wandering spleen is a rare occurrence where the spleen normal fixation to the abdominal wall is lost and thus allowed to change in position. We report a case of a child who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. The diagnosis was promptly made using computed tomography and managed with splenectomy.
Assuntos
Abdome Agudo/etiologia , Isquemia/etiologia , Infarto do Baço/etiologia , Anormalidade Torcional/etiologia , Baço Flutuante/complicações , Pré-Escolar , Emergências , Feminino , Humanos , Isquemia/cirurgia , Ligamentos/anormalidades , Esplenectomia , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/cirurgia , Baço Flutuante/diagnóstico por imagem , Baço Flutuante/cirurgiaRESUMO
Congenital rectovestibular fistulas with normal anus are a rare form of anorectal malformations, especially in the Western hemisphere. Due to its rarity, consensus on preoperative management, surgical technique and postoperative care is still in debate. We describe a specific case with its management plan and outcomes while providing an up to date literature review on current management trends.
Assuntos
Fístula Retovaginal/congênito , Erros de Diagnóstico , Feminino , Humanos , Recém-Nascido , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Fístula Retovaginal/diagnóstico , Fístula Retovaginal/cirurgia , Retalhos Cirúrgicos , Técnicas de SuturaRESUMO
Chylous jejunal cysts are extremely rare entities and if not diagnosed promptly may lead to severe complications like bowel obstruction, loss of small bowel and even death. We present the case of a 4 year-old-male referred to our institution with severe abdominal pain, constipation, abdominal distention and radiological findings of large amount of fluid in the lower abdomen with associated bowel obstruction. Operative findings were that of large chylous jejunal cyst causing segmental volvulus. Resection of the involved jejunal segment and cyst along with bowel detorsion was undertaken. Literature review on the subject follows.
Assuntos
Cistos/complicações , Volvo Intestinal/etiologia , Doenças do Jejuno/complicações , Pré-Escolar , Quilo , Humanos , MasculinoRESUMO
Adrenocortical carcinoma (ACC) is a rare neoplasm in children. Most patients with ACC suffer syndromes of adrenal hormone overproduction including hypercortisolism, hyperaidosteronism or virilization. We describe the case of an infant girl who presented features of virilization associated with elevated testosterone and DHEA levels due to the presence of a left adrenal cortical carcinoma. A dramatic regression of virilization features occurred after adrenalectomy.
Assuntos
Neoplasias do Córtex Suprarrenal , Carcinoma Adrenocortical , Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/cirurgia , Carcinoma Adrenocortical/diagnóstico , Carcinoma Adrenocortical/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido PrematuroRESUMO
In children with primary solid malignant tumors the most frequent site of metastasis is usally the lung. Pulmonary metastasectomy is part of the standard of care in adult malignancies but its role in pediatric patients has been poor characterized. This review article discusses the benefits, outcomes according tumor histology, selection criteria, adjuvant therapies and surgical techniques employed in the resection of pulmonary metastases in children with malignant tumors.
Assuntos
Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metastasectomia , Pneumonectomia , Criança , HumanosRESUMO
Intrathoracic ectopic kidney is a rare congenital abnormality with a prevalence estimated as less than one in 10000 and with only thirteen cases reported in the pediatric age group over the past twenty-five years. Herein, we report the uncommon case of a 20 month-old-male exhibiting a left ectopic intrathoracic kidney diagnosed as an incidental finding in image studies. Uncomplicated incidentals diagnosis has demonstrated normal function and development of those kidneys in long-term follow-up with no late bowel herniation.
Assuntos
Rim/anormalidades , Humanos , Lactente , Rim/diagnóstico por imagem , Rim/patologia , Imageamento por Ressonância Magnética , Masculino , Tórax , UltrassonografiaRESUMO
UNLABELLED: Children with thyroid nodules undergo extensive and costly work-up before being referred to surgeons. We attempted to identify which is the minimal clinical workup necessary to develop an appropriate surgical management plan for euthyroid children diagnosed with thyroid nodules METHODS: Case-control study including cases of thyroid nodules surgically intervened in a ten-year period at the University Pediatric Hospital. Following variables were studied: labs, physical exam, size of nodule, thyroid function tests, imaging. FNA findings, surgical procedure, and final pathology. The preoperative workup cost for each patient was estimated. RESULTS: Population consisted of twenty-four children. Nineteen were female and 5 were male with an average age of 14 years Nodules were divided in malignant 54% and benign 46% Of the 19 female cases 42% were malignant mostly papillary cell ca cinoma (PCC). All male cases were PCC. Indications fo surgical intervention in patients with benign lesions w continuous growth and symptoms not resolving with m dical treatment. Most benign lesions were follicular adenoma. We had 75% FNA results and pathology results for all case studied. Of the cases preoperatively diagnosed as malignant neoplasm by FNA all of them were confirmed by pathology and there were no false positive malignancies. Preoperative workup cost average $580 USD. CONCLUSION: A minimal workup algorithm is required before surgery in children with thyroid nodules. In a euthyroid child if a palpable nodule is found and it is accompanied by lymphadenopathy the suspicion for malignancy shoul be raised and FNA should be first line of evaluation. If no lymphadenopathy is present workup can proceed to US and progress to FNA evaluation if the nodule persists o grows. In symptomatic patients with small nodule. difficult to palpate or in smaller child, US-guided FNAwould be the best option.
Assuntos
Nódulo da Glândula Tireoide/diagnóstico , Adolescente , Criança , Técnicas e Procedimentos Diagnósticos , Feminino , Humanos , Masculino , Cuidados Pré-Operatórios , Estudos Retrospectivos , Nódulo da Glândula Tireoide/cirurgiaRESUMO
BACKGROUND: Fistula-in-ano is an abnormal connection between the inner surface of the anal canal and the perineal skin. METHODS: Between 2001 and 2010, seventeen patients with fistula-in-ano were surgically managed by a single surgeon within the University Pediatric Hospital and HIMA-San Pablo Hospital. RESULTS: There were 16 males and 1 female. The mean age at the time of operation was four years divided between infants (71%) and school children (29%). Fistulas were located on the midline right side in 5 patients, midline left side in 3 patients, midline bilaterally in 2 patients, in the anterior raphe in 4 patients and in the posterior raphe in 3 patients. Two patients of the infant group and two patients of the children group developed a perianal abscesses prior to the occurrence of fistula. All patients were managed with either fistulotomy or fistulectomy with six of them combined with Seton placement. There were no recurrence or complications. CONCLUSION: Fistulotomy is still considered the standard of care.
Assuntos
Fístula Retal , Adolescente , Criança , Feminino , Humanos , Lactente , Masculino , Fístula Retal/cirurgia , Estudos RetrospectivosRESUMO
Osteochondromas are the most common benign tumors of the skeleton. They usually arises from the metaphysial region of long bones. Only 10% of rib tumors are benign, and osteochondromas, account for half of these. These tumors typically begin to grow before puberty and continue until bone maturation is reached. We discuss a case of a 7-year-old boy found on physical examination to have a painless bony swelling arising as an outgrowth from the left fourth rib. Patient was taken to the operation room for a radical excision. CT scan and histopathological examination confirmed that the lesion was a non malignant osteochondroma. Costal osteochondroma is a rare but important condition to recognize due to its complications, such as reduced range of movement, pain, cosmetic abnormalities and bursitis. Costal osteochondromas tend to grow into the chest cavity and such lesions are rarely exophytic. There have been no previous reports of exophytic costal osteochondroma of this size in a child.
Assuntos
Neoplasias Ósseas , Osteocondroma , Costelas , Neoplasias Ósseas/diagnóstico , Criança , Humanos , Masculino , Osteocondroma/diagnósticoRESUMO
Wandering spleen is a rare birth defect characterized by absence or weakness of one or more of the ligaments that hold the spleen in its normal position. In this report we present the case of a 6-year-old girl admitted with diffuse abdominal pain, fever and emesis. Ultrasound and CT scan revealed the spleen was not found in its normal anatomical position. An enlarged spleen was identified displaced anteriorly and inferiorly at the L3 to L5-S1 level. Doppler ultrasonography of the splenic vessels revealed no blood flow consistent with infarction. Patient was taken to the operation room for a laparoscopic splenectomy. Treatment of choice for splenoptosis is surgery, either splenopexy or splenectomy. Decision to perform splenopexy or splenectomy depends on the viability of the spleen after detorsion. If the spleen appears infarcted, a splenectomy should be performed. Splenopexy is a reasonable option when the spleen appears viable after detorsion.
Assuntos
Laparoscopia , Esplenectomia/métodos , Infarto do Baço/cirurgia , Baço Flutuante/cirurgia , Criança , Feminino , Humanos , Infarto do Baço/complicações , Baço Flutuante/complicaçõesRESUMO
Esophageal atresia is the most common congenital anomaly of the esophagus in newborns. This review article discusses the incidence, embryological classification, diagnosis and associated anomalies of esophageal atresia. Emphasis is placed in the current guidelines of standard surgical management of this congenital condition.
Assuntos
Atresia Esofágica/diagnóstico , Atresia Esofágica/cirurgia , Humanos , Cuidados Intraoperatórios , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como AssuntoRESUMO
A 12-year-old male patient with a recalcitrant rectal anastomotic stricture following two failed endorectal pull-through (Soave) procedures for Hirschsprung's disease was satisfactorily managed with transanal resection using a circular stapling device. This is the first reported case of a benign colonic anastomotic stricture treated transanally with a circular stapling device in a pediatric patient.
Assuntos
Colo/cirurgia , Complicações Pós-Operatórias/cirurgia , Grampeamento Cirúrgico , Canal Anal , Anastomose Cirúrgica/métodos , Criança , Constrição Patológica/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Masculino , ReoperaçãoRESUMO
Failure to pass meconium during the first twenty-hours of life is a cardinal sign of a congenital low alimentary tract obstruction. This review article discusses a systematic approach when confronting such problem to help clinicians arrive to a correct diagnosis. Prenatal and postnatal diagnosis, imaging investigation, differential diagnosis and management of the more common causes of failure to pass meconium are reviewed.
Assuntos
Gastroenteropatias/fisiopatologia , Mecônio , Algoritmos , Gastroenteropatias/diagnóstico , Humanos , Recém-NascidoRESUMO
Spigelian hernias occur through a defect in the anterior abdominal wall adjacent to the semilunar line and lateral to the abdominal rectus. Spigelian hernias are rare regardless of the patient's age and even uncommon in the pediatric population. We report a 9-year-old male patient who presented with a bulging at the left lower abdomen consistent with a Spigelian hernia. A review of the data published between 1955 and 2010 pertaining to pediatric patients with Spigelian hernias follows. Effective treatment for this condition is surgical. Repair follows general principles with layered or plicated closure of the defect with absorbable sutures. Recurrence is unlikely.
Assuntos
Hérnia Ventral/cirurgia , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Criança , Hérnia Ventral/complicações , Hérnia Ventral/diagnóstico , Hérnia Ventral/patologia , Humanos , Masculino , Complicações Pós-Operatórias , Pressão , Escoliose/complicações , Escoliose/fisiopatologia , Escoliose/cirurgia , Técnicas de SuturaRESUMO
Double cystic duct is an extremely rare anomaly of the biliary tract not described in the pediatric literature. We report the first pediatric case born with VACTERL association found to have double cystic ducts during gallbladder surgery for symptomatic cholelithiasis. Description of the anatomic variability, cholangiography images, and pathologic findings along with review of the literature is included.
Assuntos
Anormalidades Múltiplas/patologia , Ducto Cístico/anormalidades , Dor Abdominal/etiologia , Criança , Colangiografia/métodos , Colelitíase/etiologia , Colelitíase/cirurgia , Ducto Cístico/diagnóstico por imagem , Ducto Cístico/lesões , Ducto Cístico/cirurgia , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Radiografia Intervencionista , SíndromeRESUMO
PURPOSE: The aim of this case series report is to assess the effectiveness of aspiration and injection of triamcinolone acetonide for treatment of wrist synovial cysts in children. METHODS: Twenty-one records of pediatric patients with synovial cyst on the wrist treated with aspiration and triamcinolone acetonide injection were selected for analysis of their outcomes. All cases were aspirated and injected at the operating room under mask induction anesthesia. Three categories were used to classify the patients' outcomes: (1) successful treatment with no recurrence, (2) successful treatment with residual sclerotic lump, and (3) recurrence of cyst. RESULTS: Fourteen females and 7 males with an average age of 7.2 years had a mean time with the cyst of 1 year. All children were asymptomatic. After aspiration, 13 (62%) of 21 patients experienced successful treatment of the synovial cyst with no recurrence after a single intervention. Five patients had a residual lump at the site of the cyst (24%), which disappeared after an average of 6 months. Three patients experienced true recurrence of the synovial cyst (14%). Average follow-up was 2.5 years. CONCLUSIONS: Aspiration and injection of triamcinolone accounted for a considerable reduction in recurrence. Aspiration and triamcinolone acetonide injection of wrist synovial cysts is an effective and safe treatment that may be considered as first-line treatment in the pediatric population if there is no resolution after 1 year of observation.