Laparoscopic Treatment of Gastric Duplication in a Child

Introduction: Gastric duplication is a rare congenital anomaly with an incidence of 4-8% of all gastrointestinal duplications; enteric duplications are ectopic cystic or tubular structures with a mucous and muscular tunics and they can be in contiguity/continuity with the intestinal lumen.1 Gastric duplication is often an occasional finding, associated to aspecific sintomatology for which pre-operative diagnosis is not univoque; differential diagnosis with other retroperitoneal diseases or mesenteric cysts can be difficult.1 (Run time 8min). Material and Methods: We present a case of a one-year-old child with a pre-natal ultrasound (US) finding of endo-abdominal cystic lesion. After birth, US scans showed an anechogenic-cyst of 33x28mm in the left upper quadrant, between stomach, spleen and kidney. The magnetic resonance confirmed the presence of the lesion (40x34mm), imprinting the posterior gastric wall, the spleen and the anterior side of left kidney. An esophagous-stomach-duodenum contrast study was also performed, showing the imprinting cyst on the great curvature close to the gastric fundus without communication with gastric lumen. On follow-up, the child underwent to periodic US scans and no growth or ultrasonographic changes were described. At 13-months, the diagnosis was still unclear and the patient underwent explorative laparoscopy with esophagous-gastric-duodenoscopy (EGDS). The preliminary EGDS showed a 35mm convexity on the posterior wall of gastric fundus with no evidence of orifice. A 5mm trans-umbilical trocar was placed and 5mm trocar in the epigastric region and 10-12mm trocar in the left side were positioned. At the abdominal exploration the cyst resulted to be in continuity with the posterior gastric wall on the superior third of the great curvature. The lesion was isolated from other tissues, but the postero-medial wall of neoformation appeared to be not dissociable and in continuity with the stomach; a complete resection of the cyst, using 45mm linear stapler, was performed including a small portion of the great gastric curvature. At the following intra-operative endoscopic control no more evidence of irregularity of the gastric wall was seen and the suture was assured. Results: The operative time was 140-minutes. No complications occurred and the blood loss was minimal. The patient started oral intake on 5’ post-operative-day and was discharged on 6’ post-operative-day. The histological examination confirmed the gastric nature of cyst. At 1-year of follow-up no recurrences were diagnosed and the child presents in good health with a regular growth. Conclusion: We can assume that laparoscopic surgery is the correct procedure for gastric duplication cysts, to get both definitive diagnosis and treatment, and the radical surgical excision represents the treatment of choice in order to avoid neoplastic degeneration of internal lining mucosa.2 Furthermore surgical laparoscopy appears to be a feasible and safe technique

FIRST CASE OF LAPAROSCOPIC PARTIAL SPLENECTOMY IN A CHILD WITH HAMARTOMA: CASE REPORT AND REVIEW OF THE LITERATURE

INTRODUCTION To date, laparoscopic surgery has played a key role in the treatment of not only splenic hematologic pathologies but also solid ones. Hamartoma is a rare disease; only twenty percent of them are of pediatric relevance; it is a benign tumor, but radiological features never allow proper differentiation from malignant neoplasms. In children, hamartoma may be associated with other morbid conditions, such as sickle cell disease or other hematological alterations. PRESENTATION OF THE CASE We report a case of hamartoma in a 7-year-old child treated with partial laparoscopic splenectomy After a multidisciplinary evaluation, the indication of laparoscopic splenectomy was decided; upon evaluating the age of the patient and the affected spleen portion, a partial splenectomy was proposed. The histological examination during surgery was performed to exclude any form of malignancy. The intraoperative frozen section of the specimen was negative for malignancies, and a partial splenectomy was performed. DISCUSSION Surgery remains the first choice in the definitive treatment of solid lesions of the spleen; minimally invasive technique, namely, laparoscopy, has set itself as the technique of choice for surgical treatment. In this case, the possibility of obtaining an intraoperative pathological diagnosis by frozen section of the specimen, confirming the benign nature of the lesion, allowed the surgeon to decide in favor of a laparoscopic partial splenectomy. CONCLUSION Partial laparoscopic splenectomy can be considered a safe, effective and reproducible alternative in patients suffering from benign solid diseases, safeguarding the hematological functions of the organ itself in pediatric age

CYTOREDUCTIVE SURGERY AND HIPEC IN A 14 YEARS OLD PATIENT WITH PERITONEAL RECURRENCE OF ADENOCARCINOMA OF THE RIGHT COLON

Introduction Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is nowadays a feasible and effective treatment for peritoneal metastasis. We present a case of a 14 years old child with peritoneal metastasis from recurrent colorectal cancer. Presentation of case Colonoscopy and CT-scan were performed leading to the diagnosis of a stenosing adenocarcinoma of the right colon in 2015. Two pelvic lesions were found at the total body PET scan, suspected for peritoneal metastasis. Neoadjuvant chemotherapy was administered, and restaging CT-scan and magnetic resonance (MRI) highlighted a partial response. The patient underwent right laparoscopic hemicolectomy. The postoperative staging was T4 N1 G3. Seven months after the last cycle of adjuvant chemotherapy, CT-scan revealed two huge abdominal masses. The patient underwent explorative laparotomy and bilateral oophorectomy, positive for metastasis from colorectal cancer and peritoneal washing cytology was positive for neoplastic cells. A CT-scan was performed on December 2017 showed a suspect lesion below the anterior abdominal wall. The case was discussed at the tumour board and the indication for CRS and HIPEC was given. In January 2018 the child underwent complete CRS and HIPEC with no complications. No adjuvant chemotherapy was administered. After 11 months the follow up is negative for the recurrent disease. Discussion and Conclusion Cytoreduction and HIPEC can be performed even in children as a feasible and safe treatment with successful outcomes. As for adults, an appropriate multidisciplinary pre-operative work up and a correct cases selection is needed to have the best results even regarding the quality of life

Treatment and follow-up of genital lichen sclerosus in male children: multidisciplinary management at a tertiary care center

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Thoracoscopic treatment of a rare bilateral extralobar lung sequestration in a 3-years old girl.

Majority of sequestrations fall into two categories: Intra-Lobar (ILS) and Extra-Lobar (ELS). Rarely the abnormal lung could be attached to the gastrointestinal tract, Bronchopulmonary Foregut Malformation (BPFM). We described a case of a girl of 3-years-old with antenatal diagnosis of left intrathoracic mass of the inferior lobe. Postnatal Computed-Tomography (CT) revealed a bilateral ELS with an isthmic bridge crossing the vertebral spine. She follows a MRI follow-up at 18months/30months confirming the lesion. Before surgery, a three-dimensional-CT-angiography was performed to study the mass, its blood supply and to plan surgery. She underwent to thoracoscopic resection. Two aberrant blood vessels were dissected from the thoracic aorta and ligated. The postoperative course was uneventful. She was discharged after 3 days. The rarity of our case is due to the bilateral extension. An appropriate preoperatory imaging study is necessary for the success of surgery while thoracoscopy is particularly appropriate in surgical treatment

Drug-Induced Urolithiasis in Pediatric Patients

Drug-induced nephrolithiasis is a rare condition in children. The involved drugs may be divided into two different categories according to the mechanism involved in calculi formation. The first one includes poorly soluble drugs that favor the crystallization and calculi formation. The second category includes drugs that enhance calculi formation through their metabolic effects. The diagnosis of these specific calculi depends on a detailed medical history, associated comorbidities and the patient's history of drug consumption. There are several risk factors associated with drug-induced stones, such as high dose of consumed drugs and long duration of treatment. Moreover, there are some specific risk factors, including urinary pH and the amount of fluid consumed by children. There are limited data regarding pediatric lithogenic drugs, and hence, our aim was to perform a comprehensive review of the literature to summarize these drugs and identify the possible mechanisms involved in calculi formation and discuss the management and preventive measures for these calculi

Totally Laparoscopic Partial Splenectomy in a Child with Hamartoma

Background: To date laparoscopic surgery plays a key role in the surgical treatment of not only splenic hematologic pathologies but also of solid pathologies such as benign and malignant tumors. Hamartoma is a rare disease, described for the first time by Rokitansky in 1861. Only few cases are described in the literature, and only 20% of these are of pediatric relevance. In children, hamartoma may be associated with other morbid conditions such as sickle cell disease or other hematologic alterations. Material and Methods: In July 2017, a 7-year-old child presented at the pediatric emergency room for lumbar pain and fever. Abdominal ultrasonography showed a single solid lesion of 5.5 × 6.5 cm with rounded morphology, well-defined margins, and occupying the superior two-thirds of the spleen. Magnetic resonance imaging was performed to better investigate the lesion. On evaluation of the age of the patient and the affected spleen portion, we decided to perform a laparoscopic partial splenectomy. Before surgery, the patient underwent chemoembolization of the upper pole of the spleen to minimize intraoperative blood loss. No postoperative complications occurred and the patient was discharged on the fifth postoperative day. Conclusion: The proper integration between radiologists, pediatricians, and surgeons has allowed the correct management of a pediatric patient suffering from a rare disease. Partial laparoscopic splenectomy can be considered a safe, effective, and reproducible treatment in these patients suffering from benign solid disease, safeguarding the hematologic functions of the organ itself

Hypospadias: clinical approach, surgical technique and outcome. Twenty years’ experience of a single centre

Background: Hypospadias is one of the most common congenital abnormalities in male. Nowadays, hypospadias surgical repair has become highly demanding and deeply investigated with more than 300 corrective procedures. Its success is assessed by the “reoperation rate” that occurs short after the surgery within a brief follow-up (6-12 months). However, short-term outcomes may not reflect the long-term ones, as hypospadias repair may influence adolescence and adult life. This study aims to identify the cosmetic, functional and psychosexual outcomes on a long-term follow-up and to suggest an innovative approach to the hypospadiac patient’s care, as well as providing a review of a singol center experience. Methods: Medical records of 398 patients treated by the same surgeon for hypospadias between August 2001 and December 2017 were reviewed. Families were reached by phone and invited to attend a free-charge follow-up examination. A life-related interview and 3 validated questionnaires (the Penile Perception Score-PPS, the Hypospadias Objective Score Evaluation-HOSE, the International Index of Erectile Function-5-IIEF5) were used, according to the age, to compare the parents’, patients’ and surgeon’s opinion on long-term outcomes. Results: 187 patients were included in the study (response rate 47%). 46 patients (24.6%) presented at least one complication after the repair with a mean elapsed time of 17.6 months (SD 18,96). Longitudinal differences in surgical corrective procedures (p<0.01), clinical approach (p<0.01) and hospitalisation after surgery (p<0.01) were found. Cosmetic data from the PPS were similar among patients and parents, with no significant differences according to patients’ age nor to the type of hypospadias: 83% of the patients and 87% of the parents were satisfied with the cosmetic result. A significant difference in functional outcome relating to the type of hypospadias was reflected by the HOSE among patients (p<0.001), parents (p:0.02) and surgeon (p<0.01). Patients’ HOSE total score was consistently lower compared to the surgeon one (p<0.01). The HOSE satisfaction rate on functional outcome was 89% for patients and 92% for parents. No data were available from the IIEF5 questionnaire. Conclusion: Long-term hypospadias outcomes still represent a debated issue for scientific community and a standardized approach to evaluate the consequences of surgery through time is needed. We propose an innovative algorithm in attempt to fill the gap of the present literature