Adel Ismail

Recurrent colonic volvulus in children

Recurrent intestinal obstruction caused by colonic volvulus is a rare cause of intestinal obstruction in children. Because the condition is self rectifying at times, the diagnosis can be missed or delayed. The authors present two patients, one with sigmoid volvulus and the other with sigmoid and cecal volvulus, and discuss the diagnosis and management of this condition in children. In view of the recurring nature of this condition, the authors believe that nonoperative treatment of this condition in children has no place beyond the emergency situation and that the definitive treatment should always be surgical.

Laparoscopic management of intra-abdominal testis: 5-year single-centre experience-a retrospective descriptive study.

Background. Undescended testis is one of the most common urological problems in children, affecting about 1% of boys at age of 1 year. Of these, about 20% have a nonpalpable testis with a very high probability that the testis is absent. This may have a significant impact on the possibility of malignancy in these testes, as well as on the later fertility of these subjects. Methods. We retrospectively analyzed the demographic and clinical findings, as well as immediate and 6-month outcomes, in 91 patients diagnosed with impalpable undescended testes between January 2006 and December 2010. Results. Of the 91 patients, 9 had bilateral and 82 had unilateral impalpable testes. All 100 testes were managed laparoscopically. The largest group of intra-abdominal testes in this series, 42 testes, was entering the internal ring; in these, laparoscopic exploration and standard open orchiopexy resulted in a 66% success rate. The total success rate was 63.3%. Conclusion. Laparoscopy is extremely useful in both the diagnosis and treatment of impalpable testes. Objectively measured mobility of the testis towards the contralateral internal inguinal ring is an excellent intraoperative indicator for type of orchiopexy. Standardization of management may increase the success rate of orchiopexy.

Post-monilial extensive esophageal stricture.

Candida albicans is a normal inhabitant of the gastrointestinal tract. It becomes pathogenic in severely debilitated and immunosuppressed people. With the increased use of chemotherapeutic agents in oncology, immunosuppressants in organ transplants, and potent broad spectrum antibiotics, we see more and more cases of candidiasis. We present a case of extensive esophageal stricture following candidiasis resulting from chemotherapy treatment of acute lymphatic leukemia.

Perineal canal: a simple method of repair

A perineal canal is a rare congenital, external cloacal anomaly. It is either low or high. We treated a girl with a low anomaly by excising the canal and letting it to granulate from the bottom up. We believe that this method is simple and that recurrence of this anomaly is avoided.

Solitary Rectal Ulcer Syndrome, a Pediatric Problem: Case Report

Solitary rectal ulcer syndrome is common in adults; however, it is thought to be rare in children. The etiology and exact pathogenesis of this condition are poorly understood. The main presenting feature of solitary rectal ulcer syndrome is rectal bleeding, but the clinical diagnosis and treatment remain challenging, particularly in pediatric patients. We present two pediatric patients with solitary rectal ulcer syndrome, who were treated surgically, and remain asymptomatic after the procedures. Clinicians should be aware of this problem in order to avoid delayed diagnosis and management.

Female double urethra: a case report.

Female double urethra is a very rare anomaly, with less than 40 cases reported since 1970. Most reported cases of double urethra are in the sagittal plane and tend to be stenotic. We describe a 4-year-old girl with double urethra, which was not stenotic and was in the coronal plane. Double urethra should be excluded among other causes in any girl who is incontinent beyond the continence age.

Does number of ports affect outcomes in patients undergoing laparoscopic pyloromyotomy? Retrospective chart-review study.

Background. Although open Ramstedts pyloromyotomy is the gold standard for the surgical management of infantile hypertrophic pyloric stenosis, laparoscopic pyloromyotomy has been found highly successful. Various factors, however, can affect the outcomes of surgical interventions in these patients. We observed a relationship between the number of ports used and outcome in patients undergoing laparoscopic pyloromyotomies. Methods. We retrospectively assessed the medical records of selected group of patients who underwent laparoscopic pyloromyotomy in our institution. Factors analyzed included operation time, length of hospital stay, postoperative complications, and time to postoperative full feeding. Results. We observed failure of myotomy in both two patients who underwent laparoscopic pyloromyotomy using only two working ports compared to successful myotomies in the remaining patients. Conclusion. Laparoscopy provides good results in terms of intraoperative exposure and cosmesis. However, standardized surgical technique with two working ports is advisable, and this can trigger further research to be ascertained.

Cystic lymphatic malformation of the falciform ligament: a rare cause of abdominal mass

Correspondence: Tariq O Abbas Paediatric Surgery Department, Hamad General Hospital, Doha, 3050, Qatar Tel +974 5509 3651 email tariq2c@hotmail.com Introduction: Lymphatic malformations are benign proliferations of the lymphatic vessels that occur most frequently in the skin of the axilla and neck. However, they can also occur in the mediastinum and retroperitoneum, and very rarely in the abdominal cavity. Case report: An 11-year-old male who presented with an intra-abdominal cyst is described here. Laparoscopic exploration showed that it was a cystic mass of the falciform ligament and it was resected laparoscopically. Histopathology confirmed the swelling to be a lymphatic malformation. To the authors’ knowledge, this is only the second report of a pediatric patient with a lymphatic malformation in the falciform ligament. Conclusion: Intra-abdominal cystic lymphatic malformations should be considered in the differential diagnosis of any intra-abdominal cystic mass. Management is surgical excision.

Needle in a Haystack—Parathyroid Gland in a 10-Day Old Infant: A Case Report and Literature Review

Neonatal severe primary hyperparathyroidism (NSPHT) is a rare autosomal recessive disorder of calcium homeostasis. It presents shortly after birth and is characterized by striking hyperparathyroidism, marked hypercalcemia, and hyperparathyroid bone disease. It is caused by mutations of the calcium-sensing receptor (CASR), the ionized calcium sensor for the parathyroid cells, the parafollicular thyroid C cells, and the kidney epithelium, as well as cells in bone and intestine. Without early intervention, which frequently requires surgical removal of the hyperplastic parathyroids, the patients often succumb to complications of hypercalcemia and respiratory failure. Finding the parathyroid gland in small neonates is not an easy task. Here we report on a patient with neonatal hyperparathyroidism who was treated by total parathyroidectomy and discuss the various ways of helping to find the parathyroid glands during surgery at this young age.