Akgün Hiçsönmez

High Body Mass Index as a Possible Risk Factor for Pilonidal Sinus Disease in Adolescents

Pilonidal sinus disease (PSD) is common in adults, but it may also develop in adolescents. The intergluteal groove is a deep moist area in which broken hairs and foreign bodies can collect, often leading to infection. Only a few papers have been published considering PSD in children. For the present study, we retrospectively examined the data of operated patients with PSD. From that review, it appears that high body mass index (BMI) might be a risk factor for the development of PSD and its complications in older children. Fourteen young patients (12 males, 2 females, 12–18 years of age) underwent surgery for PSD. According to the BMI-for-age, eight of these patients (57, 1%) were overweight or obese. Five of them (35.8%) developed mild to moderate postoperative complications. Symptoms recurred in one patient (7.1%) whose BMI was considered as overweight. In patients with normal weight no early or late complications developed. Our findings suggest that high BMI in adolescents is a significant risk factor in the development of both symptoms and complications of PSD after surgical treatment.

Hepatic laceration because of malpositioning of the umbilical vein catheter: case report and literature review

Umbilical vein catheterization that is a common bedside procedure in the neonatal intensive care units is not without complication. The most common complications are thrombus formation, embolism, vessel perforation, hemorrhage, and infection. Complications related to the liver carry a high risk for mortality. Laceration is an ominous complication of umbilical vein catheter that is generally a result of direct injury through the liver parenchyma. Abdominal distension that develops gradually should alert the physician for a likely development of intrahepatic bleeding. Surgery is mandatory in patients with ongoing bleeding after the withdrawal of the catheter. Early diagnosis and treatment are lifesaving in these patients.

Perianal abscess and fistula‐in‐ano in children: Aetiology, management and outcome

Aim:  We aimed to assess our experience in treatment and outcome of perianal abscess and/or fistula‐in‐ano in children.

Primary vaginal calculus secondary to urethrovaginal fistula with imperforate hymen in a 6-year-old girl

Primary vaginal stones are extremely rare in children and may be mistaken for bladder calculi on plain radiography. We present a case of a large vaginal calculus in a 6-year-old girl who had an imperforate hymen and urethrovaginal fistula. Hymenotomy and urethrovaginal fistula repair were performed, and the vaginal stone was extracted. It was postulated that the vaginal calculus originated from stasis of urine through the urethrovaginal fistula in the obstructed vagina. This is a unique case of a vaginal calculus with a congenital urethrovaginal fistula associated with an imperforate hymen.

Percutaneous treatment of portal vein thrombosis in a child who has undergone splenectomy

Thrombosis of the portal venous system is a well-recognized and potentially lethal complication after open or laparoscopic splenectomy. A 7-year-old girl with idiopathic thrombocytopenic purpura developed a portal vein thrombosis after open splenectomy. The portal vein thrombosis was diagnosed by color Doppler sonography. A percutaneous transhepatic thromboaspiration of the acute thrombus was done on the third postoperative day. Anticoagulation was continued for 6 months. The presented patient is the youngest patient to undergo percutaneous thromboaspiration of an acute thrombus via the transhepatic route. Percutaneous thromboaspiration via the transhepatic route is an effective means of treating a portal vein thrombosis.

Angiokeratoma of Clitoris: A Rare Lesion in an Adolescent Girl

Angiokeratoma is a benign vascular lesion. It is the result of dilation of ectatic subdermal vessels and congested capillaries. Weakness of the vessel walls, either from acquired or congenital reasons, can cause formation of the lesion. Angiokeratoma is more common in males, in whom it forms on the scrotal wall. An equivalent form can occur in females, generally on the vulva. The clitoris is an extremely rare location. We present the case of a 14-year-old girl with a clitoral angiokeratoma. To our knowledge, this is the first presented case of clitoral angiokeratoma in a child in English published reports.

Do hygienic factors affect labial fusion recurrence? A search for possible related etiologic factors.

BACKGROUND/PURPOSE The purpose of our study was to define the factors related to recurrence of labial fusion. METHODS The data of 110 patients diagnosed with labial fusion were gathered. The data collected and queried included age and body weight of the patient, season of presentation/occurrence, frequency of diaper change, frequency of diaper dermatitis, products used for hygiene, duration of breast milk feeding, infections, presence of allergy, thickness of the adhesion, mothers use of oral contraceptive drugs before pregnancy, mothers use of alcohol/drugs/cigarettes or presence of disease during pregnancy, the number of recurrences, treatment method, presence of labial fusion among maternal sisters or any relatives, and blood estrogen levels. RESULTS Eighty-one patients (73.6%) with labial fusion were admitted for the first time, whereas 29 patients (26.4%) had been treated previously at least once. The adhesion was denser in patients with recurrence. There was no correlation between recurrence of labial fusion and age-based body weight percentile, frequency of diaper change, frequency of diaper dermatitis, hygiene products used, presence of infection, presence of allergy, mothers use of oral contraceptive drugs before pregnancy, or presence of any pathology in other family members. CONCLUSIONS The products used for hygiene, frequency of diaper dermatitis, duration of breast milk feeding, presence of infection, and prenatal factors showed no correlation with the recurrence of labial fusion.

An unusual cause of acute abdominal pain in a child: An inverted meckel diverticulum: Report of a case

Inverted Meckel diverticulum has been reported as a lead point for intussusception in children. However all cases of isolated inversion of a Meckel diverticulum have involved adults in whom the diagnosis was clinically unexpected. We describe the sonographic appearance of isolated inversion of Meckel diverticulum in a 3‐year‐old boy with acute abdominal symptoms.

Epidermoid cyst of the spleen with elevated levels of CA125 and carcino-embryonic antigen.

Epidermoid splenic cyst is characterised by a single layer of epithelium. Although specific findings can be depicted with ultrasonography (USG) and CT, elevated levels of carcino-embryonic antigen (CEA), CA19–9 or CA125 in serum and cyst fluids have recently been used in the diagnosis [1,2]. A 12-year-old female patient was admitted with swelling and pain on the left side of abdomen. Abdominal USG and CT revealed that the spleen was enlarged and contained two cysts. The larger cyst was very close to the hilum (Fig. 1). Serum analysis revealed high levels of CA125 (35 ng/ml) and CEA (150 U/ml). She underwent total splenectomy because the tributaries of splenic artery and vein overlaying the hilar cyst prevented an alternative operative procedure. Examination of cyst fluid also revealed high levels of CA125 (70 ng/ ml) and CEA (1500 U/ml). Both cysts were thin-walled and lined with a single layer of squamous epithelium in histologic examination. CA125 and CEA returned to normal levels within 3 months. Epidermoid cysts are lined by stratified squamous epithelium. It is thought that they develope after invagination of the capsular surface mesothelium with subsequent squamous metaplasia [3]. Mostly they give signs and symptoms in late childhood and may regress completely. Cysts larger than 5 cm require resection because of their progressive growth and in order to prevent the potential severe complications such as rupture and haemorrhage [3]. Higaki et al. [1] reported that serum CEA, CA19–9 and CA125 levels had been elevated in patients with epidermoid cyst in whom epithelium was positive for anti-CEA and anti-CA19–9 antibodies. This finding shows that these markers are products of the squamous epithelium and leak into the bloodstream, presumably as a result of trauma or increasing pressure within the cyst.

Inguinal hernias containing the uterus: a case series of 7 female children.

BACKGROUND Hernia uteri inguinale (HUI), or uterus-containing inguinal hernia, is an extremely rare condition in which the uterus and uterine adnexa are found in the inguinal hernial sac in female infants. The uterus may be free within the sac adherent to the wall by adhesions or a true sliding component. However, in true sliding-type HUI, one of the walls of the hernia sac is formed by the uterus itself. PATIENTS AND METHODS The medical records for all female children with inguinal hernia who were operated from 1999 through 2010 were reviewed retrospectively (n = 3100). RESULTS Among these patients, we identified seven cases of HUI in infants with a normal female karyotype. The incidence of HUI was 0.23%. Patients were discharged on the postoperative 1st day with no complications. CONCLUSIONS Surgeons should be aware of the possibility of presence of the uterus or another organ in the hernial sac in phenotypic female children, and sliding components should be replaced carefully into the abdomen to prevent any damage.