Ali Çay

Acquired tracheo-esophageal fistulas caused by button battery lodged in the esophagus

Esophageal impacting of button batteries must be distinguished from impacting of other foreign bodies because of their severe complications. We present a 2.5-year-old girl who had an acquired tracheo-esophageal fistula (TEF) caused by a calculator battery lodged in her esophagus. We also review the literature and assess the applicability of multislice CT and its possible advantages in children with acquired TEF.

Oral teratoma: a case report and literature review

Teratomas are true neoplasms composed of tissues from all three germinal layers. They have an unknown origin and eccentric microscopic appearance. Teratomas arising from the oral cavity are rare in the newborn; only 13 cases have been reported in the literature. We describe a male neonate with an oral teratoma originating from the anterior hard palate that was successfully treated with surgery.

Eosinophilic Pancreatitis Mimicking Pancreatic Neoplasia

Eosinophilic pancreatitis (EP) is a rare disease. It typically occurs in the setting of either eosinophilic gastroenteritis or the hypereosinophilic syndrome. Isolated eosinophilic infiltration of the pancreas is less common. EP usually presents as a pancreatic tumour with abdominal pain and/or obstructive jaundice. The diagnosis is often not made until after pancreatic resection under suspicion of a pancreatic tumour. The case of a 14-year-old boy whose initial presentation was suggestive of a pancreatic tumour is reported. Radiological evaluation revealed a pancreatic mass suggestive of a pancreatic tumour obstructing the duodenum and common bile duct. The patient underwent surgery and a gastrojejunal anostomosis, tube cholecystostomy and biopsy were performed with no postoperative complications. The diagnosis of EP was established after surgical biopsy. The biopsy specimen revealed prominent eosinophilic infiltration. Serum immunoglobulin E levels were elevated. The patient was treated with oral prednisolone (40 mg/day). After two months of oral steroid therapy, clinical manifestations rapidly improved and peripheral eosinophilia subsided. Computed tomography scan revealed remission of the pancreatic mass-like lesion.

Rare clinical presentation mode of intestinal malrotation after neonatal period : Malabsorption-like symptoms due to chronic midgut volvulus

Abstract Background : Many different and non‐specific clinic presentation modes of malrotation anomalies (MA) have been reported after neonatal period. The authors describe four children with MA presented with malabsorption‐like clinical features.

A case of ureteral triplication associated with ureteropelvic junction obstruction

Ureteral triplication is one of the rarest malformations of the upper urinary tract. The association of ureteral triplication and obstruction is even rarer. We report a case of ureteral triplication associated with hydronephrosis due to ureteropelvic junction (UPJ) obstruction at the middle pole ureter. To our knowledge, such a malformation has not been described previously.

Acute Alterations in Biochemistry, Morphology and Contractility of Rat Isolated Urinary Bladder via Increased Intra-Abdominal Pressure

Objective: To determine the acute effects of increased intra-abdominal pressure (IAP) on the biochemistry, morphology and contractility of the rat isolated urinary bladder using an experimental laparoscopy model. Methods: We divided 24 adult female Sprague–Dawley rats into three groups. The control group (group I) was not subjected to increased IAP. In groups II and III, IAPs of 10 and 20 mm Hg, respectively, were established by carbon dioxide pneumoperitoneum for 60 min. Thirty minutes after desufflation, the rat urinary bladder dome was removed for in vitro pharmacological investigation, measurement of malondialdehyde (MDA) levels and histopathological examination. Statistical comparisons between groups were performed. Results: Tissue MDA levels in groups II and III were significantly higher than in the control group. In group II, only the lamina propria was significantly damaged. However, the epithelium, lamina propria, and serosa were significantly damaged in group III. Acetylcholine potentiated contractions in both IAP groups. Increased responses to electrical field stimulation in the IAP groups were significant only in group II. Conclusions: In this experimental model, 10 and 20 mm Hg of IAP induced by pneumoperitoneum increased MDA levels and caused important changes in the morphology and contractile response of the urinary bladder.

Sclerosing haemangioma arising within extralobar pulmonary sequestration

Extralobar pulmonary sequestration is a rare anomaly of abnormal pulmonary tissue without any communication to the bronchial tree. Sclerosing haemangioma is a rare lung tumour, generally seen in middle-aged women. The combination of these two rare pathologies has not been previously reported. We describe the CT and CT angiographic findings of sclerosing haemangioma arising within an extralobar pulmonary sequestration in a 2-year-old girl.

Diagnostic difficulties in children with coexisting pelvi‐ureteric and vesico‐ureteric junction obstruction

To assess the diagnosis of children with coexisting pelvi‐ureteric junction (PUJ) and vesico‐ureteric junction (VUJ) obstruction, and the management of such patients, as having these two anomalies in the same ureter creates serious diagnostic difficulties, but any delay in diagnosis might cause a deterioration of renal function and affect the success of surgery to correct either anomaly.

Multi‐Slice Computed Tomography Urography After Diuretic Injection in Children with Urinary Tract Dilatation

Purpose: To evaluate the potential use of multi‐slice computed tomography urography (MSCTU) after diuretic injection in children with urinary tract dilatation. Material and Methods: MSCTU was performed in 19 patients (11 boys, 8 girls, mean age 5.4 years) with suspicion of urinary tract obstruction and dilatation. Furosemide, 1 mg/kg, was injected 3 min before contrast material administration and followed by a bolus of 30 ml of physiologic saline solution immediately after application of contrast material. Excretory‐phase images were obtained through the abdomen and pelvis beginning 10 min after initiation of the injection of contrast material. Maximum intensity projection (MIP) and volume rendering (VR) images were post‐processed to obtain urographic views. Results: MSCTU revealed pathology in 16 of 19 patients, while 3 patients had normal findings. Ureteropelvic obstruction was found in 4 patients, obstructive megaureter in 8. Both ureteropelvic obstruction and obstructive megaureter were disclosed in 1 patient, partial ureteral duplication in 1 patient, and both complete ureteral duplication and ureterocele in 2 patients. In all patients, MIP and VR images could satisfactorily show the pathologies of the urinary tract. The estimated effective average doses of MSCTU were higher than IVU. Conclusion: Preliminary results of furosemide‐enhanced MSCTU demonstrated consistently dilated urinary tracts, obstruction levels, and underlying pathologies better than US and IVU.

Intestinal mesenteric involvement with plexiform neurofibroma in neurofibromatosis type 1

Correspondence: Mustafa İmamo ğ lu, Department of Pediatric Surgery, Karadeniz Technical University, Faculty of Medicine, 61080 Trabzon, Turkey. Email: mimamoglu61@yahoo.com Received 27 February 2004; revised 22 December 2004; accepted 28 February 2005. Neurofi bromatosis type 1 (NF1), von Recklinghausen’s disease, is a common type of neurogenetic disease in which affected individuals develop benign and malignant tumors with an increased frequency. In this disease, gastrointestinal involvement occurs in 10 – 25% of patients and includes solitary or multiple neurofi bromas, leiomyomas, and rarely plexiform neurofi broma (PNF). The last is almost always congenital lesions that can gradually grow to a large size, and are the most common cause of morbidity in the NF1 population. In gastrointestinal involvement, jejunum and stomach are the most frequently involved sites of PNF, followed by the ileum and duodenum. The colon and mesentery are rarely affected. Since the mesenteric involvement is mostly occult, this may lead to delayed diagnosis and increased morbidity. 1 – 3 We report a panmesenteric PNF with multiple segmental involvement of the intestinal wall in a girl with NF1 that presented with a 3 year history of vague abdominal pain and failure to thrive. We also reviewed the clinical presentations, diagnoses and treatment approaches of similar cases in the pediatric literature.