Arzu Pampal

A rare cause of acute abdominal pain in adolescence: Hydrosalpinx leading to isolated torsion of fallopian tube

Torsion of the fallopian tube accompanying hydrosalpinx is a rare occurrence in the pediatric population. This report describes a 13 year old sexually inactive girl with isolated tubal torsion due to hydrosalpinx. The girl had lower left abdominal pain for two days. The physical examination revealed left lower quadrant tenderness with a firm round anterior mass on rectal examination. Abdominal ultrasound showed left tubal enlargement with free pelvic peritoneal fluid. Magnetic Resonance Imaging (MRI) showed engorgement and dilatation of the left fallopian tube without contrast enhancement suspicious of tubal torsion. At operation, torsion of the left tube on its longitudinal axis was observed, and a salpingectomy was performed. Although rare, the diagnosis of torsion of the fallopian tube should be considered when evaluating acute abdominal pain. The earlier tubal torsion is diagnosed, the greater the likelihood of salvaging the fallopian tube.

Successful laparoscopic removal of mesenteric and omental cysts in toddlers: 3 cases with a literature review

Mesenteric and omental cysts are rare benign intraabdominal anomalies with uncertain etiologies. Surgical removal is the preferred treatment owing to complications related to cyst enlargement. A 1-year-old boy with an intrauterine diagnosis of a cystic mass adjacent to his stomach and liver, a 3-year-old girl, and a 3-year-old boy with an incidental diagnosis of intraabdominal cysts were scheduled for laparoscopic surgery. The mass of the 1-year-old boy was a multiloculated cyst originating from the lesser omentum, the incidental mass in the girl was a multiseptated cyst located in the jejunoileal mesentery, and the incidental mass of the 3-year-old boy was a uniloculated cyst originating from the ileal mesentery. All the cysts were excised either laparoscopically or in a laparoscopy-assisted manner. The laparoscopic or laparoscopy-assisted excision of the mesenteric and omental cysts seems to be a feasible, safe, and cost-effective surgical procedure with shorter operative times, even in toddlers.

Effects of different pulmonary surfactants in the prevention of postoperative intraabdominal adhesion formation

BACKGROUND After abdominal surgery, the formation of postoperative adhesion is a serious problem. The aim of the study is to evaluate the efficacy of 2 different pulmonary surfactants, poractant and beractant, on adhesion prevention in an experimental model. MATERIALS AND METHODS An experimental intraabdominal adhesion model was created in 18 adult female rats by cecal abrasion. The rats were randomly assigned to 3 groups. Group I received no further treatment, whereas groups II and III received intraperitoneal poractant and beractant, respectively, before closing the incision. On the 15th postoperative day, all rats underwent relaparotomy, intraabdominal adhesions were scored macroscopically according to Canbaz scoring system, and the cecum in each animal was evaluated microscopically. RESULTS The median adhesion scores of group II and III rats were significantly lower when compared with group I (P = .02). Group III had a lower median adhesion score than did group II, but this did not reach significance (P > .05). CONCLUSION These observations suggest that intraperitoneal instillation of both pulmonary surfactants is associated with lower adhesion scores, higher adhesion-free cases, and improved histologic findings.

Bloody nipple discharge in 2 infants with interesting cytologic findings of extramedullary hematopoiesis and hemophagocytosis.

Bloody nipple discharge in the infantile period is an uncommon finding. Despite its stressful course to the parents, it is generally a benign condition with a spontaneous resolution. The approach to bloody nipple discharge in the infantile period is well documented in the literature even though the number of these cases is limited. We report 2 infants with unilateral bloody nipple discharge. Their physical examination, laboratory, and ultrasound findings were normal but the cytologic examinations of the discharge revealed signs of extramedullary hematopoiesis and hemophagocytosis. These extraordinary findings made us brainstorm on the probable ongoing processes in the infantile breast tissue.

Littre hernia in childhood: A case report with a brief review of the literature

A 3-year-old boy with a right-sided and painful inguinal swelling for the last 2 h was admitted to the emergency department. As there were no apparent peritoneal irritation findings, right-sided incarcerated inguinal hernia was reduced and the patient was scheduled for an elective herniorrhaphy. Perioperatively even though the sac seemed empty, it was opened in order to inspect its content. The adherence of Meckels diverticulum (MD) to the base of hernial sac was realized and Littre hernia (LH) was diagnosed. The hernia was highly ligated after the wedge resection of the diverticulum and anastomosis. The patient was fed on the second postoperative day and discharged on the third postoperative day. Despite numerous presentations of LH in the adult age group in the literature, there are limited data about the disease in the childhood period. Even though the scarcity of the data, there are some so-called rules for LH in childhood like protruding more common through umbilical hernias, containing heterotopic tissues more frequent than adult age and incarcerating/strangulating more often. The aim of this study is to review the reported LH cases, present a new case and discuss the features of LH in childhood period.

Rectal duplications accompanying rectovestibular fistula: Report of two cases

Rectal duplication (RD) cysts are rare congenital anomalies that can be diagnosed with the presence of another opening in the perineum. They seldom accompany anorectal malformations (ARM). Two cases of RD accompanying ARM at opposite ends of the phenotypic spectrum, are described. A 3‐month‐old baby and a 2‐year‐old girl with ARM were scheduled for posterior sagittal anorectoplasty. The infant had an orifice at the anal dimple and the other had an orifice at the vestibulum posterior to the rectovestibular fistula. The infant presented with no other anomalies whereas the older one presented with an unusual coexistence of caudal duplication and caudal regression syndromes. Perioperatively both orifices were found to be related to retrorectal cysts, and were excised. Clinicians should always be alert when dealing with complex malformations. Because these malformations have variable anatomical and clinical presentations, they can represent a diagnostic and therapeutic challenge.

Commonly used intravenous anesthetics decrease bladder contractility: An in vitro study of the effects of propofol, ketamine, and midazolam on the rat bladder

Aim: This study was designed to test the hypothesis that propofol, ketamine, and midazolam could alter the contractile activity of detrusor smooth muscle. Materials and Methods: Four detrusor muscle strips isolated from each rat bladder (n = 12) were placed in 4 tissue baths containing Krebs-Henseleit solution. The carbachol (10 −8to 10−4mol/L)-induced contractile responses as well as 5, 10, 20, 30, 40, 50 Hz electrical field stimulation (EFS)-evoked contractile responses of the detrusor muscles were recorded using isometric contraction measurements. After obtaining basal responses, the in vitro effects of propofol, ketamine, midazolam (10−5 to 10−3 mol/L), and saline on the contractile responses of the detrusor muscle strips were recorded and evaluated. Results: All the 3 drugs reduced the carbachol-induced and/or EFS-evoked contractile responses of rat detrusor smooth muscles in different degrees. Midazolam (10−4 to 10−3 mol/L) caused a significant decrease in the contractile responses elicited by either EFS or carbachol (P=0.000−0.013). Propofol (10−3mol/L) caused a decrease only in EFS-evoked contractile responses (P=0.001−0.004) and ketamine (10−3mol/L) caused a decrease only in carbachol-induced contractile responses (P=0.001−0.034). Conclusion: We evaluated the effects of the 3 different intravenous anesthetics on detrusor contractile responses in vitro and found that there are possible interactions between anesthetic agents and detrusor contractile activity. The depressant effects of midazolam on the contractile activity were found to be more significant than ketamine and propofol. Despite the necessity of further studies, it could be a piece of wise advice to clinicians to keep the probable alterations due to intravenous anesthetics in mind, while evaluating the results of urodynamic studies in children under sedation.