Dalia Gobbi

Sparing-lung surgery for the treatment of congenital lung malformations☆

PURPOSE Congenital lung malformations (CLM) are traditionally treated by pulmonary lobectomy. The foremost indication for surgery is that these lesions predispose to respiratory tract infections and to malignancy. Owing to the improvement of prenatal diagnosis, most patients are operated in a timely manner and prophylactically. In this context, lung-sparing surgery (LS) has gained interest as a lung preservation strategy, especially for asymptomatic patients. In the present study, we evaluated both thoracoscopic and open lung-preserving resections as an alternative to lobectomy for CLM resection. METHODS We retrospectively reviewed all patients who underwent lung-sparing resection (segmentectomy and atypical resection) for CLM from 2001 to 2010. Data were collected regarding preoperative diagnostic workup, type of intervention, and follow up. RESULTS Fifty-four patients received LS for CLM during the study period. Twenty-six were approached thoracoscopically, with 18 cases requiring open conversion for a complete resection. There were six postoperative complications: three asymptomatic pneumothoraces that resolved without intervention, one tension pneumothorax that required replacement of a drainage catheter, and three instances of intra-operative bleeding requiring blood transfusion. Mean duration of follow-up was 65.2 months. Two patients experienced pneumonia during the follow-up period. A third patient had a cystic lung lesion on postoperative computed tomography (CT) which required a second-look surgery. CONCLUSIONS LS for CLM is a safe and effective means of lung parenchymal preservation in pediatric patients. Complication rates are comparable to that of traditional lobectomy. In our experience, this type of lung surgery does not carry a higher risk of residual disease and recurrence if accurately planned in selected patients, i.e., those with small asymptomatic lesions. The complication rate is acceptable and apparently not affected by preoperative symptoms. The thoracoscopic approach is recommended, although open conversion should be advocated to avoid too long operative times.

Bilateral hydrosalpinx with asynchronous tubal torsion: an exceptional finding in a premenarcheal girl

Bilateral hydrosalpinx with asynchronous tubal torsion is an extraordinary event in young girls. This report describes the problems associated with misdiagnosis, therapeutic approach, and the risk of suboptimal treatment of this rare clinical entity in a 13-year-old girl.

Early prenatal diagnosis of cloacal exstrophy with fetal magnetic resonance imaging

Prenatal diagnosis of cloacal exstrophy can be challenging during pregnancy and, subsequently, the counseling very difficult. Available ultrasonographic criteria may be inadequate, especially in early gestational ages. A case of early prenatal detection of cloacal exstrophy with fetal magnetic resonance imaging is reported herein for the first time.

Neonatal Bilateral Spigelian Hernia Associated with Undescended Testes and Scalp Aplasia Cutis

Fascetti-Leon F et al. Neonatal Bilateral Spigelian Hernia Associated ... Eur J Pediatr Surg 2010; 20: 123 – 125 Introduction & Spigelian hernia (SH) is a very rare entity in children and infants. A recent report found only 30 pediatric patients described in the English literature [3] . In males (the M:F ratio is 2:1), the association rate with cryptorchidism is 80 % . The site of the defect in the lateral abdominal wall is well defi ned: the intersection between the semilunar and the lateral edge of the rectus abdominis muscle is always the weakness point of the abdominal wall in these patients. A cause-and-eff ect relation between cryptorchidism and the abdominal defect has been suggested; however the pathogenic pathway is still far from clear. To contribute to the knowledge of this entity and its possible malformative associations we present a patient from our Department in whom bilateral Spigelian hernias were found at birth. In addition to bilateral cryptorchidism, the newborn had aplasia cutis congenita (ACC) of the scalp: this malformation is a rare entity, localized in the scalp in around 75 % of cases [4] , and previously described in association with other abdominal wall defects [2] .

Metachronous Bilateral Ovarian Teratoma: A Germ-line Familial Disorder and Review of Surgical Management Options

BACKGROUND Germ cell tumors in females are uncommon, and bilateral metachronous ovarian teratoma is even exceptional, with sporadic cases described in the literature. CASE We report on a girl in whom a metachronous ovarian teratoma occurred 6 years after the first. The simultaneous onset of germ-line anomalies in other members of the family supports the existence of genetic or environmental factors conferring susceptibility to germ cell lesions. SUMMARY AND CONCLUSION The case here illustrated reminds the issue of the appropriate follow-up of these patients and of their families.

Pneumatic pyloric dilatation for the treatment of gastric outlet obstruction in a child.

Acquired causes of gastric outlet obstruction (GOO) are rarely encountered in infancy, having an approximate incidence of 1 per 100 000 live births. Reports of short‐term exposure to non‐steroidal anti‐inflammatory drugs having adverse events are few. We present the case of a previously healthy 3‐year‐old boy who developed severe chronic gastric outlet obstruction and antral stenosis after a short‐term ingestion of liquid ibuprofen at a dosage not thought to be associated with unfavorable effects. Even though the optimal management of these cases remains to be determined, we report on a prompt and successful endoscopic treatment for this condition.

Feeding Jejunostomy: Is It a Safe Route in Pediatric Patients? Single Institution Experience

Introduction Impossibility to place a gastrostomy and failed gastroesophageal reflux surgery with unsafe swallow are the main indications to Feeding Jejunostomy (FJ) in children. The aim of this study is to quantify the incidence of complications associated with FJ. Materials and Methods A retrospective review of patients who had surgically inserted FJ between January 2009 and August 2013 at our institution was conducted. Data were obtained from medical records, operative notes, and radiology database, focusing on complications. Results A total of 19 patients, average age 39.6 months (3‐168 months), were treated during the study period. Indications to FJ were gastroesophageal reflux disease (GERD) associated with unsafe swallow in 12, esophageal atresia in 5, and foregut dysmotility in 2. Seventeen FJ were inserted via laparotomy and 2 were laparoscopically assisted. In all cases, a serosal tunnel on the antimesenteric border was fashioned. No intraoperative complications were recorded. Tube dislodgement/blockage occurred on an average of 0.48 times per month in 18 out of 19 patients. The average radiation dose received for tube reinsertion/manipulation was 3.316 mSv/year/patient (0‐10.66). Major postoperative complications occurred in 7 out of 19. After an average follow‐up of 21 months, two have abandoned the use of FJ due to poor tolerance and three have fully weaned off. Two patients died due to unrelated causes. Conclusion FJ, as an alternative means for enteral feeding, may require multiple readmissions and exposure to radiological procedures. The high risk of severe complications should be considered when offering this procedure.