Emrah Şenel

Anal canal duplication in children: a new technique

Anal canal duplication (ACD) is a very rare abnormality. Because of the high rate of malignant changes in anal canal duplications complete removal of the ACD is recommended. In the current study, simple mucosectomy for management of cases of ACD has been discussed. There was no complication and patients had good cosmetic results with a normal sphincter control. This technique is simple, safe, takes less time and achieves good anatomic appearance and functional results.

Clinical Experience in Hypospadias: Results of Tubularized Incised Plate in 496 Patients

OBJECTIVES To review the tubularized incised plate, a recently popularized technique, and provide outcomes. METHODS From January 2000 to December 2006, 496 patients underwent the tubularized incised plate technique for hypospadias at our clinic. The patient age range was 6 months to 14 years. The postoperative follow-up time was 2 years (range 6 months to 3 years). The patients underwent the technique as described by Snodgrass, with some small technical modifications. The patients were hospitalized for 10 days postoperatively, with a urethral stent in place. RESULTS Of the 496 patients, 48 experienced 53 complications. The most frequent complication was meatal stenosis (n = 27, 5%), followed by urethrocutaneous fistula (n = 25, 5%). Dehiscence was noted in 1 patient (0% of 496 patients and 2% of the 48 patients with complications). Initially, the fistula occurrence rate was 11% and 4% for all 496 and the 48 patients with complications, respectively, which had decreased to 3% and 8% in the most recent 3 years. During the study period, some technical modifications have applied, with a resulting decrease in the complication rates. Complications occurred in 48 patients (9%), of whom 25 required surgical repair (5% of 496 patients). CONCLUSIONS The tubularized incised plate technique is a surgical method that can be applied to most hypospadias anomalies. Increasing clinical experience and minor additions to the technique have enhanced our success with this method.

Lumbo-costovertebral syndrome with diastematomyelia

© 2008 Japan Pediatric Society Congenital lumbar hernia is the rarest of abdominal wall hernias in children. Its association with the lumbo-costovertebral syndrome is even more unusual. 1 Association of vertebral anomalies, costal defects and congenital lumbar herniation has been described by Touloukain. 2 We report a case of congenital superior lumbar hernia with lumbo-costovertebral syndrome associated with diastematomyelia and discuss this syndrome and surgical repair diffi culties in congenital lumbar hernia.

A Rare Cause of Ileus in a Child Case: Cytomegalovirus Colitis

Sitomegalovirus (CMV) birincil veya edinsel immun yetmezligi olan kisilerde farkli organ sistemlerinin tutulumu ile ciddi klinik tablolara yol acabilir. CMV koliti karin agrisi, diare, hematokezya, melena veya ates gibi klinik semptomlar ile kendini gosterebilir. CMV kolitine bagli striktur nadir bir komplikasyondur. Bu olgu sunumunda; ileus nedeni ile konsulte edilen, immun yetmezlikli bir hastadaki CMV kolitine bagli ileum ve kolon strikturu paylasilmistir. Bare Lenfosit Sendromu ile birlikte kombine immun yetmezlik tanisi nedeni ile takip edilen 2 yasindaki erkek hasta, bir aydir suren ishal ve pnomoni nedeniyle pediatri yogun bakim yatirildi. Tetkiklerinde CMV PCR pozitif olmasi uzerine tedaviye gansiklovir eklendi. Gaitada gizli kan olmasi uzerine pediatrik gastroenteroloji tarafindan kolonoskopi yapildi. Alinan biyopsi sonucu CMV koliti olarak geldi. Takipte ileus gelisen hastanin kolon grafisinde cikan kolon segmentinin dar oldugu ve kontrast maddenin terminal ileuma gecmedigi goruldu. Laparatomi yapilan olguda terminal ileum ve cikan kolonun strikture oldugu goruldu. Strikture bagirsak anslari rezeke edilerek ileokolik anastomoz yapildi. Histomorfolojik bulgular CMV koliti olarak degerlendirildi. Hasta taburcu edilerek takibi icin pediatriye yonlendirildi. CMV, immun yetmezligi olan hastalarda gastrointestinal sistemde enfeksiyona yol acabilen firsatci bir virustur. Immun yetmezlikli cocuklarda ileus tablosuna yol acan nedenler arasinda CMV koliti ve striktur ayirici tanida dusunulmelidir.Cytomegalovirus (CMV) can lead serious clinical presentations with various organ system involvements in individuals with primary or acquired immune deficiency. CMV colitis may present with clinic symptoms such as abdominal pain, diarrhea, hematochezia, melena and fever. Stricture due to CMV colitis is a very rare complication. We discuss ileum and colon stricture due to CMV colitis in an immunodeficient patient in this paper. The two-year-old male patient was being followed-up with combined immunodeficiency and the bare lymphocyte syndrome. He was hospitalized at the pediatric intensive care unit for diarrhea and pneumonia for the last month. CMV PCR was positive in the tests and ganciclovir was therefore added to the treatment. Colonoscopy was performed for fecal occult blood by the pediatric gastroenterology unit. The biopsy result was reported as CMV colitis. The patient developed ileus during follow-up, and the colon graph with contrast revealed a narrow colon segment with the contrast agent unable to pass to the terminal ileum. Laparotomy was performed and strictures observed in the terminal ileum and the ascending colon. An ileocolic anastomosis was performed by resecting the bowel loops affected by stricture. The histomorphologic findings were reported as CMV colitis. The patient was discharged and referred for follow-up to the pediatric service. Cytomegalovirus is an opportunistic virus that can lead to the infection of the gastrointestinal system in individuals with immunodeficiency. CMV colitis and stricture should be considered in the differential diagnosis in immunodeficient children with ileus symptoms.

Lung Hydatid Cysts in Children: Imaging Findings of Complicated and Non-Complicated Lesions

Amac: Cocuklarda akciger kist hidatigi eriskinlerden daha sik gorulur. Akciger kist hidatigi bronsiyal ruptur ve/veya sekonder enfeksiyon ile komplike olabilir. Komplike lezyonlar ozgun olmayan goruntuleme bulgulari gosterebilir. Arastirmada komplike ve komplike olmayan akciger kist hidatiklerinin tanisal radyolojik bulgularinin karsilastirilmasi amaclanmistir. Gerec ve Yontemler: Calismaya akciger kist hidatigi olan 23 cocuk hastada toplam 28 akciger kist hidatik lezyonu dahil edildi. Hastalarin demografik bilgileri, basvuru semptomlari, akciger grafileri, bilgisayarli tomografi (BT), manyetik rezonans goruntuleme ve abdominal ultrasonografi bulgulari retrospektif olarak degerlendirildi. Radyolojik goruntulemelerde lezyon sayisi, lobar yerlesim, bronsiyal ruptur, enfeksiyon varligi, en genis boyut, duvar kalinligi, BT incelemesi olan sivi icerikli lezyonlarin sivi dansitesi degerlendirildi. Bulgular: Calismaya dahil olan 23 cocugun (kiz: 7, erkek: 16) yas ortalamasi 10.1 (yas araligi, 4-17)’di. Lezyonlarin 17’si sag, 11’i sol akcigerde izlendi. Soliter lezyon sayisi 19’du (%82.6). Lezyonlar iki hastada cift tarafli (%9.5) goruldu. Lezyonlar en sik sag akciger alt lobda yerlesim gostermekteydi (%42.9). Hastalarin 19’u (%82.6) tani aninda semptomatikti. Yirmisekiz lezyonun 19’u (%67.9) bronsiyal ruptur ve/veya sekonder enfeksiyon ile komplike olmustu. Akciger grafilerinde bronsiyal ruptur sonucu 12 lezyonda (%42.9); nilufer (n=5), meniskus (n=5) ve cift kubbe (n=2) isaretleri saptandi. BT incelemesi olan 16 hastada toplam 21 lezyon degerlendirildi. Bronsiyal ruptur ve/veya enfeksiyon bulgusu olan 16 lezyonda (%76.2) hava kabarcigi (n=6), nilufer (n=4), meniskus (n=4), cift kubbe (n=3) ve sarmal (n=1) isaretleri saptandi. Kist hidatik icin tanisal bulgunun gosterildigi lezyon sayisi BT incelemede istatistiksel anlamli olarak daha fazlaydi (p=0.031). Sekonder enfeksiyon ile komplike olan kist hidatik lezyonlarinin duvar kalinligi komplike olmayanlara gore daha kalin olculdu (p=0.028). Sonuc: Komplike akciger kist hidatigi lezyonlarinda direkt grafiler ile tanisal zorluk yasanabilir. BT goruntuleme lezyonun kistik yapisini ortaya koymada, kist hidatige ait ozel isaretlerin ve sakli alanlarda yerlesim gosteren kistlerin gosterilmesinde, komplike lezyonlarin degerlendirmesinde, cerrahi oncesi planlamada direkt grafilere ustundur. Bu nedenle akciger kist hidatiklerinin goruntulemesinde ilk tercih edilen yontem akciger grafileri olmakla birlikte komplike kistlerin BT ile degerlendirilmesi tanisal dogrulugu artirir.Objective: Lung hydatid cysts are more common in children than adults. Lung hydatid cysts may be complicated with bronchial rupture and/or secondary infection. When complicated, they can demonstrate non-specific imaging findings. We aim to present the diagnostic radiological signs of complicated and non-complicated hydatid cysts. Material and Methods: Twenty three children who had 28 lung hydatid cysts in total were enrolled in the study. Demographic information, referral symptoms, chest X-ray, computerized tomography (CT), magnetic resonance imaging and abdominal ultrasonography findings of the children were retrospectively evaluated. The number of lesions, lobar location, bronchial rupture or infection signs, maximum diameter, wall thickness, and fluid density imaged with CT were analyzed. Results: The mean age of the 23 children (girls: 7, boys: 16) was 10.1 (age range, 4-17). Seventeen lesions were observed in the right lung and 11 in left lung. The number of solitary lesions was 19 (82.6%). The lesions were bilateral