Hamdi Louati

A Difficult Recurrent Hypertrophic Pyloric Stenosis

A 20-day-old girl presented with increasing projectile vomiting over a period of one week and progressive weight loss. The diagnosis of hypertrophic pyloric stenosis (HPS) was made by sonography (Length of pyloric channel: 22 mm; muscle thickness: 5 mm). Open standard pyloromyotomy was performed. The postoperative course uneventful. On the 50th postoperative day, the girl was readmitted with projectile vomiting for a week. Contrast radiography proved a pyloric stenosis occlusive. Ultrasound confirmed recurrent pyloric stenosis (length of pyloric channel: 22 mm; thickness of the muscle: 4.8mm). At repeat surgery, the previous incision had been healed (Fig.1).

Complications of Port-A-Caths in Children with Hematologic/Oncologic Diseases

Dear Editor: We have read with keen interest the article titled, “Usefulness of percutaneous puncture in insertion of totally implantable venous access devices in pediatric patients” by Choi et al. [1] published in the September 2017 issue of Vascular Specialist International. We congratulate the authors for extensive research and we would like to share our experience with Port-A-Caths (PACs) in children with hematologic/oncologic diseases. PACs are commonly used in children who require longterm central venous access for medications or nutrition [1]. Although these devices are extremely necessary, they pose a serious risk of complications including infection, thrombosis, and mechanical occlusions [2-4]. Over 8 years period (January 2008-December 2015), we managed 55 children with malignant hematologic disorders who need a PAC placement for chemotherapeutic treatment. Thirtyfour patients (61.8%) were male and 21 patients (38.2%) were female. Mean age was 5 years (range, 1-16 years). Fifty patients (90.9%) had acute lymphocytic leukemia, four patients (7.3%) had lymphoblastic lymphoma, and one patient (1.8%) had acute myeloid leukemia. The most common site of insertion was the right internal jugular vein (94.5%) followed by the left internal jugular vein (3.6%) and the right subclavian vein (1.8%) (Fig. 1). All ports were placed under physician-controlled fluoroscopic guidance. Sixteen patients (29.1%) had postoperative complications including infection (n=10), malfunction (n=3), occlusion (n=2), and fracture (n=1). The management of these complications required the removal of the PAC in 8 cases (50.0%) (Table 1). The average duration over which the PAC remained in place was 18 months (range, 4-48 months). The total complication rate in our series was 29.1%, which is comparable to other reported rates of up to 31.0%

Primary Peritonitis in Immunocompetent Children

Primary peritonitis is defined as peritoneal infection without an evident intra peritoneal septic focus. In the absence of these conditions, primary peritonitis is exceptional, and only few cases were reported in the literature. Here we report two cases of primary peritonitis in immunocompetent children. Although rarely encountered, primary peritonitis should be included in the differential diagnosis of acute abdominal pain in children.

Pediatric Department Experience in the Treatment of Pulmonary Hydatid Cysts in Children

Pulmonary hydatid cysts in children are a significant public health problem in Tunisia. While hepatic cysts are the most common in adult pathology, the lung is the number one location for hydatid cysts in children which causes a serious problem due to lack of standardized therapeutic strategy. We reported our experience in diagnosis and management of pulmonary hydatid cysts in a pediatric department in southern Tunisia.

Postoperative Intussusception in Children after Nissen Fundoplication: A Case Report

Postoperative intussusception (POI) is a rare complication after various kinds of operations, the incidence of POI is 0.01–0.25 % of children following laparotomy (1); and it accounts for 5–10 % of postoperative intestinal obstructions (2). We reported and analyzed a case of a patient who developed postoperative intussusception following laparotomy for Nissen fundoplication. A 6-month-old female who has been hospitalized for severe bronchiolitis and her chest X-ray showed a digestive clarity in the right lung field. Thoracic CT and contrast radiography showed a large right hiatal hernia with gastric contents (Figure.1). She was operated by median laparotomy and Nissen fundoplication was made. At the 5th postoperative day, the patient developed bilious vomiting. The standard X-ray showed pelvic hypoaeration and the abdominal ultrasound showed an intussusception (Figure.2). So the patient was operated by the same incision and in exploration we founded an ileoileocolic intussusception which was manually reduced with in appearance a good intestinal vitality. The postoperative course was simple.

Management of Perinatal Testicular Torsion: A Single Centre Experience

Perinatal testicular torsion (PTT) is a rare entity. The management of PTT is controversial, due to the low viability of the testis and the possibility of bilateral torsion. This is a review of our experience with six cases of PTT, highlighting diagnostic and therapeutic difficulties of this condition.

Congenital Pulmonary Malformations in Children: Diagnosis and Management in a Pediatric Department in a Low Source Country

Congenital pulmonary malformations (CPM) comprise a group of anatomical abnormalities of the respiratory tree including congenital cystic malformations, bronchopulmonary sequestrations, bronchogenic cyst, bronchial atresia and congenital lobar emphysema.Socioeconomic, demographic, and hospital factors were determinants of survival of CPM. Antenatal diagnosis should be developed in order to improve management and prognosis of CPM in country with low resource.

A Comparative Analysis between Right and Left Congenital Diaphragmatic Hernias

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly of the diaphragm with an incidence of 1:2000-5000 of live births. This study retrospectively evaluated patients who had been operated on for CDH at our department of Pediatric Surgery between January 2013 and December 2016. The Demographic Data and outcomes of right CDH cases (Group 1) were compared with left CDH cases (Group 2).

Influence of Appendectomy Timing in the Pathological Outcome and the Morbidity of Acute Appendicitis in Children: A Retrospective Study

Introduction: Surgery is indicated for acute appendicitis but there is controversy regarding precise timing for appendectomy. Objective: Our aim was to evaluate the impact of time delay from emergency department presentation to surgery in developing complicated appendicitis in children and associated morbidity. Methods: 540 charts of children, who underwent appendectomy, between January 2013 and December 2016 were retrospectively reviewed. Groups were divided by time of intervention. Group 1: less than 24h (n=209, 38.7%), group 2: 24h to 48h (n=293, 54.5%), and group 3: greater than 48h (n=38, 6.8%). We considered complicated appendicitis gangrenous, abscess or perforated appendix per operatively and on histopathologic examination. Statically analysis and was performed to search the predictors of complicated appendicitis and evaluate postoperative complications. Results: Among 540 children included in the study, 164 (30.4%) had complicated acute appendicitis. There was no correlation between delay to surgery and the risk of developing a complicated form of the disease for group 1 and Group 2. Beyond the 48th h (group 3), the rate of developing complicated appendicitis and post-operative complications increased significantly. Hospital stay was not affected by delayed surgery. Conclusion: A short in-hospital delay before surgery less than 48 h, for acute appendicitis in child, is not associated with an increased rate of complex appendicitis neither associated morbidity.

Pediatric Urolithiasis in Children: Diagnosis and Management

Introduction: Pediatric urolithiasis remains endemic in low-resource countries affecting children <1 to 15 years. This study aimed to investigate the diagnosis and the treatment options of pediatric urolithiasis and compare that with the literature. Materials and methods: This study retrospectively evaluated patients who had been diagnosed with urolithiasis in the in department of pediatric emergency and reanimation and the department of pediatric surgery in Hedi Chaker hospital in Sfax between 2001 and 2016. Results: Over 16 years period, we diagnosed and managed 78 children with urolithiasis. 44 were male (56%) and 34 were female (44%). The median age was 54 months (4 to 144 months). Family history of urolithiasis was found in 23 patients (29.5%). The diagnosis of urolithiasis was made after Urinary tract infection in 23 (29.5%), abdominal pain in 16 (20.5%), Hematuria in 9 (11.5%), nephritic colic in 8 (10.5%), dysuria in 11(14%) and after antenatal diagnosis of malformative uropathies in 11 (14%) patients. The treatment were surgery in 32, medical in 30, LEC and endoscopy in 8 patients. The mean of follow up was 36 months and we had 11 recurrent urolithiasis. Conclusion: Pediatric urolithiasis remains a devastating health problem. Their management requires more exploration especially in the etiology research for a best management.