M. Soares-Oliveira

Acute gastric volvulus secondary to a Morgagni hernia

Abstract Gastric volvulus (GV) is a rare surgical emergency in infancy and childhood. The first case of a child with an acute GV secondary to a Morgagni hernia (MH) is reported. The authors briefly discuss the etiology, clinical features, and management of acute GV and review the scattered reports of strangulated MHs in children.

Idiopathic perforation of the gallbladder: A novel differential diagnosis of acute abdomen

A six-year-old boy was referred with suspicion of acute appendicitis. He complained of vomiting and abdominal pain for the last 24 hours. Axillary temperature was 38oC and the abdomen was painful and tender. Complete blood count revealed leukocytosis. Abdominal ultrasonography demonstrated moderate free intraperitoneal fluid, mainly in the right iliac fossa and pelvis. An emergency laparotomy was performed with the presumptive diagnosis of peritonitis secondary to appendicitis but there was a 500 ml bile-stained ascites. Exploration of the abdominal cavity revealed a type I (3) oval perforation (2 cm) of the gallbladder infundibulum (Fig. 1). There were no gallstones or bile duct dilatation. Cholecystectomy was then performed and the child experienced an uneventful recovery. Histological examination did not reveal inflammatory infiltrate or any other significant alteration of the gallbladder wall. The cultures of peritoneal fluid were negative. Postoperative biliary MRI was normal. At 15-month follow-up the child continued to be well. DISCUSSION

Laparoscopic colonic mapping of dysganglionosis.

Abstract Retention of a proximal aganglionic segment or the unrecognized coexistence of other dysganglionoses may jeopardize the definitive surgical treatment of Hirschsprungs disease (HD). To assess the extent of the disease and/or the presence of other dysganglionoses without an additional laparotomy, we developed a laparoscopic-assisted technique to perform colonic full-thickness biopsies. After creation of a pneumoperitoneum, a 5-mm laparoscope is inserted in the supraumbilical area and a working 10/12-mm port is placed in the left iliac fossa. The sigmoid/descending colon is grasped and pulled through the abdominal wall and a full-thickness biopsy done. The same procedure is applied to the transverse and ascending colon. Rectal and colonic biopsy specimens were studied using enzyme histochemical methods. Over the last year, five children aged 7 months to 12 years with dysganglionosis underwent laparoscopic-assisted mapping of the colon. Previous rectal suction biopsies were diagnostic of HD in three patients and suspicious of hypoganglionosis in two. Proximal full-thickness biopsies revealed: normal colon in two cases of HD; coexistent type B intestinal neuronal dysplasia up to the descending colon in the other case of HD; and hypoganglionosis up to the ascending colon in the two patients with suspected hypoganglionosis. The procedures were performed easily, the patients being discharged after 36 to 48 h with no complications. Four children have already undergone pull-through procedures with resection of the affected colon in adhesion-free abdominal cavities and did not develop constipation or enterocolitis. Laparoscopic-assisted mapping of the entire colon is a simple, safe, and effective procedure that may contribute to improving the outcome of intestinal dysganglionosis by better characterization of the disease.

Intestinal duplication presenting as spontaneous hemoperitoneum.

Intestinal duplications are rare anomalies usually ap-pearing during the first year of life (1–4). Although ul-trasonography, computed tomographic (CT) scans, andscintigraphy may be helpful in diagnosis, intestinal du-plications are often unexpectedly found during laparot-omy (1–4). The blood supply and the muscular coat ofthe intestinal duplication are commonly shared by theadjacent bowel, which usually precludes selective surgi-cal excision (2–5).A case of a new clinical presentation of intestinal du-plication is described.

Diaphragm of the gallbladder: a rare cause of acalculous acute cholecystitis.

Acute acalculous cholecystitis is rare, even in pediatrics, although children are more likely to be affected than adults. Among the predisposing factors, congenital anomalies have been uncommonly recorded (1–4). A child with acute cholecystitis secondary to congenital diaphragm of the gallbladder is reported. A brief review of embryology, clinical features, and treatment of this exceptional entity is also presented.

Neonatal splenic necrosis not related to wandering spleen

Splenic necrosis is extremely rare in neonates, the cases recorded so far being secondary to torsion of wandering organs. A newborn with an abdominal mass who underwent exchange transfusions through an umbilical catheter is presented here. Comprehensive investigation led to the suspicion of enteric duplication, but a splenic necrosis with no features of wandering spleen was found at laparotomy. The pathogenesis and preoperative diagnostic work-up of splenic necrosis are emphasised.