Mourad Hamzaoui

A stump appendicitis in a child: a case report

BackgroundStump appendicitis is a delayed complication of appendectomy. It is rare and few cases reported in the paediatric literature. The authors report on another case in a child and focus on the diagnostic peculiarities of this entity.CaseA 9-year-old boy with previous history of open appendectomy was admitted for a right lower quadrant pain with bilious vomiting and fever. Physical examination demonstrated tenderness in the right lower quadrant and guarding over the appendectomy scar. The white blood cell count was 23.500 cells/mm3. Plain abdominal radiograph and ultrasonography revealed fecalith localized in the right iliac fossa. The diagnosis of stump appendicitis was advocated and confirmed at laparotomy. A gangrenous and perforated appendiceal stump was found and completely removed. The post-operative course was uneventful after 18 months follow-up period.ConclusionStump appendicitis is rare and should be considered in any patient with right lower quadrant pain even if there is a history of appendectomy. Complete removal of the appendix is the only mean to prevent the occurrence of this complication.

Une angiocholite aiguë révélant un kyste hydatique du pancréas chez l’enfant

Pancreatic hydatid cysts represent 0.1 to 1% of all hydatidoses. A 12 year-old-boy, with a previous history of abdominal pain, was admitted for acute cholangitis. Laboratory investigations showed cholestasis, cytolysis and eosinophilia. Serum amylase levels were normal. Abdominal ultrasound and CT scan revealed a 100 mm hydatid cyst, located in the head of the pancreas. The biliary and pancreatic ducts were markedly dilated. Exploratory laparotomy confirmed the diagnosis. A pancreatic fistula was discovered. Subtotal excision of the cyst and external drainage of the pancreatic fistula were performed. Laboratory tests were normal post-operatively. The pancreatic fistulae persisted for two months. Hypercaloric and hyperprotidic feeding resulted in occlusion in three weeks. The rest of the postoperative course was uneventful and the size of the biliary and pancreatic ducts was normal. The authors discuss the diagnostic features of pancreatic hydatid cyst and discuss therapeutic modalities.Resume La localisation pancreatique du kyste hydatique represente 0,1 a 1 % de l’ensemble des kystes hydatiques. Nous rapportons un nouveau cas de kyste hydatique pancreatique. Un garcon âge de 12 ans, presentant des douleurs de l’hypochondre droit evoluant depuis 9 mois etait hospitalise pour tableau d’angiocholite. Le bilan biologique montrait une hypereosinophilie, une cholestase et une cytolyse sans reaction pancreatique. L’echographie et la tomodensitometrie abdominales concluaient a la presence d’une tumeur kystique de la tete du pancreas, de 100 mm de diametre, comprimant la voie biliaire extra-hepatique et le canal de Wirsung. L’exploration chirurgicale decouvrait un kyste hydatique de la tete du pancreas avec fistule pancreatique. Une perikystectomie partielle associee a un drainage externe de la fistule etait effectuee. En postoperatoire, le bilan biologique se normalisait. La fistule restait productive pendant 60 jours. Le recours a une nutrition enterale hyperprotidique, hypercalorique a debit continu permettait la compensation des pertes et le tarissement de la fistule en trois semaines. L’evolution ulterieure etait favorable avec regression progressive de la dilatation canalaire. Cette observation permet de rappeller les aspects diagnostiques du kyste hydatique du pancreas et ses modalites therapeutiques.

Epis de graminée intrabronchiques migrateurs, un corps étranger hors du commun

Bronchial foreign body inhalation is a frequent and potentially serious accident in children. It can provoke long-term complications such as bronchiectasis and recurrent pulmonary infections. The foreign body is generally blocked in a bronchus and induces obstructive emphysema with superinfection. We report 2 cases of bronchial inhalation of a migrating cereal-ear, eliminated by parietal fistulization, in 9- and 11-year-old boys.

A rare tumour of the neck in a child

European Annals of Otorhinolaryngology, Head and Neck Diseases - Vol. 133 - N° 1 - p. 65-66

Rectal and sigmoid atresia: transanal approach.

We report 2 patients with rectal and low sigmoid atresia operated on, respectively, at 6 and 3 months of age using the transanal approach, similar to the transanal technique for Hirschsprung disease, after exploratory laparotomy with colostomy at birth. There were no intraoperative or postoperative complications after a follow-up time of 2 years. After closure of the colostomy, both patients had no fecal incontinence. The transanal approach is a safe and effective technique in the management of rectal and sigmoid atresia.

Cas cliniqueHydatidose médiastinale primitive chez l’enfant : à propos de deux casTwo cases of juvenile primary mediastinal hydatidosis

Hydatid cyst disease is still a significant clinical problem in endemic regions. The lungs and the liver are most often involved in the child. A mediastinal localisation is rare and represents 0.1 to 4% of all cases of hydatidosis. The authors reports on two cases and provides a review of the literature. In a retrospective review of the last 12 years, the authors treated two cases with a mediastinal localisation out of total of 235 intrathoracic hydatid cysts arising in 222 patients (0.85%). Two girls, one 12 and the other 13 years old, were admitted with a previous history of chest pain. The chest x-ray revealed an homogenous opacity of 150 mm in the first case and 50 mm in the second. Computed tomography in the second case revealed a cyst in the posterior mediastinum. The abdominal ultrasound was normal in both cases. The patients were approached through a posterolateral thoracotomy and the diagnosis was confirmed macroscopically. The cysts were intact and located on the left side of the posterior mediastinum. The operative field was isolated and protected with hypertonic saline solution. Hydatid fluid was aspirated, followed by the extraction of the hydatid membrane and subtotal excision of the residual cavity in both cases. The postoperative course was uneventful without any relapse or other organ involvement during four and three years, respectively. The authors notes that hydatidosis should be considered in the differential diagnosis of a mediastinal cyst mass. Because of the benign nature of the disease, they emphasize that surgical treatment must be conservative.

Hydatidose médiastinale primitive chez l’enfant : à propos de deux cas

Hydatid cyst disease is still a significant clinical problem in endemic regions. The lungs and the liver are most often involved in the child. A mediastinal localisation is rare and represents 0.1 to 4% of all cases of hydatidosis. The authors reports on two cases and provides a review of the literature. In a retrospective review of the last 12 years, the authors treated two cases with a mediastinal localisation out of total of 235 intrathoracic hydatid cysts arising in 222 patients (0.85%). Two girls, one 12 and the other 13 years old, were admitted with a previous history of chest pain. The chest x-ray revealed an homogenous opacity of 150 mm in the first case and 50 mm in the second. Computed tomography in the second case revealed a cyst in the posterior mediastinum. The abdominal ultrasound was normal in both cases. The patients were approached through a posterolateral thoracotomy and the diagnosis was confirmed macroscopically. The cysts were intact and located on the left side of the posterior mediastinum. The operative field was isolated and protected with hypertonic saline solution. Hydatid fluid was aspirated, followed by the extraction of the hydatid membrane and subtotal excision of the residual cavity in both cases. The postoperative course was uneventful without any relapse or other organ involvement during four and three years, respectively. The authors notes that hydatidosis should be considered in the differential diagnosis of a mediastinal cyst mass. Because of the benign nature of the disease, they emphasize that surgical treatment must be conservative.

Ovarian masses in pediatric patients: a multicenter study of 98 surgical cases in Tunisia

Abstract Ovarian masses requiring surgical intervention are uncommon in the pediatric population. Our aim is to report results of a multicentric Tunisian study concerning the clinical practice and the management of pediatric ovarian masses and to identify the factors that are associated with ovarian preservation. Between January 2000 and December 2015, 98 pediatric patients (<14 years) were surgically treated for ovarian masses at the five pediatric surgery departments in Tunisia. Ninety-eight patients were included in this study. The mean age of the patients at time of surgery was 8.46 ± 4.87 years. Sixty-three ovarian masses (64.3%) were non-neoplastic lesions, 24 (24.5%) were benign tumors, and 11 (11.2%) were malignant neoplasms. Conservative surgery (ovarian-preserving surgery) was successfully performed in 72.4% of the benign lesions, whereas only three patients (27.3%) with malignant tumors underwent ovary-sparing tumor resection (p < .001). The mean diameter of the tumors in the patients who underwent oophorectomy was significantly larger than that in the patients who underwent conservative surgery (7.8 ± 3.9 cm vs. 5.7 ± 2.9 cm, respectively, p = .001). In our study, the risk factors for oophorectomy were a malignant pathology and large tumor size. In accordance with the Gynecologic Cancer Intergroup consensus, we recommend that surgical management of ovarian masses in children should be based on ovarian-preserving surgery.

Unusual malignant neoplasms of ovary in children: two cases report.

Sex cord tumors with annular tubules are known to originate from the sex cord of embryonic gonads that synthesize Sertoli cells, Leydig cells, granulosa cells, and theca cells of the ovarian stroma, while ovarian small cell carcinoma of the hypercalcemic type is a type of neuroendocrine tumor. Both these tumors are uncommon, potentially malignant neoplasms in children. We report the case of a sex cord tumor with annular tubules in an 11-year-old girl and a case of small cell carcinoma of the hypercalcemic type in a 10-year-old girl. We also discuss the prognosis and management of these tumors.

Spontaneous Resolution of a Tracheoesophageal Fistula Caused by Button Battery Ingestion

Spontaneous Resolution of a Tracheoesophageal Fistula Caused by Button Battery Ingestion This observation reports a pediatric case of spontaneous resolution of tracheoesophageal fistula caused by button battery ingestion. Button battery ingestion in children is a common problem, and it can cause clinically significant morbidity and mortality. Complications including tracheoesophageal fistula are rare but serious if the battery is not removed early. Our purpose is to emphasize the importance of the conservative management prior to surgical intervention to allow possible spontaneous closure.