Salih Çetinkurşun

Anal canal duplication

IntroductionAnal canal duplication (ACD) is an extremely rare congenital intestinal anomaly. ACD is defined as a second anal orifice located posterior to the true anus ending blindly without connection to the rectum. Usually, there are no other accompanying hindgut pathologies. Patients are often asymptomatic and apply to clinics with their parent’s attention.Case 1A 9-month-old girl was referred to our clinic because of a second orifice posterior to the true anus. On the physical examination, there was a 3xa0mm in diameter orifice, about 0.5xa0cm behind the anus, at 6 o’clock direction on the lithotomy position. Duplicated lumen was checked with a metal catheter; it was about 2xa0cm in length ending blindly without connection to the rectum. A prediagnosis of ACD was made and the patient was operated. Duplicated segment was excised totally. Postoperative course was uneventful.Case 2One-year-old girl was referred to our clinic because of the same complaint. On the physical examination, there was a 2xa0mm in diameter orifice, about 0.3xa0cm behind the anus, at 6 o’clock direction on lithotomy position. Duplicated lumen was checked with a metal catheter; it was about 1.5xa0cm in length ending blindly without connection to the rectum.ConclusionACD is a rare congenital intestinal anomaly located posterior to the anus. It can be confused with other types of anorectal pathologies, such as hemorrhoids, fistula-in-ano, and perianal abscess at the time of diagnosis. Although ACD is often asymptomatic, it should be removed surgically because of the risk of inflammatory complications and colloidal cancer.

Epidermoid cyst causing clitoromegaly in a child

The abdominal route was chosen for repair as the fistula was large and the ureteric orifices were not visualized on cystoscopy. Omental interpositionwas done to increase vascularity of margins and also because it works like a physiological drain. Antifungal drugs were continued postoperatively to treat residual infection. Oral itraconazole, which has shown better results than amphotericin B for invasive aspergillosis, is unavailable in India. References

Laryngeal Fracture due to Blunt Trauma Presenting with Pneumothorax and Pneumomediastinum

Aim: Injuries due to traffic accidents are frequent in childhood, and they have high mortality and morbidity. Laryngeal injury due to a traffic accident is a rare pathology and might be missed if not suspected. Here we present a laryngeal fracture in a child after a blunt chest trauma during a traffic accident that presented with pneumomediastinum and pneumothorax. Case: A 14-year-old girl was referred for pneumomediastinum. Her physical examination was normal except subcutaneous emphysema, edema and tenderness in the cervical area, hoarseness, facial and extremity abrasions and ecchymoses. Chest tomography revealed pneumothorax and pneumomediastinum, and cranial tomography revealed maxillofacial fractures. Upper airway damage was suspected, flexible endoscopy revealed right vocal cord paralysis and cervical tomography revealed thyroid cartilage fracture. The fracture was repaired and tracheotomy was performed. She was discharged on postoperative day 6. Facial fractures were repaired in another center. Tracheotomy was removed on postoperative day 20. Her hoarseness, although decreased, still persists. Conclusion: Pneumomediastinum is a rare result of a laryngeal fracture and if not suspected, the fracture can easily be missed. It should be kept in mind after blunt cervical trauma with pneumomediastinum and/or pneumothorax. Direct endoscopy and cervical tomography may be necessary for the differential diagnosis.

Benign Cystic Mesothelioma in a Child: Case Report and Review of the Literature.

BACKGROUNDnBenign cystic mesothelioma (BCM) is a rare tumor with benign characteristic. There are only 8 child cases reported in the English literature. In this report, we present this rare entity a brief review of the literature.nnnCASE REPORTnA two year-old boy presenting with abdominal swelling was hospitalized. Physical examination revealed a mass filling the abdomen. Laboratory findings were not specific. Abdominal computerized tomography showed a 15×13×11 cm cystic mass extending from the bladder to the liver with no solid components and no infiltration to adjacent organs. Operation revealed a cystic mass filled with yellow-green serous fluid which was attached to the right lobe of the liver with a 1 cm thick peduncle. Total excision of the mass was performed by clamping and cutting the narrow attachment. Recovery was uneventful. Pathology revealed multiple cysts lined with mesothelial cells. No recurrence was seen after 5 years of follow-up.nnnCONCLUSIONnBCM should be kept in mind as a rare cause of the abdominal mass in children, as it may lead to confusion in preoperative diagnosis. Although rare, patients should be followed throughout life because of the risk of recurrence and malignant degeneration.

Cystic lymphangiomatosis with severe intra‐abdominal bleeding in a newborn: Case report

We report the case of a newborn girl with intestinal cystic lymphangiomatosis who presented with abdominal distension and intra‐abdominal bleeding following a prenatal ultrasound diagnosis of intestinal anomaly. Postnatal abdominal ultrasound revealed disseminated submucosal and intramural cystic dilatations of various sizes in the bowel and intestinal lymphangiomatosis was diagnosed. The presence of severe bleeding diathesis and widespread disease led to conservative treatment. The patient died on postnatal day 7 and postmortem examination confirmed cystic lymphangiomatosis. Detection of intestinal hyperechogenicity and/or dilatation in prenatal ultrasonography and the persistence of these findings during pregnancy are suggestive for pathologies such as meconium ileus, meconium peritonitis, and intestinal atresia. Although rare, intestinal lymphangiomatosis should be kept in mind in patients whose prenatal sonographic findings persist until birth.

A practical offer for hypospadias dressing: Allevyn®

INTRODUCTIONnAn ideal hypospadias dressing material must be cheap and non-allergenic. It also must be easily and quickly applied, non-adherent to the incision, effectively absorb the leakages of the wound, pressurise the flaps and grafts effectively, without damaging the blood circulation, protect against infections, and must be easily and painlessly removable. We use a product that is produced for healing chronic wounds and burns, Allevyn Adhesive® , as a wound dressing after hypospadias surgery and circumcision.nnnMATERIALS AND METHODSnWe included 61 hypospadias and 85 circumcision cases operated in our clinic between November 2007 and August 2010, for the study. Allevyn Adhesive® dressing was used in all the cases. For approximately every 10 patients a sheet sized 22.5 x 22.5 cm was used.nnnRESULTSnWe did not meet any difficulty in application and removal of the dressings and the dressing could be performed easily even by inexperienced health personnel. The cost of the application is about

A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study

5 for each case. We did not encounter any complications with regard to the dressing during the follow-up.nnnCONCLUSIONnWe did not encounter any of the complications with Allevyn Adhesive® that were seen with the use of traditional dressing products, such as, problems with removal of the dressing, development of maceration secondary to inadequate absorption of leakages from the wound, cohesions of the wound lips, and infections and necrosis of the flaps and grafts, secondary to erroneous locations of the dressings. There was no additional therapeutical cost due to the use of this product. For these reasons we thought that Allevyn Adhesive® is a good alternative for the dressing of hypospadias and circumcision.

The Reason for the Rare Scrotal Mass in the Newborn: Antenatal Intravaginal Torsion of the Testis

Objective: To evaluate the effect of inguinal operations performed with a modified Ferguson technique upon testicular volume and blood flow. Methods: This study involved 23 children receiving surgery for inguinal hernia, hydrocele, and cord cyst. This was a prospective study performed between April 2016 and June 2016 in a medical faculty pediatric surgery unit. The color Doppler ultrasound (CDUS) was used to assess testicular volume and blood flow before and after a modified Ferguson technique surgery. The pre- and post operative testicular volume and blood flow were compared with the contralateral testes. SPSS software was used to statistically analyze the data arising; the Mann-Whitney U test and Friedman test were used to compare samples, and P<0.05 was accepted as statistically significant. Results: Preoperative and postoperative testicular volumes were not statistically different when compared to contralateral testes. In patients with right sided inguinal pathology, testicular blood flow on the right side was significantly lower than that on the left side (P=0.023). The testicular blood flow was not statistically different compared with the contralateral testes during the first week evaluation and first month evaluation. The blood flow, probably reduced due to the pressure caused by inguinal pathology, was normalized through surgery. Conclusions: The modified Ferguson technique do not change the testes volume and blood flow.

Minimally Invasive Treatment of Mirizzi Syndrome, a Rare Cause of Cholestasis in Childhood

©Copyright 2017 by the Association of Urological Surgery / Journal of Urological Surgery published by Galenos Publishing House. Correspondence: Ahmet Ali Tuncer MD, Afyon Kocatepe University Faculty of Medicine, Department of Pediatric Surgery, Afyonkarahisar, Turkiye Phone: +90 505 948 93 71 E-mail: drtaali@yahoo.com Received: 08.02.2017 Accepted: 06.03.2017 Intravaginal testicular torsion is a very rare pathology in the neonatal period. However, it is seen most commonly torsion type in puberty. In this article, we presented a male patient with a scrotal hyperemia and an abnormal mass in the testis. According to the ultrasonographic examination, a patient had an antenatal intravaginal testicular torsion and no testicular blood flow was observed. This article was written to draw attention to the importance of neonatal examination and to remind us of testicular torsion which is a rare pathology in newborns with scrotal colour change or the presence of an abnormal mass.

Cross ectopic multicystic dysplastic kidney with ureterocele in nonectopic site

Mirizzi syndrome is the compressive blockage of the cystic or choledochal duct caused by a biliary stone occupying the cystic canal or Hartmanns pouch. This occurrence is rare and, in English literature, three cases defined in children have been observed. In order to draw attention to this rare occurrence, we preferred a 14-year-old male patient with Mirizzi syndrome. In this case, ERCP was performed preoperatively and the diagnosis was carried out with the help of clear visualisation and identification of the tissue structures as well as the stent placed in bile duct; so we protected the patient from the possible iatrogenic injury occurring during surgery.