RESUMO
BACKGROUND: Choledochal cysts (CCs) are rare congenital dilatations of the biliar tree. The incidence is 1:150,000. A correct diagnosis and surgical treatment are important because of the long term risks of infection and neoplasia. We report our experience with CCs in children. PATIENTS AND METHODS: Patients with CC disease, who were seen at the Hospital Italiano de Buenos Aires between 1999 and 2009, were identified retrospectively from our prospectively acquired hepato-pancreatico-biliary database. Prenatal, clinical, surgical and pathological records were analysed. RESULTS: We included 12 children (10 girls and 2 boys), all of them affected by a cystic dilatation type I of Todani classification. Between the 4 patients with antenatal diagnosis only one presented symptoms before surgery, expressed in acolic feces. Between the 8 patients with postnatal diagnosis, the most common clinical presentation was abdominal pain, occurring in all patients. Ultrasound was used for the diagnosis of all patients. Mean age at surgery was 74 months. All patients had intraoperative cholangiograms to definitively confirm the diagnosis. Five patients underwent open surgery and 7 laparoscopic approach. From patients with a laparoscopic approach, 1 had to be converted to open surgery due to intraoperative complications and 2 underwent an initial surgery for a cholecystectomy and a CC cyst excision. The complications observed were: anastomotic biliary fistula 1, residual lithiasis in the pancreatic portion of the duct 1 and anastomotic stenosis 1. The last 2 cases required reoperation. CONCLUSIONS: Once CCs are diagnosed, careful treatment decisions need to be taken because both intra hepatic and extra hepatic CCs, if untreated, have an increased risk of cancer. After a careful study of the cyst's characteristics, we recommend a laparoscopic approach when possible, as the best choice, after 3 months of life to increase the success of the treatment according to the size of the anatomic structure. We recommend early treatment, before 3 months of life, only in case of severe symptoms.
Assuntos
Cisto do Colédoco/diagnóstico , Cisto do Colédoco/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Wandering spleen is a very uncommon condition. Because of the risk of pedicle torsion and splenic ischemia, severe consequences may occur if not diagnosed and treated in time. Unfortunately, splenectomy is sometimes necessary (ie, when splenic infarction occurs). Once the diagnosis of wandering spleen is made, splenopexy is the treatment of choice. There are numerous techniques designed for splenopexy, either by open surgery or by minimally invasive approaches. We describe here a laparoscopic procedure that allows an excellent fixation of the spleen using the patient's own tissues. After a 2-year follow-up, the organ remains in place with good perfusion.
Assuntos
Laparoscopia/métodos , Baço Flutuante/cirurgia , Dor Abdominal/etiologia , Pré-Escolar , Procedimentos Cirúrgicos Eletivos , Seguimentos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Peritônio/cirurgia , Radiografia , Técnicas de Sutura , Ultrassonografia , Baço Flutuante/diagnóstico por imagemRESUMO
Las masas expansivas en el tórax fetal pueden producir insuficiencia cardíaca y muerte. Si el feto sobrevive, pueden causar insuficiencia respiratoria neonatal por hipoplasia pulmonar. Presentamos el caso de un feto con dos duplicaciones intestinales quísticas detectadas en la 26 semana de gestación.Con RNM se descartaron otras anomalías. No presentó hidropesía fetal y se planificó el manejo perinatal multidisciplinario al término para resolver la probable incapacidad ventilatoria.Inmediatamente después del nacimiento se drenó la masa torácica con guía ecográfica y a las 48 hs se la resecó por videotoracoscopía. Al 18 día de vida se extirpó por una minilaparotimía video-asistida, una duplicación yeyunal que medía 8x8. Fue dado de alta al día 24. El diagnóstico prenatal y el manejo perinatal inmediato evitaron la hipoxia neonatal
Assuntos
Recém-Nascido , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal , Cisto Mediastínico , Cisto Mesentérico , ToracoscopiaRESUMO
Las masas expansivas en el tórax fetal pueden producir insuficiencia cardíaca y muerte. Si el feto sobrevive, pueden causar insuficiencia respiratoria neonatal por hipoplasia pulmonar. Presentamos el caso de un feto con dos duplicaciones intestinales quísticas detectadas en la 26 semana de gestación.Con RNM se descartaron otras anomalías. No presentó hidropesía fetal y se planificó el manejo perinatal multidisciplinario al término para resolver la probable incapacidad ventilatoria.Inmediatamente después del nacimiento se drenó la masa torácica con guía ecográfica y a las 48 hs se la resecó por videotoracoscopía. Al 18 día de vida se extirpó por una minilaparotimía video-asistida, una duplicación yeyunal que medía 8x8. Fue dado de alta al día 24. El diagnóstico prenatal y el manejo perinatal inmediato evitaron la hipoxia neonatal
Assuntos
Recém-Nascido , Cisto Mediastínico , Cisto Mesentérico , Diagnóstico Pré-Natal , Toracoscopia , Ultrassonografia Pré-NatalRESUMO
An 18-month-old infant with Down's syndrome presented with a symptomatic esophageal diverticulum (ED) located at the cervical esophagus. He had been operated on successfully for an esophageal atresia and distal tracheoesophageal fistula in the newborn period. Neither surgical maneuvers nor esophageal trauma could explain the ED, which was resected through a cervical approach.