RESUMO
Choledochal cysts are cystic dilatation of the common bile duct managed by excision and hepatico-intestinal reconstruction. The gold standard after choledochal cyst excision is reconstruction using the jejunum. With the advent of laparoscopy the pendulum has changed toward hepaticoduodenostomy reconstruction. We review the classification, diagnosis and recent management of choledochal cyst.
Assuntos
Cisto do Colédoco/cirurgia , Duodenostomia/métodos , Jejunostomia/métodos , Cisto do Colédoco/diagnóstico , Cisto do Colédoco/patologia , Humanos , Laparoscopia/métodosRESUMO
Handlebar hernia is a rare traumatic abdominal wall hernia occurring after blunt trauma. We report a case of an adolescent patient with a traumatic rectus muscle abdominal wall hernia produced by injury with the bicycle handlebar. The skin abrasion caused by the trauma and a swelling reproduced after a Valsalva maneuver suggested the diagnosis. Traumatic wall hernias after blunt trauma should be repaired primarily to avoid complications.
Assuntos
Traumatismos Abdominais/complicações , Ciclismo/lesões , Hérnia Abdominal/etiologia , Ferimentos não Penetrantes/patologia , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/etiologia , Parede Abdominal/patologia , Adolescente , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/patologia , Humanos , Masculino , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/etiologiaRESUMO
Cancer of the thyroid gland in pediatric patients is rare and if left untreated spreads and become lethal. Thyroid nodules in pediatric patients are four times more likely being malignant than adult nodules. The incidence of thyroid cancer in children increases with age, sex, race and nodule size. Exposures to low level of head and neck irradiation at young age, cancer survivors, family history of thyroid cancer and iodine deficiency are specific risk factors to develop thyroid cancer. Thyroid cancer is subdivided into papillary, follicular and medullary thyroid cancer varying in histological characteristics. Children who present with thyroid nodules should undergo ultrasound and fine needle aspiration biopsy to evaluate malignant potential. If biopsy results are positive for malignancy best option is complete surgical resection of the thyroid gland with central lymph node dissection followed by radioactive iodine treatment. Surgeons need to take certain precaution to avoid postoperative complications like hypoparathyroidism or recurrent laryngeal nerve damage. Follow-up is essential in order to evaluate remission or recurrence. An excellent prognosis in pediatric patients is the result of such an aggressive approach that can be supported by the low complications rate and low recurrence rate following surgery.
Assuntos
Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Adulto , Fatores Etários , Biópsia por Agulha , Criança , Humanos , Excisão de Linfonodo , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Fatores de Risco , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/terapiaRESUMO
Wandering spleen is a rare occurrence where the spleen normal fixation to the abdominal wall is lost and thus allowed to change in position. We report a case of a child who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. The diagnosis was promptly made using computed tomography and managed with splenectomy.
Assuntos
Abdome Agudo/etiologia , Isquemia/etiologia , Infarto do Baço/etiologia , Anormalidade Torcional/etiologia , Baço Flutuante/complicações , Pré-Escolar , Emergências , Feminino , Humanos , Isquemia/cirurgia , Ligamentos/anormalidades , Esplenectomia , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/cirurgia , Baço Flutuante/diagnóstico por imagem , Baço Flutuante/cirurgiaRESUMO
Congenital rectovestibular fistulas with normal anus are a rare form of anorectal malformations, especially in the Western hemisphere. Due to its rarity, consensus on preoperative management, surgical technique and postoperative care is still in debate. We describe a specific case with its management plan and outcomes while providing an up to date literature review on current management trends.
Assuntos
Fístula Retovaginal/congênito , Erros de Diagnóstico , Feminino , Humanos , Recém-Nascido , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Fístula Retovaginal/diagnóstico , Fístula Retovaginal/cirurgia , Retalhos Cirúrgicos , Técnicas de SuturaRESUMO
Chylous jejunal cysts are extremely rare entities and if not diagnosed promptly may lead to severe complications like bowel obstruction, loss of small bowel and even death. We present the case of a 4 year-old-male referred to our institution with severe abdominal pain, constipation, abdominal distention and radiological findings of large amount of fluid in the lower abdomen with associated bowel obstruction. Operative findings were that of large chylous jejunal cyst causing segmental volvulus. Resection of the involved jejunal segment and cyst along with bowel detorsion was undertaken. Literature review on the subject follows.
Assuntos
Cistos/complicações , Volvo Intestinal/etiologia , Doenças do Jejuno/complicações , Pré-Escolar , Quilo , Humanos , MasculinoRESUMO
Adrenocortical carcinoma (ACC) is a rare neoplasm in children. Most patients with ACC suffer syndromes of adrenal hormone overproduction including hypercortisolism, hyperaidosteronism or virilization. We describe the case of an infant girl who presented features of virilization associated with elevated testosterone and DHEA levels due to the presence of a left adrenal cortical carcinoma. A dramatic regression of virilization features occurred after adrenalectomy.
Assuntos
Neoplasias do Córtex Suprarrenal , Carcinoma Adrenocortical , Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/cirurgia , Carcinoma Adrenocortical/diagnóstico , Carcinoma Adrenocortical/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido PrematuroRESUMO
In children with primary solid malignant tumors the most frequent site of metastasis is usally the lung. Pulmonary metastasectomy is part of the standard of care in adult malignancies but its role in pediatric patients has been poor characterized. This review article discusses the benefits, outcomes according tumor histology, selection criteria, adjuvant therapies and surgical techniques employed in the resection of pulmonary metastases in children with malignant tumors.
Assuntos
Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metastasectomia , Pneumonectomia , Criança , HumanosRESUMO
Intrathoracic ectopic kidney is a rare congenital abnormality with a prevalence estimated as less than one in 10000 and with only thirteen cases reported in the pediatric age group over the past twenty-five years. Herein, we report the uncommon case of a 20 month-old-male exhibiting a left ectopic intrathoracic kidney diagnosed as an incidental finding in image studies. Uncomplicated incidentals diagnosis has demonstrated normal function and development of those kidneys in long-term follow-up with no late bowel herniation.
Assuntos
Rim/anormalidades , Humanos , Lactente , Rim/diagnóstico por imagem , Rim/patologia , Imageamento por Ressonância Magnética , Masculino , Tórax , UltrassonografiaRESUMO
UNLABELLED: Children with thyroid nodules undergo extensive and costly work-up before being referred to surgeons. We attempted to identify which is the minimal clinical workup necessary to develop an appropriate surgical management plan for euthyroid children diagnosed with thyroid nodules METHODS: Case-control study including cases of thyroid nodules surgically intervened in a ten-year period at the University Pediatric Hospital. Following variables were studied: labs, physical exam, size of nodule, thyroid function tests, imaging. FNA findings, surgical procedure, and final pathology. The preoperative workup cost for each patient was estimated. RESULTS: Population consisted of twenty-four children. Nineteen were female and 5 were male with an average age of 14 years Nodules were divided in malignant 54% and benign 46% Of the 19 female cases 42% were malignant mostly papillary cell ca cinoma (PCC). All male cases were PCC. Indications fo surgical intervention in patients with benign lesions w continuous growth and symptoms not resolving with m dical treatment. Most benign lesions were follicular adenoma. We had 75% FNA results and pathology results for all case studied. Of the cases preoperatively diagnosed as malignant neoplasm by FNA all of them were confirmed by pathology and there were no false positive malignancies. Preoperative workup cost average $580 USD. CONCLUSION: A minimal workup algorithm is required before surgery in children with thyroid nodules. In a euthyroid child if a palpable nodule is found and it is accompanied by lymphadenopathy the suspicion for malignancy shoul be raised and FNA should be first line of evaluation. If no lymphadenopathy is present workup can proceed to US and progress to FNA evaluation if the nodule persists o grows. In symptomatic patients with small nodule. difficult to palpate or in smaller child, US-guided FNAwould be the best option.