Retrospective Comparative Study between Duplay and Koff Methods in Repair of Distal Hypospadias

BACKGROUND

Hypospadias repair is a complicated surgery even in the best of hands. To date, there is a lack of consensus on which surgical technique offers more favourable post-operative outcomes.

AIMS AND OBJECTIVES

The present work was undertaken to evaluate and compare the outcomes and complications rates of two single-stage techniques widely used to repair primary anterior hypospadias, namely Thiersch-Duplay Tubularized Plate Urethroplasty and Koff Urethral Mobilisation and Advancement.

SUBJECTS AND METHODS

Data from the medical records of 120 patients operated on for primary anterior hypospadias were retrospectively analysed and compared. The patients were divided into two groups: 60 patients underwent Thiersch-Duplay procedure (Group A) and 60 patients underwent Koff procedure (Group B). They were compared using the Chi-squared or Fisher's exact test to assess the relationship between the adopted surgical technique and the complications' development with a P < 0.05.

RESULTS

Neither intraoperative complications nor acute post-operative complications occurred, whereas 28.3% (n = 34/120) cases have exhibited at least one late post-operative surgical complication, including 38.3% (n = 23/60) in Group A and 18.3% (n = 11/60) in Group B, revealing a better outcome of the Koff procedure despite the statistical insignificance (P = 0.102). We did not objectify any other complication besides meatal stenosis (MS), urethro-cutaneous fistula (UCF) and wound dehiscence.

CONCLUSION

Overall, our study could not demonstrate the superiority of one technique above another. At the same time, it established the versatility, satisfactory cosmetic and functional results, low MS and UCF rates of Koff urethral mobilization and advancement technique in primary anterior hypospadias repair.

Penetrating Chest Trauma in a Child Caused by a Fall on a Metallic Bar: A Case Report

Penetrating chest trauma in children is an uncommon condition. Patients may be asymptomatic or in a critical state. Visceral and vascular damage are frequently present when penetrating objects enter the thoracic cavity. Although many studies have discussed penetrating thoracic trauma in adults, very few deal with the pediatric population. Here, we present the case of a 13-year-old child with an intrathoracic metallic bar after penetrating chest trauma. The clinical examination showed a stable patient with a palpable bar and subcutaneous emphysema in the left axillary area. The radiological scan did not reveal any vital damage. The bar was removed through the entry wound without thoracotomy or thoracoscopy. The patient evolved without any incident and was discharged after three days. Good improvement was noted over three months of follow-up. Intrathoracic foreign bodies secondary to penetrating trauma are rare in children. An exhaustive imaging examination is required to identify the precise location of the foreign material and find any severe organ or vascular injuries. If the condition permits, direct removal should be attempted in an operating room, in case surgical intervention is needed after the extraction.

Neglected trauma-induced testicular torsion: Clinical, sonographic, and surgical correlation in a 13-year-old adolescent

Post-traumatic testicular torsion is a rare condition, accounting for approximately 4%-8% of all reported cases of testicular torsion in the literature. Prompt clinical suspicion and intervention are crucial; as testicular torsion is considered a medical and surgical emergency that may lead to testicular necrosis. Ultrasound imaging plays an important role in assessing the integrity of the traumatized scrotum and facilitating early detection of associated testicular torsion. In this case report, we present a neglected post-traumatic testicular torsion in a 13-year-old child that led to orchiectomy.

Posterior mediastinal teratoma presenting as an abdominal mass in a child: A case report

We report the case of a 2.5-year-old child admitted for abdominal distension, whose imaging revealed a large posterior mediastinal cystic mass, with a tissue component, a calcification, and a minimal fat component. The ultrasound- guided biopsy led to the diagnosis of a benign extragonadal germ cell tumor, also called mature teratoma or dermoid cyst, whose mediastinal localization is rare, often localized in the anterior mediastinum, and rarely in the posterior mediastinum. The mainstay of treatment is complete surgical excision.

Diagnosis and surgical management of children with oesophageal achalasia: A 10-year single-centre experience in Morocco

INTRODUCTION

Achalasia is a primary oesophageal motility disorder with unknown aetiology. The aim of this study was to evaluate our 10-year experience in the diagnostic process and surgical management of oesophageal achalasia (OA) in children.

METHODS

A retrospective review of all children (age: 0-15 years) treated for achalasia at the department of paediatric surgery from 2007 to 2016 was conducted. The demographics, presenting symptoms, associated diseases, diagnostic process, outcomes and complications were analysed.

RESULTS

Fourteen patients were identified, with a mean age of 5.2 years. There were eight female and six male patients. The most common symptom was chronic vomiting, in all patients (100%), followed by weight loss in 10 (71.4%), cough in 6 (42.9%), dysphagia in 5 (35.7%) and chest pain in 3 (21.4%). The mean duration of symptoms until diagnosis was 36.3 ± 29.1 months. Three patients underwent an open Heller myotomy (HM) and 11 laparoscopic HM (LHM) including three conversions. The reasons for conversion were mucosal perforation in two cases and liver bleeding in one patient. The mean operating time and the average length of postoperative stay in the patients of LHM group were, respectively, 2.0 ± 0.7 h and 4 ± 1.5 days. The mean follow-up was 43.2 months.

CONCLUSION

: The diagnosis of OA in children is based on clinical arguments and especially on the barium oesophagram findings. Laparoscopic myotomy is the most effective surgical approach in children.

Falciform ligament abscess secondary to a ruptured liver abscess in a child: a case report

Abscess of the liver ligaments is extremely rare, and abscess of the falciform ligament has been sporadically reported. We report the case of a 3 years old male who presented with a three days history of right upper quadrant abdominal pain, fever and nausea. The ultrasound and computed tomography (CT) scan showed an abdominal wall abscess located anterior to the liver. The patient underwent surgery. Abscess of the falciform ligament secondary to a ruptured liver abscess was found. Excision of the falciform ligament including the abscess was performed. Although pathology of the falciform ligament is rare, it should be included in the differential diagnosis of acute abdomen.

Huge omental lymphangioma with haemorrhage in children: case report

Omental cystic lymphangioma is a rare benign intraabdominal anomaly with uncertain etiology, predominantly occurring in children. Most cases of abdominal lymphangioma are asymptomatic. However, patients may occasionally present with acute abdomen because of an intestinal obstruction or peritonitis caused by infected cysts, hemorrhaging, and/or torsion. This report describes a case of omental cystic lymphangioma with acute intracystic haemorrhage. Ultrasonography and computed tomography (CT) scan confirmed the diagnosis. Complete excision of the cyst along without omentectomy done with no clinical or radiological evidence of recurrence till 17 months.

[Long-term evolution of vesicoureteral reflux in children]

Vesicoureteral reflux is very common in children, requiring a long follow-up period to reduce its progression toward chronic renal failure. This study aims to analyze the epidemiological diagnostic features, the management of vesicoureteral reflux and long term course of patients with this disease. We conducted a retrospective study of 42 patients with suspected vesicoureteral reflux hospitalized in the Department of Visceral Paediatric Surgery at the Hassan II University Hospital of Fez over a period of 6 years from January 2010 to December 2015. Mean age of patients at diagnosis was 3 years and 2 months. The boy is to girl sex ratio was 1.8. Vesicoureteral reflux was isolated in 81% of patients and secondary or associated in 19% of patients. The most common initial manifestation was urinary tract infection (90.4%). Renal function was impaired in 54.8% of children. The treatment was based on antibiotics against diagnosed UTI (90.4%), antibiotic prophylaxis in the case of recurrence and Cohen reimplantation (97.62%). Surgical indication readily concerned all patients with grades IV and V vesicoureteral reflux (73.9%) as well as patients with impaired kidneys and 26.1% of patients after medical treatment. Early and late postoperative course was in general satisfactory: disappearance of vesicoureteral reflux in 92.68% of cases. Upper urinary tract regressed except for 9.52% of patients; 95.23% of patients had complete recovery of renal function. There was a reduction in UTI recurrence (in 19.04% of cases after surgery). The majority of parents judged positively the clinical course of their children (54.76%) after surgery.

[Complications of Meckel's diverticulum in children: about 18 cases]

Meckel's diverticulum (MD) is a remnant of omphalomesenteric channel. It is often asymptomatic but it can be responsible for various clinical complications and variable clinical status especially in children. We conducted a retrospective study on complications of MD among children hospitalized in the division of Paediatric Surgery at the University Hospital Hassan II, Fez, Morocco. The study aimed to describe the clinical, radiological and therapeutic features of MD. The study was conducted over a period of 10 years (January 2009 - December 2018) and involved 18 children (15 boys and 3 girls) aged 1 day - 15 years (with an average age of 5 years) who had undergone surgery for complications of MD. Acute intussusception and intestinal occlusion were the most frequent complications. Other complications included: infection of the MD (1 case) and digestive hemorrhage (2 cases). Two rare types of neonatal Meckel's diverticulum were described (neonatal occlusion and fistula associated with omphalocele). In no case, abdominal X-ray without treatment, ultrasound and CT scan showed MD. Scintigraphy was performed in 2 patients with hematochezia and it helped to make the diagnosis of MD in one case. Three patients underwent laparoscopic surgery with resection of the MD and intestinal anastomosis with laparoscopy. The other patients underwent laparotomy. Ileostomy was performed in one case, followed by secondary recovery. Patient's outcome was good, except for one case of anastomotic leakage. Anatomopathological examination showed two cases of heterotopia.

[Neonatal caecal perforation revealing congenital megacolon]

Les perforations intestinales spontanées sont rares chez un nouveau-né à terme. Nous rapportons le cas d'un nouveau-né issu d'une grossesse de 41 semaines d'aménorrhée, qui avait présenté à trois jours de vie, un pneumopéritoine inaugural d'un mégacôlon congénital. L'exploration chirurgicale avait mis en évidence une perforation cæcale diastatique associée à une disparité de calibre recto-sigmoïdienne. La prise en charge avait consisté à la réalisation d'une cæcostomie d'urgence après lavage de la cavité péritonéale. L'examen histologique des fragments biopsiques avait permis de confirmer le diagnostic du mégacôlon congénital. Les suites opératoires étaient simples et la cure radicale avait eu lieu six mois plus tard.

Meckel's diverticulum causing intestinal obstruction in the newborn

The causes of neonatal bowel obstruction are variable and dominated by malformations and the Meckel diverticulum must remain exceptional. We report a case of neonatal bowel obstruction in a six day old male neonate admitted on account of inability to pass stool, abdominal distension and bilious vomiting. The radiologic additional examinations are non-specific. Exploratory laparotomy found obstruction at the site of a Meckel's diverticulum.

[Pancreatic pseudocyst in children: about 7 cases]

Le pseudokyste du pancréas est une affection bénigne, rare, en particulier chez l'enfant. Ce sont des collections de suc pancréatique, dépourvues de revêtement épithélial, et dont la localisation peut être intra ou extra pancréatique. Nous rapportons une étude rétrospective de 7 enfants colligés au service de chirurgie pédiatrique du centre hospitalier universitaire Hassan II de Fès, durant une période de 11 ans, allant du 1^erjanvier 2005 au 31 décembre 2016. Tous les enfants étaient de sexe masculin, l'âge moyen était de 6,6 ans (15 mois-12 ans). Un antécédent de traumatisme abdominal était retrouvé dans 4 cas, le ballonnement abdominal, la douleur, les vomissements et les troubles du transit étaient les principaux motifs de consultation. L'examen clinique retrouvait chez tous les enfants une sensibilité épigastrique et une altération de l'état général, l'échographie abdominale et le scanner abdominal réalisés respectivement ont permis de poser le diagnostic de pseudo kyste du pancréas avant l'intervention chirurgicale. Six malades sur sept ont été opérés ; Nous avons opté pour la dérivation interne (anastomose gastro-kystique) dans 4 cas, une dérivation externe dans 2 cas, et l'abstention thérapeutique dans le dernier cas. Les Pseudo kystes du pancréas sont des affections rares, néanmoins, ils sont de loin les plus fréquents (80% des lésions kystiques du pancréas étant des pseudo kystes, et sont la conséquence d'une pancréatite aigüe et/ou chronique, d'un traumatisme pancréatique, ou d'une obstruction canalaire pancréatique.

Congenital fistulisation of Meckel's diverticulum in omphalocele sac: case report

Fistulisation of Meckel's diverticulum in the top of an omphalocele sac is very rare. To our Knowledge, three cases were reported in the literature. We presente in this report a new case of this uncommon presentation.

[Acute appendicitis due to Claudius Amyand's hernia in a newborn with intestinal obstruction]

Claudius Amyand's hernia is defined as the incarceration of the vermiform appendix in the hernia sac. The first reported appendicectomy was performed in 1735. It is very rare among children, hence its frequency is not yet established. We report the case of a 22-day old new born with untreated simple inguinoscrotal hernia who had an urgent admission to the Emergency Department due to occlusive syndrome with no evacuation of faeces and no passing of flatus, inflammatory inguinoscrotal swelling and bilious vomiting persisting for 2 days. Treatment was based on the restoration to good health and on preanesthetic assessment. Intraoperative exploration showed necrotic bulging appendix in its distal half with false membranes. Appendectomy was performed with closure of the hernia sac. Patient's evolution was marked by resumption of intestinal transit 24h after surgery.

Caecal duplication cyst: a rare cause of neonatal intestinal obstruction

We report a rare case of duplication cyst of the caecum responsible for an intestinal obstruction in a 5-day-old newborn. Preoperatively, we suspected the diagnosis of enteric duplication as ultrasonography demonstrated a cystic mass in the right iliac fossa, and laparotomy confirmed an obstructive caecal mass which was resected and an end-to-end anastomosis was performed. The neonate completely recovered with an uneventful follow-up.

Unusual cause of acute scrotum in children: a case report

A 13-year-old boy was presented in the pediatric emergency with a 2-week history of swelling of the right scrotal contents of simple evolution, which was worsened by the appearance of an acute scrotal pain 48 h prior to his consultation. The doppler ultrasound and computed tomography (CT) scan revealed an incarceration of the omentum in an inguinal hernia. Acute scrotal pain and swelling is a common reason for surgical consultation in the emergency department of children. However, omentum is a rare content of inguinal hernia in children and infarct is exceptional. It should be included in the differential diagnosis of an acute scrotum.

Multifocal rib osteomyelitis in children: a case report and literature review

Rib osteomyelitis is a rare disease, occurring in ~1% or less of all cases of haematogenous osteomyelitis. During the last century, 58 cases of rib osteomyelitis were reported in the literature, of which, multiple ribs were involved in only five patients. Because of its rarity and non-specific clinical signs, diagnostic of rib osteomyelitis may be delayed. We report a case of multifocal rib osteomyelitis revealed by a dorsal mass in a healthy 13-year-old female child.

[Neonatal purpura fulminans without sepsis due to a severe congenital protein C deficiency]

Severe congenital protein C deficiency is a rare life-threatening coagulopathy. In the early hours of life, the neonate presents with extensive purpura fulminans and substantial skin necrosis contrasting with a preserved general state and a negative infectious exam. Disseminated intravascular coagulation sets in secondarily. Prenatal outset of thrombotic events is a rare situation that worsens the prognosis, especially protein C replacement in utero is not available. We report a case of a male newborn of consanguineous parents who were asymptomatic carriers of heterozygous protein C deficiency. This infant presented prenatal ventricular hemorrhage with hydrocephalus and rapidly extensive postnatal skin necrosis that was not regressive in spite of fresh frozen plasma administrated after 24h of life. Prenatal diagnosis, early recognition, and urgent therapy with protein C replacement and anticoagulant treatment are crucial to improve the prognosis, avoid further damage after delivery, and prevent the devastating consequences of severe protein C deficiency.

[Elastofibroma of dual anterior and thoracic dorsal localization in children]

L’élastofibrome est une pseudotumeur des tissus mous typiquement localisée sous la pointe de l'omoplate. Il est caractérisé par la prolifération de tissus fibreux et adipeux et affecte plus fréquemment les femmes âgées. Nous présentons un cas d’élastofibrome chez une fille de 9 ans.

Hernia of the bladder through the broad ligament with renal agenesis and ipsilateral ureter blind ending

Hernia through a defect of the broad ligament is extremely rare in children. These defects can result from a developmental defect or a spontaneous rupture of cystic formations remnants of mesonephric ducts or Müller. Genital anomalies associated with unilateral renal agenesis are more common in females. We report the case of a 13 months girl allowed for assessment of recurrent urinary tract infection; abdominal examination did not objectified palpable mass, the external genitalia were without abnormalities. Abdominal ultrasound revealed a left renal space is empty with a retrovesical cyst. Cystography was requested that objectified a large pelvic cystic mass retrovesical communicating with the bladder, there was also a left vesicoureteral reflux. Uro- MRI showed a cystic formation retrovesical communicating with the bladder, the right pelvic kidney; uterus is normal size for age. DMSA scintigraphy confirmed the absence of the left kidney with the right kidney that ensures 100% of total renal function. To surgical exploration we found a hernia of the bladder through the left broad ligament, the uterus was dislocated on the right side; left ovary was hypoplasic; the ipsilateral ureter was blind with renal agenesis, we performed by reduction of the bladder then closing the hernial orifice, dissection of the ureter with its ligation and section at the vesical stoma. The postoperative course was uneventful. Evolution is favorable. This observation illustrates a hernia of the bladder through the broad ligament associated with ovarian hypoplasia, renal agenesis and ipsilateral ureter blind ending; this association was not described to our knowledge in the literature.

[Management of bilateral pheochromocytoma - case report]

Le phéochromocytome est une pathologie rare et sévère; sa survenue à un âge précoce, sa bilatéralité et son association à des signes de gravité en font la sévérité. Notre observation en fait l'exemple; le phéochromocytome bilatéral est révélé par un accident vasculaire ischémique qui a dominé le tableau initial chez une fille de 10 ans. L'imagerie a orienté vers le diagnostic (échographie et TDM abdominales), confirmé par le dosage des catécholamines urinaires. Après une préparation soigneuse, l'exérèse chirurgicale (surrénalectomie totale droite et partielle gauche), avec bonne surveillance péri opératoire, ont permis d'avoir de bons résultats. L’étude histologique a étayé la nature anatomo pathologique de la pièce opératoire.

Bilateral Maxillo-Mandibular Syngnathia in a Newborn

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Trans-mesenteric hernia in infants: report of two cases

Internal hernias are rare causes of intestinal obstruction in children. Trans-mesenteric hernia remains the most common form. We report transmesenteric hernia in a neonate and infant presented with intestinal obstruction.

Trans-Mesenteric Hernia in Infants: Report of Two Cases

Internal hernias are rare causes of intestinal obstruction in children. Trans-mesenteric hernia remains the most common form. We report transmesenteric hernia in a neonate and infant presented with intestinal obstruction.

[Not Available]

Nous rapportons un cas de diverticule géant para-urétéral chez un enfant de 18 mois, du point de vue des aspects cliniques, diagnostiques et thérapeutiques. Aucune anomalie associée n’a été relevée. Le patient était un enfant de sexe masculin, et la symptomatologie était dominée par la rétention aiguë d’urine et la présence d’une infection urinaire. La chirurgie a consisté en une diverticulectomie laparoscopique avec réimplantation urétéro-vésicale. L’évolution a été favorable avec disparition des signes urinaires.

[Pulmonary hydatid cyst in children treated by thoracoscopy: eight years of experience]

L’échinococcose kystique est une pathologie fréquente en zone d'endémie: pourtour méditerranéen, Afrique de l'est et l'Amérique du Sud. L'hydatidose reste à l'heure actuelle un problème majeur de santé publique. Notre travail consiste en une étude rétrospective de 27 malades opérés pour kyste hydatique pulmonaire (KHP) par thoracoscopie, au service de chirurgie pédiatrique du centre hospitalier universitaire HASSAN II à Fès, sur une période de huit ans allant de janvier 2004 au décembre 2011.

Cervical hibernoma in a two year old boy

Hibernomas are uncommon benign soft tissue tumours mimicking brown fat. They are mostly seen in the fourth and fifth decades of life. Only few cases in the cervical area have been reported. Because of its rarity in pediatrics and diffcult diagnosis, we report a tow year-old patient with a cervical tumor. Ultrasound and computed tomography exams showed an infiltrative, with hypervascular and lipomatous features. After tumor excision, histopathological exam confirmed the diagnosis of hibernoma or brown fat tumor. This presentation describes the characteristics of this type of tumor, rare in children.

[Huge cerebral hydatid cyst revealed by a coma]

La localisation cérébrale du kyste hydatique est rare (2%), nous rapportons le cas d'une fille de 6 ans, admise aux urgences pour un coma d'installation progressive et dont le bilan radiologique a montré un énorme kyste cérébral fronto-pariétal, le diagnostic de kyste hydatique a été retenu après traitement chirurgical. C'est le premier cas du kyste hydatique, à notre connaissance, qui a été révélé par un coma, la malade a bien évolué après le traitement chirurgicale sans récidive après deux ans de recul.