Journal of pediatric surgery
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Laparoscopy has been widely accepted as a technique for the excision of choledochal cyst, but there has been little experience using it as a therapeutic modality for hepatic duct stenosis. The aim of this study is to present our experiences in laparoscopic excision of biliary stenosis and Roux-en-Y reconstruction for patients with choledochal cysts. ⋯ Laparoscopically assisted hepatic ductoplasty is effective and safe for children with choledochal cyst. Bile duct endoscopy proved to be a valuable instrument in showing detailed variations of the biliary system and allowed a safe hepatic hilum exploration and accurate placed hepaticojejunal anastomosis.
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Biography Historical Article
Giovanni Battista Morgagni and his contribution to pediatric surgery.
Pediatric surgery is a less than a century old surgical specialty. However, early knowledge of human malformations and pediatric surgical conditions dates back to centuries before. One of the main contributors to progress in these fields was Giovanni Battista Morgagni (1682-1771), who also had a substantial weight in the development of future pediatric surgery. ⋯ He was also the first to describe pediatric pathological conditions like epispadia, meconium peritonitis, Crohn's disease, and coarctation of the aorta. Finally, he substantially contributed to the understanding of the pathophysiology of conditions like the vesico-ureteral reflux, the anterior wall defects (gastroschisis/omphalocele), and the spina bifida. For this, it was said of him: "If all the anatomical findings made by Morgagni should bear his name, probably one third of human body would be called Morgagni's."
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Review Case Reports
Tension gastrothorax: a case report and review of literature.
Tension gastrothorax develops when the stomach, herniated through a congenital diaphragmatic defect into the thorax, is massively distended by trapped air. We report a case of tension gastrothorax and review the literature. ⋯ Tension gastrothorax is a life-threatening condition leading to acute and severe respiratory distress. The presence of air-filled structure in left hemithorax in a previously healthy child presenting with acute respiratory distress should prompt the inclusion of tension gastrothorax in the differential diagnosis.
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Transmesenteric hernia is a rare cause of intestinal obstruction most commonly affecting the small bowel. The mesenteric defect is usually 2 to 3 cm in diameter. ⋯ The initial patient had a 30-cm-wide congenital defect in the ileal mesentery through which the sigmoid colon and some loops of small bowel had herniated. The second patient is a newborn infant who presented with symptoms and radiographic evidence of proximal bowel obstruction initially thought to be resulting from malrotation with midgut volvulus but was found at surgical exploration to have a small defect in the ileal mesentery.
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Anterior neck abscesses are not rare; but their origin from within the usually infection-resistant thyroid gland is not thought of in the first instance. We encountered 3 patients with differing presentations (tender nodule over anterior neck, recurrent abscess overlying the thyroid gland, and nonhealing fistula with inflammation of the anterior neck). These were caused by persistent embryological communication from the pyriform sinus to the thyroid gland to the left lobe. ⋯ Fistulous communication was confirmed on barium swallow (in 2 patients) or computed tomographic scan (in 1 patient). En bloc excision of the affected thyroid along with the fistulous tract was performed in all patients. Long-term follow-up confirmed a cure.