Fetal malformations caused by amnion rupture

Indian Journal of Pediatrics -     

Spontaneous rupture of the esophagus in the newborn

Two cases of neonatal spontaneous rupture of the esophagus are described, one of which is associated with a duodenal stenosis. Seventeen cases have been reported. They present clinically with non-specific signs of respiratory insufficiency and radiologically by a right-sided hydropneumothorax. Esophageal opacification shows a leak above the diaphragm. A sudden increase in esophageal pressure at birth is considered to be a major etiologic factor leading to rupture. The presence of a duodenal obstruction support this hypothesis.     

Tracheal compression caused by a foreign body in the esophagus

A two-year-old girl presented with a four month history of chronic cough and recurrent lower respiratory tract infections. Reduction of appetite and especially refuse of solid food was accompanied with weight loss of 3 kg over a period of four months. Therapy with beta 2 adrenergic drugs, theophyllines and antibiotics proved ineffective. Both inspiratory and expiratory stridor were noted, prominently during eating. On the chest radiograph a coin shaped foreign body in the upper part of the esophagus was found, leading to a compression of the trachea.     

Acquired tracheo-esophageal fistulas caused by button battery lodged in the esophagus

Esophageal impacting of button batteries must be distinguished from impacting of other foreign bodies because of their severe complications. We present a 2.5-year-old girl who had an acquired tracheo-esophageal fistula (TEF) caused by a calculator battery lodged in her esophagus. We also review the literature and assess the applicability of multislice CT and its possible advantages in children with acquired TEF.     

Mucosal-lined hemiperineal anomaly possibly caused by antenatal rupture of a caudal duplication

In a 1-month-old infant with a mucosal-line left hemiperineal defect associated with penoscrotal hypospadias, penoscrotal transposition (PST) and an overhanging caudal skin-covered soft-tissue flap resembling a caudal appendage, perineal anatomy could be restored by excising the mucosa and using the overhanging flap to cover the resultant defect. The PST was corrected at the same time. Squamous, gastric, small-intestinal, and respiratory epithelia were present histologically in the mucosa in addition to adjacent cartilaginous elements. A caudal duplication that had ruptured in utero through the hemiperineum could explain the anomaly.     

An unusual pneumomediastinum case in a child caused by spontaneous bronchial rupture

We report a case of spontaneous pneumomediastinum (SPM) in a 3 year-old child, admitted to the emergency department because he presented dyspnea for a few hours, after a paroxysm of cough. The SPM is rare in children; the term "spontaneous" is reserved for cases of pneumomediastinum that haven't a traumatic cause. SPM is seen most commonly in asthmatics and in any patient who induces a Valsalva maneuver. The clinical diagnosis is confirmed by chest radiograph. When the diagnosis is uncertain, the chest CT scan is considered the gold standard of imaging tests, capable of detecting pneumomediastinum even in patients with small amounts of mediastinal air. In this case CT images showed the cause: spontaneous bronchial rupture. The direct sign of bronchial injury is the contiguity of the luminal air with that in the mediastinum. In the literature SPM cases are very rare, at least in health patients without tracheobronchial anomalies. The SPM is generally a benign entity that requires supportive care, and resolution occurs spontaneously, such as in our patient. In this article we want to explain the main clinical, diagnostic and therapeutic aspects of SPM, because, even if it's rare in children, it must be considered in the differential diagnosis of dyspnea; then we want to demonstrate as, in this case, a TC scan was important to identifying the SPM cause: a bronchial rupture.     

Lethal gastric rupture caused by acute gastric ulcer in a 6-year-old girl

Gastric rupture is extremely rare in childhood beyond the neonatal period. We describe a previously healthy 6-year-old girl with a large laceration along the greater curvature on the posterior wall of the stomach. The patient was admitted to a neighboring hospital because of vertigo with 1-day history of intractable vomiting and epigastric pain. Although abdominal distension was noticed during the physical examination, muscular rigidity was not detected on palpation. Laboratory data showed severe hypotonic dehydration and moderate metabolic acidosis with hyperkalemia. She suddenly developed cardiac arrest within an hour after admission. After resuscitation, surgical consultation was obtained. Abdominal X-ray and ultrasound revealed abdominal free air and massive cloudy ascites. At laparotomy, there was a large laceration on the greater curvature of the stomach. Pathology of the gastric wall showed mucosal necrosis while the musculature remained intact consistent with an acute gastric ulcer. Since clinical condition of gastric rupture deteriorates rapidly, early diagnosis and appropriate treatment is essential for good prognosis. One should consider that ulcer formation might cause gastric rupture in childhood.     

Massive hemoperitoneum caused by rupture of the spleen, a complication of congenital afibrinogenemia. Conservative treatment

An hemorrhagic shock caused by spontaneous spleen rupture in a 14 year old child with a congenital afibrinogenemia is reported. A conservative treatment was carried out with perfusions of whole blood and fibrinogen and with regular echographic examinations and a splenectomy was avoided.     

Urothorax caused by traumatic rupture of the subpyelic ureter. Apropos of a case in a 5-year-old

The authors report the observation of a five years old boy who presents after a polytraumatism a chronic pleural effusion who stop only after decortication and which is caused by a ruptur of sub-pyelic uretere. Echography is a good procedure for diagnosis. Laboratory studies of pleural fluid (protein, urea nitrogen, creatinine) could give information for diagnosis.