Allantoic cyst and patent urachus

Allantoic cysts of the umbilical cord are extremely rare anomalies. Only few cases have been reported in the postnatal life. The etiopathogenesis is still obscure. We describe a case of allantoic cyst and patent urachus in a newborn associated with hypospadias and meatal obstruction. We also present the review of literature regarding this entity, embryology and etiopathogenesis.     

Allantoic cyst: a prenatal clue to patent urachus

A patent urachus, which is typically diagnosed as leakage from the umbilicus postnatally, can present as an allantoic cyst in the umbilical cord antenatally. We report a case of a patent urachus with an allantoic cyst diagnosed via fetal MR imaging at 24 weeks’ gestation. Early detection allowed for appropriate counseling and prompt corrective surgery after birth.     

Perineal accessory scrotum

A boy with perineal accessory scrotum but without any other congenital anomaly is being described. He presented with a rugose skin tag on a midline perineal mound and the diagnosis could be confirmed by the histological findings of subcutaneous smooth muscles. Other reports of perineal scrota have been reviewed and a simple classification has been proposed for such cases, based on the appearance of the accessory scrotum and the associated anomalies.     

Accessory scrotum with imperforate anus

Accessory scrotum is the rarest anomaly of the scrotum; less than two dozen cases have been reported. A case of accessory scrotum with imperforate anus is reported.     

Radical surgery and IVA-chemotherapeutic regimen to treat embryonal rhabdomyosarcoma of the urachus: case report

Although rhabdomyosarcoma is the most frequent soft tissue tumor in children, there are extremely few reports of this tumor arising from the urachus. The authors describe another case in a 6-year-old female associated with constipation and a painless suprapubic mass. The specimen had the pathological criteria used to define urachal sarcoma (cytological, histological, and immunohistochemical findings) and urachal remnants were not observed. After complete resection of the primary tumor the patient was treated with chemotherapy (ifosfamide, vincristine, and dactinomycin) and remains alive at 4 years' follow-up with no signs of recurrence. Nowadays the management of children with urachal rhabdomyosarcoma usually includes surgery and chemotherapy. Multimodal therapy and surgery are constantly evolving and have significantly improved overall survival of these patients especially in R0 resected patients.     

The acute scrotum in childhood

A review was made of 771 children with an acutely inflamed scrotum presenting during the 10 years 1976–1985. The relative incidence and age distribution of testicular torsion, torsion of an appendage, and epididymitis was compared. Epididymitis (13%) had a peak incidence in the first 2 years of life when urinary tract infections were common. The incidence of epididymitis was significantly lower than previously, and may reflect a changing pattern of disease. In addition, some patients with a diagnosis of epididymitis may have had infarction of a testicular appendage without haemorrhage. Torsion of a testicular appendage (58%) was most frequent at 11 years of age, 2 years before the maximum incidence of torsion of the testis (29%) at 13 years. This difference in timing may reflect a response by the cranial remnant of the müllerian duct to an increase in circulating oestrogens at the onset of puberty.     

Acute scrotum -etiology,clinical presentation and seasonal variation

Objective  The aim of the present study was to evaluate the etiology, history, physical examination findings, and seasonal variation of acute scrotal problems in children. Methods  A retrospective review of all boys, presenting with acute scrotum to the Pediatric Surgery Clinic of the University Hospital Heraklion between January 1989 and December 2006 was performed. Results  A total of 140 boys presented with scrotal pain were included. Overall the commonest cause of acute scrotum was epididymo-orchitis (35%, 95%CI: 27%–43%), followed by torsion of appendages. In contrast the most common cause in boys of preschool age was spermatic cord torsion (P<0.020). All cases of spermatic cord torsion were characterized by severe testicular pain and an absent cremasteric reflex. The interval between pain initiation and presentation to our clinic was 11.4 hours (SD:3.07) when the testis was salvaged by detorsion, and 19.0 hours (SD:6.32) when the testis was removed. The difference between means was statistical significant (p<0.001). The incidence of torsion of appendages (p<0.036) and/or spermatic cord (p<0.047) was increased in winter. Conclusion  The absence of cremasteric reflex in association with testicular tenderness strongly suggests testicular torsion. The low temperatures during winter may account for the increased incidence of the torsion of both the spermatic cord torsion and the appendages.     

Ectopic Nesidioblastosis

We observed one case of ectopic nesidioblastosis. A solitary nesidioblastoma was observed in the interior wall of the duodenum. Ectopic nesidioblastosi has not been previously reported, but our experience suggests the necessity of examination for ectopic pancreas in cases of SIDS or its near-miss.     

Ectopic ureterocele in nonduplicated collecting systems

Ectopic ureteroceles in nonduplicated collecting systems are rare; only 34 well-documented cases have been reported in the English-language literature. We report two cases of a single-system ectopic ureterocele associated with a nonfunctional ipsilateral kidney in two boys. Nephroureterectomy and excision of the ureterocele were performed. One of the patients had a ventricular septal defect and the other had Sotos' syndrome. An ectopic ureterocele in a nonduplicated collecting system differs from a simple ureterocele or an ectopic ureterocele of a duplicated collecting system because of its prevalence in males, the frequent presence of a nonfunctional ipsilateral kidney, and the high incidence of associated anomalies such as congenital heart disease, crossed renal ectopia, and vas deferens abnormalities. Offprint requests to: R. Gonzalez     

Acute scrotum in Kawasaki disease: Two case reports and a literature review

Acute scrotum is a rare complication of acute Kawasaki disease (KD), less well recognized than other disease manifestations. We describe the cases of two patients, aged 59 months and 19 months, with hydrocele testis in the acute phase of KD. Scrotal ultrasound and trans‐illumination were used in the diagnosis of hydrocele testis. One patient underwent eventual surgical intervention. We reviewed the literature for a better understanding of the pathogenesis of scrotal symptoms in acute KD and investigated the clinical importance of hydrocele testis. Careful further clinical observation may elucidate the true incidence of this extracardiac symptoms, thereby clarifying the diagnostic value of this possible complication in acute KD.     

Ectopic intrathoracic liver

 Accessory hepatic tissue, unlike accessory splenic and pancreatic tissue, is rare and has a limited and almost exclusively sub diaphragmatic distribution. Fewer than ten cases of intrathoracic ectopic liver have been reported so far in the literature. This paper reports a case that caused a diagnostic dilemma. Accepted: 16 June 2000     

Ectopic pancreas

Details of four patients who had ectopic pancreatic tissue are reported. One patient had diabetes mellitus and the ectopic pancreas was situated in the pyloric antrum. The pyloric antrum was also the location of the ectopic pancreas in the second child who had dyspeptic symptoms. In a third patient, in whom the ectopic pancreatic tissue lay in the pyloric canal, there was associated hypertrophy of the pyloric muscle and obstruction to gastric emptying. The fourth child had ectopic pancreatic tissue in the duodenum: this was not associated with obstruction but there was, coincidentally, exocrine pancreatic insufficiency neutropenic and metaphyseal chondrodysplasia.     

Transcatheter closure of patent ductus arteriosus

Summary 1. A technique has been presented for transcatheter closure of a patent ductus arteriosus. 2. A 3.5-kg infant has been treated successfully in this manner. 3. The method should be considered in high-risk patients. 4. Further miniaturization of the system should make it suitable for use in premature infants critically ill as a result of ductal patency. 5. Increased experience will likely indicate that the technique is applicable to most patients who require ductus closure. This investigation was supported in part by Public Health Service Grant HL12307 from the National Heart, Lung and Blood Institute, and in part by Grants from The American Heart Association, Southeastern Pennsylvania and Delaware Chapters.     

Ectopic spleen. A sonographic diagnosis

The diagnosis of an ectopic spleen can be made sonographically by recognizing the characteristic parenchymal texture and shape of the spleen. Evaluation of the left upper quadrant is necessary to confirm the diagnosis or to diagnose a mass displacing a normal spleen. A rare case of an ectopic spleen in a child with chronic torsion is presented.     

Ectopic pancreatic rests: a rare cause of persistent umbilical discharge

Ectopic pancreatic rests are rare. We report two cases discovered in infants who underwent surgical exploration of the umbilicus for persistent umbilical discharge with peri-umbilical excoriation. A shallow sinus leading to a firm cyst was excised in both infants, and histopathological study confirmed the presence of exocrine and endocrine pancreatic tissue. There is only one other case of ectopic umbilical pancreatic tissue reported, and this was in a patient presenting with an umbilical mass. Accepted: 4 February 1999     

Subcostal cross-sectional echocardiographic imaging of patent ductus arteriosus

Summary A modified subcostal short-axis cross-sectional echocardiographic view for imaging the patent ductus arteriosus (PDA) was studied. A total of 22 newborns with PDA and various associated cardiac anomalies and 16 newborns without PDA were examined. The PDA was imaged in the subcostal view in 19 newborns. In the control group, the absence of the PDA was established in 13 newborns and considered probable in three. The PDA was optimally imaged in the subcostal view in patients with normal or enlarged pulmonary artery, mainly those with the hypoplastic left heart. Among the eight patients with small pulmonary artery (pulmonary atresia or severe tetralogy of Fallot), the PDA was imaged in the subcostal view in three and in the suprasternal view in eight. By combining the suprasternal and the subcostal views, the PDA was imaged in each instance.     

Non-pharmacological management of a hemodynamically significant patent ductus arteriosus

The association between the patent ductus arteriosus (PDA) and neonatal morbidity, mortality and poor neurodevelopmental outcome in later childhood has been the focus of intense debate for decades. The lack of evidence supporting therapeutic strategies aimed at achieving PDA closure has led to the widespread adoption of conservative management aimed at mitigating the impact of shunt volume without achieving ductal closure. In this article, we review this management approach, describe the supportive evidence and potential complications associated with this strategy.     

Neonatal infective endarteritis complicating patent ductus arteriosus

Infective endarteritis complicating patent ductus arteriosus (PDA) is a rare occurrence. Most cases are reported in older children and adults, and there are little published data describing this condition in the preterm neonate. We outline the presentation, clinical course, management and outcome of two affected infants born at less than 27 weeks of gestation. Conclusion: This report highlights the importance of a detailed cardiac evaluation in a neonate with persisting bacteraemia. An increasing awareness of neonatal ductal endarteritis combined with the wider availability of more sensitive echocardiography has implications for local neonatal service delivery.     

Ectopic vasal insertion into the posterior urethra: Report of two cases

Two cases of ectopic vas deferens insertion into the posterior urethra are reported. A search of the English literature revealed only two such cases previously reported. We advocate routine cystourethroscopu when investigating childhood epididymitis. Correspondence to: S. Sen