Significance of residual abdominal masses in children with abdominal Burkitt's lymphoma

Purpose: To evaluate the natural history of children with abdominal Burkitt's lymphoma who had complete clinical remission and residual abdominal mass after treatment. Material and methods: The charts and imaging findings of all children with abdominal Burkitt's lymphoma treated and followed at our medical center between 1988 and 1999 were reviewed for the presence, management, clinical course, and prognosis of residual mass. Results: Only children who achieved complete clinical remission were included. The study group consisted of 33 children (20 boys and 13 girls) aged 2.6–17.6 years (mean 7.2 years). Of these, seven (20.6 %) were found to have a residual abdominal mass. Two underwent second-look operation with no evidence of viable tumor on histology. The remaining five were followed by imaging studies for 2.2–9.1 years (mean 6.1 years); none relapsed. Conclusion: Residual mass is not uncommon in children with abdominal Burkitt's lymphoma. The presence of residual mass in a child with complete clinical remission does not alter the long-term prognosis. Therefore, in children with Burkitt's lymphoma and residual mass with no other signs of disease activity, expectant watching may be appropriate. Received: 10 December 2000 Accepted: 25 June 2001     

Imaging of liver tumours in childhood

Primary liver tumours account for 6% of all paediatric neoplasms. In a child with a clinical abdominal mass, imaging (in consultation with a paediatric surgeon) aims to confirm the intrahepatic site, determine its likely resectability, exclude metastatic abdominal disease, and characterise the mass. The imaging in 44 patients with primary liver tumour over a 33-year period was reviewed and correlated with surgical/pathological findings. Characterising hepatic masses with ultrasound, computed tomography, nuclear medicine, and angiography is less important than determining its resectability and alerting the surgeon to vascular anomalies and the presence of metastatic disease. We conclude that a chest X-ray and ultrasound study are the primary methods for evaluation of a child with suspected hepatic mass. With careful attention to technique, the mass can be evaluated and an assessment made of tumour resectability preoperatively. Based on this review, we propose a schema for the initial evaluation of suspected hepatic masses in children. Offprint requests to: J. F. de Ocampo     

Un cas de volvulus aigu de l''estomac chez l''enfant

Gastric volvulus is an abnormal rotation of the stomach around its axis. The acute form is a surgical emergency, which doesn't tolerate any therapeutic delay. We report on a case in a young girl, revealed by painful epigastric mass and distended gastric bubble on abdominal X-ray. This case was been successfully treated by detorsion and gastropexy. The clinical picture of gastric volvulus is characterised by the Borchardt triad of symptoms: upper abdominal pain, vomiting and difficulty to pass a nasogastric tube. The gastrointestinal barium series and CT-scan help to confirm the diagnosis. As was demonstrated in this case, the treatment is surgical by reducing the volvulus and fixing the stomach to prevent recurrence.     

A case of Yersinia pseudotuberculosis septicemia accompanied by a large abdominal tumor

A 2-year-old girl with Yersinia pseudotuberculosis septicemia had a large abdominal mass that had to be differentiated from malignant tumor. The mass disappeared rapidly with antibiotic therapy and was defined to be a cluster of enlarged ileocecal lymph nodes by the clinical course and the findings at ultrasonic examination and Gallium scintigraphy.     

腹部超声在新生儿坏死性小肠结肠炎诊断及病情评估中的价值

目的 探讨腹部超声检查对新生儿坏死性小肠结肠炎(NEC)的诊断价值及其在NEC病情评估中的意义。方法 回顾性分析2013年7月至2015年1月84例NEC患儿的临床资料。根据修正Bell-NEC分级诊断标准分为NEC疑似组(n=44)、确诊组(n=40);另根据临床转归分为内科治愈组(n=58)和手术/死亡组(n=26),比较腹部超声及腹部X线平片检查结果在各组中的改变。结果 在确诊组,腹部超声对门静脉积气、肠管扩张的检出率显著高于腹部平片(PPP结论 腹部超声在NEC的诊断中有重要作用;超声表现对预测疾病的严重程度有预测作用。     

Intussusception in infants and older children: a comparison

The clinical features and operative findings in 37 infants and 29 older children with intussusception seen over a 10-year period were compared and contrasted. While most of the children presented acutely, 28% of older children had chronic intussusception compared with 5% in infants. Only about a third of all children had the four classical features of abdominal pain, vomiting, abdominal mass and bloody stool; the rest had two or three of the above features. Pain and palpable abdominal mass were more common features in older children while abdominal distension, constipation and diarrhoea were more prominent in infants. Fifty-four per cent of intussusceptions in infants were entero-colic while in older children 69% were colonic. All the intussusceptions in infants were idiopathic while in 14% of older children there were predisposing causes. Resection for gangrene/perforation was required in 30% of infants compared with 7% of older children.     

Intussusception: a supplement to the mnemonic for coma

Expected clinical manifestations of intussusception include paroxysmal abdominal pain, vomiting, abdominal mass, and with time, rectal bleeding. We report a case where lethargy and vomiting are the presenting complaints. Diagnostic delay was encountered for this infant who had altered sensorium without accompanying pain, melena, or mass on initial examination. Either plain radiographs, supplemented by ultrasonography of the abdomen, or a barium enema should be performed in infants with unexplained lethargy.     

Neonatal adrenal hemorrhage: clinical and abdominal sonographic findings.

Four neonates with adrenal hemorrhage are presented. The clinical manifestations included most often an abdominal mass but also anemia, jaundice, hypotension, bluish discoloration of the scrotum, and abdominal calcification. The diagnosis was established in each case upon abdominal sonographic findings. The review of these patients emphasizes the subtle and diverse clinical presentation of adrenal hemorrhage in a neonate and stresses the importance of abdominal sonography in establishing the diagnosis.     

Primary lymphosarcoma of the ileum and caecum

Eleven boys with primary ileo-caecal lymphosarcoma had an abdominal mass, anaemia and weight loss. One boy had an intussusception. Localised perforation occured in two boys and one developed an abscess. The palpable abdominal mass due to neoplastic involvement of the intestine and mesentery gave specific features on the abdominal radiograph in four boys. Characteristic findings on barium study permitted distinction from Crohn's disease in all but one instance. Extension of lymphosarcoma into the posterior abdominal wall prevented surgical excision and this type of extension was identified on excretion urography.     

Rare case of an abdominal mass presenting as acute abdomen: Torsion of the vermiform appendix

Torsion of the vermiform appendix is a rarely observed acute abdominal emergency. The clinical manifestations are similar to acute appendicitis. It should be included in the differential diagnosis if a patient presents with intermittent abdominal pain and an acute abdominal emergency. Here, we describe a 4‐year‐old male patient with a mass located in the right lower abdominal quadrant, whose clinical findings were consistent with an acute abdomen. The gangrenous appendix was found in the pelvic cavity and its stump was twisted clockwise. A 1.5‐cm fecalith was detected in the appendix lumen and appendectomy was performed.     

Juvenile tropical pancreatitis syndrome in northern Nigeria: a case report

A six-year-old boy with abdominal pain since the age of two years is described. Physical examination revealed no abnormality but under general anaesthesia a mass could be felt in the left upper abdominal quadrant. An X-ray showed calcification in that quadrant, anterior to the vertebrae and an IVP revealed incomplete duplication of the left ureter. At laparotomy, small multiple calculi were removed from the pancreatic duct and pancreatico-jejunostomy was performed. Following surgery, his crippling abdominal pain ceased dramatically and he has remained symptom-free.     

Extralobar pulmonary sequestration with venous drainage to the portal vein: a case report

Venous drainage to the portal vein in pulmonary sequestration is rare. A 7-month-old girl was referred to our hospital following surgery for ventricular septal defect because of a left upper abdominal mass with a large feeding artery from the abdominal aorta and venous drainage to the portal vein. She had had frequent pulmonary infections and was growth retarded. MRI demonstrated that the mass was above the left diaphragm, suggesting extralobar sequestration. An extralobar sequestered lung was resected at thoracotomy. Diagnostic problems and clinical features are presented. Received: 29 April 1999/Accepted: 10 December 1999     

Duodenal heterotopic pancreas in a child

Background  Heterotopic pancreas is characterized by pancreatic tissue outside the pancreatic bed. However, duodenal heterotopic pancreas in children is rarely reported so far. We describe herein duodenal heterotopic pancreas in a child who suffered from chronic abdominal pain. Methods  An 8-year-old boy presented with upper abdominal pain and intermittent vomiting, without a history of melena, hematochezia, hematemesis, claycolored stools, jaundice, hepatitis or dyscrasia. No specific medication or change in position relieved the pain. Based on the elevated serum amylase levels, and the findings of CT, barium meal X-ray examination, magnetic resonance imaging, and upper gastrointestinal endoscopy, a duodenal mass was diagnosed initiatively. Intraoperative frozen section analysis was performed for the diagnosis. The mass was dissected. Results  Intraoperative frozen section analysis and routine pathological examination confirmed the diagnosis of duodenal heterotopic pancreas. The patient had an uneventful recovery and remained asymptomatic postoperatively during a follow-up period of 16 months. Conclusions  Heterotopic pancreas should be considered in children with a duodenal mass and abdominal pain. Intraoperative frozen section analysis is helpful in the diagnosis of the disease. Surgical treatment of the lesion should be performed to prevent bleeding, ulceration, outlet obstruction or malignant degeneration. Zheng LD and Tong QS contributed equally to this work     

Preoperative ultrasound and gallium-67 evaluation of abdominal non-Hodgkin's lymphoma

The diagnostic accuracy of abdominal ultrasonography followed by gallium (Ga)-67 scintigraphy in 21 patients, aged 1 to 14 years, appearing with abdominal non-Hodgkin's lymphoma (NHL) was analyzed. All cases were confirmed by biopsy; in a majority (16 patients), the tissue was obtained from an abdominal mass at the time of laparotomy subsequent to the imaging studies. Nineteen satisfactory abdominal ultrasound examinations were performed; 18 were interpreted as characteristic of NHL. Sixteen of these were of masses involving the gastrointestinal tract. All 21 patients had 67Ga scintigraphy that demonstrated abnormal radionuclide accumulation in the abdomen. In no instance was the final diagnosis different from the one predicted by the combined imaging studies. Ultrasonography is recommended as the initial test in the evaluation of clinical presentations consistent with abdominal NHL to expedite suitable management and prevent inappropriate surgery.     

新生儿腹部急症救治体会:附37例报告

为探讨新生儿腹部急症的诊断和治疗。对1999年6月－2001年12月收治的37例患儿进行回顾性分析，其中男24例，女13例；入院年龄为生后1－27天，平均10天；发病时间为出生当天－20天。根据临床表现、腹部直立位平片及有关影像学检查分为消化道梗阻19例，消化道穿孔3例，腹腔脏器外露4例，外科性呼吸窘迫2例，腹部巨大肿块1例，消化道功能紊乱8例。其中11例经综合对症治疗症状缓解，21例进行手术治疗，3例放弃手术探查，2例暂缓手术回家随访。经临床、手术及病理提示，25例为先天性畸形。资料显示：新生儿腹部急症大多有胚胎发育异常造成先天性畸形的基础，肠梗阻发生率高，常伴多发性畸形；需对临床病情动态观察，及时予以辅助检查，重视把握保守治疗和手术指征及手术原则，予以综合对症治疗。提示了解新生儿腹部急症的特点，早期诊断和及时治疗是提高生存率的关键。     

44例儿童神经母细胞瘤临床分析

目的 分析儿童神经母细胞瘤（NB）的临床特点及影响生存率的因素,为进一步优化儿童NB诊治方案提供依据。方法 以2016年4月至2020年2月收治的44例NB患儿为研究对象,回顾性分析患儿的临床资料及随访资料。结果 44例NB患儿初次就诊常见临床症状依次为发热（10/44,23%）、发现肿块（9/44,20%）、腹痛（8/44,18%）、咳嗽（7/44,16%）、面色苍白（3/44,7%）、跛行（2/44,5%）及活动异常（2/44,5%）。根据INSS分期,Ⅰ期2例（4%）、Ⅱ期5例（11%）、Ⅲ期5例（11%）、Ⅳ期32例（73%）。44例患儿平均随访时间为（15.3±1.5）个月,复发率为20%,总生存率为82%,其中无事件生存29例（66%）,带瘤生存7例（16%）。病理类型为NB、血清神经元特异性烯醇化酶增高可降低NB患儿的总生存率（P < 0.05）。结论 NB患儿初诊临床症状无明显特异性,多以发热、腹痛、发现肿块最常见;初诊晚期患儿占比高;病理分型为NB、血清神经元特异性烯醇化酶增高可能与NB患儿总生存率降低有关。     

A Bronchopleurocutaneous fistula caused by an unusual foreign body aspiration simulating acute abdomen

A 12-year-old boy was admitted to hospital for abdominal pain, vomiting and fever. On physical examination he had râles on the lower right hemithorax without any respiratory complaints. Chest X-ray revealed a condensation in the right lower chest. Abdominal findings were secondary to lobar pneumonia. Treatment of pneumonia with antibiotics showed no improvement over 2 days. On bronchoscopy no foreign body was seen, but pus was aspirated. Two days later a mass appeared on the right hemithorax and fistulized. An organic foreign body,Hordeum murinum, with 3–5 ml of pus was observed. Chest X-ray taken at the day of fistulization showed no pneumothorax or subcutaneous emphysema. Less than 11 cases of pneumocutaneous fistulas secondary to aspiration of grasses have been reported in literature. Why an ear ofHordeum murinum can migrate only in a forward direction and why a pneumothorax had not developed is discussed.     

Blunt abdominal trauma caused by child abuse

We report about 3 boys under 4 years of age with abdominal blunt trauma following child abuse admitted to our clinic with different diagnoses. Common were fresh or older haematomas, burn wounds, for which the parents had no plausible explanation. The children had no skeletal or intracranial lesions, but they developed abdominal pain, which became worse in the absence of the parents. X-ray and the clinical course lead us to laparatomy. In all cases we found lesions of the intestines, especially near the duodenojejunal flexure, hepatoduodenal ligament, root of the mesentery, mesocolon and retroperitoneum, in one case a pancrease rupture. All these lesions were caused by child abuse. We want to point out the problem in the diagnosis of battered child syndrome, especially of the abdominal blunt trauma.     

新生儿原发性肠套叠临床诊治特点浅析

目的探讨新生儿原发性肠套叠的临床表现及诊断治疗特点。方法对5例新生儿原发性肠套叠的诊治经过进行回顾性分析，探讨新生儿原发性肠套叠的诊治特点。结果5例患儿中，2例有窒息或宫内窘迫病史；5例表现为呕吐，便血3例，腹胀3例，腹壁水肿2例，包块1例；5例作X线平片检查，2例完全梗阻，3例不全梗阻；4例超声检查显示：包块3例，典型的同心圆、套筒表现1例；水压灌肠复位1例失败，全部接受手术治疗，证实为原发性肠套叠，其中小肠套叠2例，回盲型2例，回结型1例；手法复位1例，肠切除吻合4例；死亡1例。结论新生儿肠套叠可以是原发性的.临床表现不典型，可表现为新生儿肠梗阻，术前明确诊断较困难；小肠套叠相对多见；早期超声检查具有诊断意义；早期手术治疗效果满意。     

An unusual presentation of pancreatic carcinoma in childhood

Carcinoma of the pancreas is rare in the pediatric population, with only 58 cases described in subjects under 16 years of age. The clinical presentation generally consists of abdominal pain and mass. We present a case of carcinoma of the pancreas in an 11-year-old girl, with abdominal pain and unusual behavior.