An isolated dissection of the celiac artery is an extremely rare condition that requires a high level of suspicion to evoke the diagnosis. Once established, the natural course is unpredictable in view of the discrepancies in its management requiring a case-by-case analysis. In this paper, we report an unusual case of spontaneous abdominal pain that was diagnosed with celiac and splenic artery rupture secondary to physical stress. This paper underlines the necessity to maintain a high level of suspicion for arterial dissections and we also review the management plan in such cases.

IntroductionDyslipidemia has been recognized as a risk factor for cardiovascular diseases. Studies have showed that the development of atherosclerotic lesions begins in childhood and progresses throughout life. While the prevalence of dyslipidemia in adults has been reported to be 10 times higher in Lebanon compared to Western countries, data on the prevalence of dyslipidemic children in Lebanon is lacking.ObjectivesThis study was conducted to assess the benefit of a protocol for universal screening for lipid disorders in Lebanese children aged between two and ten years old.Materials and methodsA total of four hundred children aged 2–10 years old (51.5% boys) were included in the study. The subjects were recruited from private pediatric clinics after parental consent. Fasting total cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) levels were measured and non-HDL cholesterol was calculated. The values were categorized according to 2011 Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents.ResultsThe overall prevalence of high TC (≥200 mg/dL), high non-HDL-C (≥145 mg/dL), high LDL (≥130 mg/dL), high TG (≥100 mg/dL) and low HDL (<40 mg/dL) was respectively 19.5%, 23%, 19%, 31.8% and 20%. The overall frequency of dyslipidemia was 51.7%. In a bivariate analysis, dyslipidemia in children was associated with a BMI ≥95th percentile and parents having TC > 240 mg/dL with a P value respectively of .006 and .0001. Furthermore, high TG was independently associated with a BMI ≥95th percentile (P = .0001). Children with parents having TC > 240 mg/dL was significantly correlated with high TC, high non-HDL-C and high LDL (P = .0001 for all variables). Finally, according to the Pediatric Dyslipidemia Screening Guidelines from the 2011 Expert Panel, 62.3% of dyslipidemic children had at least 1 risk factor that qualified them for screening while 37.7% of them didn't have any risk factor.ConclusionsIt is preferable to review the latest pediatric dyslipidemia screening guidelines by performing a universal screening program since a third of our dyslipidemic Lebanese children will be missed.

Sarcoidose is a rare disease in children. The aminotransaminase level is often normal to moderately elevated (2 to 3 folds of the normal level). We report the case of a child who presented an aminotransaminase level that was 10 times the normal level, as the first manifestation of sarcoidosis.