Background: The annular pancreas is a rare congenital disorder of the pancreas first recognized in 1818. It is believed to result from faulty rotation of the ventral pancreatic bud in its course around the posterior aspect of the duodenal anlage. The duodenum is encircled and might be obstructed by normal pancreatic tissue. The management of the annular pancreas is still developing and under revision. Case Presentation: Six cases of neonatal intestinal obstruction secondary to the annular pancreas diagnosed, operated on, and involved in our study. Age, gender, maturity, age at referral, birth weight, clinical presentation, imaging findings, associated congenital anomalies, treatment, complications, and hospital stay were all studied. Polyhydramnios is found in 3 cases (50%). Down syndrome was diagnosed in one case. One patient has associated malrotation. Symptoms started earlier within the first 24 hours. Vomiting was bile stained in 4 cases (66.7%). Passing meconium, sometimes frequent, does not exclude the annular pancreas. Most patients show double bubbles sign on plain abdominal X-ray. All six neonates were treated with duodenoduodenostomy with excellent results. Survival was 100% and complications were minimum. Conclusion: The annular pancreas, although rare, is an important cause of neonatal duodenal obstruction. The accurate diagnosis is usually performed during laparotomy. Vomiting may contain bile or not, furthermore, passing meconium does not exclude this condition. The best and the excellent surgical option is diamond duodenoduodenostomy. This case series might be added to the registered cases of the annular pancreas to standardize the method of diagnosis and to define the best management.

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INTRODUCTION/ PURPOSE Acute appendicitis is the most common surgical emergency in children. Appendicular mass is a relatively common complication in improperly treated patients. The management of appendicular mass remains controversial. This study aims at determining factors affecting the effectiveness of conservative management of appendicular mass. PATIENTS AND METHOD This was a retrospective study of 71 children younger than 15 years with appendicular mass who managed at Basra Children’s Specialty Hospital during the period between 2015 and 2019. Factors like age of the patient, duration of symptom prior to hospital admission, size of the mass, complications, hospital stay and outcome are reviewed. RESULTS Appendicular mass complicates 3.9% of all cases of acute appendicitis. Conservative management of appendicular mass was effective in 84.5%. Appendicular mass occurred most frequently in children aged 5-10 year (48%). Male is more frequently affected than female with a ratio of 1.4. Regarding age effect on the efficacy of conservative management of appendicular mass, there is a significant association with P-value = 0.017. Duration of symptoms or size of the mass has no significant association with the success of conservative management. No mortality or major surgical complications are encountered. Although effective, conservative management prolong the length of hospital stay. CONCLUSION I concluded that conservative management of appendicular mass in children should be revised particularly in children younger than 5 years old, wherein operative treatment may be the first option. The reasons for that are high rate of failure of conservative management with early progress to appendicular abscess. These could be explained by the underdevelopment of greater omentum and so lacking of its protective effect in limiting the spread of inflammation. In addition, early appendectomy has the advantage of decreased risk of adhesive intestinal obstruction, shortening of hospital stay (so that less economic burden), and avoidance of second readmission for interval appendectomy.

This study aimed to determine the type of neonatal intestinal obstruction, their mortality, and the significance of the direct causes of death. A retrospective study of all neonates managed for neonatal intestinal obstruction (total number studied was 161 child) at Basrah Children's Specialty Hospital (BCSH) between June 2012 and June 2014. Data were collected from patients' hospital records (neonatal intensive care unit) and analyzed for age, sex, clinical features, diagnosis, surgical procedure performed, prematurity, birth weight, duration of symptoms, complications and their management. The mortality due to neonatal intestinal obstruction is still high in our setting (25.5%). The significant factors associated with mortality were prematurity, birth weight, sepsis; reoperation, short bowel syndrome, and proximal intestinal stoma. Certain causes of neonatal intestinal obstruction were associated with high mortality e.g. jejunoileal atresia (52.6%), meconium ileus (50%), perforated viscus (46%), and duodenal atresia. Male are affected more than female with M:F ratio of 2.4:1. The most common cause of intestinal obstruction in neonates in this series was anorectal malformations (33.5%). Other causes of neonatal intestinal obstruction included Hirschsprung's disease (24.2%), small intestinal atresias (11.8%), intestinal malrotation with or without volvulus (9.3%), perforated viscus (8.1%), meconium ileus (7.5%), duodenal aresia (2.5%), annular pancreas (1.2%), and meconium plug syndrome, necrotizing enterocolitis and segmental dilatation (0.6%, each). In conclusion, neonatal intestinal obstruction is a common cause of admission accounting for 28.2% of all admission. Mortality from intestinal obstruction is still high in our society and strict measures regarding prenatal, natal and postnatal management should be addressed to save those neonates.