Optimization in diagnostic and therapeutic strategy of choledochal cystObjectives: The choledochal cyst has an incidence of 1 in 100.000-150.000. The purpose of this study was to analyze the variables introduced for the optimization in the diagnosis and treatment of choledochal cyst. material and methods: Retrospective study of patients treated in our center by hepatic-jejunostomy and Roux-Y, from September 1988 to november 2012. We analyzed 40 variables including age, symptoms, type of cysts, diagnostic tests, changes in surgical technique, complications and outcomes. results: Eighteen patients (66.6% female) were grouped according to the age of presentation: Prenatal (< 1 month), Early (1-24), Delayed (> 24 months). The most common symptoms were jaundice and abdominal pain (for early-onset and late-onset respectively). The 83.3% presented choledochal cysts type I, the ultrasound was sufficient for diagnosis in 94.4%. Since 2004 we modified the surgical technique, performing laparoscopic dissection of the bile duct and cyst, adding a mini-laparotomy (3-5 cm) for hepatic-jejunostomy with 40 cm intestinal loop using polypropylene suture. One complication was observed since 2004, one case of partial dehiscence of the anastomosis resolved with conservative treatment and a cholangitis in 1 patient with hepatic and renal polycystic. In 2012, 83.3% are asymptomatic. conclusions: The diagnostic have been simplified, in more than 90% of cases was done by ultrasound; advances in minimally invasive surgery and creation of descending loop of 40 cm, have helped to improve the prognosis of choledochal cyst.

Temporary colostomy before surgery in Buschke-Löwenteim tumour in childrenBuschke-Löwentein tumor is a verrucous lesion, with slow growth and locally infi ltrating. Despite her benign histology, is an intermediate lesion between condiloma acuminatum and verrucous carcinoma. It has been linked to human papilloma virus (subtypes 6 and 11). Other factors implicated include poor hygiene, chronic irritation, promiscuity and cellular inmunocompromised states. It is exceptional in children. We report a case of a 6-year-old girl with HIV infection B3 and giant condyloma that affect genitoanal region and rectal mucosa. The temporary colostomy aimed good results of the surgical excision.Key words: Buschke-Löwentein tumor, colostomy, human papilloma virus, inmunocompromised. ResumenEl tumor de Buschke-Löwentein es una lesión verrucosa, con crecimiento lento, y localmente infi ltrante. A pesar de su histología benigna, se trata de una lesión intermedia entre el condiloma acuminado y el carcinoma verrucoso. Su aparición está ligada con el virus del papiloma humano (subtipos 6 y 11). Otros factores que intervienen son la baja higiene, promiscuidad, irritación crónica y la inmunosupresión celular. Es excepcional su aparición en niños. La exéresis quirúrgica radical es el tratamiento de elección. La realización de una colostomía de descarga previa, permite el aislamiento, facilitando la cicatrización de la zona y evitando el contacto con material fecal que contribuye a la recidiva. Presentamos un caso de una niña de 6 años con VIH estadio B3 y condilomatosis gigante que afectaba a la región genitoanal y a la mucosa rectal adyacente. La colostomía temporal contribuyó al éxito tras la resección quirúrgica.Palabras clave: Tumor de Buschke-Löwentein, colostomía, virus del papiloma humano, inmunodeficiencia.

Todos los autores han participado en el caso. No existe ningún conflicto ético ni de intereses. Los padres dieron la autorización para la divulgación científica del mismo. Este trabajo cumple con los requisitos sobre consentimiento /asentimiento informado, comité de ética, financiamiento, estudios animales y sobre la ausencia de conflictos de intereses según corresponda.