External manual reduction is a radiation-free, safe and effective procedure. In case of incomplete reduction, it facilitates enema performance. External manual reduction incorporates and additional initial step in the non-surgical reduction of intussusception and should be considered a first-line procedure.

No abstract

No abstract

We present a 2-year-old girl with a 24-hour history of abdominal pain, fever, and vomiting. The diagnosis of acute splenic torsion was made by means of color and power Doppler ultrasound. Management of this rare surgical emergency is discussed.

57 Background: Patients with WT in AHOPCA present late with large abdominal masses, in poor clinical condition. This analysis focuses on treatment failure. Methods: Between 2012 and 2015, 182 evaluable patients were diagnosed with unilateral WT. Patients were staged with abdominal ultrasound/computed tomography and thorax radiograph/CT. Therapy was adapted from National Wilms Tumor Study-5 except for patients with large abdominal masses and/or severe malnutrition who received preoperative doxorubicin, vincristine, actinomycin-D for 4 to 6 weeks. Treatment failure was defined as abandonment of therapy, recurrent/progressive disease (PD), and death: early (< 2 weeks from diagnosis) or toxic (> 2 weeks after diagnosis). Results: 49% were male; 23% were <2 years (median age 3.5y). Stage distribution: I, 8; II, 21; III, 116; IV, 37 cases. For 123/181 (68%) preoperative therapy was warranted (volume 579cm3). Treatment failures were: recurrence/PD 28; abandonment 19; early death 3, and toxic death 2. 2/29 (7%) patients with stage I/II suffered recurrence/PD, 13/116 (11%) stage III, and 13/37 (35%) stage IV. Most failures were metastatic (68%). Abandonment-sensitive 3-years EFS was 68%±0.04% (SE) for the all stages, 77%±0.043% abandonment-censored, and abandonment-sensitive OS was 71%±0.05%. Conclusion: Multicenter protocol-driven therapy tailored to fit regional needs is feasible in patients with WT. Abandonment remains a challenge as do early and toxic deaths due to advanced disease presentations in fragile children. Compared to previous eras 2000-2004 (3-year EFS 50%±4.3% and 2005-2011 (3-year EFS 59%±3.1%) survivals continue to improve. This improvement reflects the engagement of the whole multidisciplinary team including surgery, radiation oncology, and pathology. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.