Epididymal cysts (ECs) are relatively common in adults, rare in children. Normally their treatment is conservative. They may be situated anywhere in the organ, frequently in the region of the head. Torsion of these cysts is extremely rare in both children and adults, causing acute scrotal swelling. The diagnosis is intraoperative. A 16-year-old boy was referred to our Divisional Clinic by the treating physician for scrotal swelling appeared 4 months earlier.Absence of a history of minor scrotal trauma. Ultrasonography showed a 40×50 mm fluid-filled right para-testicular mass. We performed surgery finding a large black cyst connected to the head of the epididymis with 720°-degrees rotation. Histology revealed an acquired EC. The particularity of our case is due to the absence of symptoms in association with a big EC twisted of 720° degrees. This is the only case reported in literature. All patients with EC torsion reported presented symptoms related to acute scrotum. IntroductionEpididymal cysts (ECs) is a benign mass that usually develop in adult men, but it is rare in children, with a prevalence of 5-20% according to varying series reported in the literature. 1 They present as single or multiple, uni-or bi-lateral spherical cysts localized most frequently in the head of the epididymis. Although the cause of EC and spermatocele is often unknown, it may be caused by epididymal ducts obstruction. They are usually of lymphatic origin. When small, ECs remain undetected and can be found in approximately 30% of asymptomatic patients having scrotal ultrasound for other reasons. On the contrary to adolescent in adults most of these cysts are spermatocele. 2 With a certain diagnosis (ultrasound), their treatment is conservative under elective condition. Rarely, as result of trauma or torsion of these cysts, exploration of the scrotum is required to rule out other pathologies such as testicular torsion. An EC torsion is extremely rare especially in young boys and to the best of our knowledge only 6 cases have been reported in literature. 3 Case ReportThe treating physician has referred a 16-year-old boy to our Service for right scrotal swelling appeared 4 months before. The patient reported the absence of a history of minor scrotal trauma. He had no fever or urinary symptoms. Physical examination demonstrated left scrotal region and left testis normal. On the right side, tenderness and swelling of the right hemiscrotum; the testis was appreciated of regular consistency, with vague margins, located on the inferior-posterior area. Superiorly was appreciated an elastic area as loculated hydrocele. No pain on palpation. At the lower pole of the testis was appreciable a hard consistency area, 1 cm in length, painless. Abdominal examination was unremarkable. The inguinal canal was not engaged. Routine hematology, serum biochemistry, and urine analysis were normal. Color-Doppler-Ultrasonography showed both testes with normal parenchymal architecture and echogenicity with no perfusion defect as the left epididymis. On the...
Objective. Duodenal atresia (DA) routinely has been corrected by laparotomy and duodenoduodenostomy with excellent long-term results. We revisited the patients with DA treated in the last 12 years (2004–2016) comparing the open and the minimally invasive surgical (MIS) approach. Methods. We divided our cohort of patients into two groups. Group 1 included 10 patients with CDO (2004–09) treated with open procedure: 5, DA; 3, duodenal web; 2, extrinsic obstruction. Three presented with Down's syndrome while 3 presented with concomitant malformations. Group 2 included 8 patients (2009–16): 1, web; 5, DA; 2, extrinsic obstruction. Seven were treated by MIS; 1 was treated by Endoscopy. Three presented with Down's syndrome; 3 presented with concomitant malformations. Results. Average operating time was 120 minutes in Group 1 and 190 minutes in Group 2. In MIS Group the visualization was excellent. We recorded no intraoperative complications, conversions, or anastomotic leakage. Feedings started on 3–7 postoperative days. Follow-up showed no evidence of stricture or obstruction. In Group 1 feedings started within 10–22 days and we have 1 postoperative obstruction. Conclusions. Laparoscopic repair of DA is one of the most challenging procedures among pediatric laparoscopic procedures. These patients had a shorter length of hospitalization and more rapid advancement to full feeding compared to patients undergoing the open approach. Laparoscopic repair of DA could be the preferred technique, safe, and efficacious, in the hands of experienced surgeons.
Unfortunately, oophorectomy and open technique are still widely adopted even if not advised. Recurrence is not rare and the risk is greater in patients without ovarian masses. OPY does not adversely affect ultrasonographic results at 1 year. When possible OPY should be performed at the first episode of OT.
Infantile Hemangiomas (IH) are the most common benign tumor of infancy, occurring in over 10% of newborns. The head and neck is the most frequently affected area (60%), and the scalp is a typical site for such large lesions. Scalp-IHs are usually focal lesions that can be both disfiguring and may lead to complications such as ulceration and bleeding. We describe a case of a 30-months old female who presented a large scalp-IH at birth that rapidly grew in the first year of life. Topical and systemic treatments (with timolol ointment and oral propranolol, respectively) were not effective in reducing dimensions of the hemangioma. After vascular imaging study, the patient underwent surgical resection of the IH and primary closure with excellent cosmetic outcome. When medical therapy is ineffective or cosmetic and functional integrity is threatened, early surgery allows to completely removing large scalp-IHs, with good cosmetic results.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.