Introduction Treatment of long-gap esophageal atresia (LEA) is a major challenge. Options for reconstruction include native esophagus, or replacement with stomach, colon, or small intestine. However, debate continues regarding the optimal conduit for esophageal replacement. Methods Medical records of patients with a diagnosis of esophageal atresia during a 20-year period were reviewed. Results Twenty-eight cases of LEA were identified. Ten patients underwent primary anastomosis either after serial pouch dilations (9/10) and/or after a lengthening procedure (2/10). Nine received colonic interpositions, and the remainder were reconstructed with a gastric tube (n = 3), or gastric interposition (n = 2). One patient died prior to repair, and two await definitive treatment. Repeat esophageal reconstruction was required in four patients because of conduit ischemia. Two ischemic events occurred in the colonic interposition group, and two in the native esophageal repairs. All patients, except one who relocated, received long-term follow-up (mean 4.2 years: range 0.5-11.5 years). Conclusions Surgeon's expertise and patient's anatomy should be considered when selecting an appropriate operation for LEA. Although native esophagus is generally preferred, it is associated with a high rate of stricture. Although our study has a limited by numbers, we found that patients with gastric conduits had lower complication rates and no conduit ischemia. We suggest that gastric transposition may be favored as an initial reconstructive option.

Enteric duplication cysts are rare congenital malformations that are most commonly diagnosed in children. Enteric duplications associated with the pancreas are especially uncommon, and may present with specific clinical findings such as severe pancreatitis. These cysts often pose unique surgical challenges. In addition, the diagnosis of pancreatic duplication cysts is often difficult, and may be confused with pancreatic pseudocysts or neoplasms. Herein we report two cases of pancreatic duplication cysts, and present a complete tabulation of all case reports of pancreatic-associated duplication cysts reported in the English literature. We conclude that pancreatic duplication cysts are a rare entity, most commonly found to occur in infants and children. We further find that although severe complications may arise as a result of their presentation and treatment, the rate of post-operative complications in patients between 3 and 21 years of age is extremely low, with the highest complication rate occurring in a bimodal distribution (\3-years and [21-years of age). Despite complications in the youngest and older patient populations, surgical excision remains the mainstay of therapy for pancreatic duplication cysts in all age groups.

IntroductionMesenteric lymphatic malformations are rare, benign tumors that are most commonly found in children. The presentation of these tumors is variable and may either be innocuous or life threatening. It has been suggested that mesenteric lymphatic malformations are congenital; however, there is evidence that their growth may be stimulated by local trauma.Case presentationWe describe the first case of a mesenteric lymphatic malformation associated with acute appendicitis in a 13-year-old Caucasian boy. The patient is well six months after surgical excision of the tumor.ConclusionThe reader should be aware that growth and/or development of mesenteric lymphatic malformations may be associated with trauma and other pro-inflammatory processes.

No abstract