Hydatid cyst caused by Echinococcus granulosus demonstrates an endemic infection in several countries such as Middle Eastern countries. Liver is the most frequently involved organ, followed by the lung. The case we present is solitary primary localization of cyst in abdominal wall which is extremely rare. A 57-year-old woman presented with an abdominal wall lesion in umbilical area that had been evolving for about 2 years with recent complaint of pain and discomfort. We detected a midline abdominal mass 12⁎13 centimeters in diameter which was bulged out in umbilicus. Preoperative clinical diagnosis of incarcerated umbilical hernia was made due to its physical examination while surgical exploration disproved the primary diagnosis and we found cystic mass adherent to superficial fascia without any communication to peritoneal space. The cyst was excised completely without any injury or perforation of containing capsule. The diagnosis of hydatid cyst was confirmed by histopathological examination of specimen. The retrograde evaluation showed no involvement of other organs. The patient was followed for two years and no recurrence of hydatid disease has been observed. Hydatid cyst should be considered as a differential diagnosis of abdominal wall and umbilical lesions especially in endemic regions.

Introduction: Congenital diaphragmatic hernia (CDH) is a congenital malformation with challenging management. The aim of this study was to evaluate the effect of the presence of hernia sac and defect size on the prognosis of CDH in Tabriz children’s hospital. Methods: In this prospective study, all the infants with the diagnosis of CDH that were admitted to the Tabriz children’s hospital since 2016-2019 were enrolled. The presence or absence of a hernia sac was evaluated, and the largest diameter on diaphragmatic defect was measured before the repair. Postoperative outcomes, including instability, duration of mechanical ventilation, mortality rate, or hospital discharge were obtained and analyzed. Results: Over the study period, 30 patients with CDH met the inclusion criteria, consisting of 15 males and 15 females. Fifteen cases were diagnosed during the first 24 hours of life and 16 cases experienced hypoxia in the first hour after birth. Defect size was significantly smaller in survived patients (P=0.041). Postoperative death occurred in 9 (42.85%) patients without a hernia sac. Results showed that none of the cases with hernia sac expired (P=0.035). Conclusion: In our study, the presence of the hernia sac was related to a lower postoperative mortality rate. Defect size in survived group was also smaller. It can be suggested that the presence of hernia sac and lower diameter of defect size act as good prognostic factors in the outcome of patients with CDH.

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Objective: Intussusception is a common condition involving infants and toddlers in which non-operative management plays an important role. The aim of this study was to present our 20 years of experience of saline enema reduction with ultrasound guide in management of intussusception. Methods: A 20-year retrospective study was performed from January 1999 to December 2018 in Iran, Tabriz Pediatric Hospital. Candidates for inclusion in the study were children from 0 to 14 years old who were diagnosed with intussusception. Treatment option (surgical or saline enema reduction) was recorded along with primary and total success rate of saline enema reduction, early recurrence rate, surgery details and lead points. Results: A total of 1376 patients with intussusception were studied. 112 patients experienced spontaneous reduction, and 1131 patients underwent ultrasonographic guided saline enema reduction. The primary attempt was successful in 76.8% of the patients (874 cases); however, in 8.4% of the patients (74 cases) recurrence was recorded during 48 hours after reduction. 264 patients were referred for second and or third reductions. The overall success rate of enema reduction was 79.9%. The mean age of the children with successful reduction was lower than the failed group (1.27±1.27 versus 1.63±1.05 years old; p=0.001). The success rate was significantly lower in patients with signs of currant jelly stool and palpable mass (p<0.001). 364 patients (26.5%) underwent surgery treatment. Leading points were recognized in 64 patients, and Meckel's diverticulum (63.24%) was the most common pathologic leading point. Conclusion:Ultrasound-guided saline enema reduction is a feasible method and is suggested as an efficient and safe method for non-operative management of intussusception. Its success rate is high and could be increased further by proper case selection and repeated reduction attempts even in recurrent cases.