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Wandering spleen in a child presenting as intermittent by abdominal mass is presented. Torsion of the spleen is rare, and the methods used to diagnose and treat this pathology are discussed. The diagnosis can be suspected preoperatively by the radioisotope scanning of the spleen.

Two children in whom the diagnosis of intramural duodenal hematoma was made have been treated. One patient had the hematoma evacuated at surgery and one was successfully managed with nasogastric suction and parenteral fluid administration. The non operative treatment for intramural duodenal hematoma is recommended after perforation of the duodenum (type IIB, III, IV) or other associated injuries requiring laparotomy have been satisfactorily excluded.

Cervical tumors of thymic origin are exceptional and can be either cystic or solid. The embryogenesis of the thymic gland explains the cervical location of these tumors. The authors present two cases in which the clinical picture was limited to cervical masses with very few symptoms. Treatment consisted of surgical removal. Subsequent course was uneventful without any immunological deficit or myasthenia.

The authors report a study on 148 female children demonstrating clinical evidence for inguinal hernias. The diagnosis was evaluated using Ducharme-Bensoussan's procedure for herniography hernia was documented in 143 cases, so which 44% revealed genital tract content. Eight cases produces unrelated pathological findings, especially crural hernia, nephro-uropathy diaphragmatic hernia. However, the main interest of the procedure is in evaluating the controlateral inguinal canal. Whereas three infants presented with bilateral symptoms, bilateral hernia was proven in 66 cases (46,2%) by herniography. In this way, the procedure is a sure way to ensure that hernia is really unilateral and to prevent any controlateral recur in the coming months.

Vegetal foreign bodies in the limbs cannot be demonstrated by X-ray examination and may lead to erroneous diagnosis. The answer should be given by surgical exploration, however, and this is particularly true for mobile foreign bodies in the joint, a high degree of suspicion is necessary at surgery. Three observations are presented in this paper which emphasize practical recommendations to perform without delay the simple efficient surgical procedure consisting in removal of the foreign body.

Since December 1987, the chirurgical pediatric team in Clermond-Ferrand performs total colonic electromyography in children. This examination is integrated into a diagnostic and therapeutic protocol for chronic constipation. We used an intraluminal probe supporting 10 groups of 3 ring electrodes. Inside the probe a lead pellet was placed opposite each electrode. The probe was inserted through the colon by colonoscopy into a starving child. The recording starts 24 hours later and is registered for 3 hours before and 3 hours after a meal. The aim of this work is to report the preliminary results of 6 electromyography in constipated children.

Six cases of acute gastric dilatation in children are reported. Clinical features of the syndrome are gastric distension, respiratory failure, dehydration and electrolyte disturbances. This potentially lethal pathology is well controlled by elementary therapeutics : gastric fluid suction and rehydration with electrolyte supplementation. Autonomic nervous system seems directly involved in the occurrence of these troubles, but pathophysiology remains unclear. In this way, one should carefully discuss the diagnosis with the aim of precisely discarding any underlying pathology (as in our case n. 6).

The authors present their experience with benign ovarian cysts based upon a series of 22 cases. Occurrence age displayed 2 peaks neonatal and para-pubertal. Ultrasound and coelioscopic examination would help in the management of such functional cysts where spontaneous regression must be weighted with potential complications.

The authors report on the asymptomatic case of a child with intra cardiac needle, which was discovered after systematic pre operative X Ray chest film. Surgical removal of this foreign body could be performed before any of its possibly lethal complications (50%).

Since 1983, the authors have performed a surgical ligation of the splenic artery in 7 patients suffering hypersplenism due to hematological diseases (4 Minkowski-Chauffard, 2 Betathalassemia Major, 1 Idiopathic Thrombocytopenic purpura). The immediate post operative course and long-term outcome of the patients were evaluated on clinical and biological grounds. The early post operative period was not influenced by the underlying hematological disorder. In all patients the hemoglobin, erythrocyte and platelet counts significantly increased and were related to functional hyposplenism. Delayed outcome depended on the underlying disease. Patients with Betathalassemia returned to preoperative status within months; thus, the only advantage of the arterial ligation was to transiently decrease the requirements in blood transfusion. Two patients with Minkowski-Chauffard disease did not present further episodes of acute hemolysis and did not required additional blood transfusion. On the other hand, the other two patients with Minkowski-Chauffard disease progressively returned to preoperative status, including severe episodes of hemolysis, and required a splenectomy be performed. Since the arterial supply to the spleen remains inchanged after the operation, it may be expected that the results (i.e. long-duration hyposplenism) could be improved by performing extensively devascularization of the spleen to complete the ligation of the splenic artery.