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Polyorchidism, or supernumerary testis, is a rare urogenital congenital disorder. Because of its rarity, there is no approved standard treatment protocol for preserving or removing the extra testicle, yet orchiopexy is frequently performed as a preferred treatment in most medical facilities. We present a 23-year-old single male with a bilaterally empty scrotum. He was unaware of his condition and had not seen a doctor before being admitted to our surgical unit. During his younger sibling's circumcision by a local circumcisionist (a medical staff member, idealy a nurse, whose duty is to perform circumcision, preferably at home), he saw something different (his emptey scrotum) and came to us with his problem. Laboratory findings revealed severe oligospermia, and tumor markers (Alpha fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase) were negative for malignancy. The patient underwent bilateral herniorrhaphy and orchiopexy of all six testicles (three in each inguinal canal) and had an uneventful recovery. As polyorchidism is not a common problem, its management remains a contentious issue due to the lack of evidence-based consensus. However, with the introduction of new imaging modalities and on-table frozen section biopsy, the decision to continue with orchiopexy or orchiectomy can be easily justified; however, conservative treatment is preferable in cases of no coexisting anomalies, particularly cryptorchidism. Polyorchidism could run unnoticed for years, especially if there is no direct and consistent access to a medical facility. In cases where polyorchidism is detected accidentally by imaging or during surgical exploration, the treatment must be justified accordingly. • Supernumerary testis, or polyorchidism, is a rare urogenital anomaly. • Three to four testicles are often found, but the presence of six testicles is extremely rare. • Malignancy and cryptorchidism are considered risk factors. • The coexistence of conditions such as cryptorchidism and malignancy with polyorchidism necessitates surgical exploration; otherwise, conservative treatment with regular follow-up is recommended. [ABSTRACT FROM AUTHOR]

Mesenteric cysts are uncommon intra-abdominal benign masses that appear in childhood with varying degrees of clinical manifestations, ranging from being asymptomatic to presenting as an acute abdomen. The diagnosis is made incidentally during the work-up for other abdominal pathologies such as acute appendicitis, bowel obstruction, etc. The treatment is mostly surgical and varies depending on the clinical type of the lesion. A 26-month-old child was referred to our teaching hospital's pediatric surgery department with an abdominal mass. The patient had previously complained of constipation and been treated symptomatically with laxatives. Ultrasonography reported ovarian cysts confirmed by computerized tomography scanning (as a misdiagnosis report of an ovarian cyst instead of a mesenteric cyst), done outside the hospital in a private diagnostic center. The patient was prepared for operation and during the surgical procedure, she was found to have a duplex cyst, which was mostly incorporated in the mesentery of the distal 1/3 of the transverse mesocolon. The cyst was enucleated through a lower midline laparotomy incision without bowel resection and anastomosis. The histopathological analysis of the specimen confirmed a mesenteric cyst. Mesenteric cysts are rare lesions in children and should be considered when approaching any intra-abdominal mass. Except for the rare cases where intestinal resection and/or partial cyst excision are required, all mesenteric cysts can be excised while preserving intestinal integrity and vascular supply. • Mesenteric cyst is a rare intra-abdominal condition in children. • The common location is the small bowel mesentery, but it may occur anywhere from the duodenum to the rectum. • The condition is asymptomatic, but sometimes it is accompanied by gastrointestinal signs and symptoms, therefore, mesenteric cysts should always be considered in the differential diagnosis of acute abdomen in children. • Complete enucleation of the cyst with or without bowel resection and anastomosis is the treatment of choice. [ABSTRACT FROM AUTHOR]

Duplex collecting system is a urinary tract defect that represents a condition where upper and lower pole moieties fuse incompletely. Duplication could be complete or partial (Y-shaped ureter). We report two cases (complicated and uncomplicated) of unilateral duplicated collecting system with a Y-shaped ureter. The first (complicated) case was diagnosed as having kidney stone and treated surgically. The second (uncomplicated) case was diagnosed incidentally during a routine check-up. As there were no other associated urinary tract anomalies, our team advised the patient's parents to seek regular follow-up by a pediatric surgeon (for the development of possible urinary tract infection and calculus which are more prevalent in low-resource settings). Both patients were followed-up for six months in satisfactory condition. [ABSTRACT FROM AUTHOR]

Polyorchidism is a rare birth defect of the male genital system characterized by the presence of extra testis on one or both sides. To date, more than a hundred cases have been reported in the literature. The problem is asymptomatic and comes across incidentally. The management of polyorchidism is conservative if there are no associated problems, but some authors suggest surgical treatment in individualized patients. We present a case of testicular duplication in a 6-year-old boy who presented with left-side cryptorchidism, confirmed by ultrasonography (US). We performed orchiopexy for both testes on the ipsilateral side, and the operation ended uneventfully. [ABSTRACT FROM AUTHOR]

Esophageal achalasia is a motility disorder of the esophagus with unknown etiology characterized by the failure of lower esophageal sphincter relaxation. Diagnosis is made by barium esophagography, endoscopy, and esophageal manometery. Heller Esophagomyotomy along with Dor's fundoplication is the treatment of choice. Persisting undiagnosed cases may lead to malnutrition. We present a case of an 8-year-old child suffering from dysphagia and regurgitation. The child was misdiagnosed and maltreated for the suspicion of respiratory tract and gastrointestinal problems in the local clinics. During this time, he remained unresponsive to the mentioned treatments, and the local physician advised him to have an upper gastrointestinal (GI) endoscopy, which revealed esophageal achalasia (EA). On admission to our pediatric surgery ward, the patient had coexistent parotitis, which was treated conservatively. Following recovery, the patient was prepared for surgery and underwent esophageal myotomy along with Dor's fundoplication. Esophageal achalasia is rare in children, but poses major health challenges to children if left untreated. Symptomatic treatment may mask the actual picture of the problem and last for years. Following surgery and discharge from the hospital in a three-month follow-up interval of time, our patient exhibited full recovery, with gaining 4 kg weight. Respiratory and gastrointestinal conditions with similar signs and symptoms should always be considered in differential diagnosis of esophageal achalasia, especially where there is no direct access to a pediatric specialized complex. On-time evaluation and treatment will further prevent children from malnutrition in long-lasting undiagnosed patients. • Esophageal achalasia is a motility disorder with unknown etiology. • Esophageal achalasia is rare in children. • Dysphagia and respiratory infection will mask the actual picture of the problem. • Unprofessional symptomatic treatment for a long time is the main cause of undiagnosed patient and may lead to malnutrition. [ABSTRACT FROM AUTHOR]

Choledochal cyst is an uncommon congenital biliary tract abnormality of unknown etiology. Its classical symptoms are jaundice, abdominal pain, and right upper quadrant mass. However, the disease may present with a vague and non-specific chronic abdominal discomfort. Delay in diagnosis and management may increase the risk of complications particularly the malignancy, which can directly affect the prognosis and outcome. Complete excision of the extra-hepatic duct, cholecystectomy, and Roux-en-Y hepaticojejeunostomy through the open surgical intervention or laparoscopic procedure is the mainstay of treatment. A 14-year-old male was presented to our hospital complaining of vague abdominal pain for 5 years. The radiologic imaging showed the features of a type IVa choledochal cyst. He underwent complete excision of the extra-hepatic duct, cholecystectomy, and Roux-en-Y hepaticojejeunostomy. Although the bile leakage occurred as a complication of the procedure, our team best managed the patient in the post-operative period until full recovery. The Choledochal cyst was first described by Vater, which is a congenital anomaly that sometimes may remain asymptomatic till adulthood. Surgical intervention is the mainstay of treatment. However, postoperative complications including bile leakage need a close follow-up of the patient. Diagnostic delay (antenatal and postnatal) and non-specific symptoms will mask the real feature of the disease, especially in low-resource settings. Technical facilities and professional care of the patient may preclude complications. • The choledochal cyst is an uncommon congenital biliary tract anomaly. • Early diagnosis and management can directly affect the prognosis and outcome. • Low-resource settings and less symptomatic cases may lead to diagnostic delay. • Open surgery or laparoscopic intervention is the mainstay of treatment. [ABSTRACT FROM AUTHOR]

Amyand hernia (AH) is defined as protrusion of appendix or its entrapment within the inguinal hernia sac. It occurs rarely and difficult to diagnose before operation. The cause of amyand hernia is unknown but pressure by the sharp edge of the internal ring may cause pressure necrosis, inflammation and consequently appendicitis. We present a case of 3 years old child with asymptomatic right sided inguinal hernia. On exploration, we found a long appendix (10 cm) with small olive like (1.5 cm) mass at its tip, so we performed appendectomy along with herniotomy. The patient tolerated the operation well and was discharged with satisfactory condition 48 hours post-operation. [ABSTRACT FROM AUTHOR]

Schizencephaly is a rare congenital anomaly of the brain secondary to neuronal migration defect, characterized by slit or cleft in the cerebral hemispheres running from the pia to lateral ventricles. From clinical pint of view most of the patients present with different level of motor and psychological disorders. Imaging (CT-Scan and MRI) plays a key role in the definite diagnosis by which associated central nervous system (CNS) anomalies (absence of septum pellucidum and corpus callosum dysgenesis) could be diagnosed as well. Here, we present a case of 22 months old aphasic child suffering from head enlargement. CT-Scan image revealed unilateral schizencephaly compressing lateral ventricles and causing ventriculomegaly. We applied ventriculoperitoneal shunt (V–P shunt). After one month follow-up and brain repeated CT-Scan image for confirmation, the size of brain ventricles considerably diminished. [ABSTRACT FROM AUTHOR]

Crossed renal ectopia (CRE) is a rare congenital anomaly in which both kidneys reside in one side. It could be detected incidentally or during the late stage when the kidney is functioning poorly or even being non-function. We report a case of 12 years old child with symptoms of right flank pain and dysuria due to urinary tract infection (UTI). We performed routine laboratory tests (blood and urine) along with whole abdominal Ultrasonography (US) and abdomenopelvic CT-Scan. Both kidneys were located in the right side joining in the upper and lower poles with both ureters draining separately in urinary bladder. No any other anomalies related to the kidneys (congenital obstruction and cystic anomalies) and other organ system were detected. We treated UTI appropriately and discharged the patient with advice. [ABSTRACT FROM AUTHOR]

Giant Encephalocele is a rare entity in which the central nervous system structures in any combination protrude through a defect in the skull and the size of the head is smaller than that of the deformity. A few cases are reported globally. It could be existed alone or in combination with other central nervous system (CNS) anomalies. We report a case of 4 months old child with giant encephalocele associated with hand deformity. She underwent excision of the sac and the patient is doing well after 3 months follow up. [ABSTRACT FROM AUTHOR]

Transverse testicular ectopia (TTE) is a rare congenital anomaly where both testicles are migrated in the same hemiscrotum or inguinal canal. The etiology is unknown and it has three types. Embryologically, several theories regarding the origin of TTE have been suggested including adhesion and fusion of developing Wolffian canals, aberrant gubernaculum, testicular adhesions, defective formation of the internal inguinal ring, and traction on the testis by persistent Mullerian structures. To date, more than 100 cases of TTE have been reported in the literatures. TTE with fused vas deferens is extremely rare. We present a case of 3 years old child referred for admission in our teaching hospital with right side inguinal hernia and left side undescended testis. After diagnosis with physical exam and ultrasonography, TTE was diagnosed and the child underwent inguinal herniotomy, ipsilateral orchiopexy and contralateral transseptal orchiopexy. The association of TTE with fused vas deferens is rare and transseptal orchiopexy is the procedure of choice for definite treatment. [ABSTRACT FROM AUTHOR]