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To evaluate the management of children with severe gastrointestinal symptoms during the disease course of COVID-19 and multisystem inflammatory syndrome (MIS-C).After ethical approval, we reviewed the medical records, retrospectively, of children with COVID-19 or MIS-C requiring surgical consultation for severe gastrointestinal symptoms.The subjects comprised 15 children, 13 with MIS-C and 2 with COVID-19. Twelve children (80%) had been in known close contact with a person with SARS-CoV-19 and 13 were positive for Anti-SARS-CoV-2 IgG. All the children had experienced fever for at least 1 day and had signs of involvement of two or more systems. Three patients required surgical intervention: one underwent surgical exploration with a presumptive diagnosis of acute appendicitis in the referring center and was transported to our center following clinical deterioration, where a diagnosis of MIS-C was confirmed; and the remaining two developed appendicitis during hospitalization for COVID-19. All three patients had a longer duration of abdominal pain, a higher number of lymphocytes, and a lower level of inflammatory markers than the non-surgically managed patients. None of the patients presenting with MIS-C underwent surgical exploration.Gastrointestinal involvement may mimic acute abdomen in children with COVID-19. Thus, children presenting with acute abdomen in the pandemic era require careful evaluation and prompt diagnosis to avoid unnecessary surgical intervention.

Urorectal septum malformation sequence (URSM) is a rare congenital anomaly of caudal end of mesoderm. There is usually a single or no opening in the perineum. An infant with dysmorphic facial features, ambiguous genitalia, meningomyelocele, pes equinovarus, left renal agenesis, severe hydronephrosis of the right kidney, and anuria requiring right ureterocutaneostomy during the neonatal period is reported. Initial physical examination revealed fusion of labioscrotal folds forming a single sac without a raphe, and a single gonad on the left side of the sac, less than 1 mm in size. There was no phallus, urethral opening, or any palpable cavernous body. Karyotype analysis from peripheral blood was 46XY. Chromosomal microarray analysis using Agilent 8X60K platform revealed arr [hg19](1-22)x2,(X,Y)x1. DNA sequence analysis for WT1 gene was normal. During inguinal hernia repair, cavernous bodies were detected in the retroperitoneal space under the hernia sac intraoperatively. Penis was reconstructed using two rotational flaps from the midline skin above the pubic bone to cover the cavernous bodies. This report aims to discuss the clinical features as well as surgical options for reconstruction of an abnormally located penis in an infant with partial URSM. Level of evidence: Level V, therapeutic study.

A systematic review of the literature was performed to evaluate the results and outcomes of the thoracoscopic bullae and/bleb excision (TBBE) for the treatment of spontaneous pneumothorax (SP) in children. An electronic search of MEDLINE and PUBMED was performed by using the keywords: thoracoscopy’, ‘spontaneous pneumothorax’, ‘bullae’, ‘bleb’ and ‘children’. The selected articles searched for demographic features, localization of blebs and preoperative computed tomography (CT) findings. The operative time, postoperative outcomes (duration of chest tube and length of hospital stay) and complications (air leak, failure and recurrence) were also recorded. Eighteen studies include 814 cases in which 57% (n = 464) of them associated with bullae/bleb. The mean age of patients was 14.8 years. 82.8% of patients were male. The left side was the most common localization. Bullae/blebs were defined in 31.3% (n = 144) of preoperative CT scans. The mean operative time showed a range of 55–85 min depending on the surgical procedure. Five of the studies reported the duration of postoperative chest tube drainage ranging from 3.3 to 25 days. The mean hospital stay was 4.3–10 days. The complications were bleeding (n = 1), postoperative air leaks (n = 6) and Bernard-Horner Syndrome (n = 1). The recurrence rates were reported in 4–30% of all the TBBE procedures. TBBE is a safe and effective treatment for SP in children. TBBE has several advantages over thoracotomy, including less recurrence and complication rates. The timing of the thoracoscopic excision, the best surgical instruments that would lead to less complications, and optimum treatment of recurrence still need to be addressed.

The antegrade continence enema (ACE) procedures are successful surgical options to achieve bowel cleaning in children with faecal incontinence due to a neuropathy or an anorectal malformation and an intractable constipation. The reversed and orthotopic appendicocecostomy, tubularized ileal conduit and the tubularized cecal flap are frequently applied procedures in the treatment of faecal incontinence (FI). The most common complications are the stoma stenosis, leakage, prolapse, adhesive obstruction and the difficulty in catheterization. Each procedure has its own advantages and disadvantages with different complication rates. The postoperative complications of ACE procedures may reduce patient compliance and quality of life. Most of these complications can be preventable and are easy to manage. This review aimed to discuss the prevention and management strategies for various ACE procedure complications.

Chest wall tumors (CWT) are rarely seen in childhood and surgery constitutes a complementary part of the therapy. The early and late results of CWT resection and chest wall reconstruction were evaluated retrospectively. The children who underwent chest wall resection for CWT between January 1990 and November 2003 were evaluated retrospectively. Seventeen children (male/female = 12/5, mean age: 7.58 years) underwent chest wall resection for CWT. Fifteen patients underwent initial biopsy (tru-cut, n = 8 or open biopsy, n = 7) and two underwent initial resection. The diagnosis was malignant tumor in 12 (70%) and benign in 5 (30%). They were Ewing's sarcoma (ES) (n = 4), primitive neuroectodermal tumor (PNET) (n = 3), Askin's tumor (n = 1), rhabdomyosarcoma (RMS) (n = 2), neuroblastoma (n = 2), osteochondroma (n = 1), aneurysmal bone cyst (n = 2) and hamartoma (n = 2). Preoperative chemotherapy was given to most patients with malignant tumor. All patients had only local tumor at the time of resection. Thoracotomy was performed in all patients. All tumor tissues with the affected rib/ribs were resected en bloc with the adjacent tissues. The number of resected ribs was 1 (n = 6), 2 (n = 7) and 3 (n = 4). Chest wall defects were repaired primarily (n = 8) or with grafts (n = 9). Dura (n = 4), Neuro-patch (n = 3) and Goretex (n = 2) were used for closure. Wound infection and pleural fistula occurred in one patient. Patients with benign tumor were free of complaints or complications during follow up. All patients with malignant tumor received postoperative chemotherapy. Local recurrence did not occur in all patients. Five patients developed distant metastasis and two died. Scoliosis was encountered in one patient during follow-up. Since most of the CWT are malignant and not initially suitable for surgical excision, the management includes tissue diagnosis either by tru-cut or open biopsy. Determination of malignant condition should be followed by an intensive chemotherapy. Chest wall resection is planned to control local disease. Chest wall reconstruction may be needed for large defects following resection of CWT. Prosthetic materials can be used safely. Early complications of the surgery are limited. The patients should be closely followed up for late complications such as scoliosis, restrictive pulmonary disease and for the development of metastasis, which is a part of natural course of malignant CWT in children.

An aneurysmal bone cyst (ABC) is a benign tumor of the skeletal system, which is rare in childhood and mostly occurs in long bones. An aneurysmal bone cyst of the rib is also very rare and it is difficult to distinguish from other rib tumors of childhood, especially Ewing's sarcoma. An unusual case of an aneurysmal bone cyst in the rib of a 12-year-old boy is presented herein. The entity is discussed with special emphasis on the clinicopathologic features, differential diagnosis, and treatment. The most important diagnostic aid in accurately identifying such cysts is to be aware of such a possible diagnosis when a child presents with a rib mass. An en bloc resection of the mass along with the affected portion of the rib is mandatory to obtain a satisfactory outcome.

Multiple failed hypospadias reconstructions may cause minimal residual skin, as a result of extensive scarring. However, extragenital full thickness skin grafts or mucosal grafts are often used for urethral substitutions; local tissue expansion can provide additional matched skin, which can be easily harvested and used for penile constructions. Though tissue expanders were used as the choice of treatment in children with multiple failed hypospadias repairs, the use of tissue expander in the management of staged proximal hypospadais repair has not been reported previously. A 3-year-old boy with proximal hypospadias is presented to discuss the use of tissue expansion in the management of staged proximal hypospadias repair. © 2010 Springer-Verlag.