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Torsion of the hydatid of Morgagni is a rare condition which can cause acute abdominal pain in young female. We present a case report of a 13-year-old girl with acute abdominal pain and treated for torsion of the hydatid of Morgagni. Less than 20 cases of female younger than 18 years old with this condition are been described in the literature. Through our systematic review performed following the PRISMA statement, we want to emphasize the difficulty in diagnosis and the importance of considering this pathology in the differential diagnosis of acute abdomen in females with the aim of obtaining a timely surgical treatment to preserve fertility in these patients.

Introduction: Congenital pouch colon (CPC) is a rare intestinal anomaly usually associated with an anorectal malformation (ARM). Because of its low incidence, there are no guidelines on the correct treatment. We report the step-by-step management and challenging surgery of a newborn with CPC and cloaca to ensure the patient's best quality of life possible. Case presentation: We describe a case of type II CPC associated with a complex cloaca with a retro-vesical didelphus uterus in a 1530g preterm syndromic female. A preoperative cystoscopy identified a urogenital sinus with an anterior bladder and a posterior vagina. The abdominal exploration done on day 1 showed a dilated CPC with the cecum ending in a large structure extending toward the bladder, and a proximal diverting ileostomy was created. Eight months later, the CPC was mobilized, and the common wall of the bladder and the pouch colon was excised. The 8-cm colonic pouch was tabularized by a triangle resection resulting in a colonic tube used to create a colostomy. Because of the syndromic nature of the patient, the consensus has been not to proceed with the urogenital reconstruction and the ileo-anal pull-through. Conclusion: CPC malformations should be suspected in the case of a single perineal orifice. There is no consensus about the best surgical approach to CPC. The operative reconstruction must be tailored to each patient in order to ensure the best possible quality of life.

All allergic responses to food indicate the failure of immunological tolerance, but it is unclear why cow’s milk and egg (CME) allergies resolve more readily than reactivity to peanuts (PN). We sought to identify differences between PN and CME allergies through constitutive immune status and responses to cognate and non-cognate food antigens. Children with confirmed allergy to CME (n = 6) and PN (n = 18) and non-allergic (NA) (n = 8) controls were studied. Constitutive secretion of cytokines was tested in plasma and unstimulated mononuclear cell (PBMNC) cultures. Blood dendritic cell (DC) subsets were analyzed alongside changes in phenotypes and soluble molecules in allergen-stimulated MNC cultures with or without cytokine neutralization. We observed that in allergic children, constitutively high plasma levels IL-1β, IL-2, IL-4, IL-5 and IL-10 but less IL-12p70 than in non-allergic children was accompanied by the spontaneous secretion of sCD23, IL-1β, IL-2, IL-4, IL-5, IL-10, IL-12p70, IFN-γ and TNF-α in MNC cultures. Furthermore, blood DC subset counts differed in food allergy. Antigen-presenting cell phenotypic abnormalities were accompanied by higher B and T cell percentages with more Bcl-2 within CD69+ subsets. Cells were generally refractory to antigenic stimulation in vitro, but IL-4 neutralization led to CD152 downregulation by CD4+ T cells from PN allergic children responding to PN allergens. Canonical discriminant analyses segregated non-allergic and allergic children by their cytokine secretion patterns, revealing differences and areas of overlap between PN and CME allergies. Despite an absence of recent allergen exposure, indication of in vivo activation, in vitro responses independent of challenging antigen and the presence of unusual costimulatory molecules suggest dysregulated immunity in food allergy. Most importantly, higher Bcl-2 content within key effector cells implies survival advantage with the potential to mount abnormal responses that may give rise to the manifestations of allergy. Here, we put forward the hypothesis that the lack of apoptosis of key immune cell types might be central to the development of food allergic reactions.

Abstract Background The minimally invasive surgery (MIS) in term of robot-assisted surgery changed in a dramatic way the surgical approach either in adults or children. For many specialties (urology, gynecology, general surgery) robotic surgery rapidly became the gold standard for some procedures, while the experience in pediatric population is not wide for some reasons. The aim of this study is to retrospective analyze trends of application of robotic surgery in pediatric patients across the country, focusing on indications, limitations, development, and training acquired by national experience and in comparison to the literature. Methods We made a retrospective multicenter study on behalf of Italian Society of Pediatric Surgery. We performed a census among all pediatric surgery units in the country to enroll those performing robotic surgery on children between 2013 and 2019. Results We enrolled 7 pediatric surgery referral Centers (Ancona, Bologna, Brescia, Genova, Pavia, Pescara, Siena). A total of 303 patients were included in the study, 164 males (54%) and 139 females (46%). The most commonly performed interventions for each anatomic area were respectively atypical pulmonary resection (38%), pyeloplasty (49%), and fundoplication (30%). Conclusions Since its first application in Italy, about 10 years ago, several considerations were made about application and feasibility of robotics in children.

Background:The coronavirus disease 2019 (COVID-19) time exacerbated some of the conditions already considered critical in pediatric health assistance before the pandemic. A new form of pediatric social abandonment has arisen leading to diagnostic delays in surgical disorders and a lack of support for the chronic ones. Health services were interrupted and ministerial appointments for pediatric surgical healthcare reprogramming were postponed. As a result, any determination to regulate the term “pediatric” specificity was lost. The aim is, while facing the critical issues exacerbated by the COVID-19 pandemic, to rebuild future perspectives of pediatric surgical care in Italy.MethodsEach Pediatric Society, including the Italian Society of Pediatric Surgery (SICP), was asked by the Italian Federation of Pediatric Associations and Scientific Societies to fill a questionnaire, including the following the main issues: evaluation of pre-pandemic criticalities, pediatric care during the pandemic and recovery, and current criticalities. The future care model of our specialty was analyzed in the second part of the questionnaire.ResultsChildren are seriously penalized both for surgical treatment as well as for the diagnostic component. In most centers, the pediatric surgical teams have been integrated with the adult ones and the specificity of training the pediatric operating nursing is in danger of survival. “Emotional” management of the child is not considered by the general management and the child has become again an adults patient of reduced size.ConclusionA new functional pediatric surgical model needs to be established in general hospitals, including activities for day surgery and outpatient surgery. To support the care of the fragile child, a national health plan for the pediatric surgery is required.

Lichen Sclerosus (LS) is a chronic inflammatory skin disease with unknown etiology. In pediatric age the main disease “lichenlinked” is the phimosis in male. This is a retrospective study that reports the experience of our clinic and review of the literature. We included all patients affected by pathological phimosis, treated by circumcision between January 2015 and May 2020, older than 6 years old and with an histopathological diagnosis of lichen sclerosus. The aim was to identify prognostic factors based on histological report to plan the clinical management of patients. Statistical analysis was done. We included 207 patients. The mean age of children was 9,78 years (5-18 years, DS±3.29). Based on the histological features we divided patients in 2 groups: early lesions (70/207, 34%) and advanced (137/207, 66%). In term of complications lichen linked we considered meatal stenosis that needed of urethral dilatations. We included 7 patients (7/207, 3,4%). We report P value Statistical Significance in many aspects. An early diagnosis of LS and surgical treatment of foreskin are essential to prevent early and late complications in children. The size of sample is a limit of the study but results encourage our management.

Rotavirus infections in neonates are often asymptomatic, but they can become complicated, up to Necrotizing Enterocolitis.Aim of the study is to resume the history of a rare case of NEC due to Rotavirus infection comparing clinical features, lab tests and development of Rotavirus-NEC to bacterial-NEC in order to identify the correct management and the best therapeutical strategy for this group of patients.Our case report described the complicated story of a preterm female affected by Rotavirus-NEC who underwent surgery three times, but at least with good outcome.Different risks factors predispose to NEC due to Rotavirus such as prematurity, seasonality and formula feeding. Associated symptoms are abdominal distention, tenderness, bloody stools and fever. Development of NEC in newborns affected by Rotavirus is pathognomonic: only a very small percentage of newborns affected by Rotavirus infections develop NEC, but all of them need surgery which is resolutive most of time. The average hospital stay of surgical newborns affected by Rotavirus infection was longer than that of newborns surgically treated for bacterial gastrointestinal infections.Prevention of Rotavirus infections may be important to decrease the incidence of NEC, the morbidity and the mortality rate in neonatal period.

We present a very rare case of gastric duplication treated with complete excision with two surgical procedures. We decided to report our case to share our experience that confirm the difficult of preoperative/intraoperative diagnosis of gastric duplication in a pediatric patient. Finally we reviewed the literature to date.

Lymphangioma accounts for 5% of benign pediatric tumors and less than 1% is located in the abdomen. Indeed mesenteric cystic lymphangioma is a rare benign abdominal mass and its pathogenesis is still unknown.Mesenteric cystic lymphangioma is often diagnosed incidentally. Nevertheless, in some cases its clinical presentation can mimic several common surgical pathologies. Here we describe a case of mesenteric cystic lymphangioma mimicking an ileo-colic intussusception.

Background: Congenital pouch colon (CPC) is an unusual malformation associated with anorectal malformations (ARMs) that are seen especially in Asia. The aim of this study was to analyse our series of CPC associated with ARM in our centre and report our experience based on the rarity of pathology. Materials and Methods: This is a retrospective study conducted at the Department of Paediatric Surgery in North Iraq. We identified patients from a prospectively kept database, including all patients managed between 1997 and 2014. Results: In total, 17 patients (3 females and 14 males) were included; all had CPC and high ARM; male:female ratio was 5.6:1. Two females had colo-vestibular fistula, 1 had a colo-cloacal fistula, all males had imperforate anus with colovesical fistula. Pre-operative diagnosis of CPC was made in eight patients (47%). Four patients (23.5%) had an incomplete pouch colon (Type III and IV), and 13 (76%) had complete pouch colon (Type I and II). All patients were managed with staged surgery. Mortality rate was 17.6% (3/17). Conclusions: CPC associated with ARM can be defined as 'Asian' complex malformation. Few cases are reported in Literature from Europe and USA. However, it is known that it is ever more frequent the collaboration between Asian and European surgeons (as in our study), so the suspicion should be considered in all patient high ARM who come from Asian region. We reviewed literature and report our experience of 15 years, after a retrospectively analysis, to share it and add our data to their reported.

Traumatic herniation of buccal fat pad (BFP) is very rare, usually seen in young children, from 5 months to 12 years of age. A minor injury or perforation of the buccinator muscle and buccal mucosa can cause the extrusion of the buccal fat pad into the oral cavity. A differential diagnosis is very important but a history of trauma, an absence of masses before the accident, anatomical site and fatty appearance should suggest the correct diagnosis. The treatment options are usually excision or repositioning of the herniated fat. For the present case report, a 7 month-old boy, diagnosed with traumatic buccal fat pad herniation, was successfully treated with surgical excision. Keywords: Buccal fat pad, Herniation, Children, Trauma

Background: Ewing Sarcoma (ES) and Neuroblastoma (NB) belong to a family of tumours of primitive neuroectodermal origin (PNET) that occurs in both bone and soft tissue. Notwithstanding ES and NB are two distinct malignant tumours, sometimes there could be a link between them. Case report: We describe a case of an extraosseous ES localized in the retrosternal region and the upper lobe of the right lung, which had been previously treated for NB in a 6 years old female. We treated this case with a clamshell approach which allows, in a one-step surgery, a complete excision of the mass reconstructing the hemysternectomy with a non-crosslinked matrix. Conclusion: the clamshell approach is therefore useful to achieve the retrosternal space and the lung with a single surgical access. According to our experience, we consider appropriate to use a non-crosslinked matrix for sternal reconstruction.

An association between malrotation and congenital duodenal webbing is rare. We present our experience with four patients at two centers, and a review of published reports. There are currently 94 reported cases of duodenal pathology associated with malrotation. However, only 15 of the 94 cases (15.9%) include patients with malrotation and a duodenal web. We suggest that nonbilious vomiting in a child must prompt the surgeon to consider duodenal pathology even in the presence of malrotation.

Multiseptate gallbladder (MSG) is a rare congenital anomaly. MSG may be accompanied with other abnormalities of the biliary tree. MSG can be asymptomatic and most cases are detected incidentally. Nevertheless, some patients present with biliary pain or colicky abdominal pain due to biliary stasis and calculi. We report a case of MSG in a girl who presented with recurrent abdominal pain and normal laboratory work-up recovered after laparoscopic cholecystectomy. A pediatric literature review of this rare anomaly is also performed. Keywords: Multiseptate gallbladder, Laparoscopic surgery, Children

Torsion of an epididymal cyst is an extremely rare cause of acute scrotum in children and in young boys. Its reported incidence is 5-20%. The treatment is usually conservative. Many cases (up to 60%) regress spontaneously, especially if below 3 cm. Few cases have been reported in Literature (7 cases/2018). We add our patient as eighth case. He was a 13-year-old boy who was admitted for acute scrotum. Ultrasound excluded torsion of the testis and he was managed for 5 day conservatively. Based on clinical history and physical exam, we decided to perform a prompt surgery that revealed a torsion of epididymal cyst that was confirmed by histological exam.

Achalasia is a rare neuromuscular esophageal disorder in children. There are many surgical options to treatment including botulinum toxin (Botox) injections, oral pharmacologic therapies with nitrates and calcium channel blockers, pneumatic dilation (PD), and surgical myotomy (open surgery, endoscopy, laparoscopy and recently robotic approach). In pediatric age, usually, Heller's myotomy is the main choice. Laparoscopic approach is known and standardized. Few robotic have been published. We decided to report our first case to share our experience with scientific community. Keywords: Achalasia, Child, Dysphagia, Myotomy, Robotic surgery

Persistent pulmonary interstitial emphysema (PPIE) is a rare condition that occurs in both preterm and term infants. It is thought to arise from a disruption of the basement membrane of the alveolar wall allowing air entry into the interstitial space. The characteristic CT scan appearance of PPIE can be used to differentiate it from other congenital cystic lesions that may present similarly. The management of infants suffering from diffuse persistent interstitial pulmonary emphysema varies according to severity and stability of the patient, being either conservative treatment or aggressive surgical treatment by pneumonectomy. We report a case of an unstable patient with diffuse persistent interstitial pulmonary emphysema successfully treated by lobectomy as a form of conservative surgical approach.

More than 50% of infants with esophageal atresia have associated anomalies. We present a case report of a 46XX neonate with long-gap esophageal atresia and tracheoesophageal fistula (EA/TEF), anorectal malformation, bowel duplication and vaginal agenesis. This is an unusual association of abnormalities which had not yet described in literature.

Background: The varicocele is the most commonly diagnosed pre-pubertal andrological condition with an incidence of 10%-15% between adolescents. The aim of this study was to evaluate the efficacy of retroperitoneoscopic varicocelectomy (RV) in two Italian centres with particular attention to post-operative testicular volume and semen analysis after 18 years of life.Materials and Methods: From 1999 to 2010, 286 adolescents underwent retroperitoneoscopic left varicocelectomy. Of these patients, 67 were evaluated by clinical examination, ultrasound and semen analysis, allowing an adequate long-term follow-up.Results: Surgery was performed at a mean age of 13 years (range 10-17) without intraoperative complications. There were two recurrences (3%), two left testis hypotrophy (3%) and four hydroceles (6%), not yet undergone surgery because asymptomatic or without tension. Currently, 44 patients accepted to perform semen analysis which showed a reduction in sperm motility in 12 cases, with associated morphological alterations in 3 and reducing number of spermatozoa in one case.Conclusions: In consideration of morphological and biomolecular spermatic alterations reported in adolescent varicocele that could interfere with cellular migration, differentiation and nutrition, it is fundamental to consider the correction of varicocele, not only for the classical indications, but also as a choice for arresting the progressive damage that inevitably acts for several years on the adolescent testis. The RV in adolescents is a safe and feasible procedure for experienced paediatric laparoscopic surgeons with early good clinical outcomes, but more studies occur to understand the real impact of adolescent varicocelectomy on testicular function. [ABSTRACT FROM AUTHOR]