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Introduction: Congenital diaphragmatic hernia (CDH) usually presents with respiratory distress at birth, which can be severe enough to cause cardiorespiratory failure. Late presentation of CDH is less common. CDH can be associated with malrotation, which is typically asymptomatic. Case presentation: We describe a case of a 7-year-old child who had non-specific gastrointestinal symptoms and no respiratory symptoms. The patient had been suffering from non-bilious vomiting for a week, had abdominal pain and was dehydrated and malnourished. Breath sounds were diminished and bowel sounds were present in the left hemithorax. A diagnosis of CDH was suggested on a chest x-ray and confirmed by a barium study. On exploration, a small-sized left CDH associated with malrotation and Ladd's bands were discovered. The diaphragmatic defect was closed primarily, and the malrotation corrected with a Ladd's procedure. The post-operative course was uneventful. Conclusion: Patients with non-specific gastrointestinal symptoms and a suspicious chest X-ray should undergo further imaging studies to rule out a CDH. Failure to do so can potentially lead to complications such as bowel obstruction and volvulus. Respiratory symptoms are uncommon in late-presenting CDH.

Hepatoblastoma is the most common malignant neoplasm of the liver in infancy. In this paper, we present a rare case of non-treated hepatoblastoma in an 18-month-old baby male who presented with an asymptomatic abdominal mass associated with elevated Alpha-fetoprotein. Contrast-enhanced CT revealed a solid mass located in the left lobe of the liver, measuring about 6 × 6 cm, and not enhancing the contrast. US-guided Tru-cut biopsy was performed which showed pure epithelial fetal-type hepatoblastoma. The parents refused neoadjuvant chemotherapy and the connection was disconnected with them because of the ongoing crisis in Syria. After five years, the patient returned with the same clinical picture. CT scan was repeated which revealed the same tumor without metastases. The decision was made to do a left hepatectomy after another confirmation with a surgical biopsy. Histopathological examination showed a multifocal pure epithelial-fetal well-differentiated type of hepatoblastoma with a favorable grade. Moreover, surgical margins and liver capsule appeared free, and the tumor was considered in Stage 1 accordingly. To this date, the boy was followed up with serial US and Alpha-fetoprotein (AFP)levels without signs of recurrence. Conclusion: Hepatoblastoma with pure fetal-type histology can be treated with complete surgical excision without neoadjuvant or adjuvant chemotherapy if the tumor was resected completely because this type of neoplasm is slow growing and has a good prognosis.

Congenital chest wall defects are uncommon and present commonly at birth or later in infancy. The most common types are pectus excavatum, pectus carinatum, and sternal clefts. We present the first case report of multiple congenital anomalies that include bilateral chest wall defects with complete absence of the skin and muscular layer plus microtia that are associated with right facial nerve paralysis. The baby was managed conservatively with an application of a daily dressing. Both defects healed properly and closed after seven weeks of treatment without evidence of a hernia. On follow-up, after five years the boy was seen with good scars without complications.

Although Meckel's diverticulum (MD) is the most common congenital anomaly in the GI tract, it is usually located as one true diverticulum at the antimesenteric side of the small intestine. It is very rare to find MD as a double diverticulum. In literature, only four cases of a double MD were reported in pediatric population.A 5-year-old girl was brought to the emergency department complaining of periumbilical abdominal pain associated with frequent bilious vomiting. The only abnormal lab result was leukocytosis with neutrophilia. An erect abdominal X-ray revealed multiple air-fluid levels in the upper abdomen. On laparotomy, the intestinal loops were extensively dilated and adhesions were noticed. After releasing the adhesions, two different Meckel diverticula were surprisingly discovered, a small one located 15 cm from the ileocecal valve, and a large one causing the obstruction and located 35cm proximal to the ileocecal valve. A double diverticulectomy along with a primary repair was undertaken followed by an unremarkable postoperative course. Conclusion: Double MD is a rare and extraordinary entity that may be seen during the surgical practice, so it is crucial to trace the entire intestine during an exploratory laparotomy, especially the last 100 cm of the terminal ileum, to detect the associated congenital anomalies such as duplication or diverticula to avoid future mishaps.

Abstract Background The perception of organ donation and brain death among Syrian population has not been previously explored. The goal of this study is to evaluate the attitude and knowledge of organ donation among Syrians and the willingness of this population to donate their organs. Methods We conducted a survey-based cross-sectional study in four hospitals in Aleppo, Syria in November 2019. Patient demographic, awareness of brain death; and attitude toward organ donation were collected and analyzed. Results A total of 350 individuals were invited to participate in the survey among whom 303 (197 females, 106 males) agreed to participate in the study (87% response rate). The majority of our participants (n = 249, 82%) heard about organ donation with television (n = 166, 55%), social media (n = 77, 25%), and the internet (n = 77, 25%) being the most common sources of information. When assessing knowledge about brain death, only 40% (n = 116) answered 3 or more questions (out of 5) correctly. Fifty-eight percent (n = 176) of respondents agreed with the idea of organ donation and 183 (62%) would like to donate their organs one day. The leading motivation to organ donation was the desire to help (n = 234, 77%), while the most common reason to refuse donation was the refusal to disfigure a dead body by removing an organ (n = 125, 41%). Religious reasons were cited as motivation for organ donation by 43% of participants (n = 130), and a reason for refusing to donate organs by 24% (n = 71). Most respondents (n = 261, 88%) were unaware of the laws and legislations related to organ donation in Syria. When asked if religion and law were encouraging organ donation, 76% of respondents (n = 226) would donate their organs. Although more positive attitude was found in those with better brain death knowledge (score ≥ 3), this did not translate into more willingness to donate organs in this group of participants. Conclusions The promotion of organ donations from deceased donors is a necessity given the rising shortage of organs. The information provided by this study could help policy makers build future strategies to promote deceased organ donation programs and overcome current obstacles preventing such initiatives from achieving their goals.

Meckel diverticulum is usually located at the antimesenteric aspect of the small intestine. It is very rare to arise from the mesenteric border near the blood supply. In literature, 13 cases of mesenteric Meckel diverticulum (MMD) were reported in the pediatric population. A 2-year 7-month-old boy was brought to the clinic with a history of recurrent, painless per rectal bleeding over the past year. Upon review, there are no other associated symptoms or signs. Following a systematic approach, all lab and radiological assessments were negative. Further upper and lower endoscopies were also normal. Technetium-99 m scintigraphy scan revealed a focus of rising uptake tracer in the middle of abdomen suggesting gastric ectopia. Diagnostic laparoscopy showed an unexpected mesenteric Meckel diverticulum which is exteriorized through an extended umbilical incision and resected extracorporeally along with primary anastomosis. The postoperative course was uneventful. Conclusion: The mesenteric Meckel diverticulum is a very rare entity, but it is more serious due to closity to the blood vessels of the bowel. So, even when it is asymptomatic and discovered incidentally it should be excised to avoid complications. The laparoscopic-assisted approach is a fast and straightforward method to diagnose and treat many intra-abdominal lesions in the pediatric population.

Coccydynia is very rare in children and is most often caused by a traumatic event. A 7-year-old girl presented to an outpatient clinic with a long history of post-traumatic coccydynia for the past eight months, not responding to conservative management with NSAIDs and associated with the inability of sitting. On examination, a rigid tender bony protuberance in the coccygeal area was palpated. No inflammatory signs were noticed. All lab investigations were normal. MRI of the lumbosacral spine revealed straightening of the coccyx without evidence of posterior luxation. Because of the intractable pain that did not respond to conservative management that interferes with the sitting position, the girl underwent coccygectomy through a midline posterior sagittal incision followed by a favorable clinical outcome. Conclusion: The principles of treating coccydynia in children are similar to those of adolescents and adults, with due regard to the rare congenital anomalies that may hide behind.