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Background: Post-circumcision penile ischemia is a devastating complication. We will present our experience in managing children with various forms of penile ischemia.Material and methods: This cohort prospective observational study was performed on all male children with post-circumcision penile ischemia between April 2017 and October 2021. A designed and approved protocol includes a combination of early pentoxifylline infusion, hyperbaric oxygen inhalation, early catheterization, and appropriate surgical debridement were applied for all cases. Data of patient age, anesthesia method, monopolar diathermy use, early presentation and positive wound culture were collected and analyzed statistically.Results: During the study period a 3,382 child were circumcised for non-medical reason; 23 children were diagnosed with penile ischemia (0.7%), among other complications (9%) Most of the penile ischemia is associated with use of monopolar diathermy (74%), compressive wound dressing to control post-circumcision bleeding and infections are responsible for ischemia in 52.2% and 43.5% of cases. Inexperienced physicians were commonly responsible for ischemia (73.9%). Patients managed at first 24 hours had better outcomes than those who were presented later (p = 0.001).Conclusion: In children with post-circumcision penile ischemia, a combination of hyperbaric oxygen therapy and pentoxifylline is effective, and reduces penile tissue loss.

Highlights • CDS is a very rare congenital anomaly that includes duplication of distal body organs. • Our case has a complete double penis with two separate scrotums. • Colostomy with 4 stomas was done for duplicated colon., Introduction We present a newborn with double penis and double scrotum as a part of a caudal duplication syndrome (CDS) which is a condition includes duplication of the distal organs of the body. It is crucial to have knowledge about it to be able to be identified. Presentation A male newborn presented with double penis, double scrotum double urethra, double colon, and double imperforate anus. After work up a low descending colostomy was done (4 stomas of duplicated colon) and started feeding with normal passage from colostomy. Discussion The cause of CDS is unknown many theories have tried to explain that, but the most accepted theory is failure of monchorial twins to separate completely. CDS may be associated with other congenital anomalies as imperforate anus, renal anomalies, and omphalocele. Conclusion CDS is a very rare condition which needs multidisciplinary team to manage and needs staged repair. Most pediatricians and pediatric surgeons are unable to diagnose it, we add a case of CDS to the literature.

Introduction Splenic tumours are relatively rare and include malignancies such as lymphomas, angiosarcomas, plasmacytomas, primary malignant fibrous histiocytomas, and splenic metastases. Benign tumours of the spleen such as hemangiomas, cysts, and inflammatory pseudotumours are very rare (Kaza et al., 2010, PisaniCeretti et al., 2012) [1], [2]. There are fewer than 160 cases of splenic hamartoma or splenomas having been reported in the literature (Basso et al., 2012) [3]. Only 20% of the cases were detected in children (Abramowsky et al., 2004) [4]. Although multi-modality imaging findings were described preoperatively, the final diagnosis was splenic hamartoma based on histology and immunohistochemistry. Case report Here, we report a case of a14 year old child left upper quadrant abdominal pain and worsening sickness. Multi-modality imaging detected a solid lesion of the spleen, who required splenectomy and was pathologically diagnosed as a splenic hamartoma. The postoperative course was uneventful. Discussion Splenic hamartoma is very rare. Only 20% of hamartomas occur in children. They are commonly found incidentally on imaging with no symptoms. Conclusion Splenic hamartoma is a benign vascular proliferative lesion that requires a multi-modality imaging studies for diagnosis and confirmed by histopathology. It must be included in the differential diagnosis of splenic mass forming lesions., Highlights • There are fewer than 160 cases of splenic hamartoma having been reported in the literature. Only 20% of the cases were detected in children. • Although imaging findings were described preoperatively, the final diagnosis was splenic hamartoma based on histology. • We report a case of solid lesion of the spleen, who required splenectomy and was pathologically diagnosed as splenic hamartomas.

Highlights • Budd-Chiari syndrome is characterized by hepatic venous outflow obstruction. • Liver transplantation is a definitive treatment of BCS, indicated in failure of other treatment modalities or end stage liver diseases. • The Budd-Chiari syndrome patients with IVC obstruction can receive liver transplantation with IVC removal and without IVC replacement. • Living donor liver transplant with refined techniques can be performed safety with stable hemodynamics peri-and post-liver transplantation., Introduction Suprahepatic caval resection and replacement of inferior vena cava (IVC) is standard procedure in deceased donor liver transplantation for patients with Budd-Chiari syndrome (BCS). However, replacement of IVC in living donor liver transplantation (LDLT) is difficult. We report a case of BCS successfully treated by LDLT without replacement of IVC. Presentation of case A 52-years-old female with a primary BCS due to IVC thrombosis. A vena cava (VC) stent placed after angioplasty without improvement of the hepatic, portal venous flow and liver functions, Transjugular intrahepatic portosystemic shunt was considered and the patient had a rapid deterioration and increased ascites. The patient was scheduled for living donor liver transplantation (LDLT). Her Child-Paugh and MELD scores were 11, 18, respectively at time of transplantation. Left lobe was obtained from her son. Preservation of the native suprarenal IVC was impossible due to massive fibrosis and thrombosed. The suprahepatic IVC was also fibrotic and unsuitable for anastomosis with hepatic vein. The retrohepatic IVC resected include suprahepatic IVC together with the liver. The supradiaphragmatic IVC was reached and encircled through opening the diaphragm around the IVC and a vascular clamp applied on the right atrium with subsequent anastomosis with hepatic vein of the graft. The hemodynamic stability of the patient was maintained throughout the operation without IVC replacement due to developed collateral vessels. Conclusion Patients with Budd-Chiari syndrome with obstructive IVC are successfully treated with living donor liver transplantation without replacement of IVC.

Introduction Human tails are rare congenital malformations that describe protrusions commonly located around the midline of the lumbosacral region covered by skin, representing an embryonic remnant. Human tails are broadly classified into true and pseudo-tails. The real ones represent the persistence of a remnant of the embryonic tail formed between the fourth and eighth week of gestation. Presentation A male infant aged 42 days presented to our institution with a tail-like structure that originated from the anal mucocutaneos junction. The parents did not bring the baby at birth because of the social stigma and ignorance. On examination, there was a tail-like structure that is about 22 cm in length and 1.5 cm in diameter originated from the mucocutaneous junction at the anus at the left side. There was no bony element on palpation. The lower vertebral column examination showed no abnormalities, and this was confirmed with an x-ray. The patient was operated on with simple excision of the tail and primary closure of the wound at the base. He was discharged on the same day well and good. The tail was taken for microscopic histopathology. Discussion There are few reported cases describing human tails. However, none of them was originating from the anal mucocutaneous junction. Conclusion We report the first case of a human tail arising from the anal mucocutaneous junction worldwide. Due to its very superficial origin, it was not associated with any other anomalies., Highlights • Human tails are rare congenital protrusions located commonly around the midline of the lumbosacral region • It is the first reported case worldwide of a human tail arising from the anal mucocutaneous junction. • We performed a simple excision of the tail and a primary closure of the defect and the tail was sent for histopathological examination

Highlights • Sigmoid volvulus is rarely considered a diagnosis in children. • We are presenting a case of a child with sigmoid volvulus causing compression of the mesentery of the small intestine. • It is the first reported case worldwide of a sigmoid volvulus to cause short bowel syndrome. • We performed a sigmoidectomy with end colostomy (Hartman`s) and primary anastomosis of the healthy part of small intestine., Introduction We present a case of a male child 8 years old presenting with a sigmoid volvulus causing ischemia of most of bowel loops resulting in a short bowel syndrome. It is the first reported case worldwide. Presentation A male child presented with a picture of intestinal obstruction. After complete laboratory and radiological investigation, laparotomy was done revealing a sigmoid volvulus compessing most of the small bowel loops with gangrenous sigmoid colon for which sigmoidectomy with end colostomy, resection of gangrenous small bowel loops and primary anastomosis of the remaining healthy part. Discussion There are few reported cases describing sigmoid volvulus in this age group. However, none of them resulted in short bowel syndrome. The median age was 7 years with a higher ratio in males than females (3.5:1). Conclusion Sigmoid volvulus is not a common problem in children and adolescents, and is rarely considered as a cause of intestinal obstruction and it was never reported as a cause of short bowel syndrome. Early diagnosis and prompt treatment confer an excellent prognosis.

We aimed to compare the early results of i.v. with p.o. TAC as a primary immunosuppressant in pediatric patients undergoing LT. This retrospective study enrolled 75 children who underwent LT and received TAC-steroid regimens as a primary immunosuppressant between September 2011 and October 2015 at our institution. Thirty-five recipients received TAC i.v. and 40 received TAC p.o. Early results were evaluated and compared, including ACR, EBV, or CMV infection; renal adverse effects; and hospital stay. Comparisons of 90-day post-transplant results showed that the rates of overall viral (74% vs 40% P

PV reconstruction is an important aspect of LDLT, with post-transplant outcomes depending on PV reconstruction methods. However, it is unclear whether the preferential selection of these techniques is dependent on preoperative recipient characteristics. This retrospective study assessed whether preoperative recipient factors differed in pediatric patients who did and did not receive VGs for PV reconstruction. Of 113 pediatric patients who underwent LDLT from January 2010 to July 2015, 31 (27%) underwent PV reconstruction with VGs and the other 82 (73%) without VGs. The presence of collateral vessels (P

Multiseptate gallbladder is a rare congenital anomaly that may be silent or with symptoms. Herein, we report a case of 12-year-old male child with abdominal pain associated with nausea and vomiting. The diagnosis of multiseptate gallbladder was settled at 6 months after the first episode of abdominal pain by screening ultrasound and was confirmed by magnetic resonance cholangiopancreatography. We performed laparoscopic cholecystectomy with complete resolution of preoperative symptoms. The patient was discharged on postoperative day 1. The postoperative course was uneventful without complications.