Pediatric Surgery International (Pediatr Surg Int)

Publications in this journal

• Article: Air enema reduction of intussusception: a registrar-led, protocol-driven service is safe and effective.

  Edward John Hannon, Rosemary Anne Allan, April Samantha Negus, Feilim Murphy, Bruce Obi Okoye
  [show abstract] [hide abstract]
  ABSTRACT: PURPOSE: In the UK, air enema reduction of intussusception is predominantly performed by consultant radiologists. At our institution, it is usually performed by a team involving radiology and surgical registrars. The purpose of this study was to assess who performs air enemas in the UK and the efficacy and safety of our registrar-led service. METHODS: A telephone survey of paediatric surgical centres in the UK was performed asking who performs air enema in these institutions. Following this, a retrospective review of all air enemas at our institution between January 2005 and 2011 was performed. Cases were identified from radiology databases and reviewed for grade of radiologist, perforation and outcome. RESULTS: At all 25 centres, consultant radiologists performed air enemas. At our institution 145 enemas were performed in 6 years. 141 were analysed (54 girls, 87 boys). Median age was 9 months (range 3-107 months). 82 % were performed by the registrar-only team. Over 6 years the registrar-led reduction rate was 77.5 % and in the last 3 years 84 %. The perforation rate was 0.9 %. CONCLUSION: A paediatric surgical registrar-led service for air enema reduction can be safe and effective ensuring a team approach is adopted, equipment is efficient and a strict protocol is applied.
  Pediatric Surgery International 06/2013;
• Article: Single-incision laparoscopic resection of ovarian masses in children: a preliminary report.

  Elizabeth M Pontarelli, Claudia Emami, Nam X Nguyen, Manuel Torres, Dean M Anselmo
  [show abstract] [hide abstract]
  ABSTRACT: PURPOSE: Ovarian masses in the pediatric population are commonly resected with a three or four port laparoscopic approach. Single-incision laparoscopic (SIL) resection is an alternative approach. However, there is limited experience with this modality in ovarian mass resection. METHODS: We reviewed SIL ovarian mass resections performed by our group from 2010 to 2012. We evaluated patient demographics, surgery statistics, and hospital course. RESULTS: Six patients were identified with mean age of 14 years. Imaging studies showed cystic masses ranging 4-6 cm in five patients, and 20 cm in one patient. One patient presented with recurrent teratoma. Pathology revealed four benign teratomas, one benign cyst, and one serous cystadenoma. Average operating time was 75 min. All patients had an ovarian-preserving resection. Three patients had cyst spillage, including the one who presented with recurrence (this was the only patient with a subsequent recurrence). Hospital stay averaged 37 h. Narcotic use averaged 9.9 mg of morphine daily. All patients had excellent cosmetic results, and no postoperative complications. CONCLUSIONS: Ovarian cystic mass excision using the SIL approach carries a higher risk of tumor spillage. Although the incidence of malignancy is low, they cannot be conclusively excluded with our current preoperative evaluations. At this time, we recommend SIL resection only for simple cysts with low malignant potential; however, further experience with this procedure will likely improve the risk of tumor spillage in the future.
  Pediatric Surgery International 06/2013;
• Article: Clinical management of infantile fibrosarcoma: a retrospective single-institution review.

  Lalit Parida, Israel Fernandez-Pineda, John K Uffman, Andrew M Davidoff, Matthew J Krasin, Alberto Pappo, Bhaskar N Rao
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Infantile fibrosarcoma (IFS) is an uncommon soft-tissue sarcoma. Here we review our experience treating this tumor. PATIENTS AND METHODS: We retrospectively reviewed records of patients with IFS treated at St. Jude Children's Research Hospital between 1980 and 2009. RESULTS: We identified 15 patients, 8 girls and 7 boys; 13 white and 2 black. Median age at diagnosis was 3 months. Primary sites included the leg (n = 3), chest wall (n = 2), foot (n = 2), and one each in the tongue, occipital region, axilla, parascapular region, arm, forearm, retroperitoneum, and thigh. All patients underwent resection; 11 upfront surgery, and 4 delayed. Complications included loss of the posterior tibial nerve and artery, axillary vein, biceps, pectoralis major, gallbladder, and transverse/sigmoid sinus. Eight received chemotherapy and three radiotherapy. Seven experienced local recurrence and three lung metastasis. Median follow-up was 65 months. At the time of the review, 12 patients were alive and 3 had died. All deaths were in patients older than 1 year at diagnosis with an axial primary site. CONCLUSIONS: Non-mutilating surgery should be the primary treatment for IFS. Neoadjuvant chemotherapy is indicated when upfront resection is unfeasible. Patients with positive surgical margins should receive adjuvant chemotherapy. Radiotherapy is indicated for axial primary sites where complete resection is impossible.
  Pediatric Surgery International 05/2013;
• Article: Cloacal malformation variants in male.

  Tahmina Banu, Tanvir K Chowdhury, Mozammel Hoque, M A Mushfiqur Rahman
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE: The published surgical literatures have referred only to females as having cloacal defects and the incidence in males is not well established. As during embryogenesis, both sexes have to pass through the stage of a cloaca, there is every chance of development of cloacal anomalies in males also. Here, we are presenting our experience of male cloacal malformations. METHODS: We identified four cases of male cloaca by reviewing medical records of all anorectal malformation (ARM) patients treated at our institution in the past 19 years. Time of presentation, clinical, radiological, cystoscopic and operative findings, and outcomes were analysed. RESULTS: Out of 1,837 patients, we identified four cases (0.2 %) of male cloacal variants. All presented after 45 days (range 46 days to 28 years). Three of them had proximal hypospadias, two had a vaginal remnant and cystoscopic evaluation showed the length of the common channel ranged from 0.5 to 8 cm. One patient died of multiple anomalies and the other patients are doing well following reconstruction. CONCLUSION: None of the male cloacal patients presented in the neonatal period, proximal hypospadias was the common external genital abnormality and half of them had a vagina. Surgical outcome was satisfactory. The scarcity of reported cases of this group is a subject of further research.
  Pediatric Surgery International 05/2013;
• Article: Diagnostic accuracy of preoperative alpha-fetoprotein as an ovarian tumor marker in children and adolescents: not as good as we thought?

  Amos Hong Pheng Loh, Kelvin Wai Cheak Gee, Joyce Horng Yiing Chua
  [show abstract] [hide abstract]
  ABSTRACT: PURPOSE: To evaluate the diagnostic accuracy of preoperative serum alpha-fetoprotein (AFP) levels in predicting malignancy risk in children and adolescents presenting with ovarian neoplasms. METHODS: In 110 girls aged 18 and below diagnosed with ovarian neoplasms, we retrospectively correlated preoperative serum AFP levels with histological diagnosis of germ cell tumor or immature teratoma (GCT/IT) versus non-GCT/IT, and benign versus non-benign. We determined area under receiver-operating characteristic curves (AUC), sensitivity, specificity, and likelihood ratios. RESULTS: Twenty patients (18.2 %) had non-benign ovarian neoplasms, of which 12 had GCT/IT (10.9 %). In diagnosing GCT/IT versus non-GCT/IT, specificity of preoperative serum AFP was 87.8 %, sensitivity 66.7 %, and AUC 0.853. Excluding infants to remove the effects of increased variance in AFP in this group, specificity improved (92.0 %), but not sensitivity (66.7 %); AUC was 0.926. Increasing AFP cutoff to two times upper normal limit improved specificity (94.9 %), but not sensitivity (66.7 %). For benign versus non-benign tumors, AFP specificity was only 88.9 % and sensitivity 50.0 %. CONCLUSION: The diagnostic accuracy of preoperative serum AFP for detecting GCT/IT in girls was limited by poor sensitivity and positive predictive value. Excluding infants and raising cutoff levels improved specificity marginally. Clinicians should be aware of these limitations when using AFP in the preoperative evaluation of childhood ovarian neoplasms.
  Pediatric Surgery International 05/2013;
• Article: Costal osteochondroma spicule associated with pleural effusion.

  James Chen, Scott Nelson, Brian Tzung, Harry Applebaum, Daniel A Deugarte
  [show abstract] [hide abstract]
  ABSTRACT: Costal osteochondromas are a rare cause of lung injury. We report a 7-year-old male who presented with chest pain, cough, and left-sided pleural effusion following a fall. Imaging identified a 2 cm costal osteochondroma, which was resected with a thoracoscopic-assisted segmental rib resection.
  Pediatric Surgery International 05/2013;
• Article: Percutaneous treatment of bladder stones in children: 10 years experience, is blind access safe?

  Hassan Ahmadnia, Ali Kamalati, Mehdi Younesi, Mohammad Mehdi Imani, Mahmoodreza Moradi, Mohammad Esmaeili
  [show abstract] [hide abstract]
  ABSTRACT: PURPOSE: Bladder stones are more commonly found in children from developing countries. Open cystolithotomy or transurethral cystolithalopaxy are the traditional treatments but a percutaneous approach has been advocated. We present our experience with percutaneous cystolithotomy in children with bladder stones without any ultrasonic or fluoroscopic guidance. MATERIALS AND METHOD: From April 2001 to October 2011, a total of 147 children (135 boys and 12 girls) with a mean (range) age of 4.07 (1-12.5) years underwent percutaneous cystolithotripsy (PCCL). The mean (range) stone diameter was 2.74 (0.8-5) cm. 138 children (94 %) had a solitary stone while nine (6 %) had more than one stone. The main component of the stones was calcium oxalate in 70 patients (48.6 %). RESULTS: All children were stone-free after one PCCL; no recurrent stones developed. The mean (range) PCCL procedure time was 29.6 (12 to 48) min and intraoperative blood loss was scant. Perioperative complications were few. The mean (range) hospital stay was 1.2 (1-3) days. CONCLUSIONS: Blind access PCCL (without any ultrasonic or fluoroscopic guidance) is a facile and safe approach for removing stones in the pediatric bladder stones. Advantages include the lack of ionizing radiation, no need for opacification by iodine contrast media and low relative cost. We recommend this minimally invasive technique for management of large bladder stones (larger than 1 cm) in children. To our knowledge, this is the largest single-center series reported on percutaneous cystolithotripsy of endemic bladder stones in children.
  Pediatric Surgery International 05/2013;
• Article: Patterns of internet use by parents of children attending a pediatric surgical service.

  F Hand, D T Mc Dowell, R W Glynn, H Rowley, A Mortell
  [show abstract] [hide abstract]
  ABSTRACT: PURPOSE: The internet has revolutionised the way we search for information. We determined the level of internet use by parents of children attending general surgical services and identified trends in online information-seeking behaviour. METHODS: A questionnaire based on the work by Boston and Tassone was distributed to parents attending both the day surgical units and surgical outpatients department in a paediatric tertiary referral centre. RESULTS: There were 214 (82.3 %) questionnaires returned, with 82 (38.3 %) of respondents having searched the internet regarding their child's surgical issue. Access to a smartphone, a university education and private health insurance were factors that positively influenced online searching (p < 0.005). Of those respondents who searched the internet, 42 (51 %) felt that information they found online was understandable, while only 14 (17 %) admitted to online sourced information influencing the treatment decisions they had made for their children. When asked to rank information sources on Likert-type scales in terms of importance; parents ranked the surgeon as most important (mean = 4.73), whilst the internet ranked lowest (mean = 3.02). CONCLUSION: We demonstrated significant use of the internet amongst those attending paediatric general surgical services. Clinician sourced information remains important, however we should engage with patients to utilise this vast resource effectively.
  Pediatric Surgery International 04/2013;
• Article: Congenital hepatic cyst with antenatal diagnosis: a case report and literature review.

  Andrew B Nordin, Sara C Fallon, Beth A Carter, Mary L Brandt
  [show abstract] [hide abstract]
  ABSTRACT: Congenital hepatic cysts are rare lesions of infancy. While operative management and outcomes have been extensively studied in adult patients with hepatic cysts, data in pediatric patients are limited. We discuss our experience in an infant and review relevant literature regarding operative technique and surgical outcomes.
  Pediatric Surgery International 04/2013;
• Article: Preparation of a severely obese adolescent for significant and long-term weight loss: an illustrative case.

  Andrew J Kruger, Kathleen B Hrovat, Stavra A Xanthakos, Thomas H Inge
  [show abstract] [hide abstract]
  ABSTRACT: For severely obese patients planning bariatric surgery, many surgeons advise pre-operative weight loss which can be difficult for some to achieve. We report a 16-year-old male who was referred for weight loss surgery in a very late stage of severe obesity with a weight and BMI of 310 kg and 93 kg/m(2), respectively. He also suffered from obstructive sleep apnea and hypertension. To prepare him for laparoscopic gastric bypass, a strict pre-operative nutritional intervention with inpatient and outpatient phases was designed. He lost 22 kg pre-operatively and an additional 86 kg by 67 months post-operatively, representing a 35 % total reduction in BMI. This case illustrates the feasibility and value of a defined pre-operative dietary intervention to effectively manage the weight of an adolescent referred late in the progression of severe obesity.
  Pediatric Surgery International 04/2013;
• Article: Thoracoscopic lobectomy for type I pleuropulmonary blastoma in an infant.

  Abbey Fingeret, Alejandro Garcia, Alain C Borczuk, Steven S Rothenberg, Gudrun Aspelund
  [show abstract] [hide abstract]
  ABSTRACT: Pleuropulmonary blastoma (PPB) is a rare, aggressive, intrathoracic mesenchymal neoplasm associated with cystic lung lesions. The authors describe an 8-month-old male who underwent thoracoscopic left upper lobectomy for a cystic lung lesion initially diagnosed as congenital pulmonary airway malformation. Pathology revealed type I PPB.
  Pediatric Surgery International 04/2013;
• Article: Total colectomy for ulcerative colitis in children: when are we operating?

  Jarod P McAteer, Cindy Larison, Ghassan T Wahbeh, Matthew P Kronman, Adam B Goldin
  [show abstract] [hide abstract]
  ABSTRACT: PURPOSE: Ulcerative colitis (UC) in children is frequently severe and treatment-refractory. While medical therapy is well standardized, little is known regarding factors that contribute to surgical indications. Our aim was to identify factors associated with progression to colectomy in a large cohort of pediatric UC patients. METHODS: We conducted a retrospective cohort study using the Pediatric Health Information System database. We identified all patients under age 18 discharged between January 1, 2004 and September 30, 2011 with a primary diagnosis of UC. Primary outcome was odds of total colectomy. RESULTS: Of 8,688 patients, 240 (2.8 %) underwent colectomy. Compared with non-operative patients, a greater proportion of colectomy patients received advanced therapies during admission, including corticosteroids (84.2 vs. 71.3 %) and biological therapy (25.4 vs. 13.6 %). Odds of colectomy were increased with malnutrition (OR 1.86), anemia (OR 2.17), electrolyte imbalance (OR 2.31), and Clostridium difficile infection (OR 1.69). TPN requirement also independently predicted colectomy (OR 3.86). Each successive UC admission significantly increased the odds of colectomy (OR 1.08). CONCLUSION: These data identify factors associated with progression to colectomy in children hospitalized with UC. Our findings help to identify factors that should be incorporated into future studies aiming to reduce the variability in surgical treatment of childhood UC.
  Pediatric Surgery International 04/2013;
• Article: Infantile neuroblastoma of the urinary bladder detected by hematuria.

  Shin-Ichiro Kojima, Minoru Yagi, Kimio Asagiri, Suguru Fukahori, Yoshiaki Tanaka, Shinji Ishii, Nobuyuki Saikusa, Yoshinori Koga, Motomu Yoshida, Daisuke Masui, Naoko Komatsuzaki, Shin-Ichiro Nakagawa, Shuichi Ozono, Ken Tanikawa
  [show abstract] [hide abstract]
  ABSTRACT: Malignant tumors of the urinary bladder in infants are extremely rare. Rhabdomyosarcoma is the most likely tumor in this site, whereas neuroblastoma of the urinary bladder is exceedingly uncommon and is not listed as a differential diagnosis for tumors of this site. We present a case of neuroblastoma arising from the dome of the bladder wall, detected by hematuria. Only six cases of neuroblastoma originating from the bladder, including the present case have been reported. Of the cases, five arose from the dome of the bladder wall. In this report, the differential diagnosis of bladder tumors in children is discussed. A diagnosis of neuroblastoma should be taken into consideration, especially in the case of tumors arising from the dome of the bladder wall despite an uncommon location.
  Pediatric Surgery International 03/2013;
• Article: Epidemiology and outcome analysis of children with traumatic out-of-hospital cardiac arrest compared to nontraumatic cardiac arrest.

  Chun-Yu Chen, Yan-Ren Lin, Lu-Lu Zhao, Yung-Kang Wu, Yu-Jun Chang, Wen-Chieh Yang, Kang-Hsi Wu, Han-Ping Wu
  [show abstract] [hide abstract]
  ABSTRACT: PURPOSE: This study aimed to determine predictive factors for sustained return of spontaneous circulation (ROSC) in pediatric patients with traumatic out-of-hospital cardiac arrest (OHCA) and compared to those with nontraumatic OHCA. METHODS: This was a retrospective prognostic study of children with OHCA presenting to the emergency department (ED) was conducted from 2005 to 2010. Related clinical factors that influenced sustained ROSC in traumatic OHCA patients were identified and compared to nontraumatic cases. Significant parameters in predicting sustained ROSC in traumatic OHCA children were also determined using multivariate logistic regression analysis, and etiologies of the ICU admissions were analyzed in patients with sustained ROSC. RESULTS: Among 2,978 critically ill children admitted to the ED, 150 were pediatric OHCA patients, including 76 traumatic cases and 74 nontraumatic cases. Of children with OHCA, initial sustained ROSC was achieved in 51 cases (34.0 %), including 31 traumatic cases and 20 of nontraumatic cases. Head and neck injuries were the majority of traumatic cases in the traumatic OHCA children, followed by abdominal injuries and chest injuries. However, abdominal injuries accounted for the highest rate to gain sustained ROSC, while chest injuries had the lowest rate for successful sustained ROSC. Significant factors associated with sustained ROSC in traumatic OHCA included initial cardiac rhythm (P < 0.05), the period from scene to hospital (P < 0.05), and the duration of in-hospital cardiopulmonary resuscitation (CPR) (P < 0.05). CONCLUSIONS: Significant factors related to sustained ROSC have been identified as initial cardiac rhythm, duration of in-hospital CPR, and the period from scene to hospital. Head and neck injuries were the majority of traumatic cases and the prevention in head and neck trauma may play an important part in public health aspects.
  Pediatric Surgery International 03/2013;
• Article: Hepatobiliary cystadenoma: a rare pediatric tumor.

  Sifrance Tran, Loren Berman, Nitin R Wadhwani, Marybeth Browne
  [show abstract] [hide abstract]
  ABSTRACT: Hepatobiliary cystadenoma is a rare hepatic neoplasm that has been reported only 10 times in the pediatric population. Although considered a benign cystic tumor of the liver, hepatobiliary cystadenoma has a high risk of recurrence with incomplete excision and a potential risk for malignant degeneration. Complete tumor excision with negative margins is the mainstay in treatment. Unfortunately, due to the paucity of cases and its vague presentation, hepatobiliary cystadenoma is rarely diagnosed preoperatively. Therefore, in patients with hepatic cystic masses without a clear diagnosis, total resection of the lesion with negative margins is indicated to adequately evaluate for malignant potential and limit the risk of recurrence. We describe a 2-year-old girl with an asymptomatic abdominal mass that was found to be hepatobiliary cystadenoma. In addition, the pathogenic, histopathologic and clinical features of hepatobiliary cystadenoma are reviewed.
  Pediatric Surgery International 03/2013;
• Article: Local delivery of bupivacaine in the wound reduces opioid requirements after intraabdominal surgery in children.

  Olga Hermansson, Mary George, Tomas Wester, Rolf Christofferson
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Local anaesthetic infusions into the surgical wound have been shown to reduce postoperative pain and the need for opioids in adults. In children, it was found to be safe and efficacious following sternotomy and orthopaedic surgery. The aim of this study was to evaluate the need for opioids postoperatively in children receiving wound catheters delivering either bupivacaine or saline following one of three defined abdominal or bladder procedures. METHODS: Prospective, randomized, double-blind, placebo controlled study. Thirty-three children, 6 months of age to 13 years of age, undergoing elective surgery for enterostomy closure, open gastrostomy or ureteral reimplantation were randomized to receive bupivacaine or saline wound infusions for 72 h postoperatively. All patients received acetaminophen orally or rectally for every 6 h. Breakthrough pain was treated with morphine bolus doses of 0.05 mg/kg or infusions if more than three morphine doses were required. Pain scores were assessed every 3 h. Outcome measures were morphine dosages, return to full oral intake and length of hospital stay. RESULTS: On the first postoperative day, patients with bupivacaine infusions had significantly less need for morphine (1.3 ± 1.3 SD doses) compared to those receiving saline infusions (3.1+/2.5 SD doses, p < 0.05). No difference was seen during postoperative day two or three. There was no significant difference between the groups regarding time to full oral intake and time to discharge. CONCLUSIONS: Continuous infusion of bupivacaine in the abdominal wound was effective in reducing postoperative pain in children. It significantly reduced the need for additional opioids and can be considered for postoperative pain management in children.
  Pediatric Surgery International 03/2013;
• Article: Appendicitis in obese children.

  Balazs Kutasy, Prem Puri
  [show abstract] [hide abstract]
  ABSTRACT: During the past two decades, the incidence of childhood obesity has increased at alarming rates throughout the world. Obesity is associated with a variety of physiological changes that may impair a patient's response to surgery. With the rising rates of childhood obesity, pediatric surgeons must appreciate differences in the management and outcomes of these patients. Difficult physical examination, elevated inflammatory blood markers, and negative influence of obesity on the detection rate of the appendix on ultrasound have been reported causing diagnostic challenging of appendicitis in obese children. Moreover, obesity is associated with longer hospital stay and higher morbidity and minimal invasive techniques' superior outcomes over open technique in children undergoing appendectomy.
  Pediatric Surgery International 03/2013;
• Article: Meatal and corpus spongiosum advancement: a better technique for distal hypospadias repair.

  Hemonta Kr Dutta
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE: Several procedures have been described for repair of distal hypospadias. However, these are not without any complications. Corpus spongiosum advancement is a new technique employed in our patients for distal hypospadias repair with excellent clinical outcome and no post-operative complications. PATIENTS AND METHODS: A total of 56 patients aged from 24 to 126 months were operated between January 2009 and August 2011. 32 patients had coronal, 9 had glanular and 15 had distal penile hypospadias. The meatus was located within 1 cm of the corona in all the patients. There was minimal or no chordae. All the patients underwent advancement of corpus spongiosum. RESULT: The mean operating time was 36 min and mean operating blood loss was 15 ml. In three patients, the corpus spongiosum was opened inadvertently during dissection. It was repaired with 5-0 vicryl and stitched to the cavernosal bed. An indwelling catheter was kept for 5 days. None of these three patients had any problem after removal of the catheter. Mean hospital stay was 0.5 days (0-6 days). 42 patients were discharged from the hospital on the day of surgery. Eight patients complained of dysuria on the first day. There were no other complications. The functional and cosmetic results have been excellent. The mean follow-up period was 16 months (8-38 months). CONCLUSION: Corpus spongiosum advancement is an easy technique, consumes less time and has excellent cosmetic and functional outcome. The procedure is most suitable for children with distal hypospadias without chordae.
  Pediatric Surgery International 03/2013;
• Article: Bilateral Wilms' tumour in a developing country: a descriptive study.

  G P Hadley, M Mars, P K Ramdial
  [show abstract] [hide abstract]
  ABSTRACT: PURPOSE: To present our experience of 20 children with bilateral Wilms' tumour seen in a resource-challenged environment over a 10-year period. METHOD: All patients with a diagnosis of bilateral synchronous Wilms' tumour were identified and recruited. RESULTS: Study patients represented 11 % of a cohort of 177 new patients with Wilms' tumour seen over the same period. Three patients had a syndromic predisposition to Wilms' tumour. Metastatic disease was seen at presentation in four patients (20 %) and three children presented with unilateral tumour rupture. One patient presented with paraplegia and one with obstruction of the duodenum. All children received neoadjuvant chemotherapy. One HIV-infected child died of IRIS after neoadjuvant treatment, but before surgery. One child died of progressive disease after unilateral nephrectomy. Nephron-sparing surgery was performed in 22 kidneys and 15 kidneys were removed in toto. Following enucleation of tumours, three children had positive margins. Discordant histopathology was seen in 53 % of patients. Overall survival at 2 years is 85 %. CONCLUSION: Despite significant co-morbidity and advanced disease, bilateral Wilms' tumour is a treatable disease in a resource-constrained environment.
  Pediatric Surgery International 03/2013;
• Article: Extra-hepatic bile duct hamartoma in a 10-month-old with a morgagni hernia and multiple anatomical anomalies: a rare and incidental finding.

  Adil A Shah, Michael Karass, Andrew J Page, Bahig M Shehata, Megan M Durham
  [show abstract] [hide abstract]
  ABSTRACT: Von Meyenburg complexes (VMCs), also known as bile duct hamartomas, are a part of a group of ductal plate malformations. They are typically present intrahepatically. In this case, we present to our knowledge the first report of an extra-hepatic VMC in the pediatric population. The patient presented as a 10-month-old infant with a weeklong history of progressive breathing difficulty. A chest radiograph was obtained, showing intestinal loops in the thoracic cavity consistent with a Morgagni's hernia, unrelated to his breathing difficulty. The patient then underwent an elective repair of his congenital diaphragmatic defect. During the operation, the bile duct hamartoma was found adherent to the accessory lobe of the liver, present to the left of the ligamentum teres.
  Pediatric Surgery International 03/2013;