Situs inversus is a rare condition. But situs inversus in association with malrotation of the gut and Ladd’s bands not reveled in new-born period is extremely rare. This report describes a girl of 4 years with persistent bile-stained emesis during two months. Her radiological investigations revealed reverse position of stomach and duodenum whereas the heart located in normal position. Surgical exploration noticed stomach and spleen in the right side and liver in the left side with gallbladder in the epigastric area. Intestinal malrotation with Ladd’s band was also noticed. Two levels of obstruction were found. The duodenal obstruction was partial and due to extrinsic compression by Ladd’s band. Jejunal obstruction linked to an intramesenteric “8” crossing immediately downstream the Treitz angle and was also partial. Only jejunal derotation and Ladd procedure allowed the girl healed with an eventful postoperative period. Treatment of duodenal or jejunal obstruction with or without situs inversus is the same.

Background: Aim of this study is to evaluate if there is any difference in terms of hemodynamic parameters during Laparoscopic Cholecystectomy (LC) in children with Sickle Cell Disease (SCD) and Non-Sickle Cell Disease (NSCD).

Methods: Twenty children with asymptomatic cholelithiasis, recruited for elective LC were allocated into two groups: group 1 (n: 10) children without SCD (control group), and group 2 (n: 10) children with SCD. All of the patients with SCD had preoperative hematological evaluation for the surgical procedure. Study parameters included: heart rate, mean blood pressure, Peak Inspiration Pressure (PIP), end-tidal carbon dioxide concentration (PETCO2), expiratory tidal volume (Vt), O2 saturation, arterial blood gases (pH, PaCO2, PaO2, HCO3), hematocrit and intra-abdominal pressures. Parameters were recorded at five moments: before CO2 insufflation, 15, 45, 60 minutes after insufflation in reverse Trendelenburg position and 5 minutes after CO2 insufflation in the supine position.

Results: Regarding all parameters, before and after CO2 insufflation and after CO2 insufflation, there were insignificant changes in each group and between the two groups. Intra-abdominal pressure changes did not affect the hemodynamic parameters. No postoperative complication was observed and the post-operative hospital stay in two groups was similar.

Conclusion: Although sample size is not enough this study reveal that laparoscopic cholecystectomy does not have any adverse effects on hemodynamic parameters of children with sickle cell disease. Laparoscopic cholecystectomy may be feasible and as safe as in NSCD patients.

Cystic Lymphangioma (CL) is a rare benign tumor of malformative etiology. It is seen mainly in children and sits at the neck and axilla. Abdominal localization is rare and representing only 10% of cases.

Aim: To study the clinical, radiological and therapeutic management of abdominal cystic lymphangioma.

Patients and methods: This is a retrospective study of seven cases of abdominal CL collected over a period of 11 years in the department of pediatric surgery, of the children’s hospital of Tunis. These are four boys and three girls with a mean age of 2 years 7 months. The diagnosis was made prenatally in only one case and in postnatal period in the remaining cases due to abdominal pain in 3 cases, an abdominal mass in 4 cases and an acute intestinal obstruction in 2 cases. The radiological diagnosis was made by abdominal ultrasound in 6 cases, and during surgical exploration in emergency in case of acute intestinal obstruction. All patients were operated. The localization of CL was the mesentery in four cases, the left meso-colon in one case, the spleen lodge in one case and the retro-peritoneum in a case. The lesion was totally removed in five cases and partially in 2 cases. The outcome was favorable in all cases outside of flange on occlusion occurred late postoperatively in one case and who has advanced medical treatment.

Conclusion: Abdominal cystic lymphangioma is a benign tumor malformation, preferably sitting in the mesentery. Surgical resection should be as complete as possible but without sacrifice of body, putting the patient free from complications and recurrences.

Echinococcosis or hydatic cyst disease of the kidney is extremely rare in children and constitutes only 2-4% of all cases of hydatid disease. It can be complicated by opening in the urinary tract and cause obstructive renal failure.

We present a pediatric case of hydatid cyst of the kidney opened in the urinary tract and causing obstruction and urinary tract dilatation. The presentation is as acute pyelonephritis and the diagnosis was confirmed by renal ultrasound and CT. Surgical treatment is urgent and must be as conservative as possible by excision of the cyst and preservation of the renal parenchyma.

The kidney location of hydatic cyst is uncommon and represents only 2-5% of visceral involvement. The rupture of the cyst in the urinary tract is a complication that can be sometimes the first manifestation of this disease. Treatment should be undertaken urgently to best preserve the renal parenchyma.

Objective: Gastric duplication cyst is rare. The symptoms and signs are nonspecific. Thus, preoperative diagnosis often becomes difficult. It should be differentiated from other possible cases of gastric outlet obstruction. Inspite of this, the prognosis has improved due to improvised operative techniques. We report a rare case of gastric duplication cyst which was successfully treated by mucosal tripping of the cyst wall.

Case Report: A 1-year 5-months boy presented with features of gastric outlet obstruction. A thorough preoperative investigation failed to reach the diagnosis. On exploration, a gastric duplication cyst was detected. It shared a common wall with the stomach and thus, complete excision was not possible. The major part of the cyst was excised. Rest of the cyst wall was treated by mucosal stripping to avoid major resection of the stomach. At 2-year follow up, there was no evidence of recurrences of the symptoms.

Conclusion: Gastric duplication cyst should be kept as a differential diagnosis while dealing with any case of gastric outlet obstruction in children. And when the cyst is not amenable for complete resection, mucosal stripping can be done safely to achieve the fruitful outcome.