Mesenteric cyst is a rare cause of intra-abdominal mass in children. The most common site is the mesentery of the ileum. The other rare sites are descending colon, sigmoid colon, and the retroperitoneum. We are presenting a case of 12 years old male who presented to us as epigastric mass and was finally diagnosed to have huge sigmoid mesenteric cyst. We want to emphasize here that the sigmoid mesenteric cyst which in itself is a rare entity can also present as an epigastric mass making the diagnosis even more difficult.

Chronic Appendicitis (CA) is still considered a controversial diagnosis. Although it should be included in the differential diagnosis of recurrent abdominal pain. It was initially reported by Crymble and Forsythe, who defined chronic appendicitis as a condition with one or more mild attacks of appendicitis occurring in a sequence that might include more severe attacks [1]. This definition has mildly changed over the years. In current practice, chronic appendicitis is best defined by clinical course and histological findings as a long-standing inflammation or fibrosis of the appendix that presents clinically as prolonged (> 48 hours) or intermittent abdominal pain. Ultrasound imaging has been widely used (using graded compression technique for appendix visualization) for the diagnosis and follow up of acute appendicitis [2-5]. But there are no definite sonographic criteria for chronic appendicitis. We present the case of a 9, 5-year-old girl with history of recurrent abdominal pain lasting one and a half month with co-existence of mesenteric adenitis, who eventually underwent appendectomy and histopathology revealed acute or chronic appendicitis.

There is a wide range of anatomical variation in appendiceal length reported in the literature despite the appendix achieving its adult proportions at approximately 3 years of age. Our seven year-old patient had acute appendicitis with a 1cm appendix well outside of the normal range. This variation should be kept in mind as it may impact imaging and treatment of acute appendicitis in special circumstances.

Pediatric distal radius fractures are common injuries. Most can be treated with closed reduction and immobilization. However, malunions can be sequelae of this injury pattern due to the risk of re-displacement after initial reduction, and clinical manifestations of these complications can be significant. In addition to malunion, the most concerning of these complications are nonunion and growth arrest. Addressing these concerns, particularly accurately determining which are clinically significant and may warrant surgical intervention, presents considerable clinical challenges. Acceptable parameters for flexion-extension angulation, radial-ulnar deviation and malrotation are controversial and vary based on age. Patients with functional impairment of motion, pain, and or deformity due to malunion may be candidates for surgical reconstruction. Among these, the greatest improvements have been documented in patients with supination deficits, but the literature provides insufficient evidence to draw specific and definitive conclusions. The most commonly used reconstruction techniques are dorsal opening wedge osteotomy of the distal radius with volar bone grafting and ulnar shortening osteotomy, with release of the interosseous membrane. These are complex procedures that require assessment of 3-D anatomy, meticulous pre-operative planning and templating and continuous intra-operative reassessment. In addition, the risks of long-term sequelae, such as residual deformity resulting in impaired function, as well as an unacceptable cosmetic result, must be discussed with patients and their families at length when discussing the potential benefits, as well as complications, of operative versus non-operative management of malunions of the distal radius and forearm.

A 5 month-old infant consulted in pediatric emergency with abdominal discomfort and intermittent fever for last four days. On physical examination, she presented a mild abdominal distention. During bladder catheterization in the study of unexplained fever, drainage of pus was visualized by introitus [1-3]. Abdominal ultrasound showed a heterogeneous collection located between bladder and rectum, compatible with uterine abscess.