We present two cases of intestinal perforation following admission and treatment for croup. The details of the respective hospital courses are discussed with a focus on potential etiologies of the intestinal demise. To our knowledge, these represent the only reported cases of viral croup progressing to intestinal perforation. Croup or laryngeotracheo-bronchitis is an infection of the upper respiratory tract most commonly affecting young children. This inflammatory process causes a classic barking cough and low grade fevers. It can be caused by myriad viruses with Parainfluenza 1 and 3 being the most common. Although generally self-limited, in its most severe form croup can cause severe respiratory distress requiring hospitalization. Current treatment of severe croup includes oral or intravenous steroids, racemic epinephrine, heliox and occasionally, intubation [1]. In general croup does not involve the gastrointestinal tract. We report two patients with severe croup requiring intubation that developed intestinal ischemia and subsequent perforation. To our knowledge, these are the only reported cases in the literature of croup and associated intestinal ischemia.

Wilm’s tumor is the commonest malignant renal tumor in infants and children. Congenital Cystic Partially Differentiated Nephroblastoma (CPDN) is a rare form of Wilm’s tumor. It presents with painless abdominal distention and flank mass. It is considered of low malignancy potential. Complete surgical resection is usually curative. We report a 10 month old boy with a right flank mass. CT scan showed a right well capsulated hypodense cystic mass occupying the whole kidney with septations. Right nephrectomy was done. The pathology revealed (CPDN). Post-operative course was uneventful. The infant is doing well.

Materials and Methods: The patients were treated either traditionally (open method, Group-1) or laparoscopically (Group-2). After obtaining informed consent, Group-2 patients were submitted to diagnostic laparoscopy under general anesthesia. Briefly, the patient was placed in the Trendelenburg position, after which a 5 mm umbilical port was made for the telescope, two 3 mm or 5 mm working ports were made in the left lower quadrant and a 3 mm or 5 mm port was made in the left suprapubic region using the open Hasson technique.

Results: No complications were observed during the procedures in both groups. Follow-up varied from 6 months to 8 years and no complications were observed except one patient who underwent laparoscopic assisted wedge resection for rectal bleeding and was hospitalized with a small bowel obstruction secondary to adhesions 2 weeks later. He was successfully managed with medical treatment.

Discussion: We included patients who initially were started laparoscopically and then were converted into an open approach. A comparison of these two groups showed some factors that can be used to predict failure of laparoscopy in a complicated case of MS.

Conclusion: In conclusion, laparoscopy can be an alternative to open approach for managing MD in children but the usefulness of laparoscopy is limited when the diagnosis is an intestinal obstruction due to MD.

Objective: Patent Ductus Arteriosus (PDA) is a common Congenital Heart Disease (CHD) usually treated with catheter closure or surgical ligation. Yet, there is no superiority of one procedure over the other. No prospective randomized trials have been done comparing device closure of PDA versus surgical closure of PDA. We performed this meta-analysis to compare the outcome of both treatment options to determine which option is superior to the other.

Methods: We performed a literature search of MEDLINE, PubMed, EMBASE, Google Scholar, CENTRAL, CINHAL, Cochrane library and literature references for articles published in the last 20 years between January 1997 and January 2017. We excluded studies of adult or premature patients, patients with other CHD, patients with metabolic or systemic disease and those without a direct comparison between surgical and catheter closure of PDAs. Outcomes of interest were success rate, residual shunt with reintervention, need for blood transfusion, complications and length of stay.

Results: Seven thousand five hundred seventy-eight articles were identified. Six studies fulfilled the inclusion criteria. Regarding success rate, no significant difference was found between surgical and catheter closure (RR: 1.01; 95% CI: 0.99- 1.03, P=0.35). Residual shunt was significantly lower in catheter closure than surgical closure (RR: 0.45, 95% CI: 0.21-0.94, P=0.03). Complications and need for blood transfusion were significantly lower in catheter closure (RR: 0.19, 95% CI: 0.11-0.32, P<0.00001) and (RR: 0.12, 95% CI: 0.05-0.32, P<0.0001) respectively. Length of hospital stay was significantly shorter after catheter closure (CI: -3.5- -3.1, P<0.0001).

Conclusion: Catheter closure was superior to surgical closure with lower residual shunt, complications, need for blood transfusion and shorter hospital stay but overall success rate was not higher than surgical closure.

Spiegelian hernia is a rare entity, accounting for 0.10 to 1% of hernias. It is a protrusion of a peritoneal sac through an acquired or congenital anatomical orifice of the Spiegel line or semi-lunar fascia. We report a case of Spiegelian hernia in a 4-year-old girl with no pathological history, received for a right para rectal mass. Physical examination revealed a non strangulated spiegelian hernia of 13 × 12 cm. It was treated by a peritoneal closure according to lazaro Dasilva’s like technique with interposition of a polypropylene mesh. Spiegelian hernias are rare congenital malformations in children. It can be diagnosed clinically but sometimes requires paraclinical explorations (sonography or computed tomography). Surgical management has good results.