Hepatoblastoma is the most common hepatic tumor in children, it accounts for 1% of pediatric malignant tumor [1]. The treatment modalities include surgery and neoadjuvant or adjuvant chemotherapy. The advancement in the field of chemotherapy led to improved survival [2,3]. Herein, we report 4 cases of children with advanced stage hepatoblastoma who were successfully treated with combination of chemotherapy and surgery with an excellent outcome.

Background: The term bezoar refers to swallowed material (either food or foreign body) that fails to clear from the stomach and accumulates into masses of concretions. It can be classified into many types: phytobezoar (vegetable); trichobezoar (hair); lactobezoar (milk/curd), pills (pharmacobezoar) and miscellaneous (wool, cotton, sand, paper, etc.). Usually, the trichobezoar is confined within the stomach but in some cases extends through the pylorus into duodenum & various lengths of the intestine & this is called “Rapunzel Syndrome”.

Method: we presented a case of 4-year-old boy with gastric trichobezoar and extension of its tail to the duodenum & rest of small bowel. The purpose of reporting this case is the rare occurrence of such condition discussing the presentation, diagnostic modalities & the ideal option of surgical treatment.

Result: The patient was presented with recurrent attacks of acute epigastric pain, vomiting and loss of appetite. Abdominal examination revealed mild abdominal distention with a soft, non-tender mass in the epigastric region. The mass was movable with respiration and it was possible to get above it. Abdominal sonography revealed a large a heterogeneous mass within the stomach, a diagnosis of gastric trichobezoar was suggested and confirmed by CT scan with oral contrast which revealed a large filling defect in the stomach and non-enhancing intraluminal gastric mass. During laparotomy, a stomach-casted mass of trichobezoar was delivered through gastotomy with uneventful postoperative recovery and no complications were recorded.

Conclusion: Trichobezoar or Rapunzel syndrome in children is rare and there are many factors associated with trichophagia. The clinical Presentation is usually late, may present as an emergency that surgeons should be prepared to deal with. It can be diagnosed by ultrasound, contrast films, CT scan or endoscopy. In spite of several therapeutic options used, laparotomy is still considering the treatment of choice.

Viruses, parasites and bacteria destroy cell and tissues by direct action and indirectly eliciting inflammation. Allergy and insulin resistance worsen and maintain inflammation.

Foreign Body (FB) ingestions are common in childhood and are commonly observed in the emergency departments of the hospitals. Most of the ingested FBs pass the entire gastrointestinal tract uneventfully and spontaneous passage of FB with feces is commonly observed and surgical interventions to remove the ingested objects out of the gastrointestinal tract may be necessary in little number of patients. A 2-month-old baby with vomiting after feedings is presented in this report. A metal coin was detected at the first esophageal narrowing during endoscopy and removed. The patient is discussed under the light of relevant literature.

Alagille Syndrome (ALGS) is a rare multisystem congenital disorder, with a minimum incidence of approximately 1:30,000 live births. Several of the characteristics of Alagille syndrome may result in patients having an especially high risk of fracture. Case presentation; a 6-months-old girl admitted to pediatric surgery unit with jaundice since one month of age, progressive abdominal distention. She had been diagnosed with biliary atresia at the age of 1 month on the base of clinical diagnosis; she was malnourished with stunted growth. She had most of the features of Alagille syndrome. Chest radiographs showed generalized decreased in bone density with multiple ribs fractures on the left side, with pulmonary consolidation in the left middle and lower zone. Osteodystrophy (hepatic cause) was enrolled based on the fact that there was no evidence or history of trauma (child abuse by the family was not considered). Our study is one of a few reports to document ribs fracture in children with AGLS.