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.

Urethral prolapse is a complete eversion of the distal urethral mucosa through the external meatus. It is a rare condition in children that relates to girls with a peak frequency of four to sixyears, more commonly in black girls.

This condition can be a forensic problem, in fact the clinical presentation of the urethral prolapsed is mainly a vulvar bleeding.

Urethral prolapse can be definitively diagnosed without laboratory or radiographic evaluation by demonstrating that the edematous tissue surrounds the meatus circumferentially.

We retrospectively analyzed the records of 8 cases of urethral prolapse in girls admitted to the Emergency Department Pediatrics Surgical, over a period of 17 years (1998 - 2014) in our series; the age of diagnosis was between 05 and 12 years with a median age of 08 years. 100% of our girls were Caucasian.

The treatment is the subject of great controversy between surgery and conservative treatment, all of our patients underwent surgical treatment except for one patient.

The risk of complications, including urethral stricture, and recurrence, is not rare, due to a poorly conducted medical treatment or poorly mastered surgery.

In our series, the outcome was favorable in all our patients.

An early withdrawal of the urinary catheter can help to shorten the hospital stay and thus, a lower cost of hospitalization.

Benign Multicystic Peritoneal Mesothelioma (BMPM) is an uncommon lesion of the serosal membranes. Many terms used in the literatures to describe this particular entity. There are larger series reported from pathologist consultation files with patients from different institutions with incomplete clinical information and lack of long-time follow-up data. Therefore, this disease is classified as an exceedingly rare medical entity. We reported two cases with such rare entity of BMPM admitted and managed in our pediatric surgery unit with a review of the literature.

Case 1: A 4 years old male was admitted to our pediatric surgery unit with a preliminary diagnosis of appendicitis. For 15 days prior to admission, he had been complaining of a crampy abdominal pain, episodes of non-bilious vomiting, progressive abdominal distention and constipation. The patient was operated with a supraumbilical transverse incision. Operation revealed a cystic mass filled with dark brown-dark green serous fluid, which was attached to the greater curvature of the stomach.

Case 2: A 28-month-old male presented with a few days history of abdominal pain, mild fever with twice episodes of non-bilious vomiting. The CT images confirmed the sonogram studies. The patient was operated with a supraumbilical transverse incision. Operation revealed a cystic mass filled with dark brown-dark green serous fluid, which was attached to the greater curvature of the stomach. In both case the histopathology an Immunohistochemistry revealed and confirmed BMPM. Benign multicystic mesothelioma should be kept in mind as an unusual cause for an abdominal mass in children.

Background: Surgeon and cardiologist on their own cannot cope with patients needs, occasionally. Hypoplastic left heart syndrome witnessed the collaboration between them for a palliative, hybrid procedure. As a strategy, hybrid approach has been applied in several, unforeseeable settings. Our initial experience is presented, pointing at indications, shortcomings and mid-term results.

Methods: Fifty-one patients were scheduled for a hybrid procedure along five years. This was defined as close collaboration between surgeon and cardiologist working together in the same room, either cath-lab (26 patients) or theatre (25 patients)

Results: Five groups were arbitrarily defined. A: vascular cut-down in the cath-lab (17 neonates); B: bilateral banding (plus ductal stent) in hypoplastic left heart syndrome or alike (10 children); C: perventricular closure of muscular ventricular septal defect (9 cases); D: Balloon/stenting of pulmonary branches along with major surgical procedure (9 kids); E: surgical implantation of Melody valve (5 patients) and others (1 case). Two complications were recorded: left ventricular free wall puncture and previous conduit tearing. Both drawbacks were successfully sort out under cardiopulmonary by-pass.

Conclusion: Surgeon and cardiologist partnership can succeed where their isolated endeavors are not enough. Hybrid procedures keep on spreading, overcoming initial expectations. As a bridge to biventricular repair or transplant, bilateral banding plus ductal stent sounds interesting. Novel indications can be classified into different groups. Hybrid procedures are not complication-free.

A new and simple trick to encircle the Inferior Vena Cava (IVC) in minimally invasive cardiac surgery is depicted. With the aid of a shafted, flexible-tip dissector, the IVC is surrounded with a tape for its exclusion in a gentle movement.

Background: A colostomy is an operation that creates an opening for the colon, or large intestine, through the abdomen. A colostomy may be temporary or permanent. Hirschsprung’s disease is a birth defect in which nerves are missing from parts of the intestine. Ano-rectal malformations are a spectrum of abnormalities of the rectum and anus occurred at birth or problems that happen to an unborn baby are developing during pregnancy.

Aims of study: To analyzing the common colostomy complications, immediate, early and late. Taking into consideration the site, type of the colostomy performed and measures that should be taken to avoid this complication.

Patients and methods: A retrospective study on a total number of one hundred sixty temporary colostomies were performed for neonates, infants and children over one year old of age in the pediatric surgical department of Children Welfare Teaching Hospital in Baghdad in the period from January 2008 to January 2011. Seventy patients had Hirschsprung’s disease and ninety patients had Ano-rectal malformations. A standardized data sheets were prepared for collection of information including age, sex, body weight, age, associated anomalies, type, site and the indication and the complications of colostomies.

Results: Most of the colostomies about 69.3% were done in the neonatal period and mainly for imperforate anus as 83.3%. Those performed in infancy period constituted about 26.2% of total operations and were done mainly for Hirschsprung’s disease which represented 41.4%.The most common type of stoma in our study was right loop transverse colostomy for Hirschsprung’s disease represented 71.4% and pelvic loop for imperforate anus as 75%. Hundred and seven different complications developed in 71 patients as a result of colostomy formation and the most common complications were stomal prolapse, skin excoriation, wound sepsis, para-stomal hernia, adhesive intestinal obstruction, bleeding and stomal stenosis. Stomal prolapse was the commonest complication in observed and developed in 32.7% of patients.

Conclusion: Hirschsprung’s disease and imperforate anus were commonest indications of stoma formation in pediatric age group. The right transverse loop and pelvic loop colostomy was the commonest stoma used and had the higher rate of complications. Prolapses and skin excoriation were the most common complications obtained.

ACTA2 (actin, alpha 2, smooth muscle) mutation associated with PDA aneurysm rarely presents with heart failure in neonates. Survival is poor with impaired quality of life due to strokes, aneurysms and thromboticischemic events.

We describe a neonate with ACTA2 mutation found to have a 3 cm arterial duct aneurysm (PDA) extending into the distal arch and proximal main pulmonary artery (MPA) with impaired left ventricular systolic function. She underwent excision of the aneurysm and repair of distal arch under deep hypothermic circulatory arrest (DHCA) with good immediate outcome.

A trichobezoar is a mass of cumulated hair within the gastrointestinal tract. Bezoars are rare in children. They are commonly found in stomach. Rarely, bezoars can be located in small bowel, which are most often located in the ileum. Intestinal obstruction due to trichobezor is extremely rare. In this case report we describe an atypical localization of trichobezoar in jejunum (76cm long) causing intestinal obstruction without a primary in stomach in 7 year girl which was managed successfully with surgery.

Splenogonadal fusion is a rare congenital abnormality. Preoperative diagnosis is difficult but can be based on scintigraphy using technetium 99m. It’s a benign lesion that remains to be differentiated from a testicular tumor.

In most cases, the splenic tissue can be dissected of the gonadal structures easily, and if there are any doubts concerning the nature of the swelling, an intraoperative frozen section can be performed to avoid an unnecessary orchiectomy.

We report the case of a 4-year-old child in whom a scrotal mass indicated many investigations before a surgical exploration, and in whom the surgical specimen was diagnosed histologically as a splenogonadal fusion.

Post-traumatic diaphragmatic rupture is defined as the passage of a portion of the abdominal viscera into the thorax through the diaphragmatic tissue following trauma. It is rare in children and most often fits in a context of polytrauma. We report a case of fracture of the left diaphragmatic cupola associated with stage II spleen fracture following thoracoabdominal trauma by the fall of a cart in a boy of 07 years without any particular pathological antecedents. The surgical management of the patient consisted of a suture of the diaphragmatic cupola with the mersuture and a monitoring of the splenic rupture. The postoperative course was simple.

Introduction: Varicocele is a dilatation of the venous pampiniform plexus considered the leading cause of correctible male infertility. It affects 15% of the adolescent population. Over 90% of cases are located on the left hemiscrotum. The treatment is surgical and several methods have been described which main goal is to improve the potential for future fertility. Varicocele etiology remains controversial and there have been several studies that reports varicoceles are found less frequently in obese adolescents but yet, relationship between varicocele and BMI is controversial.

Matherial and Methods: We analyzed patients with varicocele surgical correction in our centre in the last 10 years. At our institution all patients were treated by Palomo technique open or laparoscopic. We analyzed: age, location and degree of varicocele, weight and height, surgical technique, appearance of reactive hydrocele or others complications, varicocele recurrence and reoperation. Our objective is studying the relationship between IMC and varicocele in adolescent boys.

Conclusion: We observed varicocele in our serie was found more frequently in taller patients and less frequently in obese patients (higher BMI). Future studies will be needed to confirm that theory and to understand varicocele etiology but we consider that this fact is very useful because we are talking about a pathology with repercussion in fertility so we must be alert about it in adolescent population to correct it.

One day preterm female neonate was presented with excessive drooling of saliva and non passage of meconium since birth to the Department of Pediatric with antenatal history of polyhydramnios detected at 28 weeks followed by fetal distress at 32 weeks which leads to preterm delivery. An X-ray of the chest and abdomen with a nasogastric tube showed coiling of nasogastric tube in the upper oesophageal pouch in the upper chest and a gasless abdomen confirming the diagnosis of pure oesophageal atresia; child had absent anal opening with rectovaginal fistula which was confirmed by passing small feeding tube in the fistula. Oesophagostomy and feeding gastrostomy were done at first surgery. On 2nd postoperative day child developed intolerance and blockage to feed after first few feeds. Contrast dye study done through feeding gastrostomy showed duodenal atresia which was missed during first surgery due to small, collapsed stomach and duodenum due to no gas in the abdomen due to pure oesophageal atresia. Second surgery duodenoduodenostomy was done on 3rd postoperative day of first surgery, but child succumbed postoperatively due to septic shock and prematurity.

Lumbar Disk Herniation (LDH) is one of the most common disorders among adults with degenerated lumbar intervertebral discs [1]. However, its occurrence in childhood and adolescence is less frequent mostly because children and adolescents tend to have a healthier lumbar spine as compared with adults [2]. The main factors associated with LDH in children are trauma with subsequent axial load or a sport-related injury in some findings [2-4]. According to previous publications, pediatric patients constituted 0.5% to 6.8% of all patients hospitalized for LDH [1]. Hence the structural malformations in the lumbar spine could predispose intervertebral disks to early degeneration; it is usually recommended to be fused surgically [2,4].

The aim of the present review is to provide the latest clinical information and findings of pediatric LDH. Since the disease is rare among pediatric population this article would be helpful to overcome the typical delay in diagnosis compared with the adult LDH.

A ten-year-old boy was referred to the Clinic for further treatment after frequent bronchopneumonia in the last 4 years. Each time on the X-ray, basal right, the shadow on the lungs was verified. After antibiotic therapy, the control X-ray always showed incomplete regression of the shadow. The boy was born with esophageal atresia with tracheoesophageal fistula and was successfully operated on the eighth day of life.