Neonatal appendicitis is a rare condition with high mortality rate. Signs and symptoms are often nonspecific, imaging modalities are not always diagnostic, and preoperative diagnosis is difficult with subsequent delay and complications. Its pathophysiology may be different from appendicitis in older children and comorbidities can be found. We report a case of a female neonate with Patau's syndrome, intestinal malrotation, and Fallot tetralogy in whom perforated appendix, probably occurring during fetal period due to vascular insufficiency, was found at laparotomy.

Splenic cysts are uncommon lesions and are classified as true or pseudocysts based on the presence of an epithelial lining. True congenital cysts can be epidermoid, dermoid or endodermoid and require surgery when large, sympthomatic or complicated. Ultrasonography and computerised tomography scan are useful for diagnosis and serum test for echinococcosis should be done. Several procedures, open or laparoscopic, have been described, with emphasis on the spleen-preserving surgery, when possible. We present a boy with a giant symptomatic epidermoid cyst in whom total splenectomy by open technique was carried out.

INTRODUCTION Vesico-ureteral reflux (VUR) is the most common pathology found in patients with complete duplex renal system (DS) and it shows lower tendency to spontaneous resolution when compared to single renal system (SS). Still nowadays the treatment of choice is open surgery with ureteric reimplantation. This is a retrospective study with the aim of compare efficacy of subureteric polydimethylsiloxane (Macroplastique ©) injection (SMING) in the management of VUR in DS and SS. MATHERIAL/METHODS Fifteen children (24 refluxing renal units) with VUR in DS underwent SMING. Ten children had monolateral VUR which was more frequent in lower moiety. VUR was graded intermediate/severe (III/IV-V grade) in 88% of renal units. Clinical history of urinary tract infections and bladder dysfunction was found in 40% of children. Indications for SMING were breakthrough urinary tract infections, severe or persistent VUR, development of new scars or deteriorating renal function. During follow-up patients underwent urinocolture, renal ultrasounds, micturating cystourethrography and Tc 99m DMSA renal scan. Antibiotic prophylaxis was continued until resolution of VUR or improvement to grade I. The outcome was compared with 44 children (60 refluxing renal units) with intermediate/severe VUR in SS. RESULTS VUR resolution/improvement rate was 88% in DS and 95% in SS. Ureteric reimplantation was necessary in 13% and 7% of DS and SS respectively. Transient ureteral obstruction was found in 1/15 and 5/44 patients. One child per group required double-J ureteric stent. Macroplastique © used was 1.2 ±0.5 cc in DS and 0.8 ±0.5 cc in SS (p<0.05). CONCLUSION We can say that SMING procedure is effective also in DS patients with intermediate/severe VUR. Success rate, number of procedures and complications are similar to SS group. The only difference was the mean amount of Macroplastique ©required, which was higher in DS.

We report a 10-year experience of children with recurrent thyroglossal duct cysts (TGDCs) who have been treated using the "extended" Sistrunk procedure.

We report a case of xanthogranulomatous pyelonephritis (XGP) complicated by shaped urolithiasis, severe hydroureteronephrosis and kidney exclusion treated by laparoscopic-assisted nephroureterectomy. A 9 year-old boy was referred to us for recurrent episodes of urinary tract infection, abdominal pain and severe hydronephrosis. Abdominal CT and a Tc-99m MAG3 scan showed a non-functioning obstructed kidney with shaped urolithiasis of the distal ureter. XGP was suspected, and nephroureterectomy was performed by laparoscopic distal ureterectomy and open extraperitoneal nephrectomy. This technique avoided the need for a more extended nephrectomy incision or even a second iliac incision. It also ensured complete excision of the distal ureter with minimal risk of developing the ureteral stump syndrome, which sometimes follows nephroureterectomy. We believe that laparoscopic-assisted nephroureterectomy may be a suitable technique in those cases of difficult nephrectomy where a ureteral stump syndrome is likely to develop.

INTRODUCTION Unexplained recurrent right iliac fossa (RIF) pain is a frequent problem in children, especially in school age and adolescent. It is responsible for multiple hospital admission and conventional diagnostic studies fail to identify the cause in up to 90% of cases. The aim of this study has been to investigate the role of elective laparoscopic appendectomy in patients with RIF pain. MATHERIAL/METHODS A retrospective analysis of ninety-eight laparoscopic appendectomy from January 2008 and December 2010 was carried out. Fourteen children underwent elective appendectomy for recurrent RIF pain. This group was characterized by history of frequent episodes of RIF during the last months or three or more recurrent attacks of pain over one year. In all children, symptoms were severe enough to warrant repeated visits and hospitalization with significant impact on social life. Clinical exam, behavioral history, serological and instrumental investigations were not conclusive for diagnosis. Mean age was 13 years (range 8 to 16 years), 10 (67%) were female and the mean duration of symptoms was 6 months (range 2 to 10 months). Follow-up was 6-36 months (median 18 months) and outcome data were obtained by visits and interview by phone. RESULTS At laparoscopy, all appendix appeared normal or slightly inflamed but appendectomy and pathology exam was carried out. No other abnormalities or pathology were found at laparoscopy as possible cause of pain. There were not intra- or post-operative complications. Of the 14 patients studied, 13 (93%) had complete resolution of symptoms at follow-up. All the specimens, however, showed chronic inflammation with fibrosis, hyperplastic - follicular changes and mononuclear inflammatory infiltrate (lymphocytes and plasmacells). CONCLUSION Our study demonstrate that children with chronic RIF pain have pathology in the appendix and laparoscopy appendectomy is a valuable procedure for diagnosis and treatment even if the appendix seems macroscopically normal, when no other causes of pain are found, appendectomy should be done. Fibrosis and chronic inflammatory cells found at histology reports support the conditions of chronic appendicitis, which may presents as chronic or recurrent pain.

Graded compression ultrasonography (US) has become the most popular technique used in suspected appendicitis and in our prospective study, we have evaluated its contribution to the diagnosis of acute appendicitis during the period 2010-2013.

To retrospectively analyze the feasibility, safety and complication rate of laparoscopic inguinal herniorraphy in babies weighing 5 kg or less.

Sigmoid volvulus (SV) is an extremely rare cause of bowel obstruction in the newborn period. We report a neonatal case of SV misdiagnosed as small bowel volvulus. At laparotomy, the classical findings of SV were observed without gangrene. The operative procedure consisted of simple detorsion without sigmoidopexy.

INTRODUCTION Bowel perforation is a tragic event in newborns, especially in VLBW. Intestinal perforation usually involves small intestine while colon is rarely affected. Colon perforation is associated with higher mortality rate, so prompt surgical treatment is mandatory. We report on 2 cases of female near term neonates with unusual colon perforations. MATHERIAL/METHODS CASE A: a six day-old female babe presented with acute abdomen and evidence of free air on the abdominal x-ray. She was born at 34th weeks of gestation (birth weight 2000gr) and her mother suffered for placenta previa. She passed meconium at birth and was regularly feeded. An emergency operation was performed through an upper abdominal transverse incision and four sites of extended perforations were found at descending and sigmoid colon with purulent abdominal fluid. Left emicolectomy was necessary because of large perforations. Colostomy on transverse colon was made. There weren’t signs of other associated conditions(NEC or trauma/mechanical bowel obstruction or intestinal duplication).Stoma was closed 1 month later with a transverse-sigmoid T-T anastomosis. CASE B: a twelve day-old female babe born at 38th weeks of gestation(birth weight 2850gr)with intestinal malrotation, tetralogy of Fallot and Patau’s syndrome developed abdominal distension without any local or systemic signs of peritonitis. In the suspect of bowel obstruction secondary to malrotation, a Ladd’s procedure was started. Murky fluid as well as fibrinous purulent exudate was noted in bilateral lower quadrants. Appendix with “pig tail” shape was apparently mildly inflamed and perforated at tip. So appendectomy and Ladd’s procedure were done. Aggressive antibiotic therapy was started. Unfortunately, 3 months later the babe died for cardiovascular complications associated to her syndrome. RESULTS In case A histology report showed ulceration/necrosis and inflammation of the colon. Ganglion cells were normally distributed and not signs of cystic fibrosis were found on genetic analysis and on sweat test. The post-operative course was uneventful and at 5-mo follow-up the infant is growing well. In case B the histology report showed signs of purulent appendicitis with peri-appendix inflammatory response. CONCLUSIONS Spontaneous colon perforation is usually observed in neonates VLBW and cystic fibrosis. Its occurrence in term or nearly term neonates is rare and sometimes without apparent risk factors. Neonatal appendicitis has been described in few reports, some in association with cardiac anomalies such as tetralogy of Fallot. Despite these two cases may appear different with clear signs of intra-abdominal inflammation we believe that pre-or perinatal ischemic events could be the primary etiology. This hypotesis may be supported by the risk factors for ischemia present in both patients, placenta previa and complex cardiac malformations.

We demonstrated down-regulation of epidermal growth factor (EGF) and up-regulation of monocyte chemotactic protein-1 (MCP-1) in the renal parenchyma in children who underwent pyeloplasty for ureteropelvic junction obstruction (UPJO). These findings were paralleled by urinary levels of EGF and MCP-1 before and after surgery. The aim of this study is to evaluate the urinary excretion of these cytokines and β2-microglobulin (β2M) in children with urine flow impairment at the ureteropelvic junction or who underwent pyeloplasty.