Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all spleen ligaments that fixate the spleen in the left upper quadrant. Many different terms refer to wandering spleen like dislocated spleen, ectopic spleen and displaced spleen. We report in this case a 13-year-old Syrian girl presented to the emergency department complaining of acute generalized abdominal pain with fever, anorexia and vomiting started 2 days prior to presentation. A splenectomy was performed, with uneventful postsurgical follow-up. Wandering spleen is prone to torsion and infarction resulting in acute abdomen and a life-threatening condition with high mortality rate reaching 50%. We advise the investigation of any recurrent episodes of chronic pain keeping up within mind this diagnosis.

The urachus is an embryonic tube that connects the upper portion of the bladder to the umbilicus, and obliterates normally during embryonic development stages forming the median umbilical ligament. Incomplete obliteration of this tube results in many anomalies such as congenital patent urachus, umbilical urachal sinus, vesicourachal diverticulum and urachal cyst. We report in this case a 5-year-old female presented to the Emergency, complaining of generalized abdominal pain, fever, vomiting, and constipation with no umbilical discharge. The clinical presentation accompanied by radiology investigations suggested a case of acute abdomen. We performed an exploratory laparotomy and found a mass above the bladder connected to the umbilicus; we excised the mass and sent a specimen to pathology that confirmed Urachal cyst. Urachal cyst is usually asymptomatic unless it is complicated; depending on our case, we recommend surgical management by complete excision for complicated urachal cyst.

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Desmoid tumors are rare benign tumors that arise most commonly in the abdomen, but can occasionally appear in extra-abdominal sites. We present a 3-year-old girl with mitral regurgitation in whom the final diagnosis was a mediastinal desmoid tumor. We managed the patient with complete surgical resection with an uneventful follow-up. Desmoid tumors are rare benign soft-tissue tumors that consist of proliferated, well-differentiated fibroblasts. They represent only 0.03% of all tumors, and their incidence is between 1 and 4 per million population annually. 1 Most patients are between 15 and 60 years old, and they affect women more commonly than men. 2 Desmoid tumors are locally aggressive and often recur even after complete resection, but they do not metastasize. 2 Desmoid tumors most commonly arise in the abdomen, but can occasionally appear in extra-abdominal sites such as chest wall, shoulder, mediastinum, and other rare sites. 3 We report a case of a 3-year-old girl with a mediastinal desmoid tumor and a thorough review of the literature to summarize the characteristics of mediastinal desmoid tumors. 2 | CASE PRESENTATION A 3-year-old girl presented to the hospital with a 4-month history of dry cough and dyspnea. Her past medical and surgical history was unremarkable. On physical examination, there was mild-to-moderate dyspnea without cyanosis or pallor. Chest examination showed diminished breath sounds on the right side with a respiratory rate of 44/min and an oxygen saturation of 95%. Heart rate was 136/min, blood pressure was 100/70 mm Hg, and there was a pansystolic murmur heard in the mitral area graded 3/6. The abdomen was tender, and the liver was displaced inferiorly about 6 cm below the costal margin without splenomegaly or venous dilations on the abdominal wall. Laboratory tests revealed abnormal levels of CRP (8 mg/L), ESR (31 mm/h), K + (3.4 mmol/L), and urea (32 mg/dL). Other laboratory tests, including tumor markers, were unremarkable. Chest X-ray (CXR) revealed a homogeneously increased density over the entire right side of the chest, shifting the mediastinum to the left, as seen in Figure 1.

Histiocytosis encompasses a group of diverse disorders characterized by the accumulation and infiltration of monocytes, macrophages, and dendritic cells in the affected tissues. The clinical presentations vary greatly, ranging from mild to life threatening. A 46-year-oldman presented to Aleppo University Hospital after 4 years from the beginning of his complaint, because he was living in a hard-to-reach area. He presented with grade II dyspnea and painful and swelled legs. Patient past medical history was remarkable for polyuria and polydipsia for 4 years. We diagnosed the patient with multi-organ Langerhans cell Histiocytosis depending on radiological investigations and histopathological examination. We treated the patient with radiation and chemotherapy. On follow up, there was clinical remission but we did not observed any radiological improvement.