A case of isolated Caroli's disease in a 2-year-old female presented as an exophytic cystic mass of the liver. A palpable mass below the right costal margin and displacement of the right colon were the main points of clinical presentation. Preoperatively, sonographic signs of intraluminal vascular tracts were identified. At laparotomy, the mass was found at the inferior border of the right lobe of the liver next to the gallbladder and was easily removed by wedge excision. Intraoperative liver biopsies and histologic findings of the excised lesion confirmed the diagnosis.
An 8-year-old boy presented with a prostate utricle cyst, measuring 14.7 x 27.8 cm on ultrasonogram ( Fig. 1).An indwelling catheter was placed in the bladder and the patient placed in a knee-chest position. The skin was incised sagittally in the midline from the tip of the coccyx downward up to the posterior anal perimeter. The underlying part of the external sphincter and muscle complex were cut in the midline with an electroknife under guidance of an electrostimulator. The rectum was exposed and pulled laterally to the right side using two rubber slings. The prostatic cyst was revealed and easily dissected free. It was elliptical and measured 8 x 16 cm after needle aspiration of its urine-like content (Fig. 2 ) . The fistulous communication of the cyst with the prostatic urethra was sutureligated and the cyst removed. Haemostasis was meticulous and draining of the operative field was deemed unnecessary. The rectum was released from the slings and replaced. The incised parts of the muscle complex Fig. 1. Transverse ultrasonogram. The bladder and a large fluid collection posterior to the bladder are demonstrated.and external sphincter were stitched and the skin incision closed. The post-operative course was normal. The catheter was retained until the sixth day and the patient was discharged on the eighth day after surgery, having achieved normal micturition. Histological studies of the cyst demonstrated a two-layer wall, consisting of fibrous tissue and transitional epithelium with foci of infection. CommentExcision of large or symptomatic utricle cysts is recommended. The rarity of the operation and anatomical difficulties in the operative field have led to a variety of surgical approaches, which are not free of complications. These approaches include the suprapubic transvesical or extravesical, transperitoneal, perineal, transurethral and posterior parasacral. The posterior sagittal approach has been widely used in the repair of congenital anorectal malformations [ 11, cloacal, urogenital sinus and postoperative faecal incontinence in children with anorectal 0 1995 British Journal of Urology 397
OBJECTIVE:Bladder exstrophy is a congenital anomaly which is not always successfully managed by surgery. Major goals of surgical intervention in such cases are preservation of normal renal function, development of adequate bladder function and urinary continence and avoidance of future urinary tract infections. We present 5-year data on a patient who underwent complete repair of the bladder exstrophy. CASE REPORT : We describe a full term female infant who presented at birth with complete bladder exstrophy. Complete repair of the condition was performed 3 days after birth (Ransley technique). During hospitalization the patient had a positive urinary culture with Candida lusitaniae, enterococcus and septicemia with Klebsiella pneumoniae ESBL. The patient had no complications until the age of 20 months when she developed an episode of pyelonephritis and fi ve further episodes of cystitis with E. coli. Radiographic testing showed small bladder capacity (23 ml at the age of 3 years), bilateral vesicoureteral refl ux, a long stenotic urethra and no loss of renal function. Because of the recurrent urinary tract infections, dilatations of the stenotic urethra (Scheldinger technique) were successfully performed at the age of 3. Twenty-two months later the child had negative urinary cultures, a normal renal function and had also gained partial control of the bladder sphincters. CONCLUSIONS: Surgical repair of bladder exstrophy remains a challenging surgery for the pediatric urologist. Following surgical correction both early and long-term post-operative complications may be present. Longitudinal follow up is required by an experienced team of health care professionals.Key words : bladder exstrophy, neonate, complications Folia Medica 2014; 56(1): 60-63 Copyright © 2014 Medical University, Plovdiv РЕЗЮМЕ ЦЕЛЬ: Экстрофия мочевого пузыря представляет собой врожденную аномалию, которую не всегда возможно успешно лечить оперативным методом. В таких случаях основной целъю хирургической интервенции являются сохранение нормальной почечной функции, достижение адекватного функционирования мочевого пузыря и нормальной континенции, а также и избежание будущих инфекций мочевых путей. В работе авторы представляют пятилетнее прослеживание пациента, перенесшего полное восстановление экстракорпорального мочевого пузыря. КЛИНИЧЕСКИЙ СЛУЧАЙ: Авторы сообщают о мальчике, родившемся в сроке с полной экстрофией мочевого пузыря. Проведена полная реконструкция пузыря на третий день после рождения по методу Ransley. Лабораторные тесты пациента во время госпитализации показали положительную культуру мочи -Candida lusitaniae с энтерококками и септицемию с Klebsiella pneumoniaе ESBL. Пациент без осложнений до 20-имесячного возраста, когда развивает пиелонефрит и 5 раз заболевает циститом, вызванным E. coli. Рентгенологическое исследование показывает мочевой пузырь небольшого объема (23 мл, в возрасте 3 лет), двусторонний везикоуретеральный рефлюкс, стеноз уретры и сохраненную почечную функцию. В возрасте 3 лет проведена дилатация уретры (...
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