HighlightsWe describe a case of a 3 years old girl, with all features of Herlyn–Werner–Wunderlich syndrome (HWWS) who came to our attention for lower abdominal mass.Only six cases are reported in Literature with early onset of this syndrome under 5 years.The aim of this article is to share our experience and focus the attention on the importance of high level of suspicion of HWWS in neonatal period to early diagnosis and treatment.The possible early presentation of this syndrome should be suspected in all neonates (females) with renal agenesia confirmed postnatally or with prenatal diagnosis.An error of evaluation with planning of removal of mass, that can damage patients in term of chance for a successful reproductive outcome.Our team consider HWWS as differential diagnosis in newborn with prenatal ultrasonography of a cystic mass behind the urinary bladder in the absence of a kidney and plan a pelvic ultrasound (with aim to identify an uterus, normal or dydhelfus, and presence or absence of pelvic mass), an examination under anesthesia and cisto-vaginoscopy, if it is necessary. A high level of suspicion, indeed, is the key to early diagnosis.

Persistent pulmonary interstitial emphysema (PPIE) is a rare condition that occurs in both preterm and term infants. It is thought to arise from a disruption of the basement membrane of the alveolar wall allowing air entry into the interstitial space. The characteristic CT scan appearance of PPIE can be used to differentiate it from other congenital cystic lesions that may present similarly. The management of infants suffering from diffuse persistent interstitial pulmonary emphysema varies according to severity and stability of the patient, being either conservative treatment or aggressive surgical treatment by pneumonectomy. We report a case of an unstable patient with diffuse persistent interstitial pulmonary emphysema successfully treated by lobectomy as a form of conservative surgical approach

The management of choledochal cysts has evolved during the last 3 decades. Laparoscopic surgery has revolutionized the treatment of choledochal cyst (CC). We report our case, 2-year old female, in which total excision of cyst and Roux-en-Y hepaticoenterostomy is done by laparoscopic approach. In the hands of experts, laparoscopic excision of the CC is safe and effective approach. This is our first experience and our outcome has been good to a follow-up of 6 months. In our opinion, laparoscopic surgery is a safe treatment of choledochal cyst with less postoperative morbidity, a shorter length of stay and a lower blood loss when compared with open approach. Laparoscopic surgery may become the first choice procedure for choledochal cyst

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Introduction: The recycling of proximal stoma losses is known as a good practice to manage patients with high output stoma. In our center, we introduced this practice about 10 years ago. We revised our series before and after recycling protocol and we reviewed the literature. Methods: This is a retrospective study. We included all neonates who underwent ileostomy between 2000 and 2019. They were divided into two groups, Group A and Group B, before and after the introduction of recycling of stoma losses. Demographic data were included. Outcomes evaluated to demonstrate the efficacy of stools recycling were: weight at the time of anastomosis and at discharge, length of total parenteral nutrition, and time (expressed in days) between anastomosis and passage of the stools. Data were analyzed using Student’s t-test. P values <.05 were considered significant. Results: A total of 85 patients (29 females, 56 males) were included—Group A: 20 (24%) (13 males/7 females); Group B: 65 (76%) (43 males/22 females); Group A: 12/enterocolitis, 5/meconium-related ileum (MRI), 3/single intestinal perforation; Group B: 45 enterocolitis, 10/MRI, 8/single intestinal perforation, 1/an ileal atresia, 1/meconial peritonitis. Outcome about weight at anastomosis and discharge and about time of canalization were significant. Conclusion: We believe that the recycling of stoma losses is a safe and effective practice in neonates with ileostomy. Our technique of recycling is simple and practical. The benefit/risk rate is certain, in our opinion, in favor of the benefits as showed from our data.

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More than 50% of infants with esophageal atresia have associated anomalies. We present a case report of a 46XX neonate with long-gap esophageal atresia and tracheoesophageal fistula (EA/TEF), anorectal malformation, bowel duplication and vaginal agenesis. This is an unusual association of abnormalities which had not yet described in literature.

Classically the management of vesico-ureteral reflux associated to poorly functioning kidney is nephrectomy and total removal of ureter. However total removal of ureter is not always possible, especially if it is ectopic. For this reason a distal ureteral stump (DUS) may remain. Literature reports minimal late complications in DUS but when pathologic findings occur it is necessary a patient's surveillance and appropriate therapeutic strategy. Generally the diagnosis of DUS is clinical for presence of infections, stones, tumors and obstruction with or without concomitant infections. In others patients it is described the "Stump Ureteral Syndrome" characterized by recurrent urinary infection, abdominal pain and haematuria. Radiologic support is necessary to confirm the diagnosis and a simple mintional retrograde cystouretrography can see the stump and its morphology if refluxing. We present an assessment of patient with DUS post total nephrectomy and our diagnostic and surgiacal approach. CASE REPORTM.S, a male born at term by natural childbirth after a normal pregnancy. Fetal ultrasound didn't show abdominal malformations. After the birth the baby presented many episodes characterized by fever, abdominal pain and urine culture showed the presence of many colonies of Escherichia Coli. Also the patient showed important growth retardation. For this reason when he was three months of live abdominal ultrasound was performed and it revealed a right renal hypoplasia (diameter 2,5 cm) and reduction of renal medulla while the left kidney (diameter 6,5 cm) was normal. Scintigraphy with DMSA confirmed the right renal hypoplasia and we performed a voiding micturating cystourethrography that showed a right grade 4 vesico-ureteral reflux. When he was old 7 months of life right retroperitoneoscopic nephrectomy was performed with removal of ureter by an additional incision on the flank. The histological examination confirmed the renal hypoplasia and dysplasia with disorganization of muscle fibers of pieloureteral junction and ureter. The patient was discharged in seventh day and there weren't complications like fever, obstruction or UTI. However the patient presented recurrent urinary infections after 4 years from the surgery and antibiotic therapy was prescribed to the baby. We performed voiding micturating cystourethrography that it showed the presence of urinary reflux in the right distal ureteral stump also after total bladder empty ( Fig.1 a-b). Because the parents did not accept to continue antibiotic therapy surgical removal of stump was necessary. Introdution. Distal Ureteral Stump is a residual ureter after total or partial nephrectomy. It is a rare complication and it also appears many years after surgery. Majority of patients are asymptomatic but Literature reports patients with recurrent bacteriuria or haematuria, empyema, stones and tumors (transitional-cell carcinoma or renal-cell carcinoma). We present one case of diseased ureteral stump and surgical strategy. Case Report. We report a case of a patient subjected t...