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Congenital epulis is a rare benign tumor of the newborn that could be detected in the prenatal period. Females are more often affected than males and the premaxillary region is usually the predilection site for this oral mass. Excision is the treatment of choice and no recurrences have been reported so far. We present our experience with two cases of congenital epulis, detected in the second trimester of gestation and treated shortly after birth with no further complications. Histopathology should differentiate between congenital epulis and other congenital oral tumors even if its clinical appearance is usually enough to make a tentative diagnosis. A multidisciplinary assessment in the management of this tumor can avoid unwanted complications such as airway obstruction or bleeding.

Wilson’s disease (WD) is an autosomal recessive disorder, in which the metabolism of copper is affected by metal accumulation in several organs that causes gradual organ degeneration. Since Wilson’s initial description of WD over a century ago, there have been significant improvements in understanding and managing the condition. Nevertheless, the ongoing gap between the onset of symptoms and diagnosis highlights the difficulties in identifying this copper overload disorder early. Despite being a treatable condition, detecting WD early remains a challenge for healthcare professionals at all levels of care, likely due to its rarity. The key challenge is, therefore, to educate physicians on how to identify atypical or infrequent symptoms of WD, prompting them to consider the diagnosis more carefully. The purpose of our review is to draw attention to the difficulties associated with diagnosing pediatric WD, starting from our personal experience of a complex case and then examining relevant literature. In summary, the diagnosis of WD in children is intricate and requires a heightened level of suspicion to identify this infrequent condition. A thorough evaluation by a multidisciplinary team of physicians, along with genetic testing, histopathologic examination, and specialized imaging studies, may be necessary to confirm the diagnosis and guide treatment.

Introduction. Minimal invasive treatment for congenital hydronephrosis in children remains a controversial topic, both in defining the necessity and timing of operation using laparoscopic techniques in neonates and infants. Materials and methods. This study aims to analyze criteria used for surgery in a series of patients operated in a laparoscopic manner, for congenital hydronephrosis, at the Emergency Clinical Hospital for Children “Marie Curie” Bucharest, Department of Pediatric Surgery, between 2007-2015. Results. In our series, the most frequent found criteria for surgery were anterior-posterior diameter over 3 cm, followed by 50% reduced parenchymal thickness, decreased renal function under 40% and finally symptomatic criteria – urinary tract infections and flank colicky pain. Both pelvic dilatation and parenchymal thickness correlates with renal function, though reduced parenchymal thickness has a stronger correlation. Infants under 1 year and under 10 kg represented a significant proportion (17.5% and 22.5% respectively). Conclusions. Young age (under 1 year old) and low-weight (under 10 kilos) in children are not reasons to delay classical or laparoscopic surgical treatment for PUJO (pyelo-ureteric junction obstruction). Pyelectasis is not specific to PUJO. It does not always mean obstruction and does not always show a strong correlation with impaired renal function. Best in establishing therapeutic conduct are the magnitude of renal parenchymal restructuring, the degree of renal function impairment and clinical symptomatology. Laparoscopic treatment is an effective surgical approach, that meets all the major advantages of minimal invasive surgery, applicable to infants and small children, regardless of age and weight.

Introducere. Tratamentul minim-invaziv al hidronefrozei congenitale la copil rămâne un subiect controversat, atât prin prisma momentului şi criteriilor operatorii, cât şi prin adresarea tehnicilor laparoscopice la sugar şi copilul mic. Material şi metodă. Studiul îşi propune analiza criteriilor operatorii ale unui lot de pacienţi operaţi laparoscopic pentru hidronefroză congenitală în perioada 2007-2015, în cadrul Clinicii de Chirurgie Pediatrică a Spitalului Clinic de Urgenţă pentru Copii „M.S. Curie“, Bucureşti. Rezultate. În lotul studiat, cel mai frecvent criteriu utilizat pentru indicaţia chirurgicală este dilataţia bazinetului peste 3 cm, urmat de alterarea (sub 50%) a grosimii parenchimului, alterarea funcţionalităţii renale sub 40% şi în final criteriile simptomatice – infecţiile urinare şi durerile colicative lombare. Atât dilataţia bazinetului cât şi grosimea parenchimului renal se corelează cu funcţia renală, corelaţia fiind mai puternică pentru grosimea parenchimului renal. Sugarii sub 1 an şi sub 10 kg au fost reprezentaţi în proporţie semnificativă (17,5% şi respectiv 22,5%) Concluzii. Vârsta mică (sub 1 an) şi greutatea redusă (sub 10 kg) a pacientului nu constituie un motiv de temporizare a tratamentului chirurgical. Pielectazia nu este specifică sindromului de joncţiune pielo-ureterală, poate apărea în absenţa unei obstrucţii şi nu prezintă întotdeauna o corelaţie puternică cu alterarea funcţiei renale. Elementele de bază în stabilirea conduitei terapeutice sunt: amploarea restructurărilor parenchimatoase renale, gradul afectării funcţiei renale şi simptomatologia clinică. Tratamentul laparoscopic este o soluţie chirurgicală care întruneşte toate avantajele minim-invazivităţii, aplicabilă copiilor şi sugarilor, indiferent de vârstă şi greutate.

Left retrocaval ureter is an extremely rare congenital malformation which is associated with situs inversus, duplicated or translated inferior vena cava (IVC). We report a female adolescent who presented with a history of intermittent, colicky lumbar pain. Diagnostic workup revealed left retrocaval ureter and left ureterohydronephrosis. The girl underwent laparoscopy. The renal pelvis and ureter posterior to the vena cava were dissected, transected at the caudal point of the dilated ureteral segment, and uncrossed and repositioned lateral to the vena cava. Ureteroureterostomy was performed over a double-J ureteral stent after spatulation of the distal ureter. The postoperative course was uneventful and the ureteral stent removed after 5 weeks. During follow-up, the patient is symptom-free. Our case demonstrates that our laparoscopic approach is feasible in this rare anatomic anomaly.