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Background Perineal groove is a rare congenital malformation that is unknown to many clinicians and is often misdiagnosed. Although it may be self-resolving during childhood, this nonepithelized mucous membrane can pose the risk of local irritation and infection, particularly urinary tract infection. Methods A retrospective study of female infants diagnosed with a perineal groove was performed, demographic characteristics and clinical features were analyzed, and a photographic review was conducted. Results Five patients with perineal groove were observed in our clinic in 2015-16. The mean age was 14 months. None had symptoms, and no treatment was required. During follow-up of 1 year, all remained asymptomatic. Conclusions Our retrospective review suggests that perineal groove may be an underdiagnosed condition. Most cases resolve spontaneously, but confusion in diagnosis may lead to misdiagnosis or misinterpretation of sexual abuse and unnecessary treatments.

Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) successive papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la colaboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1ª. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2ª. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisiones a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

La ingestión de cáusticos representa un grave problema médico-social por las consecuencias devastadoras e irreversibles que puede producir en el tracto digestivo superior. En Iberoamérica no se han publicado datos fidedignos sobre la incidencia o la prevalencia de lesiones inducidas por cáusticos. La información disponible sobre la presentación clínica, diagnóstico, tratamiento y pronóstico se basa en series retrospectivas de casos y, de hecho, su manejo clínico se sustenta en muchos casos fundamentalmente en la opinión de expertos. Recientemente como una iniciativa de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP) y con la colaboración de colegas de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátrica (SEGHNP), hemos diseñado una Guía de Práctica Clínica (GPC) la cual incluye una serie de enunciados y recomendaciones dirigidos a optimizar la atención a los pacientes y que se basan en la revisión sistemática de la evidencia y la valoración de los beneficios y riesgos de las opciones asistenciales alternativas. En dos (2) manuscritos sucesivos nos hemos enfocado primero, en los aspectos fisiopatológicos y de diagnóstico clínico-endoscópico de la esofagitis cáustica en niños (1ª. Parte) y en segundo lugar, en los aspectos más relevantes del tratamiento (2ª. Parte). Esperamos esta guía se convierta en una herramienta útil para el clínico en el difícil proceso de toma de decisiones a la hora de evaluar un paciente posterior a la ingesta de una sustancia cáustica.

A34-year-old primigravida with no significant medical history underwent a routine ultrasound at 21 weeks’ gestation. Fetal sonography revealed the presence of a solid mass, 14 mm 19 mm in size, arising from the region of the glabella (Figure 1B). No other abnormalities were detected. Fetal MRI was performed at 21 weeks (Figure 2A) to clearly define the lesion and rule out calvarial defects. The patient chose to continue with the pregnancy. A male fetus was uneventfully delivered at 39 weeks. The presence of a solid friable mass located in the left internal canthus was noticed (Figure 2B). The mass was resected with no complications at 2 weeks of age (Figure 2C), and pathological study confirmed the presence of neuroglial heterotopic tissue (nasal glioma). Although benign in nature, gliomas are cosmetically unfavorable, and early surgical intervention is the treatment of choice to minimize nasal distortion.1,2 Differential diagnosis includes encephalocele, teratoma, dermoid cyst, dacryocystocele, retinoblastoma, and hemangioma.2,3 Prenatal suspected diagnosis and assessment is of paramount relevance SI

To evaluate our experience using laparoscopic Palomo varicocele ligation in a population under 18years, and confirm the factors involved in postoperative hydrocele formation.Between 1997 and 2007, 156 boys diagnosed as having varicocele were evaluated retrospectively. Outcome variables recorded for analysis were age at presentation, symptoms, varicocele grade (Dubin-Amelar classification), testicular atrophy, length of hospital stay, perioperative complications, recurrence and hydrocele formation after surgery. Mean follow up was 5.6 years (6 months- 9 years).Age at diagnosis ranged between 9 and 18 years. Mean age at operation was 14.1+/-1.8 years. There were 153 left-side varicoceles (98%) and three cases were bilateral. All patients had grade II or III varicocele (38%/62%) and testicular atrophy was noted in 43.8%; 8.1% mentioned testicular pain at diagnosis. All boys underwent Palomo laparoscopic ligation of the spermatic vessels. Mean operative time was 38 min (25-82 min). The last 51 surgeries were performed on a two-trocar basis with Ligasure vascular sealing device and operative time decreased significantly to 22 min (16-32 min) (P0.05). Median hospital stay was 31+/-8 h. Conversion rate was 1.28%. Twenty-one patients developed hydrocele (13.5%); 11 of these underwent Winkelman-Lord's hydrocelectomy at least 1 year after Palomo (9% of total). Of the remaining 10, two resolved spontaneously and eight were stable at mean 4-year follow up.Laparoscopic Palomo varicocele surgery for pediatric patients is a safe and effective procedure. Recurrence and complication rates are similar to those reported with open surgery.

A 5-year-old caucasian child is described with a congenital melanocytic periungual and subungual nevus on the right second toe. Histopathologic examination revealed a junctional nevus. Congenital subungual nevi in this location are rare. To the best of our knowledge, this represents the first case of lesion on the right second toe to be reported in the literature.

Plantar warts often are refractory to any treatment and can last for decades in adults. Recalcitrant warts are defined as those that have persisted for more than two years, or after at least two treatment modalities.A total of 15 consecutive patients with recalcitrant plantar warts were included in this preliminary study. The treatment consisted of applying one to two sessions that comprised compounding 1% cantharidin, 5% of podophyllotoxin, and 30% salicylic acid (CPS), with an interval between applications of four weeks.With treatment and subsequent follow-up for six months, there was complete eradication of lesions in 15 patients, eight (53.3%) required a single application of the solution, and seven (46.7%) two applications, with no side effects. Patient satisfaction related to treatment was measured by a visual analog scale (VAS) of 10 cm in length, with an average score 9.73 ± 0.46, and all said they would proceed with the treatment again if necessary.Topical treatment by compounding is safe, effective, and a promising therapeutic modality when applied in recalcitrant plantar warts.

One of the most controversial aspects of hypospadias surgery is the election of an appropriate wound dressing. In fact, there may be as many different types of dressing as there are types of surgical repair. Here, we describe a new, simple method for hypospadias dressing in children that minimizes painful removal.

Objective: to determine whether arch height has an effect on the health-related quality of life of schoolchildren. Methods: One hundred and thirteen schoolchildren attended an out-patient centre where self-reported data were recorded, their feet were classified into one of three groups according to their arch index (high, normal or low) and the scores obtained from the Foot Health Status Questionnaire (FHSQ – Spanish version) were compared. Results: The groups with high, low and normal arch recorded lower scores in Section One for the general foot health and footwear domains and higher scores in foot pain and foot function. In Section Two they obtained lower scores in general health and higher scores in physical activity, social capacity and vigor. Conclusions: Comparison of the scores obtained reveals that arch height has a negative impact on quality of life. Given the limited extent of available evidence in respect of the aetiology and treatment of foot diseases and deformities, these findings reveal the need to implement programmes to promote foot health and carry out further research into this commonly occurring disabling condition. Objetivo: conocer si la altura del arco del pie tiene impacto en la calidad de vida relacionada con la salud en la etapa escolar. Métodos: ciento trece escolares acudieron a un centro ambulatorio donde se registraron datos autoinformados, se clasificaron los pies en función de los valores del índice del arco en tres grupos (aumentado, disminuido y normal) y se compararon las puntuaciones obtenidas según el Foot Health Status Questionnaire (FHSQ) versión española. Resultados: Los grupos con arco del pie aumentado, disminuido y normal muestran puntuaciones más bajas en la primera sección en las dimensiones salud del pie y calzado y puntuaciones altas en dolor y función del pie. En la segunda sección obtuvieron menos puntuación en la dimensión salud general y puntuaciones altas en función física, función social y vitalidad. Conclusiones: La comparación de las puntuaciones obtenidas muestra que la altura del arco tiene un impacto negativo en la calidad de vida. Dado que la evidencia actual sobre la etiología y el tratamiento de las enfermedades y deformidades es limitada, estos resultados ponen de manifiesto la necesidad de implementar programas para promover la salud de los pies y seguir investigando en esta condición común e incapacitante. SI

Summary Congenital absence of the nose is an extremely infrequent congenital malformation with less than 40 cases reported previously in the literature. Only three cases of partial arhinia have been reported. It is commonly seen associated with other central nervous system and craniofacial malformations. Somatic anomalies have been reported in more than 50% of cases. Severe airway, feeding and phonetic problems may accompany this pathology in children. We describe a case of complete heminose agenesis and absence of the ipsilateral nasal fossae, without other congenital malformations.

The part of the penile skin that covers the glans penis is named prepuce or foreskin. The embryologic development of the prepuce and urethra is related. Several congenital anomalies of the prepuce have been previously reported, but the absence of the prepuce with a normal development of the urethra is a very rare association. We report a sporadic case with absence of the prepuce and normal urethral development.

An 8 year-old-boy was referred because of abdominal pain 24 hours after being hoof-kicked by a horse in the abdominal wall. On arrival the boy appeared ill, with nausea and vomiting and right abdominal pain. Physical examination revealed epigastric tenderness with muscle guarding in the upper abdominal wall. Because of persistent pain CT was performed and further revealed a very small amount of free subhepatic air just attached to the duodenum (Fig. 1). A hollow viscus injury was suspected. At surgery there was bile staining and dirty fluid in the paraduodenal area. A duodenal perforation (1 cm) located in the retroperitoneal segment was noticed (Fig. 2). A primary surgical repair of the duodenal rupture was made. The patient’s postoperative course was uneventful and was discharged at home seven days later.

Background Umbilical cord hemangioma is very rare and may not be detected prenatally. However, it should be considered in differential diagnosis with other umbilical masses because it can cause significant morbidity. Methods We report the case of a newborn referred with suspected omphalitis and umbilical hernia. Results Physical examination showed an irreducible umbilical tumor, the size of olive, with dubious secretion. The initial suspected diagnosis was urachal or omphalomesenteric duct remnants. Abdominal ultrasound and magnetic resonance imaging showed an umbilical and a mesenteric mass. Tumor markers were negative. A definitive diagnosis of umbilical cord and intestinal hemangioma was established after surgical excision and histologic examination of the umbilical mass. Propranolol was prescribed due to the extent of the intestinal lesion. Conclusion This report highlights the diagnostic challenges of hemangiomas in unusual locations. Apart from the rarity of these tumors, few tests are available to guide diagnosis, and surgery and histologic examination are generally required for a definitive diagnosis. Finally, it is essential to rule out associated malformations and hemangiomas in other locations.

Midline congenital cervical cleft is an extremely uncommon anomaly of the neck. Fewer than 100 cases have been reported. It is usually described as a cervical scar-like skin defect. We present a case of midline cervical cleft mimicking linear morphea and treated with topical steroids for 2 years. This is an unusual presentation of this entity that must be treated with surgical excision to confirm the diagnosis histopathologically. © 2012 Wiley Periodicals, Inc.

Incomplete polyorchidism (also called bilobed testicle) is an extremely uncommon congenital anomaly. Only 3 cases of bilobed testicle were previously reported in the available literature. We describe a case of a 4-year-old boy who presented with a 6-month history of an asymptomatic scrotal mass located in the upper pole of the left testicle mimicking testicular tumour. After partial orchiectomy, macroscopic and pathological examination of the lesion confirmed the diagnosis of normal testicular tissue.

Background To present our initial experience with electrothermal bipolar vessel device and only 2 expandable ports for laparoscopic Palomo varicocele procedure in pediatric and adolescent population. Methods In a 3-year period between 2006 and 2009, sixty-three boys and adolescents diagnosed in our institution as having varicocele underwent Palomo laparoscopic surgery with a two 5-mm expandable-trocar laparoscopic approach using the LigaSure technology (Valleylab Inc., Covidien, Boulder, CO) for spermatic vessels sealing. The outcome variables recorded for analysis were age at presentation, symptoms, varicocele grade based on Dubin and Amelar Classification, testicular atrophy, operative time, complications, recurrence, and reactive hydrocele formation. Mean follow-up was 1.8 years (range, 6 mo to 3 y). Results Children's age at diagnosis ranged between 9 and 19 years. Mean age at operation was 14.8 ± 1.2 years. All cases were left side varicoceles and 70% had grade III varicocele. Testicular atrophy was noticed in 39.8% of cases. All boys underwent Palomo laparoscopic sealing of the spermatic vessels using bipolar vascular electrothermal device Ligasure with a 2-trocar approach. Mean operative surgery time was 21 minutes. Median hospital stay was 21 ± 8 hours. No conversion cases were registered. Nine patients developed hydrocele after laparoscopic procedure (14.2%). Three patients of these cases underwent Winkelman-Lord's hydrocelectomy (4.7% of total). Conclusions Laparoscopic Palomo varicocele surgery for pediatric patients using Ligasure as spermatic vessels sealant and only 2 radially expandable 5-mm trocars is a safe, feasible, and time-effective technical improvement.

OBJETIVOS Evaluar la incidencia de hidrocele reactivo tras la tecnica de Palomo laparoscopico en pacientes menores de 19 anos en nuestro centro. METODOS Entre los anos 1997 y 2009, 180 varones menores de 19 anos diagnosticados de varicocele fueron incluidos en el estudio. Las variables registradas fueron edad, sintomatologia, grado de Varicocele segun la clasificacion de Dubin-Amelar, tamano testicular, estancia hospitalaria, complicaciones, recurrencia y formacion de hidrocele tras la intervencion .El seguimiento medio fue de 5 anos (6 meses a 9 anos). RESULTADOS La edad al diagnostico fue de 9 a 19 anos. 177 fueron varicoceles izquierdos (98%) y 4 casos fueron bilaterales. Todos tenian varicocele grados II o III y atrofia testicular un 45%; El 8.1% referian dolor testicular. Todos los pacientes se operaron mediante un procedimiento de Palomo laparoscopico. El tiempo medio de duracion de la intervencion fue de 38 minutos. Las ultimas 63 cirugias se realizaron solo con 2 trocares y Ligasure para sellar los vasos, logrando disminuir el tiempo quirurgico a 22 minutos. La estancia hospitalaria media fue de 31 h. 23 pacientes desarrollaron hidrocele reactivo (13%); 11 de los cuales precisaron una hidrocelectomia (procedimiento de Winkelman-Lord) como minimo un ano despues de la primera intervencion laparoscopica. De los restantes, en 2 casos se resolvio espontaneamente y 10 casos permanecen estables con un hidrocele leve tras 4 anos de seguimiento. CONCLUSIONES Segun nuestro estudio, la correccion laparoscopica del varicocele es una tecnica segura, eficaz e idonea para su empleo en pacientes pediatricos y adolescentes. La complicacion mas indeseable y frecuente es el hidrocele reactivo, que a veces puede aparecer mas de un ano despues de la intervencion. Debido a este hecho, la incidencia de hidrocele descrita en los estudios puede ser inferior a la real. OBJETIVOS Evaluar la incidencia de hidrocele reactivo tras la tecnica de Palomo laparoscopico en pacientes menores de 19 anos en nuestro centro. METODOS Entre los anos 1997 y 2009, 180 varones menores de 19 anos diagnosticados de varicocele fueron incluidos en el estudio. Las variables registradas fueron edad, sintomatologia, grado de Varicocele segun la clasificacion de Dubin-Amelar, tamano testicular, estancia hospitalaria, complicaciones, recurrencia y formacion de hidrocele tras la intervencion .El seguimiento medio fue de 5 anos (6 meses a 9 anos). RESULTADOS La edad al diagnostico fue de 9 a 19 anos. 177 fueron varicoceles izquierdos (98%) y 4 casos fueron bilaterales. Todos tenian varicocele grados II o III y atrofia testicular un 45%; El 8.1% referian dolor testicular. Todos los pacientes se operaron mediante un procedimiento de Palomo laparoscopico. El tiempo medio de duracion de la intervencion fue de 38 minutos. Las ultimas 63 cirugias se realizaron solo con 2 trocares y Ligasure para sellar los vasos, logrando disminuir el tiempo quirurgico a 22 minutos. La estancia hospitalaria media fue de 31 h. 23 pacientes desarrollaron hidrocele reactivo (13%); 11 de los cuales precisaron una hidrocelectomia (procedimiento de Winkelman-Lord) como minimo un ano despues de la primera intervencion laparoscopica. De los restantes, en 2 casos se resolvio espontaneamente y 10 casos permanecen estables con un hidrocele leve tras 4 anos de seguimiento. CONCLUSIONES Segun nuestro estudio, la correccion laparoscopica del varicocele es una tecnica segura, eficaz e idonea para su empleo en pacientes pediatricos y adolescentes. La complicacion mas indeseable y frecuente es el hidrocele reactivo, que a veces puede aparecer mas de un ano despues de la intervencion. Debido a este hecho, la incidencia de hidrocele descrita en los estudios puede ser inferior a la real. OBJETIVOS Evaluar la incidencia de hidrocele reactivo tras la tecnica de Palomo laparoscopico en pacientes menores de 19 anos en nuestro centro. METODOS Entre los anos 1997 y 2009, 180 varones menores de 19 anos diagnosticados de varicocele fueron incluidos en el estudio. Las variables registradas fueron edad, sintomatologia, grado de Varicocele segun la clasificacion de Dubin-Amelar, tamano testicular, estancia hospitalaria, complicaciones, recurrencia y formacion de hidrocele tras la intervencion .El seguimiento medio fue de 5 anos (6 meses a 9 anos). RESULTADOS La edad al diagnostico fue de 9 a 19 anos. 177 fueron varicoceles izquierdos (98%) y 4 casos fueron bilaterales. Todos tenian varicocele grados II o III y atrofia testicular un 45%; El 8.1% referian dolor testicular. Todos los pacientes se operaron mediante un procedimiento de Palomo laparoscopico. El tiempo medio de duracion de la intervencion fue de 38 minutos. Las ultimas 63 cirugias se realizaron solo con 2 trocares y Ligasure para sellar los vasos, logrando disminuir el tiempo quirurgico a 22 minutos. La estancia hospitalaria media fue de 31 h. 23 pacientes desarrollaron hidrocele reactivo (13%); 11 de los cuales precisaron una hidrocelectomia (procedimiento de Winkelman-Lord) como minimo un ano despues de la primera intervencion laparoscopica. De los restantes, en 2 casos se resolvio espontaneamente y 10 casos permanecen estables con un hidrocele leve tras 4 anos de seguimiento. CONCLUSIONES Segun nuestro estudio, la correccion laparoscopica del varicocele es una tecnica segura, eficaz e idonea para su empleo en pacientes pediatricos y adolescentes. La complicacion mas indeseable y frecuente es el hidrocele reactivo, que a veces puede aparecer mas de un ano despues de la intervencion. Debido a este hecho, la incidencia de hidrocele descrita en los estudios puede ser inferior a la real. 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Lipoblastoma of the greater omentum is an extremely rare benign tumor with less than 10 cases reported in the available literature. We report an unusual case of a 10-month-old girl with a giant omental lipoblastoma that composed 20% of her total body weight (1480 g, 17 x 12 x 16 cm). Complete excision of the tumor was performed. Histology confirmed the diagnosis of omental lipoblastoma.

Prolapse of a cecoureterocele through the urethra presenting as a prenatal vulval mass is an extremely uncommon entity. We present a case of a newborn girl with a cecoureterocele extending through the urethra (diagnosed at 29 weeks’ gestation) and we present its postnatal findings and outcomes.