Subphrenic bronchopulmonary foregut malformation with pulmonary-sequestration-like features

A retroperitoneal bronchopulmonary foregut malformation in a 62-year-old man is reported. The lesion was composed of mature lung tissue with randomly distributed bronchial structures and ciliated epithelium-lined cysts, some of which were lined with gastric mucosa. The histological features of this lesion were of both pulmonary sequestration and a bronchogenic, or foregut, cyst, and thus were a unique example of bronchopulmonary foregut malformation with pulmonary differentiation. This case is important in understanding the pathogenesis of foregut anomalies (i.e. bronchopulmonary foregut malformations), which range from pulmonary sequestrations to bronchogenic cysts and foregut duplication cysts.

Gastric volvulus in three children with asplenic syndrome

Gastric volvulus was surgically corrected in three patients with asplenic syndrome associated with severe cardiac anomalies. One patient, whose stomach was necrotic, died postoperatively with an intra-abdominal abscess. The other two patients have remained well. Four intra-abdominal abnormalities were found in the three asplenic patients: (1) absent gastrophrenic ligaments; (2) absent gastrosplenic ligaments; (3) deficient fixation of the pylorus, and (4) proximity of the pylorus to the cardia. Cardiac surgeons and pediatricians who treat the asplenic syndrome should be aware of extracardiac anomalies, especially malfixation of the stomach, which can lead to acute gastric volvulus.

[Current trends in the treatment of reflux esophagitis in childhood]

A problem of some complexity is the management of pathological gastro-esophageal reflux due to the presence of cardio-hiatal malformation, malposition of the cardia and gastric tuberosity, a congenitally short esophagus, and the like. Sometimes, however, there is no demonstrable morphological aleration and the condition, characterized by primitive hypotonia of the LES, goes under the name of infant chalasia of the esophagus. The general policy is to try first a conservative treatment consisting of dietary and postural measures and the administration of metoclopramide and d;ugs that protect the esophageal mucosa; this stage, however, should not be prolonged beyond 6 weeks. The presence of gastro-esophageal reflux associated with hiatal hernia; the presence of severe esophagitis or peptic stenosis of the esophagus and the persistence of symptoms after an adequate period of conservative therapy constitute as many indications for surgical correction. Good results can be obtained by restoring or strengthening the failing function of the LES, as is done quite successfully with funduplication after Nissen or with method of Belsey-Mark IV.