Alvin Bernardo Caballes

Background: Beyond the duodenum, aside from Meckel’s diverticulum (MD) and intestinal duplication, heterotopic gastric mucosa (HGM) is rarely found in the rest of the intestines. The lesion can have clinical and radiologic characteristics that are also usual for MD, leading to misdiagnosis and inadequate treatment. Technetium-99m pertechnetate Single-Photon Emission Computed Tomography combined with Computed Tomography (SPECT CT) scan was utilized in a patient with massive GI bleeding and guided the conduct of surgery. This is the first reported use of the modality for the preoperative assessment of solitary ileal HGM. Case presentation: An 11-year-old male was admitted for dizziness and vomiting. He previously had surgery for intussusception at 2 years of age, and no pathologic lead point (PLP) was identified then. While confined, he had massive hematochezia. A Meckel’s scan was done, which showed isotope uptake at the right hemiabdomen. A SPECT CT localized the area in the ileum. On laparotomy, a dilated ileal segment was found and resected. A polyp was present and determined to be HGM on histologic examination. Conclusion: SPECT CT was a useful adjunct in the preoperative evaluation of a pediatric patient with massive GI bleeding from ileal HGM.

COVID-19 can involve the gastrointestinal tract, causing secretory diarrhea, bacterial translocation, and heightened inflammatory response, which may predispose to the development of perianal dermatitis. Two male infants separately came with shock and respiratory distress. Perianal skin ulcerations were found in the first patient while scrotal abscess and anal fissures were additionally present in the other. Both patients were confirmed to have COVID-19 and bacterial coinfections. Severe perineal lesions may thus be signifying critical disease, particularly among pediatric patients with GI -associated COVID-19.

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) for pediatric mesenchymal hamartoma: A case report - Turkish Journal of Surgery

The COVID-19 pandemic led to a health crisis with widespread social and economic adverse effects. To address the fallout, vaccine development has been pursued in record time. Several vaccines have already been deployed in countries worldwide, but as the supply is limited, these have been provided selectively. Various allocation schemes, premised on ensuring an equitable distribution, have prioritized the elderly, given their apparent susceptibility. For the Philippines and possibly other countries with extremely limited supplies, the elderly need not always be given primary preference. The level of available supplies can be so low that the immediate focus of allocation should be on mitigating both infection and transmission. The proposed alternative vaccine allocation framework gives priority to groups rendered more vulnerable, such as those who are unable to avoid prolonged exposure to possibly infected people because of medical necessity or occupational conditions. Vulnerable groups include healthcare and other essential workers as well as patients requiring continued healthcare services. The proposed allocation scheme is meant to be complementary to concurrent public health measures, which have to be maintained though made less restrictive as the pandemic is brought under control.

Background: Hydrops fetalis as well as abdominal compartment syndrome (ACS) are conditions that are associated with high mortality rates. A rare case of immature gastric teratoma causing fetal hydrops and subsequent ACS is presented. The related pathophysiologic mechanisms are discussed, and the importance of timely recognition and appropriate interventions are highlighted. Case presentation: The male patient was born preterm, weighing 3.9 kg., by Cesarean section. Prior prenatal ultrasounds were normal, but a scan done just before delivery had findings indicating polyhydramnios, fetal ascites, and meconium peritonitis. Upon delivery, the patient had respiratory distress, anasarca and a massively distended abdomen. Resuscitation measures, including ventilatory support, were instituted. Imaging studies showed ascites as well as a large, complex intra-abdominal lesion with calcifications. In the succeeding hours, anuria persisted, anasarca worsened, the abdomen became more distended, and inotrope requirements increased. The occurrence of ACS, from what was presumed to be a retroperitoneal teratoma, was therefore considered. Laparotomy was done on the 28th hour of life, with en bloc excision of a massive tumor and attached section of the greater curvature of the stomach. Passage of urine occurred intra-operatively, and the patient was soon after weaned off inotropes and ventilator support. The histopathologic result was immature gastric teratoma. No chemotherapy was given, and the patient’s serum AFP is at normal levels 15 months following surgery. Conclusion: The presence of a massive intra-abdominal lesion can result in the pathophysiologic continuum of hydrops fetalis and neonatal ACS. The early recognition of such an association can enable appropriate expectant management of similarly affected neonates, including emergent decompression laparotomy.

The case involves a 10-year-old child who underwent a left radical nephrectomy for what was believed to be a Wilms’ tumor. Histopath examination indicated a benign vascular lesion, subsequently determined to be an anastomosing hemangioma of the kidney. A comparison with the previously cited pediatric patients with renal vascular tumors is provided, and the inconsistent diagnostic terminologies for these conditions are highlighted. The therapeutic implications of these predominantly benign renal tumors, in the context of the much more frequently encountered malignant neoplasms in children, are additionally discussed.