Abstract Introduction Long-gap esophageal atresia (LGEA) leads to multifactorial morbidity. The aim of this study is to analyze midterm gastrointestinal and respiratory morbidities with special assessment of feeding difficulties. Secondary goals were to determine risk factors of malnutrition and the impact of surgical techniques on morbidity. Methods We conducted a prospective observational national study. Using French national database, we reviewed medical charts of every patient treated for LGEA between 2008 and 2010 in France. Phone contact was proposed to assess orality disorders using Functional Oral Intake Scale (FOIS). Patients with complete data were included. We compared conservative management with esophageal replacement. Results We included 31 cases with a median age of follow-up of 9 years [7–10]. Median z-score for weight was −0.97 [−3.52–2.50], Conclusion Midterm morbidity in LGEA concerns 80% of our population. Gastrointestinal morbidity includes mainly dysphagia, GER, and orality disorders. This study suggests that conservative management provides more orality disorders. Other studies are mandatory to confirm it.

Abstract Objectives and study Anastomotic stricture (AS) is a frequent complication of the surgery for œsophageal atresia (OA) during the first year of life. The primary objective of this study was to evaluate the prevalence of AS before 1 year old in infants with type A and C OA who were operated on. Secondary objectives were to determine risk factors for AS in OA, for recurrent and refractory AS, and to establish if AS is associated with antireflux surgery. Methods A prospective national multicentric study was conducted including all infants born with OA between 2008 and 2015. Patients deceased before one year old, OA types B and E, and patients for whom data about AS were missing were excluded from the study. Data were collected at birth and at 12 months of age. Anastomosis under tension was defined by the surgeon and a delayed anastomosis was defined by an anastomosis after 15 days of life. Recurrent stricture was defined by the need of ≥3 dilations and refractory stricture was defined by the need of ≥5 dilations. Univariate and multivariate statistical analyses were conducted. Results Of the 1258 eligible patients (84%), 1054 were included in the study from 38 centers. The prevalence of AS in the first year of life was 23.3% [20.7–28.9]. Anastomosis under tension (AUT) and delayed anastomosis (DA) were found to be independent risk factors for AS (respectively 2.5 [1.73–3.45] and 3.7 [1.95–7.2] (OR [CL 95%])) in the total population. Neither sex, birth weight, prematurity, intrauterine growth retardation, associated malformations, type A OA, nor the type of surgical approach was a risk factor for AS. In type C OA, DA was the only risk factor for AS (OR: 3.1 [1.65–5.86]). The group with AS had 2.5-fold more fundoplication compared to the patients without AS (P = 0.0005) in the total population and in type C OA. AUT and DA were found to be independent risk factors for recurrent stricture (OR: 2.4 [1.47–3.9] and 4.7 [2.2–10.4], respectively) and DA was the only risk factor for refractory stricture (OR: 6.23 [2.4–16.2]). Conclusion Surgical factors at the time of first repair of OA are the only risk factors for AS.

Summary Respiratory diseases are common in children with esophageal atresia (EA), leading to an increased morbidity and mortality in the first months of life. Objective Assess the prevalence of hospitalizations linked to a respiratory disease and of maintenance inhaled therapy at the age of 1 year in French children. Methods Population based-study using data from the French national EA register. We included all children born between 2010 and 2015 with data available at birth and at follow-up at one year of age. Results A total of 981 patients born with EA were included in the register, 75 of them (8%) being deceased at the age of 1 year. Data were missing for 60 patients, thus 846 children (86%) were retained for analysis. EAs were type III of Ladd classification in 89% and type I in 7%. Rate of prematurity was 37% while 51% presented associated malformations. At 1 year of age, 1297 hospitalizations were reported for 508 patients (60%), at least one hospitalization for a respiratory disease for 251 children (51%). Factors significantly associated with respiratory hospitalizations were longer median length of oxygen supplementation (P < 10−2) and noninvasive ventilation in the neonatal period (P = 0.02), gastrostomy tube (P < 10−2), esophageal anastomosis dilation (P < 10−2). At 1 year of age, 29% had an inhaled maintenance treatment, and 85% inhaled corticosteroids. Factors significantly associated with inhaled maintenance treatment were male gender (P = 0.04), advanced older median age at gastrostomy tube insertion (P < 10−3), enteral feeding at one year of age (P < 10−3). Conclusion This study shows a high rate of respiratory problems responsive of frequent hospitalizations and inhaled maintenance treatment in children born with EA in the first year of life.

Abstract Objectives and Study The aim of our study is to assess the risk factor of mortality and morbidity in a large population-based registry in a population of type III/C esophageal atresia (EA). Methods Under the umbrella of the national plan for rare disease, a population based register was set up in 2008 recording the data of all the live newborns with EA in France. Based on the registry data, survival and morbidity at 1 year were studied. Morbidity was approached by calculating the rate of full oral autonomy and the hospital length of stay during the first year. Multivariate analysis was performed via multinomial logistic regression to evaluate independent predictors of overall survival and morbidity items among all significant category variables identified on univariate analysis. Results A total of 1008 patients with type III EA were extracted from the national database born from January first 2008 till 31 December 2014. Mean birth weight was 2610 g (2060 to 3075). Right lateral thoracotomy was used in 93% of cases and primary anastomosis was possible in 95% of cases. Associated abnormalities were present in 53% of patients, VACTERL in 19%, and CHARGE syndrome in 3%. Mortality at 3 months was at 5% and at one year at 6% and was correlated to prenatal diagnosis (odd ratio (OR):2.96 (1.08 to 8.08)), low birth weight (OR: 0.52 (0.38 to 0.72)), and heart defect (OR: 6.09 (1.96 to 18.89)). Length of hospitalization was correlated to birth weight (OR: 0.83 (0.61–1.13)), the difficulty of the anastomosis (OR: 1.59 (0.71–3.55)) and associated abnormalities (OR: 1.93(0.65–5.68)), the prenatal diagnosis is correlated only to the rate of full oral autonomy and not with the length of hospitalization. Conclusions Surgical procedure or difficulties did not seem to affect survival in this group of patients. In addition to the continuous need to improve care of low weight neonates, our results clearly identify that efforts should be focused on the small group of EA with prenatal diagnosis and/or severe cardiac malformation to reduce even more mortality and morbidity in EA patients.

Pour nombre de pathologies, la confrontation des diagnostics anténataux à une réalité histopathologique n’est pas toujours possible. La pathologie pulmonaire fœtale, par son taux élevé d’interventions chirurgicales en postnatal, permet de faire cette évaluation. Cette étude propose une approche de la fiabilité du diagnostic anténatal ainsi qu’une analyse de l’évolution postnatale de l’ensemble des enfants pris en charge pour malformation pulmonaire congénitale (MPC). Il s’agit d’une étude rétrospective incluant tous les cas de MPC diagnostiqués au CHU de Poitiers de 1995 à 2011. Les cas diagnostiqués en anténatal ont été identifiés et la fiabilité diagnostique a été étudiée grâce à l’histologie pour les cas opérés. L’évolution postnatale des cas diagnostiqués en anténatal est décrite et comparée aux enfants n’ayant pas bénéficié d’un diagnostic prénatal. Parmi les 45 cas de MPC pris en charge au CHU de Poitiers, 30 avaient bénéficié d’un diagnostic anténatal (DAN) de MPC isolée. La concordance diagnostique entre l’échographie anténatale et le diagnostic final est de 0,67 (IC 95 % [0,38–0,94]). La sensibilité de l’échographie est de 90 % (IC 95 % [55–99,7]) dans notre série pour le diagnostic de MAKP (malformation adénomatoïde kystique pulmonaire). Nous avons constaté une disparition échographique des lésions chez 4 enfants, une régression chez 1 enfant, la stabilité des lésions dans 21 cas. Quatre enfants ont présenté une augmentation de volume de la malformation, avec des signes de mauvaise tolérance dans 3 cas. Après la naissance, les enfants ayant bénéficié d’un DAN n’étaient pas plus symptomatiques que ceux dont le diagnostic étaient fait en postnatal : 21 (70 %) versus 11 (73 % ; p = 1) respectivement. De même, ils ont plus souvent bénéficié d’une chirurgie préventive : 18 (60 %) versus 2 (13 %) respectivement (p < 0,01) et moins souvent subi une chirurgie post-complication : 3 (10 %) versus 10 (67 %) respectivement (p < 0,01). Le nombre d’enfants surveillés n’était pas significativement différent dans les deux groupes. Le diagnostic anténatal permet d’établir la nature précise de la lésion dans 90 % des cas en 2013 sans impact sur la symptomatologie à la naissance. Lorsqu’un diagnostic prénatal est possible, la chirurgie préventive permet probablement de diminuer la survenue d’une chirurgie en urgence. For many diseases, the comparison of prenatal diagnosis with a histopathological reality is not always possible. Fetal lung pathology, with its high rate of surgery in postnatal, allows this assessment. This study proposes an approach to the reliability of prenatal diagnosis and analysis of the postnatal development of all children in care for congenital pulmonary malformation (CPM). This is a retrospective study of all cases of CPM diagnosed in Poitiers University Hospital from 1995 to 2011. Cases diagnosed prenatally were identified and the diagnostic accuracy was studied by histology when cases had surgery. The postnatal development of prenatally diagnosed cases is described and compared to children who did not receive prenatal diagnosis. Among the 45 cases of CPM supported at the Poitiers University Hospital, 30 had received prenatal diagnosis of isolated CPM. The diagnostic concordance between antenatal ultrasound and the final diagnosis is κ = 0.67 (CI95% [0.38 to 0.94]). The sensitivity of ultrasound was 90% (CI95% [55–99.7]) in our series for the diagnosis of CAMP (cystic adenomatoid malformation pulmonary). We found a sonographic disappearance of lesions in 4 children, 1 child in regression, stable lesions in 21 cases. Four children showed an increase in volume of the malformation, with signs of poor tolerance in 3 cases. After birth, children who received a prenatal diagnosis were no more symptomatic than those whose diagnosis was made postnatal: 21 (70%) versus 11 (73%; P = 1) respectively. Similarly, they often received prophylactic surgery: 18 (60%) versus 2 (13%) respectively (P < 0.01) and less often suffered post-surgery complication: 3 (10%) versus 10 (67%) respectively (P < 0.01). The number of children monitored was not significantly different in the two groups. Prenatal diagnosis allows for the precise nature of the lesion in 90% of cases in 2013 and had no impact on symptomatology at birth. When prenatal diagnosis is possible, preventive surgery probably reduces the occurrence of emergency surgery.

Objectives. - For many diseases, the comparison of prenatal diagnosis with a histopathological reality is not always possible. Fetal lung pathology, with its high rate of surgery in postnatal, allows this assessment. This study proposes an approach to the reliability of prenatal diagnosis and analysis of the postnatal development of all children in care for congenital pulmonary malformation (CPM).Methods. - This is a retrospective study of all cases of CPM diagnosed in Poitiers University Hospital from 1995 to 2011. Cases diagnosed prenatally were identified and the diagnostic accuracy was studied by histology when cases had surgery. The postnatal development of prenatally diagnosed cases is described and compared to children who did not receive prenatal diagnosis.Results. - Among the 45 cases of CPM, supported at the Poitiers University Hospital, 30 had received prenatal diagnosis of isolated CPM. The diagnostic concordance between antenatal ultrasound and the final diagnosis is kappa = 0.67 (CI95% [0.38 to 0.94]). The sensitivity of ultrasound was 90% (CI95% [55-99.71) in our series for the diagnosis of CAMP (cystic adenomatoid malformation pulmonary). We found a sonographic disappearance of lesions in 4 children, 1 child in regression, stable lesions in 21 cases. Four children showed an increase in volume of the malformation, with signs of poor tolerance in 3 cases. After birth, children who received a prenatal diagnosis were no more symptomatic than those whose diagnosis was made postnatal: 21 (70%) versus 11 (73%; P = 1) respectively. Similarly, they often received prophylactic surgery: 18 (60%) versus 2(13%) respectively (P < 0.01) and less often suffered post-surgery complication: 3 (10%) versus 10(67%) respectively (P < 0.01). The number of children monitored was not significantly different in the two groups.Conclusion. - Prenatal diagnosis allows for the precise nature of the lesion in 90% of cases in 2013 and had no impact on symptomatology at birth. When prenatal diagnosis is possible, preventive surgery probably reduces the occurrence of emergency surgery. (C) 2015 Elsevier Masson SAS. All rights reserved.

Neonatal small left colon syndrome is a rare cause of bowel obstruction. Its etiology remains unknown, but a significant association has been noted between maternal diabetes and small left colon. No reported cases within the same family could be found in the literature, excepting 2 sets of twins. We report 3 cases of small left colon syndrome in 3 consecutive sisters born of a nondiabetic mother. This raises the question of a genetic factor in its etiology.

Summary Pulmonary agenesis is a rare congenital malformation of lung development defined as complete absence of lung tissues, bronchi, and pulmonary vessels; it may be uni‐ or bilateral. The right‐sided form carries the poorest prognosis due to severity of co‐existent anomalies. Its diagnostic circumstances are variables: first reported cases were diagnosed at autopsy, but early postnatal as well as fortuitous discovery have been reported. In recent years, progress in obstetrical imaging has made antenatal diagnosis possible so that fetal ultrasound and MRI allow early diagnosis and refinement by permitting the elimination of differential diagnoses (diaphragmatic hernia, cystic adenomatoid malformation of the lung, giant lobar emphysema, and situs inversus). This anomaly is compatible with normal life provided co‐existent malformations are thoroughly investigated and managed in a multidisciplinary setting. We report four cases of lung agenesis two of which were diagnosed antenatally at 23rd and 30th weeks of gestation respectively. Our aim is to describe the circumstances having led to diagnosis and report both follow‐up and outcome of our patients. Pediatr Pulmonol. 2014; 49:E96–E102. © 2013 Wiley Periodicals, Inc.

Pubertal gynecomastia is common, and may affect up to 70% adolescents boys. Its course is spontaneously benign with resolution occurring by age 18 years. Although the exact physio-pathological mechanism remains unknown, it is thought to result from hormonal imbalance between estrogens and testosterone at puberty. Association with Leydig cell tumour is more common in adults, so that scrotal ultrasound is part of routine work up. A 15-years-old boy with Leydig cell tumour revealed by bilateral gynecomastia is reported. Diagnosing this condition requires high level of suspicion, we suggest that clinicians always do a testicular examination on adolescents especially if they have gynecomastia, scrotal ultrasound may be performed in boys aged > or =14 years with gynecomastia that measures > or =4 cm, should there be any doubt.

Pylephlebitis or septic thrombophlebitis of the portomesenteric veins is a complication of intra-abdominal infections. The disease is rare in children and the diagnosis is often delayed. The morbidity of pylephlebitis is relatively low, although there is a risk of residual thrombosis. We report on 2 cases of pylephlebitis in a 12-year-old girl and a 13-year-old boy, following undiagnosed appendicitis. In the 1st case, the young girl had been misdiagnosed with Salmonella infection and was given antibiotics; in the 2nd case, the boy had retrocecal appendicitis that was clinically subacute. An accurate diagnosis was finally made in both cases by CT scan. Both children evolved satisfactorily following appendectomy, long-term antibiotics, and anticoagulation. Clinically, the severe sepsis associated with pylephlebitis is at the forefront. Physical examination is often normal and therefore of little help; the knowledge of a preceding abdominal infection leads to further radiological investigations. Biologically, there are pronounced signs of infection. CT is the preferred exam for diagnosing pylephlebitis, as it can also show the underlying cause of the intra-abdominal sepsis or possible complications. Doppler sonography is recommended more for follow-up of the portal vein thrombosis. Treatment of pylephlebitis associated with appendicitis always includes long-term antibiotics. An appendectomy is always performed either at the time of diagnosis or later. The need for anticoagulation therapy in children is controversial. However, most pediatricians recommend its use, beginning as soon as possible, to be continued until normalization of portal vein flow.

Background We performed a quantitative and qualitative evaluation of keratinocytes from foreskin in childrenMaterials and methods We harvested 18 foreskins after circumcision The mean average age of the operated children was 4 years The keratinocytes were isolated after double enzymatic digestion After filtration and centrifugation we put the keratinocytes in culture Then the keratinocytes were cultivated on collagen lattices The keratinocytes were cultured in submerged condition for 2 days and then in an air-liquid interface condition for further differentiation After cultures the cells were counted and a histological examination was done An immunohistologic analysis enabled us to highlight the markers characteristic of neo epidermis differentiationResults After enzymatic digestion we obtained 11 4 million cells per foreskin After 10 days of culture and from 2 million cells we obtained 24 million cells In contact with the collagen lattices we obtained a neo epidermis and we described the markers of keratinocytes differentiation as well as the markers of the dermo epidermal junctionConclusion Keratinocytes from foreskin have a high capacity for division These cells can divide for long periods before differentiation These observations allow us to propose foreskin keratinocytes as a potential source of cells to provide coverage in burns (C) 2010 Elsevier Ltd and ISBI All rights reserved

L'agénésie pulmonaire unilatérale est une malformation congénitale rare dont le diagnostic peut être réalisé en anténatal. Elle est associée dans 50 à 70 % des cas à d'autres malformations qui conditionnent son pronostic. L'objectif est d'évaluer le devenir à court et moyen terme des enfants porteurs de cette pathologie afin de donner une information éclairée aux parents lors du diagnostic anténatal. Il s'agit d'une étude rétrospective répartie sur plusieurs centres hospitaliers de 1983 à 2004. Quatre cas d'agénésie pulmonaire unilatérale sont rapportés dont deux de découverte prénatale. Les malformations associées sont retrouvées dans tous les cas et sont surtout cardiovasculaires et squelettiques. Tous les enfants ont survécus avec un recul maximum de 7 ans. Ils sont tous en bon état général, scolarisés et conservent une activité physique sous un traitement respiratoire pour certain et un suivi adapté et régulier des malformations associées pour tous. Le pronostic de cette anomalie est bon en dehors de malformations associées graves, en particulier les malformations cardiovasculaires, mais nécessite un suivi régulier, notamment pulmonaire et orthopédique puisque la morbidité à long terme est liée aux pathologies pulmonaires infectieuses et aux malformations costo-vertébrales.

Pylephlebitis or septic thrombophlebitis of the portomesenteric veins is a complication of intra-abdominal infections. The disease is rare in children and the diagnosis is often delayed. The morbidity of pylephlebitis is relatively low, although there is a risk of residual thrombosis. We report on 2 cases of pylephlebitis in a 12-year-old girl and a 13-year-old boy, following undiagnosed appendicitis. In the 1st case, the young girl had been misdiagnosed with Salmonella infection and was given antibiotics; in the 2nd case, the boy had retrocecal appendicitis that was clinically subacute. An accurate diagnosis was finally made in both cases by CT scan. Both children evolved satisfactorily following appendectomy, long-term antibiotics, and anticoagulation. Clinically, the severe sepsis associated with pylephlebitis is at the forefront. Physical examination is often normal and therefore of little help; the knowledge of a preceding abdominal infection leads to further radiological investigations. Biologically, there are pronounced signs of infection. CT is the preferred exam for diagnosing pylephlebitis, as it can also show the underlying cause of the intra-abdominal sepsis or possible complications. Doppler sonography is recommended more for follow-up of the portal vein thrombosis. Treatment of pylephlebitis associated with appendicitis always includes long-term antibiotics. An appendectomy is always performed either at the time of diagnosis or later. The need for anticoagulation therapy in children is controversial. However, most pediatricians recommend its use, beginning as soon as possible, to be continued until normalization of portal vein flow. (C) 2010 Elsevier Masson SAS. All rights reserved.

La survie des enfants nés avec hernie diaphragmatique congénitale (HDC) a augmenté ces dernières années. Nous avons étudié leur devenir à long terme respiratoire, digestif, nutritionnel, cardio-vasculaire, sur la qualité de vie.

PURPOSE OF THE STUDY:We tested in vitro the keratinocytes capacity for division and differentiation. The donor site was the human foreskin. PATIENTS AND METHODS:For 12 months, we harvested 18 foreskins after circumcision. The middle age of the operated children was four years. The keratinocytes were isolated after double enzymatic digestion (thermolysin and trypsin, respectively). After filtration and centrifugation we put the keratinocytes in culture. In parallel, the keratinocytes were cultivated on the surface of collagen lattices. The keratinocytes were cultured in submerged condition for two days and then in an air-liquid interface condition for further differentiation. After nine days of culture, a histological examination and immunostain were used. An immunohistologic analysis made it possible to highlight the markers characteristic of epidermal skin differentiation. RESULTS:We obtained an average of 8.8 10(6) cells per foreskin. After seven days of culture, we obtained on average 23.7 10(6) cells by culture. In contact with the collagen lattices, we obtained an epidermal skin and we highlighted the markers of keratinocytes differentiation as well as the markers of the dermoepidermic junction. CONCLUSION:The keratinocytes resulting from foreskin have a high capacity of division. These cells can divide a long time before differentiation. The observations enable us to propose with our patients the keratinocytes from foreskin for wound healing especially for burns in children.

The aim was to examine the bony maxillary structures by computed tomographic measurements in newborns with unilateral cleft lip and palate before cheiloplasty. Analysis of maxillary bone was performed and size parameters were measured by computed-tomographic analysis in 12 infants with unilateral cleft lip and palate. We compared the bony maxillary length and the bony maxillary width between the cleft side and the healthy side. For eight patients, the bony maxillary length was different between the cleft side and the healthy side. For three patients, the bony maxillary width was different between the incisor alveolar structure in the cleft side and the healthy side. For six patients, the bony maxillary width was different between the canine alveolar structure in the cleft side and the healthy side. We noted an asymmetry without hypoplasy in bony maxillary structure in newborns before cheiloplasty. The data can serve as the starting point for a control and later evaluation on the efficiency of different therapeutic approaches of alveolar and maxillary development in children with cleft lip and palate.

Présenter deux observations de pyléphlébite, infection des voies portales, compliquant par translocation un sepsis intra-abdominal. Faire le point pour cette affection réputée rare sur la démarche diagnostique, le choix des techniques d’imagerie, et son traitement. Nous rapportons deux observations de pyléphlébite, chez des enfants pubères, une fille de 12 ans et un garçon de 13 ans, ayant compliqué une appendicite méconnue. Dans une observation l’appendicite avait été refroidie par une antibiothérapie en ambulatoire pour suspicion de salmonellose, dans l’autre observation l’appendicite rétro cæcale évoluait sur un mode subaigu et n’a été évoquée que sur le scanner qui a mis en évidence la pyléphlébite. Cliniquement la pyléphlébite avec son sepsis sévère est au premier plan, l’examen physique est souvent normal et peu contributif, c’est la notion d’une note digestive (douleurs abdominales, vomissements) précédant l’état septique qui doit conduire à l’exploration radiologique. Biologiquement les signes de sepsis sont marqués. Le scanner avec injection est l’examen d’imagerie le plus sensible pour le diagnostic positif de pylephlébite et permet la recherche de l’infection abdominale à l’origine de la translocation. L’échographie avec doppler est un bon examen pour la surveillance de la reperméabilisation des voies portales. Le traitement comprend toujours une antibiothérapie prolongée jusqu’à guérison du sepsis, la chirurgie est proposée par toutes les équipes, soit au moment de la pylephlébite soit à distance à froid. Le traitement anti-coagulant est plus discuté chez l’enfant, systématique dans les séries adultes, il a souvent été mis en œuvre dans les séries pédiatriques. La rareté des observations ne permet pas d’établir un consensus sur ce traitement, il est conseillé par les équipes référentes en thrombose de l’enfant et poursuivi jusqu’à normalisation des flux portaux. La recherche d’une thrombophilie est presque toujours négative. Il faut penser à rechercher une pyléphlébite devant un syndrome septique non étiqueté si des signes digestifs l’ont précédée.

Aim. We evaluated the utility of systematic neonatal radiological explorations in 20 instances of isolated cleft lip and palate in 20 cases.Methods. This study included 13 infants with prenatal ultrasound diagnosis. The type of cleft and possible associated anomalies were noted. A systematic chromosomal test was done. In cases, the cleft lip was noted at birth. Postnatal outcome was obtained and a clinical examination and radiological explorations were carried out.Results. For the cases with prenatal diagnosis. the chromosomal test was normal in 11 cases, and we noted associated anomalies in three cases. For the Cases with neonatal diagnosis, the chromosomal test was normal ill 6 cases and 1 infant had associated anomalies.Conclusions. The biological and radiological explorations can be In our study, the systematic neonatal radiological explorations did not find more elements compared with neonatal clinical examinations, The high risk of having a chromosomal anomaly in children with cleft if requires systematic prenatal chromosomal exploration. (C) 2008 Elsevier Masson SAS. All rights reserved.

In haemodynamically stable children with splenic trauma, conservative treatment is recommended to preserve the spleen and prevent potentially lethal post-splenectomy infectious complications. We report on the case of a 11-year-old child who suffered a fistula of a huge subcapsular splenic hematoma into the colon, 16 days after the traumatism. Decision to sustain the non-operative treatment allowed the preservation of the spleen without complications. (C) 2007 Elsevier Masson SAS. Tous droits reserves.

Pediatric non hypertrophic pyloric stenosis (NHPS) are uncommon. Their causes and treatments are debated.Material and method. - Retrospective review of all cases of NHPS from 3 pediatric surgery services during the period 1984-2002. Results. - Six children, aged 17 months to 15 years, underwent surgery for NHPS. Clinical symptoms, food vomiting and loss of weight, were present for several weeks before the diagnosis of NHPS was made. The diagnosis was peptic stenosis in 3 cases and has not been established in 3 cases. Search for Helicobacter pylori was negative in all cases. Failure of specific medical treatment and endoscopic dilatations led to pyloric resection in 3 cases and pyloroplasty in 3 cases. Post operative course was uneventful with normal oral feeding and normalisation of weight status. Histologic data were aspecific. No recurrence was observed.Discussion. - We discuss the origin of the pyloric stenosis, regarding clinical, operative and pathological data: were the stenosis the cause or consequence of peptic ulcer? Peptic disease is always advocated, but difficult to prove and may be excessively incriminated. Late symptomatic congenital and acquired idiopathic pyloric stenosis should be recalled. In all cases of proved pyloric stenosis, after failure of medical and endoscopic treatment, a simple surgical procedure (pyloroplasty) associated with medical treatment seems to be effective.Conclusion. - The diagnosis of NHPS should be suspected in a child with food vomiting and loss of weight if his age is not concordant with hypertrophic pyloric stenosis. Upper gastro-intestinal series and endoscopy are diagnostic. The precise cause of the stenosis is more difficult to asses. When the medical treatment fails, a pyloroplasty is usually curative. (c) 2006 Elsevier Masson SAS. Tous droits reserves.