Choristoma is a developmental anomaly of normal tissue growing outside the anatomical localization. We present the case of 14 -year-old boy, in whom
abdominal pain, occurring since one year, was connected with the type of choristoma developmental disorders. After imaging studies we decided to
perform a laparotomy, which revealed a large bowel conglomerate covered by abdominal omentum, perforated diverticulum of the small intestine
and mesentery tumor located around Meckel’s diverticulum. During surgery, we resected the mesenteric tumor, the part of the small intestine with an
inflamed Meckel ‘s diverticulum and the part of large intestine. In both cases, the continuity of the digestive tract was reproduced by anastomosis. The
Tumor’s histopathological examination showed developmental disorders such as choristoma, wherein apparented pancreatic and gastritis tissue were
properly constructed. In the literature we find a few reports of such a disease in children. We present, for the first time, the case of a boy diagnosed with
choristoma constructed not only from pancreatic tissue, but also gastric mucosa of the stem positioned in the mesentery.

We present diagnostic challenges in a case of H-type tracheoesophageal fistula in a newborn. Repeated radiological imaging measures confirmed
diagnosis with precise position of malformation, what enabled a correct choice of surgical approach.

Small foreign bodies swallowed by children are usually spontaneously evacuated without any clinical symptoms. Ingestion of small magnetic beads may lead
to another scenario. The Authors present a case of 7-year-old girl with multiple intestinal perforations and peritonitis resulting from ingestion of magnetic
beads. Tiny size of the foreign bodies and appendicitis found on first surgery delayed the proper diagnosis. The paper presents the diagnostic and therapeutic
management in that case and refreshes the guidelines for foreign body ingestion in children.

Introduction: Kasabach-Merritt syndrome (KMS) is a severe coagulopathy with decreased platelet count caused by the presence of the vascular tumor
(Kaposiform hemangioendothelioma, KHE or Tufted angioma), leading in up to 30% to a fatal outcome.
Case report: The paper presents case report of a 3 month-old girl with a large abdominal vascular tumor (KHE) complicated by KMS. The girl presented
increasing signs of multi-organ failure, required the use of mechanical ventilation, use of catecholamine pressor agents, abdominal and pleural drainage.
Due to the lack of treatment efficacy with glucocorticosteroids (GCS) and propranolol, no possibility of surgical intervention, deteriorating clinical state, the
patient was qualified for chemotherapy and rapamycin treatment. The therapy resulted in significant improvement of clinical status and KMS symptom
resolution. Treatment was subsequently continued with vincristine for 7 months (15 doses) and rapamycin for 10 months until full tumor regression.
Conclusion: Despite the availability of several treatment methods full tumor regression may be achieved mainly by the use of combined therapy. In our case,
simultaneous treatment with vincrystine and ramapycin effectively eradicated KHE.

Aim: A retrospective analysis of a 10-year experience of the university pediatric surgical centre in the treatment of hydrocephalus in children
Material and methods: The medical notes of all children treated operatively on for hydrocephalus in the University Department of Pediatric Surgery
in Wroclaw in the period between 2003 and 2012 were analysed. Indication for surgical management, type of operative intervention and its potential early
and late complication were assessed in each case.
Results: There were 220 children in the study period in whom 473 operative intervention were performed. Two hundred ninety two operative procedures
(69,2%) were conducted in children aged less than 12 months. Insertion of a new ventricular shunt as a first intervention was noted in 137 children (62,3%).
Three-hundred of all procedures (63,4%) were performed due to shunt complications. One-hundred and three children (46,8%) required more than one
operative intervention, and in 47 of them (21,2%) more than 2 procedures were necessary. Infectious complications were noted in 28 (12,8%) children, while
mechanical complication of ventricular shunt occurred in 71 patients (32.3%).
Conclusion: Majority of shunt complication are noted within the first year following its insertion so this is a critical time for a patient with hydrocephalus.
Due to risk of potential late complication of ventricular shunt every patient with hydrocephalus should be subjected to a long term follow-up review at
the surgical centre where the initial surgical management was performed.

From 2003 to 2013 in 804 children, 801 ventriculoperitoneal shunts and 3 ventriculoatrial shunts were implanted and revised due to hydrocephalus
of various origin. Abdominal complication occurred in 24 children (3,34%) shunted peritoneally. There were recognized in ultrasound pseudocysts in
18 children, abscessus in 5 and ileus in one child. The treatment consisted on: control of hydrocephalus by external drainage, efficient amelioration
of pseudocysts and abscesses by drainage, laparotomy, laparoscopy. Finally in 9 children ventriculoatrial and in 11 ventriculoperitoneal shunts were
inserted. In two children hydrocephalus became stable.

Achilles tendon rupture is not a common injury in pediatric population. In order to avoid disability in adult life it requires an adequate method of
treatment. 8 cases of Achilles tendon ruptures in children (with average age of 12.5 years) were identified and analyzed at authors’ center from 01.2001 to
08.2013. Patients were treated operatively with a following rehabilitation. All children did return to normal activity after the treatment. No re-ruptures in
operated Achilles tendon were observed.

Objective: The employed to date classic methods of treating clavicular fractures in children by means of a Dessault-type plaster brace do not stand
the test of time. The objective of the report is the presentation of the effectiveness of an ERH-53 ‘eight’ type shoulder brace employed not as an
alternative solution, but rather as the fundamental management method in clavicular fractures in children, regardless of the fracture character.
Material and method: In the course of numerous follow-up studies and observation of the healing process in clavicular fractures in children carried
out at the University Children’s Hospital of Cracow, a solution was proposed to treat such fractures by means of an ERH-53 “eight” type shoulder brace.
The “device” uses a very simple but extremely successful method of continuous bilateral stretching of the shoulder girdle employing a modified “eight”
type immobilization in the form of braces. In addition, the brace does not limit excessively the movement of the upper extremities of the child and
is definitely easier in maintaining the necessary hygiene. Of 437 children with clavicular fractures treated in the years 2010-2013, more than one-half
were treated using an ERH-53 “eight” type shoulder brace.
Results: The therapeutic effects were very good, what was confirmed by follow-up X-ray imaging; in the present material, not a single case of
complications in the form of persistent pseudoarthrosis was noted.
Conclusions: The ERH-53 “eight” type shoulder brace employed in our hospital is an effective orthopedic tool employed in clavicular fractures in
children.

Head injuries in children is common and dangerous condition caused increasing amount of hospitalization and the most common cause of death and
neurological disorders in this age group.
Objective: To evaluate the causes and mechanism of head injuries in children including epidemiological aspects, radiological imaging, and the early
results of treatment.
Material and Methods: An retrospective analysis of head injuries in children and adolescents up to 18 years old, diagnosed and treated in Emergency
Department Białystok University Children’s Hospital of L. Zamenhofa 2012-2013.
Results: In 2012-2013, 1857 children under 18 years old with head injury attended to the Emergency Department, including 908 children in 2012 (49%)
and 949 in 2013 (51%). The main cause of head injury in children under the two years old was downfall (79%). In the group of children 3-5 years oldwas downfall (31%) and the same-level-falls (18%). In the age group 6-13 y.o. main cause was one level-falls (27%). In adolescents (14-18 years) head
injury was a result of violence (39%) The largest group was slightly injured with wounds and soft tissue contusion of head (76%). 23% of all children’s
hospitalization was necessary.
Conclusions: Head injuries are the most common in groupe of boys aged 6-13 years. The main causes of head injury are different in various age
groups. It seems very important to create uniform algorithms of treatment in children after head injury.

This paper presents issues of a comprehensive treatment after soft tissue injury of the ankle joint in children and adolescents, one of the most common
injuries in the emergency, pediatric surgery and orthopedic departments in Poland and worldwide. Children are more vulnerable to ankle sprain than
adults, which is due to their great spontaneous motor activity. The most common mechanism of injury is excessive ankle plantar flexion in combination
with inversion, resulting from the anatomical conditions in the ankle joint. Due to the specificity of bone growth in children, this type of injury frequently
results in fractures, particularly in the tibial growth plate. The treatment initiated by a pediatric surgeon does not end after immobilization period both
in case of conservative treatment and operation. Continuation of treatment of young patients involves physiotherapeutic procedures, following the
stages of connective tissue healing process, in order to prevent ankle sprain recurrence and reduce the risk of chronic ankle instability. It seems essential
that pediatric surgeon and physiotherapist are a truly synergistic team and know exactly the goals and methods of work of each member of the team.