We report the case of a 16-year-old female with a huge mass (40 × 30 × 40 cm) on the left ovary, causing mild bilateral hydronephrosis. Ultrasonography and computed tomography allowed us to diagnose this condition and showed an associated uretero-hydronephrosis. A unilateral salpingooophorectomy was performed on the left ovary, and final pathology revealed a mature cystic teratoma. The patient did not experience any problems in the follow-up six months later, and her hydronephrotic appearance disappeared.

Hydrocolpos is a rare congenital genitourinary anomaly that can cause clinically significant urinary tract obstruction with oligohydramnios and hydronephrosis antenatally and renal failure postnatally. Here, we discuss the management of a neonate with hydrocolpos and renal failure. Vaginostomy tube and bladder catheterization have been described previously. However, in this population, external tubes can be difficult to manage and have a high propensity of failure. Therefore, the patient was managed via creation of a vaginostomy, which allowed for continuous passive drainage of fluid into a diaper and maintained a decompressed urinary tract until further reconstruction could be pursued.

Infant feeding tubes are routinely used as urethral catheters in neonates and children. Although considered safe, it can lead to significant morbidity if the catheter knots in the bladder. We report a case of a spontaneous urinary catheter knotting in a neonate. It required a perineal urethrotomy for successful removal. A lateral oblique radiograph to characterize the complexity of knot helps in its management. Training of staff involved in the insertion, maintenance or removal of the catheters is essential to decrease catheter related complications.

Perinephric abscess is an uncommon infection in children, but it is usually caused by Escherichia coli, Staphylococcus aureus, Proteus mirabilis and Pseudomonas aeruginosa. Group B Streptococcus (GBS) is an uncommon cause of perinephric abscess or serious bacterial infections beyond the neonatal period. Comorbid conditions such as diabetes mellitus and immunosuppression can increase the risk of GBS invasive disease. We describe a 10-year-old female who presented with 1-month of right-sided flank pain and swelling with ultrasound showing large (>3 cm) right perinephric and subcutaneous abscesses. She was additionally diagnosed with new onset type 2 diabetes mellitus (DM) during admission. Abscess cultures obtained after placement of two percutaneous drains and the initiation of broad-spectrum intravenous antibiotics grew beta-hemolytic GBS. Here, we present to our knowledge, the first known documented case of GBS perinephric abscess in a school-aged child with DM. Much of the knowledge of perinephric abscess management is extrapolated from adults, therefore making optimal treatment in the pediatric population challenging. We propose that GBS be considered in the etiology of perinephric abscess in children with DM and other immunosuppressing conditions. In addition, percutaneous drainage of larger abscesses (>3 cm) in conjunction with antibiotic therapy is a reasonable management strategy.

Isolated epididymal torsion is a very rare cause of an acute scrotum. Anomalies of the epididymis are more commonly encountered with undescended testicles and can predispose to epididymal torsion. Management is similar to that of testicular torsion. We report the case of a 3-year-old boy who presented with an acute scrotum. Immediate surgical exploration revealed an isolated epididymal torsion in an undescended testis, only the second of its kind to be reported so far. The epididymis and testis were salvaged and the testis was fixed in the scrotum. There are multiple learning points from this case report. Firstly, that epididymal torsion is a diagnosis to be considered when exploring an acute scrotum. Secondly, that epididymal torsion even an undescended testis can result in clinical symptoms of an acute scrotum. And finally, that epididymal anomalies encountered during surgery should be tackled appropriately, to prevent retorsion.