JournalTOCs

Annals of Pediatric Surgery

Subscription journal
ISSN (Print) 2090-5394
Published by Wolters Kluwer - Lippincott Williams and Wilkins

[283 journals]

Laparoscopic management of right paraduodenal hernia along with the correction of malrotation in a pediatric patient: a case report
- Authors: Gupta; Rahul K.; Kothari, Paras; Gupta, Abhaya; Ranjan, Ritesh; Kesan, Krishna K.; Mudkhedkar, Kedar; Karkare, Parag; Mohammed, Niyaz
  Abstract: Paraduodenal hernias (PDH) are rare; however, they are the most common form of internal hernias. A 11-year-old boy presented to us with a history of intermittent abdominal pain since 1 year. His physical examination was normal. Plain abdominal radiographs and ultrasonography were inconclusive. Contrast-enhanced computed tomography of the abdomen reported a right subhepatic cecum. The patient underwent diagnostic laparoscopy followed by successful laparoscopic right PDH repair (excision of hernial sac, release of Ladd’s bands, and appendectomy). Ours is the sixth report to describe laparoscopic repair of a right PDH and the third in the pediatric age group. He was discharged home on postoperative day 1. He was completely asymptomatic at the 1-year follow-up.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
Pyloric atresia epidermolysis bullosa aplasia cutis syndrome: a case report and literature review
- Authors: Hassan; Mohamed E.; Al Ali, Khaled; Khalaf, Mona; Taryam, Layla
  Abstract: The association between epidermolysis bullosa and congenital pyloric atresia is rare, but is a known distinct clinical entity with autosomal recessive inheritance. We report on a case of a baby girl born by cesarean section at 37 weeks’ gestation to a G7 P7 mother and weighed 2.84 kg. At birth, there was denuded skin over the right leg from the knee joint up to the middle of the right foot. Abdominal radiograph was thus performed and indicated absent gas in the small bowel and single bubble appearance of the stomach. Pyloric atresia was surgically corrected. Electron microscopy of skin biopsies showed junctional epidermolysis bullosa. There was typical nail dystrophy and no corneal lesions; ultrasonography for the renal system was normal. At 4 months of age, the baby required gastrostomy and fundoplication for severe failure to thrive. Six weeks after her second surgical procedure, the patient presented to the emergency room dead; the parents provided a typical scenario of sudden infant death syndrome at home. Examination indicated no signs of child abuse; the parents refused an autopsy exam for the child.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
Gastrointestinal bleeding following NSAID ingestion in children
- Authors: Anyanwu; Lofty-John C.; Mohammad, Aminu M.
  Abstract: Gastrointestinal (GI) bleeding could result from various conditions in a child, and could be life threatening. Severe GI bleeds are, however, rare and their incidence is relatively unknown. Here, we report on two children who presented with GI bleeding following ingestion of NSAID. Two female children presented to our unit with GI bleeding. One was 6 years old and the other was 2 years old. Both presented with a history of fever and passage of bloody stools. There was a positive history of NSAID ingestion in both patients that was prescribed in the referring hospitals. The older child had a packed cell volume of 19% on presentation, and digital rectal examination indicated melaena. There was no history of vomiting. She received one unit of blood transfusion and was managed nonoperatively with antacids. Her recovery was uneventful. The younger patient presented with an abdominal distension and peritonitis, packed cell volume was 17% on presentation, and was malnourished. Exploratory laparatomy showed two kissing perforations, one measuring about 2 cm in the second part of the duodenum and the other measuring 1 cm in the gallbladder. There were no demonstrable gallstones. She underwent a cholecystectomy and closure of the duodenal perforation. The patient, however, developed a superficial surgical site infection that responded to local wound care. Recovery was otherwise uneventful. A thorough assessment of drug history should be performed to rule out NSAID ingestion in a child with a GI bleed.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
An abdominal tuberculosis case mimicking an abdominal mass
- Authors: Erdogan; Derya; Tasci Yildiz, Yasemin; Cengiz Boduroglu, Esin; Gönül Tanir, Naciye
  Abstract: Abdominal tuberculosis is rare in childhood. It may be difficult to diagnose as it mimics various disorders. We present a 12-year-old child with an unusual clinical presentation who was diagnosed with abdominal tuberculosis only perioperatively.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
Absent testis: does it exist in 46,XY males'
- Authors: Amin ElGohary; Mohamed
  Abstract: Aim: To challenge the concept of genetically absent testis in normal 46,XY males. Background: The term absent testes has been used in the literature to denote vanishing testis, atrophied testis, nubbin of testicular tissue, or genetically absent testes. When no testicular tissues are found during diagnostic laparoscopy, the vas and testicular vessels are traced as leading pointsfor testicular localization, and if both end blindly at a closed ring, vanishing testis is diagnosed. When the vas and vessels are seen entering the canal, a testicular nubbin may be present at the end of the epididymis. Methods: Both Mullerian inhibitory factor and testosterone act locally as paracrine hormones. Unilateral absent testis should be associated with an ipsilateral persistent of Mullerian tissues. Individuals with bilateral testicular agenesis will develop into a phenotypic female with persistent Mullerian structures. Results: The absence of Mullerian structures in patients with impalpable testis means that there has been a functional testis that survived well beyond the ninth week of gestation. We have encountered testicles at the subrenal position after an initial laparoscopic finding of an absent. Conclusion: Based on embryological process of testicular development and testicular descent, agentic absent testis cannot exist. Therefore we strongly recommend to re-scope all patients who were initially diagnosed as absent testis to look for a hidden testis at the initial site of development and along the line of descent.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
The value of laparoscopic classifications in decision on definitive surgery in patients with nonpalpable testes: our experience and review of the literature
- Authors: Kaya; Mete; Ozcakir, Esra; Sancar, Serpil; Aydiner, Cagatay
  Abstract: Background/purpose: The aim of the study was to present our clinical experience with the laparoscopic approach in patients with nonpalpable testes (NPTs) and review the literature on laparoscopic classifications. Materials and methods: Between May 2010 and August 2012, 30 boys with NPT (mean age 3.9 years) underwent laparoscopy as a part of diagnosis and treatment in our clinic. The laparoscopic findings were classified into four types according to Castilho. The patients were managed according to the presence or position of the testes and testicular vessels. Results: Six patients were excluded from the study. Twenty-six testicular units (19 left, three right, and four bilateral units) in 24 patients were managed laparoscopically. Laparoscopy was terminated in eight patients in whom blind-ending cord structures were detected intra-abdominally. An inguinal canal exploration was performed in 10 cases in whom cord structures were seen entering the internal inguinal ring. No viable testis was found, and testicular remnants were excised for histopathologic examination. Four canalicular testes (peeping) were treated with open orchiopexy. Laparoscopy-assisted orchiopexy without vascular ligation was performed in two testes. Fowler-Stephens orchiopexy in single stage was performed in one testicular unit and in two stages in another unit. All patients were discharged on the same day. The testes were normal in size and found in the scrotum after a mean follow-up period of 14 months. Conclusion: The laparoscopic findings in NPT had an important influence on treatment decisions. To be able to interpret the definitive surgery relative to the laparoscopic classification, collaborative studies are required.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
Two-stage repair of low anorectal malformations in girls: is it truly a setback'
- Authors: Elsaied; Adham; Aly, Kamal; Thabet, Waleed; Magdy, Alaa
  Abstract: Background/purpose: Anorectal malformations (ARMs) affect 1 in 4000–5000 births. Low ARMs are nowadays treated in the first stage rather than at second or third stages. However, reports suggest problems with continence in these children because of wound dehiscence and infection; thus, protective colostomy may still be recommended. Colostomies do have complications, but the question is whether these disadvantages outweigh the protective effect on wound healing after anal reconstruction. The aim of this study was to define whether two-stage repair of low ARMs in girls is truly a setback or whether it is beneficial. Patients and methods: During the period of June 2008–June 2012, 30 female patients suffering from low ARMs were admitted to Mansoura University Children Hospital. Their ages at the time of surgery ranged from 3 to 11 months (mean age 6.2) and they were divided into two equal groups. The fistula location was defined either anocutaneous or anovestibular according to the Pena classification. The choice of management was totally randomized; thus, patients of group A underwent a two-stage posterior sagittal anorectoplasty and group B patients underwent a one-stage posterior sagittal anorectoplasty operation. Data recorded included age, fistula location, associated anomalies, operation performed, operative time, length of hospital stay, approximate cost, and postoperative complications. Results: A comparison of data showed that treatment of patients of group A involved more time and money and they had a longer duration of hospital stay than did patients of group B. Seven patients (47%) in group A and nine patients (60%) in group B showed postoperative complications. Wound infection occurred in three patients (20%) of group A and in eight patients (53%) of group B. More importantly, two (13%) wound disruptions occurred among the three cases with wound infection in group A, whereas six (40%) disruptions occurred among the eight patients (53%) with wound infections in group B. The incidence of redo operation in group B was found to be significantly higher than in group A. Mucosal prolapse occurred in only one patient (7%) of group B. Complications related to colostomy occurred in group A only; five patients (33%) suffered skin excoriation around the stoma and one patient (7%) showed a prolapsed distal stoma loop. Constipation was noted during follow-up in five patients (33%) of group A and in six patients (40%) of group B. Conclusion: Two-stage repair of low ARM in girls is truly beneficial, as we could perform a successful operation and achieve continence in the child regardless of the complications of colostomy, which are temporary and tolerable.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
Management of necrotizing enterocolitis: experience at a tertiary care hospital in Oman
- Authors: Rathod; Kirtikumar J.; Khan, Asfaq A.; Kripail, Mathew; Fazallulah, Muhammad; Al Balushi, Zainab; Abdellatif, Mohamed
  Abstract: Introduction: Necrotizing enterocolitis (NEC) is the most common surgical emergency in the neonatal intensive care unit. The aim of this study was to determine the incidence of NEC and identify the factors predicting the surgical management and also to determine the mortality due to NEC at our tertiary care neonatal unit in Oman. Materials and methods: The parameters studied included sex-based differences, gestational age at birth, birth weight, maternal risk factors, patient risk factors, age when feeding was started, type of feed, age when signs of NEC appeared, presence of any antecedent associations, clinical features, radiological features, blood investigations, requirement of surgery, surgical findings, and outcome. Results: The study included 14 male and 12 female neonates. The mean gestational age at birth was 29.8±3.7 weeks (range: 25–38 weeks). The mean birth weight was 1348.4±774.1 g (range: 610–3900 g). The total incidence of NEC was 2.28%, whereas its incidence in neonates with birth weight less than 2500g was 4.47%. Surgical management was carried out for 11 (42.3%) patients. The mean platelet count in patients managed surgically was significantly lower compared with those managed conservatively (106.5 vs. 218.1 cells/μl of blood, P
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
Abnormalities of intestinal rotation and congenital intrinsic duodenal obstruction
- Authors: Al-Salem; Ahmed H.; Kothari, Mukul R.; Oquaish, Mohammad M.; Khogeer, Suzie S.; Desouky, Mohammed Samir S.
  Abstract: Background: Congenital duodenal obstruction (CDO) is a unique anomaly with variable presentation depending on the site, type of obstruction, as well as the presence of associated anomalies. This is a review of our experience with 51 infants and children with CDO, stressing on the importance of associated rotational abnormalities of the gut. Methods: Over a period of 18 years (January 1993–December 2011), 51 infants and children with CDO were treated at our hospital. Their medical records were reviewed retrospectively for age at diagnosis, sex, gestation, birth weight, clinical features, associated anomalies, method of diagnosis, treatment, and outcome. Results: Fifty-one (27 boys and 24 girls) infants and children with intrinsic CDO were treated. Their birth weight ranged from 1.38 to 3.8 kg (mean 2.3 kg). Sixteen (31.4%) were premature. The mean maternal age was 25 years (range 18–40 years). Seven presented at 5 months, 18 days, 3.5 years, 1.8 years, 18 days, 1.5 years, and 2 months of age, respectively. Associated anomalies were observed in 34 (66.7%) of them. Sixteen (31.4%) had Down’s syndrome and 11 (21.6%) had congenital heart disease. Nine (17.6%) had rotational abnormalities of the gut, including two with situs inversus. The site of duodenal obstruction was located in the second part of duodenum in 48 (94%) of them. In two, the site of obstruction was in the fourth part of duodenum, whereas in the third it was located in the third part of duodenum. The causes of obstruction were duodenal atresia in 20 (39.2%), without a gap in eight (15.7%) and with a gap in 12 (23.5%), duodenal stenosis in 11 (21.6%), and duodenal diaphragm in 20 (39.2%). In 14 (27.5%) patients, an annular pancreas was observed. The different operative procedures were as follows: duodenoduodenostomy in 26; excision of the duodenal diaphragm and duodenoplasty in 12; Ladd’s procedure, excision of the duodenal diaphragm, duodenoplasty, and appendectomy in four; Ladd’s procedure, appendectomy, and duodenoduodenostomy in two; and duodenojejunostomy in seven. Two underwent reduction duodenoplasty to decrease the size of the duodenum. Three required reoperations, two because of an anastomotic leak and another because of duodenal dysfunction. Sixteen (31.4%) required total parenteral nutrition. Four died, resulting in an overall survival of 92.2%. Conclusion: CDO is classified as intrinsic and extrinsic depending on the cause. Rotational abnormalities including situs inversus are among the rare but interesting anomalies associated with intrinsic CDO. The presence of malrotation or nonrotation with congenital bands does not exclude the presence of an associated intrinsic cause, which should be looked for intraoperatively. This is to obviate the possibility of further subsequent operative treatment.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
Recurrence and complications of pediatric inguinal hernia repair over 5 years
- Authors: Askarpour; Shahnam; Peyvasteh, Mehran; Javaherizadeh, Hazhir; Mehdianzadeh, Fatemeh
  Abstract: Introduction and aim: Inguinal hernia is one of the most common pediatric diseases in children and it presents most commonly during the first year of life. The aim of this study was to determine epidemiologic indexes and complications of inguinal hernia repair in pediatric patients who underwent inguinal hernia surgery. Patients and methods: This retrospective study was carried out in the Imam Khomeini and the Abuzar hospitals. All inpatients who underwent surgery for inguinal hernia from 2003 to 2004 were included in this study. Their hospital records were reviewed till 2007 for age, sex, wound infection, recurrence, and other complications. The χ2-test was used for analysis using SPSS, version 13.0. Results: In this study, 269 children were included. Of all the patients, 237 (88.1%) were boys and 32 (11.9%) were girls (P
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
Peritoneal drainage for newborn intestinal perforation: primary treatment or unnecessary delay'
- Authors: Meier; Donald E.; Ahmeti, Mentor
  Abstract: Background: Peritoneal drainage (PD) was introduced 30 years ago as a temporizing treatment for extremely ill newborns with intestinal perforation (IP). Subsequent reports have shown it to be helpful as a definitive treatment, whereas others have labeled it as an unnecessary delay before laparotomy. Methods: This is a retrospective analysis of all newborns (2004–2009) with presumed IP treated with PD irrespective of gestational age or weight. Drainage was achieved with a single Penrose drain placed between incisions in each lower quadrant. This was followed by extensive irrigation. Laparotomy was performed if needed for progressive sepsis, intestinal stricture, or persistent leak. Parameters analyzed included gestational age and weight, time before IP, findings at drain placement, and need for subsequent operations. Results: Drains were placed in 24 consecutive newborns with IP. The median gestational age was 29 weeks and weight was 755 g. IP was confirmed in nine (38%) by free air on radiograph. In 15 newborns, PD was performed for progressive sepsis and succus was identified in 11 (73%). The overall mortality rate was 33% (25% in newborns 1500 g). No parameters were statistically significant in predicting mortality. PD served as a definitive treatment without the need for further laparotomy in 50% of survivors. Conclusion: PD with extensive irrigation for newborns with IP has an acceptable mortality rate. It is not a delay tactic but serves as a definitive treatment for 50% of survivors. Children weighing more than 1500 g and those without succus at the time of drain placement should, however, receive laparotomy as the primary treatment.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-
Tapping for pneumoperitoneum in neonates and infants
- Authors: A. Ibrahim; Ibrahim; E. Ahmed, Ahmed
  Abstract: Purpose: The aim of this study was to shed some light on the presence of pneumoperitoneum in neonates and infants and to present and evaluate our method for its treatment. Materials and methods: This study included 33 patients diagnosed with pneumoperitoneum during 2004–2011, of whom 19 were girls and 14 were boys, and their ages ranged from 1 week to 5 months; 21 patients were neonates and seven of them were premature; two were aged less than 32 weeks and had mild pneumoperitoneum, which could be treated conservatively and five were aged between 32 and 34 weeks. Tapping was performed for all patients. Tapping can help in selection of patients with necrotizing enterocolitis needing exploration when the aspirate is bilious or feculent. Tapping could be performed as a temporary measure before exploration to decrease respiratory distress and the occurrence of abdominal compartment syndrome and also as a routine procedure in patients with pneumoperitoneum. Tapping is an easy procedure and can be performed with the patient in bed or in the incubator. Pneumoperitoneum is not an absolute indication for surgical exploration and a small subset of patients should be managed by laparotomy. Each patient with pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain, or surgical exploration. Pneumoperitoneum occurs in neonates more frequently than in infants, and most cases are idiopathic. Results: A total of 29 patients were treated by tapping alone (in nine patients, tapping was performed once; in 13, it was performed twice, and in the other seven, it was performed three to four times). Rapid improvement in the general condition and respiratory distress occurred in most patients. Six patients (five neonates and one infant) were explored because of: (a) aspiration of a bile-stained or feculent fluid in two patients and (b) failure of conservative treatment in four patients. Conclusion: Pneumoperitoneum occurs in neonates more than infants and most cases are idiopathic. Each case of pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain or surgical exploration. Pneumoperitoneum is not an absolute indication for surgical exploration and small subset of patients should be managed by laparotomy. Tapping is an easy job and can be done with the patient in bed or in the incubator. Tapping could be performed as a routine in cases of pneumoperitoneum. Tapping could be done as a temporary measure before exploration to decrease respiratory distress and abdominal compartment syndrome.
  PubDate: Mon, 01 Apr 2013 00:00:00 GMT-