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Wiadomosci Lekarskie (Warsaw, Poland :... 2022The aim: To analyze the current state of the issue of Hirschsprung disease in newborns and infants on the basis of literature data and first-hand experience. (Review)
Review
OBJECTIVE
The aim: To analyze the current state of the issue of Hirschsprung disease in newborns and infants on the basis of literature data and first-hand experience.
CONCLUSION
Conclusions: 1. Hirschsprung disease should be suspected in all newborns with late meconium passage. 2. The main methods of diagnosing Hirschsprung disease in newborns and infants are the assessment of anamnestic data, clinical manifestations and features of the clinical course of the pathology, contrast enema, morphological examination of rectal biopsies and immunohistochemistry for ACE. 3. The presence of enterocolitis in newborns and infants should raise suspicion of Hirschsprung disease. 4. Low intestinal obstruction, perforation of the cecum, ascending or terminal small intestine, and peritonitis in the first days of a child's life may be complications of Hirschsprung disease. 5. In newborns and infants, early diagnosis of Hirschsprung disease and timely surgical correction by one-stage surgery help improve treatment outcomes.
Topics: Biopsy; Child; Digestive System Surgical Procedures; Enterocolitis; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Intestinal Obstruction
PubMed: 35633338
DOI: 10.36740/WLek202204220 -
Case Reports in Obstetrics and... 2015Meconium periorchitis is a rare disorder caused by fetal meconium peritonitis, with subsequent passage of meconium into the scrotum via a patent processus vaginalis. To...
Meconium periorchitis is a rare disorder caused by fetal meconium peritonitis, with subsequent passage of meconium into the scrotum via a patent processus vaginalis. To date, clinical significance of meconium periorchitis for the prenatal diagnosis of meconium peritonitis and prediction for postnatal surgery remains to be determined. We present a clinical course of a fetus presenting with meconium periorchitis induced by meconium peritonitis. At 28 weeks' gestation, fetal ultrasonography indicated fetal ascites associated with bilateral hydrocele and peritesticular calcification without other signs of meconium peritonitis. The pregnancy was uneventful until delivery and the infant was delivered at 37 weeks' gestation. No abdominal distension was observed at birth, and radiography did not reveal any abdominal calcification except for scrotal calcification. Abdominal distension was observed 3 days after birth and laparotomy was performed. The diagnosis of meconium peritonitis was confirmed at surgery. Our case illustrated that careful examination of the scrotum during fetal life was helpful for prenatal diagnosis of meconium peritonitis as well as postnatal management.
PubMed: 26491584
DOI: 10.1155/2015/606134 -
The National Medical Journal of India 2018Pregnancy with massive splenomegaly is a rare entity and is associated with increased risk to both mother and foetus. There is paucity of studies in the literature to...
BACKGROUND
Pregnancy with massive splenomegaly is a rare entity and is associated with increased risk to both mother and foetus. There is paucity of studies in the literature to guide clinicians for the management of this condition.
METHODS
We reviewed the course of pregnancy, maternal and foetal outcomes of 5 pregnant women with massive splenomegaly who were managed in our unit during 2015-16.
RESULTS
All 5 women had anaemia and thrombocytopenia, and had different causes for splenomegaly. One patient had chronic malaria, 2 had portal hypertension with cirrhosis and the remaining 2 had non-cirrhotic portal hypertension. Life-threatening complications were present in 2 patients; one of them had severe pre-eclampsia complicated by pulmonary oedema, cardiac arrest and the other patient developed spontaneous bacterial peritonitis. Intrauterine growth restriction and meconium-stained liquor were the most common perinatal complications. Two patients had vaginal delivery and 3 required emergency caesarean section. Postpartum haemorrhage was present in 2, and the hospital stay was prolonged in all the patients. All mothers and babies were discharged in a satisfactory condition.
CONCLUSION
Pregnancy with massive splenomegaly poses a challenge because of diverse aetiology and potentially adverse outcomes. Multidisciplinary care in a tertiary centre can help optimize the outcome.
Topics: Adult; Cesarean Section; Delivery, Obstetric; Female; Fibrosis; Humans; Liver Cirrhosis; Malaria; Portal System; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care; Splenomegaly; Young Adult
PubMed: 31044760
DOI: 10.4103/0970-258X.255756 -
Irish Medical Journal May 2024
Topics: Humans; Infant, Newborn; Down Syndrome; Peritonitis; Infant, Premature; Meconium; Cysts; Male; Female
PubMed: 38801146
DOI: No ID Found -
Cureus May 2024Intrauterine appendicular perforation leading to meconium peritonitis is exceptionally rare, with few reported cases in the literature. This case underscores the...
Intrauterine appendicular perforation leading to meconium peritonitis is exceptionally rare, with few reported cases in the literature. This case underscores the diagnostic challenges and high mortality associated with neonatal appendicular perforation. Neonatal appendicitis and subsequent perforation are uncommon due to the funnel shape of the fetal appendix, which reduces susceptibility to luminal obstruction. While advances in neonatal care and diagnostic modalities have improved outcomes, challenges persist in timely diagnosis and management. We present the case of a preterm infant, one of dichorionic-diamniotic (DCDA) twins delivered via cesarean section, who developed gross abdominal distension and respiratory distress shortly after birth. Diagnostic abdominocentesis revealed meconium-stained fluid, prompting further investigation with imaging and subsequent exploratory laparotomy. Extensive adhesions and cecal perforation were observed, necessitating a cecostomy. Despite interventions, the infant's condition deteriorated, leading to a fatal outcome. Intrauterine appendicular perforation leading to meconium peritonitis is a rare and difficult-to-diagnose condition. Antenatal suspicion and early surgical intervention are crucial for improving outcomes. Factors contributing to neonatal appendicular perforation include ischemia, obstruction, and infective etiologies. Neonatal appendicular perforation is a rare but life-threatening condition requiring a high index of suspicion for prompt diagnosis and management. Advances in diagnostic tools and antenatal monitoring have contributed to improved outcomes, highlighting the importance of considering this diagnosis in cases of unexplained neonatal abdominal distension.
PubMed: 38894799
DOI: 10.7759/cureus.60576 -
BMC Pediatrics Jul 2022This study explored the feasibility of mesoplasty with end-to-side anastomosis in the treatment of different apple-peel mesenteric defects with high jejunal atresia.
OBJECTIVE
This study explored the feasibility of mesoplasty with end-to-side anastomosis in the treatment of different apple-peel mesenteric defects with high jejunal atresia.
METHODS
A retrospective analysis was performed on 42 premature infants admitted to the hospital between 2014 and 2021. Prenatal ultrasound scans revealed bowel dilatation. The patients experienced vomiting after birth and produced white or no meconium. Plain radiography showed double or triple bubble signs and the patients underwent emergency laparotomy. High jejunal atresia with different apple-peel atresia appearance was discovered intraoperatively, involving mobilization of the ileocecal region. Patients received end-to-side anastomosis between the enlarged blind pouch and atretic bowel, as well as mesoplasty. A jejunal feeding tube was placed trans-nasally. Patients were discharged after achieving full enteral feeding. We also reviewed the literature on the subject.
RESULTS
Three patients died and 39 survived. The discharged patients were followed up for 12 months, and none showed post-operative complications such as intestinal obstruction, malnutrition, or chronic diarrhea. All surviving patients reached the expected height and weight for children of the same age.
CONCLUSION
For cases of high jejunal atresia with apple-peel intestinal atresia, mesoplasty may be a good option to avoid postoperative volvulus.
Topics: Anastomosis, Surgical; Child; Female; Humans; Infant; Intestinal Atresia; Jejunum; Mesentery; Pregnancy; Retrospective Studies
PubMed: 35820908
DOI: 10.1186/s12887-022-03475-z -
Radiographics : a Review Publication of... Feb 2023US is the imaging modality of choice for evaluation of a variety of abdominal conditions, and in recent years it has also become useful and promising as a bedside...
US is the imaging modality of choice for evaluation of a variety of abdominal conditions, and in recent years it has also become useful and promising as a bedside technique for assessment of acute abdominal conditions in neonates. Bedside US can help, complement, and sometimes replace radiographic or contrast-enhanced studies in critically ill and labile neonates who are difficult to transport to the fluoroscopy suite. Some of the features of bedside US can be applied as point-of-care US (POCUS) of the sick neonate. Some of the abdominal conditions in neonates that can be assessed and monitored with bedside US are necrotizing enterocolitis and its complications, malrotation with a midgut volvulus, segmental volvulus, meconium peritonitis, and complicated inguinal hernia. High-resolution US with the use of 15-MHz and higher-frequency probes allows characterization of the bowel anatomy and features of intestinal abnormalities in neonates in fine detail. Color Doppler US and microvascular imaging improve accuracy in the detection and characterization of bowel vascularity, which is important in the treatment and follow-up of patients with intestinal conditions. RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Topics: Infant, Newborn; Humans; Intestinal Volvulus; Intestines; Intestinal Diseases; Abdomen; Diagnostic Imaging
PubMed: 36602924
DOI: 10.1148/rg.220110 -
BMC Pediatrics Mar 2020Meconium peritonitis is defined as aseptic chemical inflammation caused by intrauterine bowel perforation. The underlying causes of bowel perforation include intestinal...
BACKGROUND
Meconium peritonitis is defined as aseptic chemical inflammation caused by intrauterine bowel perforation. The underlying causes of bowel perforation include intestinal atresia, midgut volvulus, intussusception, congenital bands, and meconium ileus.
CASE PRESENTATION
Siblings with prenatally diagnosed meconium peritonitis of different etiologies were found. The elder sister was born at 36 + 6 weeks gestation with a birth weight of 3110 g. She was diagnosed with meconium peritonitis caused by ileal atresia. Two years later, the younger brother was born at 34 + 3 weeks gestation with a birth weight of 2850 g. He was diagnosed with meconium peritonitis caused by midgut volvulus.
CONCLUSIONS
Among the previously reported cases of meconium peritonitis, familial occurance of meconium peritonitis is extremely rare. We present a case of prenatally diagnosed meconium peritonitis in siblings to promote further understanding of its etiology and clinical course.
Topics: Cesarean Section; Female; Humans; Infant, Newborn; Intestinal Atresia; Intestinal Volvulus; Male; Meconium; Peritonitis; Pregnancy; Siblings
PubMed: 32138710
DOI: 10.1186/s12887-020-2016-3 -
Clinical Radiology Feb 2018To use prenatal magnetic resonance imaging (MRI) to define features of meconium peritonitis (MP) and analyse the relationship between prenatal MRI findings and postnatal...
AIM
To use prenatal magnetic resonance imaging (MRI) to define features of meconium peritonitis (MP) and analyse the relationship between prenatal MRI findings and postnatal outcomes.
MATERIALS AND METHODS
Eight cases were enrolled who had been diagnosed with MP through prenatal MRI; the diagnoses were confirmed at surgery and pathology or follow-up. MP was diagnosed by the findings of meconium ascites, meconium pseudocyst, or dilated bowel loops. Prenatal follow-up after diagnosis by MRI was performed by ultrasound.
RESULTS
Prenatal MRI findings included massive meconium ascites (five out of eight cases), a small meconium pseudocyst (one out of eight), a large meconium pseudocyst along with a dilated bowel loop (one out of eight), a dilated bowel loop alone (one out of eight), and micro-colorectum (six out of eight). Six fetuses showed abdominal distension, bilious vomiting, and no normal meconium at birth; they underwent exploratory laparotomies and subsequently, survived and prospered. Only one fetus (with a small meconium pseudocyst) received conservative treatment. There was one mortality, and the cause of death was full-bowel necrosis.
CONCLUSION
Prenatal MRI may be helpful for diagnosing MP, in cases where the specific MRI findings are persistent meconium ascites, a dilated bowel loop, micro-colorectum, and meconium pseudocyst. In particular, a micro-colorectum might indirectly reflect ileum atresia, which requires postnatal surgery.
Topics: Female; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Meconium; Peritonitis; Pregnancy; Prenatal Diagnosis
PubMed: 28954695
DOI: 10.1016/j.crad.2017.08.006 -
Annals of Surgery Jul 2023Investigate patterns of infant perioperative mortality, describe the infant diagnoses with the highest mortality burden, and evaluate the association between types of...
OBJECTIVE
Investigate patterns of infant perioperative mortality, describe the infant diagnoses with the highest mortality burden, and evaluate the association between types of postoperative complications and mortality in infants.
BACKGROUND
The majority of mortality events in pediatric surgery occur among infants (ie, children <1 y old). However, there is limited data characterizing patterns of infant perioperative mortality and diagnoses that account for the highest proportion of mortality.
METHODS
Infants who received inpatient surgery were identified in the National Surgical Quality Improvement Program-Pediatric database (2012-2019). Perioperative mortality was stratified into mortality associated with a complication or mortality without a complication. Complications were categorized as wound infection, systemic infection, pulmonary, central nervous system, renal, or cardiovascular. Multivariable logistic regression was used to evaluate the association between different complications and complicated mortality.
RESULTS
Among 111,946 infants, the rate of complications and perioperative mortality was 10.4% and 1.6%, respectively. Mortality associated with a complication accounted for 38.8% of all perioperative mortality. Seven diagnoses accounted for the highest proportion of mortality events (40.3%): necrotizing enterocolitis (22.3%); congenital diaphragmatic hernia (7.3%); meconium peritonitis (3.8%); premature intestinal perforation (2.5%); tracheoesophageal fistula (1.8%); gastroschisis (1.4%); and volvulus (1.1%). Relative to wound complications, cardiovascular [odds ratio (OR): 19.4, 95% confidence interval (95% CI): 13.9-27.0], renal (OR: 6.88; 4.65-10.2), and central nervous system complications (OR: 6.50; 4.50-9.40) had the highest odds of mortality for all infants.
CONCLUSIONS
A small subset of diagnoses account for 40% of all infant mortality and specific types of complications are associated with mortality. These data suggest targeted quality improvement initiatives could be implemented to reduce adverse surgical outcomes in infants.
Topics: Infant, Newborn; Infant; Humans; Child; Treatment Outcome; Postoperative Complications; Hernias, Diaphragmatic, Congenital; Enterocolitis, Necrotizing; Retrospective Studies
PubMed: 35943204
DOI: 10.1097/SLA.0000000000005658