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Frontiers in Pediatrics 2022Meconium peritonitis (MP) combined with intestinal atresia (IA) is a rare neonatal condition, and it is even rarer in combination with biliary atresia (BA). We describe...
Meconium peritonitis (MP) combined with intestinal atresia (IA) is a rare neonatal condition, and it is even rarer in combination with biliary atresia (BA). We describe a case of an infant who developed short bowel syndrome after partial intestinal resection due to MP and IA, along with a Santullienterostomy. During continuous enteral and parenteral nutrition, the stool color became paler. BA was identified by elevated direct bilirubin (DBIL), gamma-glutamyltransferase (GGT), serum matrix metalloproteinase-7 (MMP-7), and hepatobiliary ultrasound; then, Kasai portoenterostomy (KPE) was performed promptly. The Roux-en-Y limb was adjusted intraoperatively to preserve the maximum length of the small intestine while closing the enterostomy. After the operation, the infant gradually adapted to enteral nutrition, his bilirubin level returned to normal, and his weight gradually caught up to the normal range. Although rare, BA should be suspected when MP is combined with IA and when the stool becomes paler in color in the enterostomy state.
PubMed: 35722473
DOI: 10.3389/fped.2022.917116 -
Cureus Jun 2020A moderately preterm, 2.68 kg, male child was born to para 3 live 3 mother by Cesarean delivery done in view of preterm labor with fetal ascites. The baby had...
A moderately preterm, 2.68 kg, male child was born to para 3 live 3 mother by Cesarean delivery done in view of preterm labor with fetal ascites. The baby had antenatally detected ascites. The baby had distended but soft abdomen. Ultrasound abdomen showed gross ascites. X-ray of the abdomen in supine showed faint lucency in the mid-abdomen region posterior to the bowel gas, which was visualized as free gas along the right half of the abdomen in lateral decubitus position, suggestive of bowel perforation. Laparotomy was done on day three of life, intraoperatively found to have perforated Meckel's diverticulum. Ascites resolved postoperatively. Isolated fetal ascites is a rare condition but has a favorable prognosis.
PubMed: 32642348
DOI: 10.7759/cureus.8433 -
Pediatrics and Neonatology Jul 2021
Topics: Female; Fetal Diseases; Fetal Macrosomia; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Peritonitis; Pregnancy
PubMed: 33931345
DOI: 10.1016/j.pedneo.2021.03.006 -
Pediatric Gastroenterology, Hepatology... Nov 2019Meconium peritonitis as a cause of non-immune hydrops in neonates is rarely reported. Here we report such a rare occurrence. In our case, a routine antenatal scan at 25...
Meconium peritonitis as a cause of non-immune hydrops in neonates is rarely reported. Here we report such a rare occurrence. In our case, a routine antenatal scan at 25 weeks revealed isolated ascites. By 31 weeks of gestation, all features of hydrops were observed in scans. However, antenatal workup for immune and non-immune hydrops was negative. Subsequently, a preterm hydropic female baby was delivered at 32 weeks. She required intubation and ventilator support. An X-ray revealed calcification in the abdomen suggestive of meconium peritonitis. Ultrasound showed gross ascites, a giant cyst compressing the inferior vena cava, and minimal bilateral pleural effusion. Emergency laparotomy revealed meconium pellets and perforation of the ileum. Double-barrel ileostomy was performed, and the edema resolved and activity improved. The baby was discharged after 3 weeks. Ileostomy closure was done at follow-up. The baby is growing well.
PubMed: 31777724
DOI: 10.5223/pghn.2019.22.6.576 -
Pediatrics and Neonatology Jun 2019The purpose of this study is to examine the outcome of transumbilical minilaparotomy for infants and compare the results between normal birthweight (NBW) and low...
BACKGROUND
The purpose of this study is to examine the outcome of transumbilical minilaparotomy for infants and compare the results between normal birthweight (NBW) and low birthweight (LBW).
METHODS
Between July 2010 and March 2017, infants who underwent abdominal surgery through transumbilical minilaparotomy were enrolled. Medical records were retrospectively reviewed. Patients were divided into two groups, NBW and LBW. Complexity was defined as complicated conditions other than intestinal atresia and malrotation.
RESULTS
Totally, 16 patients were included. The diagnosis included intestinal atresia (n = 3), meconium peritonitis (n = 4), bowel infarction/necrosis (n = 4), spontaneous intestinal perforation (n = 2), segmental volvulus and necrosis (n = 1), necrotizing enterocolitis (n = 1), and malrotation (n = 1). The median gestational age and body weight were 32 (24-40) weeks and 1731 (560-4200) grams respectively. The median age at operation was 3 (1-41) days. The surgical procedure included primary repair of the intestine (n = 14), ileostomy (n = 1) and Ladd's procedure (n = 1). Postoperative complications included anastomotic leakage (n = 2), adhesion ileus (n = 1), and missed rectal atresia (n = 1). There was one mortality due to extremely low birthweight and poor lung maturation. Re-operation was required in 3 patients for anastomotic leakage (n = 2) and missed rectal atresia (n = 1). Mean birthweight was 2932 ± 97 and 1263 ± 667 g in NBW (n = 5) and LBW (n = 11), respectively (p < 0.01). Complexity rate was 40% and 90.9%, respectively (p = 0.034). The mean operation time was 139.4 ± 65.8 and 124.3 ± 46.1 min, respectively (p = 0.60). The complicated rate and reoperation rate were similar.
CONCLUSIONS
Transumbilical minilaparotomy is technically feasible and an alternative option of minimally invasive surgery for LBW infants and complex conditions.
Topics: Birth Weight; Enterocolitis, Necrotizing; Female; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Intestinal Atresia; Intestinal Volvulus; Laparotomy; Male; Postoperative Complications; Retrospective Studies; Umbilicus
PubMed: 30145106
DOI: 10.1016/j.pedneo.2018.07.014 -
Yonago Acta Medica Nov 2023In recent years, the number of neonatal surgeries has been on the rise despite the decline in the number of births, and we examined the actual trends and problems at...
BACKGROUND
In recent years, the number of neonatal surgeries has been on the rise despite the decline in the number of births, and we examined the actual trends and problems at Tottori University Hospital located in the Sanin region.
METHODS
Medical records were retrospectively searched for patients who underwent major surgery during the neonatal period (within 30 days of age) at the Tottori University Hospital over the past 10 years (Jan. 2011 to Dec. 2020).
RESULTS
Sixty-five cases were included. Early birth infants (< 37 gestational weeks) comprised 15 cases (23%) and low birth weight (< 2500 g) infants involved 27 cases (42%). In the latter half (2016-2020), early birth and low birth weight infants were significantly less than in the first half (2011-2015). The common diseases were anorectal malformation (14 cases), esophageal atresia (10), duodenal atresia (10), and diaphragmatic hernia (9). Prenatal diagnosis was obtained in 26 cases (40%), with high diagnostic rate obtained in duodenal atresia (100%), abdominal wall defect (100%), ileal atresia (75%), meconium peritonitis (67%), and diaphragmatic hernia (67%). Fifty-five cases (85%) were operated on within 7 days of age. Other major malformations were associated in 23 cases (35%). There were 6 deaths (9%), of which 3 cases were low birth weight infants with gastrointestinal perforation, 2 cases with severe chromosomal abnormalities (esophageal atresia, omphalocele), and 1 case with diaphragmatic hernia with severe pulmonary hypertension. Home medical care has been required with gastrostomy tube in 2 cases.
CONCLUSION
Neonatal surgery at Tottori University has been well performed as required with acceptable results along with the progression of other perinatal care. However, further investigation for improvements in premature delivery or organ hypoplasia may be required.
PubMed: 38028267
DOI: 10.33160/yam.2023.11.003 -
Clinical Case Reports Dec 2023Fetal meconium periorchitis (MPO) is rare prenatal diagnosis associated with meconium peritonitis. The prenatal ultrasound finding consists of an enlarged fetal scrotum...
Fetal meconium periorchitis (MPO) is rare prenatal diagnosis associated with meconium peritonitis. The prenatal ultrasound finding consists of an enlarged fetal scrotum with echogenic fluid and debris. In this report, we describe a case in which a prenatal diagnosis of MPO was accurately made at 32 weeks of gestation. The neonate delivered without complications, underwent immediate evaluation followed by major surgery, and ultimately had a favorable outcome. An accurate prenatal diagnosis is important to counsel the patient in a multidisciplinary approach. This case highlights the prenatal ultrasound findings as well as the neonatal presentation and the possibility for conservative management by pediatric urology.
PubMed: 38107083
DOI: 10.1002/ccr3.8319 -
Asian Journal of Surgery Nov 2023article's main point: This article retrospectively analyzes clinical data from a rare case of fetal retroperitoneal solid, mature teratoma, aiming to provide insights...
article's main point: This article retrospectively analyzes clinical data from a rare case of fetal retroperitoneal solid, mature teratoma, aiming to provide insights into diagnosing and treating fetal teratomas. This case of fetal retroperitoneal teratoma provides the following insights into diagnosis and treatment: 1) Due to the special nature of the retroperitoneal space, retroperitoneal tumours grow hidden, especially in fetal retroperitoneal tumours that are even more difficult to detect. Prenatal ultrasound screening is of great value for the diagnosis of this disease. 2) Although ultrasound can determine the location and blood flow of the tumour and monitor changes in its size and composition, there is a certain degree of misdiagnosis due to fetal position, clinical experience, and imaging resolution. When necessary, fetal MRI can provide further evidence for prenatal diagnosis. 3) Although fetal retroperitoneal teratoma is rare, a few tumours grow rapidly and have the potential for malignant transformation. When a solid cystic mass lesion in the retroperitoneal space is found during the fetal period, this disease should be considered as one of the differential diagnoses and distinguished from fetal renal tumours, adrenal tumours, pancreatic cysts, meconium peritonitis, parasitic fetus, and lymphangioma, among others. 4) Based on the situation of the pregnant woman, fetus, and tumour, the time and method of termination of pregnancy should be decided. After birth, the timing and manner of surgery and postoperative follow-up should be determined by neonatology and pediatric surgery.
Topics: Female; Child; Humans; Infant, Newborn; Pregnancy; Retroperitoneal Space; Retroperitoneal Neoplasms; Retrospective Studies; Teratoma; Fetus; Magnetic Resonance Imaging
PubMed: 37202258
DOI: 10.1016/j.asjsur.2023.05.016 -
Case Reports in Obstetrics and... 2018Fetal volvulus is a rare, yet life-threatening condition that requires skilful diagnosis and management. Volvulus occurs when bowel loops become twisted and the twisting...
BACKGROUND
Fetal volvulus is a rare, yet life-threatening condition that requires skilful diagnosis and management. Volvulus occurs when bowel loops become twisted and the twisting of the mesenteric artery leads to congestion, impaired venous return, and bowel necrosis.
CASE DESCRIPTION
We present a case of fetal ileal volvulus suspected on third trimester ultrasound, complicated by premature labour, small bowel necrosis, and meconium peritonitis. Progressive dilatation and decreased peristalsis of echogenic bowel were noted in the early part of the third trimester. Daily surveillance ultrasound was performed and spontaneous labour occurred at 32 weeks' gestation. A proactive postnatal approach guided by prenatal sonographic findings allowed prompt treatment and an urgent laparotomy was performed for an ileal volvulus with necrosis and meconium peritonitis. A segment of small bowel volvulus was resected and an end-to-end anastomosis was performed with uneventful recovery.
DISCUSSION
Clinically signs of fetal midgut volvulus are not pathognomonic, such as intestinal dilatation, abdominal mass, ascites, peritoneal calcifications, or polyhydramnios; thus, the diagnosis is often challenging. Complications reported in the literature include perforation and haemorrhagic ascites, which may lead to anaemia, hypovolemia, heart failure, and fetal demise.
CONCLUSION
This case highlights the importance of assessing the fetal bowel as a part of routine third trimester ultrasound. The case describes the complexity of diagnosis in the fetus, important considerations along with multidisciplinary team approach to management.
PubMed: 29854513
DOI: 10.1155/2018/5312179 -
Nagoya Journal of Medical Science Nov 2022This study aimed to evaluate the safety and effectiveness of circumumbilical incision (CUI) for neonates requiring intestinal anastomosis. Seventy neonates requiring...
This study aimed to evaluate the safety and effectiveness of circumumbilical incision (CUI) for neonates requiring intestinal anastomosis. Seventy neonates requiring intestinal anastomosis at our institution between 2003 and 2020 were included in this retrospective case-control study. Patients were classified into the CUI (25 patients: 36%) and transverse incision (TI) groups (45 patients: 64%). Postoperative complications and surgical outcomes were compared between the two groups. Intestinal perforation at the non-anastomotic site occurred significantly more often in the CUI group than in the TI group (3 patients: 12%, and 0 patients: 0%, respectively ( = 0.042)). There were no between-group differences regarding anastomotic leakages, anastomotic strictures, time to enteral feeding, operative time, and blood loss. Neonatal intestinal surgery employing CUI might be associated with increased intestinal perforation at the non-anastomotic site. Hesitating to enlarge the skin incision to maintain favorable cosmetic outcomes might cause severe injury to the delicate neonatal intestine during the surgical procedure owing to the restricted surgical field. When performing CUI, we suggest that the skin incision should be extended without hesitation whenever there is difficulty in manipulating the intestine.
Topics: Infant, Newborn; Humans; Retrospective Studies; Case-Control Studies; Intestinal Perforation; Treatment Outcome; Intestines; Anastomosis, Surgical
PubMed: 36544608
DOI: 10.18999/nagjms.84.4.716