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Taiwanese Journal of Obstetrics &... Oct 2017
Topics: Fetal Diseases; Fetal Therapies; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Taiwan; Ultrasonography, Doppler; Ultrasonography, Prenatal
PubMed: 29037567
DOI: 10.1016/j.tjog.2017.08.024 -
Journal of Cystic Fibrosis : Official... Nov 2017Meconium ileus (MI) is often the first manifestation of cystic fibrosis (CF) and occurs in approximately 20% of patients diagnosed with CF. This article reviews the... (Review)
Review
Meconium ileus (MI) is often the first manifestation of cystic fibrosis (CF) and occurs in approximately 20% of patients diagnosed with CF. This article reviews the pathophysiology of MI and its clinical presentation. It focuses on the medical and surgical management emphasizing the importance of nutrition and a multidisciplinary approach to improve both short-term and long-term outcomes for CF patients with MI.
Topics: Cystic Fibrosis; Humans; Infant, Newborn; Meconium Ileus; Patient Care Management
PubMed: 28986020
DOI: 10.1016/j.jcf.2017.06.007 -
World Journal of Clinical Pediatrics Feb 2017To compare the outcome between patients with jejunoileal atresia (JIA) associated with cystic meconium peritonitis (CMP) and patients with isolated JIA (JIA without CMP).
AIM
To compare the outcome between patients with jejunoileal atresia (JIA) associated with cystic meconium peritonitis (CMP) and patients with isolated JIA (JIA without CMP).
METHODS
A retrospective study was conducted for all neonates with JIA operated in our institute from January 2005 to January 2016. Demographics including the gestation age, sex, birth weight, age at operation, the presence of associated syndrome was recorded. Clinical outcome including the type of operation performed, operative time, the need for reoperation and mortality were studied. The demographics and the outcome between the 2 groups were compared.
RESULTS
During the study period, 53 neonates had JIA underwent operation in our institute. Seventeen neonates (32%) were associated with CMP. There was no statistical difference on the demographics in the two groups. Patients with CMP had earlier operation than patients with isolated JIA (mean 1.4 d 3 d, = 0.038). Primary anastomosis was performed in 16 patients (94%) with CMP and 30 patients (83%) with isolated JIA ( = 0.269). Patients with CMP had longer operation (mean 190 min 154 min, = 0.004). There were no statistical difference the need for reoperation (3 6, = 0.606) and mortality (2 1, = 0.269) between the two groups.
CONCLUSION
Primary intestinal anastomosis can be performed in 94% of patients with JIA associated with CMP. Although patients with CMP had longer operative time, the mortality and reoperation rates were low and were comparable to patients with isolated JIA.
PubMed: 28224094
DOI: 10.5409/wjcp.v6.i1.40 -
Polish Journal of Radiology 2017Fetus in fetu (FIF) is a rare entity in which a malformed diamniotic monochorionic parasitic fetal twin develops inside a normal co-twin's body, most commonly in the...
BACKGROUND
Fetus in fetu (FIF) is a rare entity in which a malformed diamniotic monochorionic parasitic fetal twin develops inside a normal co-twin's body, most commonly in the abdominal cavity. FIF is differentiated from the teratoma by the presence of vertebral column often with an appropriate arrangement of other organs or limbs around it.
CASE REPORT
A two-and-a-half-year-old girl presented with a painless abdominal swelling in the right hypochondrium. On imaging, a heterogenous soft tissue mass with internal calcific densities was noted in the retroperitoneum. The mass had vertebral organization, limb and pelvic bones. The presence of a fetiform teratoma was suspected and surgery revealed an encapsulated mass with an anencephalic head, spine, upper and lower limb buds. Histopathology confirmed the presence of a fetus in fetu. The postoperative period was uneventful with no evidence of recurrence.
CONCLUSIONS
FIF is a pediatric rarity. Cross-sectional imaging helps in differentiating it from a teratoma, meconium peritonitis and abdominal ectopic pregnancy. Surgical excision is the treatment of choice for this benign condition, which requires a follow-up only in certain cases. This case report describes a retroperitoneal fetus in fetu and discusses its clinical presentation, differential diagnosis and embryologic origin.
PubMed: 28217238
DOI: 10.12659/PJR.899956 -
BMJ Case Reports Feb 2017
Topics: Adult; Duodenal Obstruction; Female; Fetal Diseases; Humans; Intestinal Atresia; Meconium; Peritonitis; Pregnancy; Premature Birth; Ultrasonography, Prenatal
PubMed: 28159774
DOI: 10.1136/bcr-2017-219208 -
Medicine Jan 2017Benign pneumoperitoneum (BPPT) is defined as asymptomatic free intraabdominal air or as pneumoperitoneum without peritonitis. Symptomatic free air requires surgical...
INTRODUCTION
Benign pneumoperitoneum (BPPT) is defined as asymptomatic free intraabdominal air or as pneumoperitoneum without peritonitis. Symptomatic free air requires surgical anagement, but management of asymptomatic pneumoperitoneum is controversial. In this study, we investigate the diagnosis and treatment of BPPT in children.
CLINICAL FINDINGS
The clinical data of 9 pediatric patients with BPPT who were admitted to our hospital from January 2000 to January 2015 were retrospectively analyzed to summarize the diagnosis and treatment. Overall, 9 cases were included with 8 males and 1 female, aged from 4 days to 4 years. Among them there were 6 newborns (including 1 premature infant). Patients were all admitted to hospital with the major clinical symptom of abdominal distension, including 2 cases accompanied by tachypnea, 2 cases with vomiting, 1 case with diarrhea, and 2 cases with fever. No previous constipation or obstructive defecation existed. Six newborns had meconium defecation within 24 hours after birth. Physical examination revealed all patients with relaxed abdominal wall except 1 patient with abdominal distension had slight muscle stiffness and hyperactive bowel sounds. Abdominal X-ray suggested free air under the diaphragm in all cases.
INTERVENTIONS/OUTCOMES
All patients except for one case of laparotomy were conservatively treated and cured with fasting, infection prevention, rehydration, abdominocentesis, and close observation. Nine cases of patients were all discharged with no death occurrence. After discharge follow-up of 7 months to 6 years was conducted. There was no recurrence of similar symptoms, and children were in good growth and development.
CONCLUSION
The diagnosis of BPPT mainly relies on clinical symptoms in patient, careful abdominal examination, abdominal X-ray combined with abdominocentesis, and the exclusion of gastrointestinal perforation for confirmation. Conservative treatment can cure the disease. Attention should be paid to distinguish with surgical pneumoperitoneum to avoid unnecessary surgical exploration.
Topics: Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Laparotomy; Male; Physical Examination; Pneumoperitoneum; Radiography, Abdominal; Retrospective Studies; Treatment Outcome
PubMed: 28079808
DOI: 10.1097/MD.0000000000005814 -
Journal of Neonatal Surgery 2016To evaluate the results of the use of the T-tube ileostomy in neonatal intestinal surgery cases. A retrospective review of sixty two neonates underwent intestinal...
To evaluate the results of the use of the T-tube ileostomy in neonatal intestinal surgery cases. A retrospective review of sixty two neonates underwent intestinal obstruction surgery by using T-tube ileostomy was conducted between January 1990 and January 2013.The pathologies of the intestinal obstruction were; thirty four of jejunoileal atresia cases, thirteen case meconium ileus, eight cases perforated necrotizing enterocolitis (NEC), three cases meconium peritonitis, three cases with bowel resection due to intestinal volvulus, and one case of gastroschisis. Mean duration of T-tube placement was 13 days (range9-20days) and the sites of T-tube insertion closed spontaneously in 2 days (range 1-4 days). The mean duration for starting oral intake postoperatively in these patients was 9 days (6-16 days). All patients well tolerated the procedure and there were no serious complications related to the T-tube insertion. However, four patients died due to other reasons like sepsis, respiratory failure and prematurity. T-tube enterostomy is an effective and safe technique for treatment of selected cases of neonatal intestinal surgery. It showed less morbidity and mortality rates than the conventional stoma. Therefore, it is considered a helpful approach in cases where there is danger of hypoperistaltic dilated bowel proximal to the anastomosis.
PubMed: 27896154
DOI: 10.21699/jns.v5i4.456 -
Journal of Neonatal Surgery 2016To review nine-year experience in managing jejuno-ileal atresia (JIA) by primary resection and anastomosis and identify factors associated with reoperations. From...
To review nine-year experience in managing jejuno-ileal atresia (JIA) by primary resection and anastomosis and identify factors associated with reoperations. From April 2006 to May 2015, all consecutive neonates who underwent bowel resection and primary anastomosis for JIA were analyzed retrospectively. Patients with temporary enterostomy were excluded. Patient demographics, types of atresia, surgical techniques, need for reoperations, and long-term outcomes were investigated. A total of forty-three neonates were included, in which nineteen (44.2%) of them were preterm and fourteen (32.6%) were of low birth weight. Thirteen patients (30.2%) had jejunal atresia whereas thirty patients (69.8%) had ileal atresia. Volvulus, intussusception and meconium peritonitis were noted in 12, 8, and13 patients, respectively. Eight patients (18.6%) had short bowel syndrome after operation. Ten patients (23.3%) required reoperations from 18 days to 4 months after the initial surgery due to anastomotic stricture (n=1), adhesive intestinal obstruction (n=1), small bowel perforation (n=2) and functional obstruction (n=6). Prematurity and low birth weight were associated with functional obstruction leading to reoperation (p=0.04 and 0.01 respectively). The overall long-term survival was 97.7%. All surviving patients achieved enteral autonomy and catch-up growth at a median follow-up of 4.7 years. Long-term survival of JIA after primary resection and anastomosis are excellent. However, patients have substantial risk of early reoperations to tackle intraabdominal complications.
PubMed: 27896150
DOI: 10.21699/jns.v5i4.444 -
Journal of Indian Association of... 2016To report a series of scrotal abscess, a rare problem, their etiology, and management.
AIM
To report a series of scrotal abscess, a rare problem, their etiology, and management.
MATERIALS AND METHODS
A retrospective study of children who presented with scrotal abscess between January 2010 and March 2015, analyzed with respect to clinical features, pathophysiology of spread and management.
RESULTS
Eight infants and a 3-year-old phenotypically male child presented with scrotal abscess as a result of abdominal pathologies which included mixed gonadal dysgenesis (MGD) [1]; three anorectal malformations with ectopic ureter [1], urethral stricture [1], and neurogenic bladder [1]; meconium peritonitis with meconium periorchitis [2], ileal atresia [1], and intra-abdominal abscess [1]; posturethroplasty for Y urethral duplication with metal stenosis [1] and idiopathic pyocele [1]. Transmission of the organism had varied routes include fallopian tube [1], urethra ejaculatory reflux [4], hematogenous [2], and the patent process of vaginalis [2]. Two of the nine required extensive evaluation for further management. Treating the predisposing pathology resolved scrotal abscesses in eight of nine patients, one of whom, required vasectomy additionally. Idiopathic pyocele responded to needle aspiration and antibiotics.
CONCLUSION
Scrotal abscess needs a high index of suspicion for predisposing pathology, especially in infants. Laparoscopy is safe and effective in the management of the MGD and ectopic ureter.
PubMed: 27695207
DOI: 10.4103/0971-9261.186545 -
Indian Journal of Anaesthesia May 2016
PubMed: 27212729
DOI: 10.4103/0019-5049.181614