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European Journal of Pediatric Surgery... Jan 2019Infantile fibrosarcoma (IFS) is a rare nonrhabdomyosarcoma soft tissue tumor and accounts for less than 1% of childhood cancers. Forty per cent are present at birth and...
Infantile fibrosarcoma (IFS) is a rare nonrhabdomyosarcoma soft tissue tumor and accounts for less than 1% of childhood cancers. Forty per cent are present at birth and only 10% of IFS occurs in the abdomen. Our case of neonatal fibrosarcoma presented as a distal small bowel stenosis complicated with meconium peritonitis. The diagnosis was by histology of the surgical resection. The diagnosis of IFS is challenging as there are no specific features of IFS on imaging. Any unexpected solid lesion should raise the suspicion of complicated bowel tumoral lesion. If a neoplastic lesion is suspected extensive, surgery may be postponed until the final diagnosis is made.
PubMed: 31192106
DOI: 10.1055/s-0039-1692154 -
Journal of Pediatric Surgery Oct 2019Mortality for neonates requiring surgery for serious pathology such as NEC, remains high. Damage control surgery (DCS) has evolved as an operative strategy in...
INTRODUCTION
Mortality for neonates requiring surgery for serious pathology such as NEC, remains high. Damage control surgery (DCS) has evolved as an operative strategy in battlefield trauma that sacrifices the completeness of the initial surgery to address the deadly triad of acidosis, hypothermia and coagulopathy. This approach is now used routinely in sick adults with nontrauma surgical emergencies. Here we describe our experience of using DCS in neonates.
METHOD
Neonates undergoing DCS at our hospital from 1/8/2010 to 30/11/17 had data collected prospectively.
RESULTS
27 neonates (median age 21 days; gestation 29 weeks; weight 1200 g; M:F 18:9) underwent DCS. Diagnosis (NEC 23, volvulus 2, meconium peritonitis 1, spontaneous perforation 1). Preoperative physiology: median temperature 35.5 °C, lactate 3.7, Activated prothrombin time 49; on a median of 1 inotrope (range 0 to 4); 19 had surgery on the intensive care unit. Surgery involved resection of dead bowel with the ends ligated and the abdomen left open. Operation took 38 min (26-80 min) and crew-resource management techniques were used to optimize efficiency. Second look occurred at 48 h (24-108 h) when the physiology had normalized. There were a total of 32 anastomoses in 18 patients with one leak; 3 patients had stomas for distal rectal disease. Overall mortality was 15% (4/27) or 18% in the NEC group (4/23).
CONCLUSION
Though techniques such as "clip and drop" exist, they have not been routinely incorporated into an operative strategy for sick neonates based on physiological derangement. The two benefits from our DCS approach were a low mortality and an avoidance of stomas. This approach deserves more investigation to see whether it is as effective in babies and children with nontrauma associated abdominal catastrophes as it is in adults.
TYPE OF STUDY
Case controlled study.
LEVEL OF EVIDENCE
Level III.
Topics: Case-Control Studies; Emergencies; Enterocolitis, Necrotizing; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Volvulus; Peritonitis
PubMed: 31103271
DOI: 10.1016/j.jpedsurg.2019.04.001 -
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 -
The Pan African Medical Journal 2018
Topics: Abdomen; Calcinosis; Female; Humans; Infant, Newborn; Meconium; Peritonitis
PubMed: 31011385
DOI: 10.11604/pamj.2018.31.84.16592 -
Journal of the College of Physicians... Jan 2019
Topics: Humans; Infant, Newborn; Male; Ascites; Fatal Outcome; Ileum; Intestinal Perforation; Meconium; Peritonitis; Respiratory Distress Syndrome, Newborn; Female; Cesarean Section
PubMed: 30630586
DOI: 10.29271/jcpsp.2019.01.97 -
Neonatal Network : NN Jul 2018Meconium peritonitis is a sterile chemical peritonitis preceded by bowel perforation, resulting in meconium leakage and subsequent inflammatory cascade within the...
Meconium peritonitis is a sterile chemical peritonitis preceded by bowel perforation, resulting in meconium leakage and subsequent inflammatory cascade within the peritoneal cavity. The presentation can range from simple failure of the neonate to pass meconium to complications such as persistent pulmonary hypertension, lung hypoplasia, and systemic inflammatory syndrome. The purpose of this article is to review a case of meconium peritonitis while considering its etiology, diagnosis, management, and multidisciplinary team care.
Topics: Adult; Education, Nursing, Continuing; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Male; Meconium; Middle Aged; Neonatal Nursing; Nurses, Neonatal; Peritonitis; Practice Guidelines as Topic; Treatment Outcome
PubMed: 30567921
DOI: 10.1891/0730-0832.37.4.233 -
Radiology Case Reports Feb 2019Meconium pseudocyst (MPC) is a rare but well-known surgical condition due to prenatal bowel perforation. A case of MPC secondary to prenatal bowel perforation is...
Meconium pseudocyst (MPC) is a rare but well-known surgical condition due to prenatal bowel perforation. A case of MPC secondary to prenatal bowel perforation is presented. Massive ascites requiring peritoneal drainage and disappearance of prenatal intraperitoneal calcifications have not been previously reported in MPC. MPC may present at birth with large ascites requiring peritoneal drainage to establish breathing and ventilation. Absence of prenatal intra-abdominal calcifications does not rule out MPC.
PubMed: 30479678
DOI: 10.1016/j.radcr.2018.10.013 -
Zhejiang Da Xue Xue Bao. Yi Xue Ban =... May 2018To summarize experience in the treatment of complex congenital intestinal atresia in children, so as to investigate the key points and effect of the operation.
OBJECTIVE
To summarize experience in the treatment of complex congenital intestinal atresia in children, so as to investigate the key points and effect of the operation.
METHODS
Medical notes of 49 children with complex intestinal atresia treated between January 2012 and January 2018 were reviewed. The information of age, sex, age at operation, full-term or premature, birth weight, clinical manifestation, auxiliary examination, preliminary diagnosis, treatment process, discharge diagnosis, pathological results and prognosis of patients were analyzed.
RESULTS
All patients underwent surgical treatment, including 42 cases with laparotomy (85.7%) and 7 with laparoscopic surgery (14.3%); 1 case undergoing laparoscopic surgery was converted to laparotomy due to meconium peritonitis. The mean operation time was (147±43) min (70-270 min); the mean fasting time after surgery was (8±3) d (4-16 d); the mean parenteral nutrition time was (12±6) d (3-30 d). Eleven cases were discharged against medical after operation and lost to follow-up. Among rest 38 children, 1 child (2.6%) received intestinal resection and ostomy five days after operation due to gastrointestinal perforation; 1 child (2.6%) received conservative treatment one month later due to adhered intestinal obstruction and left hospital with cure; 1 child (2.6%) received enterodialysis and ileostomy eight days after operation due to anastomotic leak, and received the operation for the closure of fistula after three months; 4 children had complications including fluid and electrolyte disorders, anemia, hypoproteinemia and so on, and recovered after conservative treatments. Postoperative follow-up showed that 1 child with duodenal atresia had lower body weight at 6 month after operation, but the body weight returned to normal when the child was one year old; 1 child with preterm labor of 32 weeks was treated with enteral nutrition, and gradually restored the normal diet after 6 months. Growth retardation was not observed in other children.
CONCLUSIONS
With active treatment and reservation of normal bowel tube as much as possible during the operation, the prognosis of children with complex intestinal atresia is usually favorable.
Topics: Child; Congenital Abnormalities; Duodenal Obstruction; Enteral Nutrition; Humans; Infant; Infant, Newborn; Intestinal Atresia; Laparoscopy; Retrospective Studies
PubMed: 30226325
DOI: 10.3785/j.issn.1008-9292.2018.06.06 -
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 -
Pediatric Radiology Nov 2018The role of imaging in meconium peritonitis is not limited to establishing a diagnosis; rather, it might also be helpful in determining which neonates require surgery.... (Comparative Study)
Comparative Study
BACKGROUND
The role of imaging in meconium peritonitis is not limited to establishing a diagnosis; rather, it might also be helpful in determining which neonates require surgery. However, few data in the literature correlate the postnatal radiographic and sonographic findings with the need for surgery.
OBJECTIVE
To compare the role of postnatal radiographic and sonographic findings in predicting the need for surgery in neonates with meconium peritonitis.
MATERIALS AND METHODS
We conducted a retrospective analysis of clinical, imaging and surgical findings in all neonates with meconium peritonitis in the period 1999-2014. We divided the children into operative or non-operative groups and then correlated each group with the presence or absence of the following findings on both the radiographs and sonograms: peritoneal calcification, meconium pseudocyst, intestinal obstruction, volvulus, ascites and pneumoperitoneum.
RESULTS
Thirty-seven neonates (22 males, 15 females) had meconium peritonitis in this period, of whom 23 (62%) required surgery and 14 (38%) were successfully treated non-surgically. None had an antenatal infection and three had cystic fibrosis (8%). Bowel obstruction identified on radiography (12/23, P=0.01) and sonography (9/23, P=0.04) and ascites identified with sonography (7/23, P=0.01) were associated with the need for surgical intervention. The presence of pneumoperitoneum and volvulus were also associated with surgical intervention. There was no significant statistical difference in the number of neonates with diffuse peritoneal calcification who were treated operatively or non-operatively. Four (33%) of the 12 neonates with meconium pseudocysts were successfully treated non-operatively.
CONCLUSION
Imaging findings that predicted the need for surgery were intestinal obstruction, ascites, volvulus and pneumoperitoneum. Neonates with meconium pseudocysts did not require surgery if they were not associated with the described findings. The findings in our patients also indicate that those with diffuse peritoneal calcification as an isolated finding can be successfully treated non-operatively.
Topics: Female; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Predictive Value of Tests; Retrospective Studies; Treatment Outcome; Ultrasonography
PubMed: 30014199
DOI: 10.1007/s00247-018-4198-5