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Frontiers in Pediatrics 2023Congenital Morgagni hernia (CMH) is a rare midline defect involving herniation of abdominal viscera into the thoracic cavity through triangular parasternal gaps in the...
BACKGROUND
Congenital Morgagni hernia (CMH) is a rare midline defect involving herniation of abdominal viscera into the thoracic cavity through triangular parasternal gaps in the diaphragm.
METHODS
The medical records of three patients with CMH admitted to the Department of Pediatric Surgery at the Affiliated Hospital of Zunyi Medical University between 2018 and 2022 were retrospectively reviewed. Pre-operative diagnosis was based on chest x-ray, chest computerized tomography, and barium enema. All patients were treated with single-site laparoscopic ligation of the hernia sac.
RESULTS
Hernia repair was successful in all patients (males; age: 14 months, 30 months, 48 months). The average operative time for repair of a unilateral hernia was 20 ± 5 min. Volume of surgical blood loss was 2-3 ml. There was no damage to organs such as the liver or intestines, or to tissues such as the pericardium or the phrenic nerve. Patients were allowed a fluid diet 6-8 h after surgery, and remained on bed rest until 16 h after surgery. No postoperative complications occurred, and patients were discharged on postoperative Day 2 or 3. No symptoms or complications were noted during the 1-48 months of follow-up. Aesthetic outcomes were satisfactory.
CONCLUSIONS
Single-site laparoscopic ligation of the hernia sac provides pediatric surgeons a safe and effective technique for repair of CMH in infants and children. The procedure is straightforward, operative time and surgical blood loss are minimal, recurrence is unlikely, and aesthetic outcomes are satisfactory.
PubMed: 36896400
DOI: 10.3389/fped.2023.1078244 -
Scientific Reports Feb 2023To explore the clinical application value of optical coherence microscopy (OCM) in Hirschsprung's disease. 109 HSCR patients were recuited in a Chinese hospital from...
To explore the clinical application value of optical coherence microscopy (OCM) in Hirschsprung's disease. 109 HSCR patients were recuited in a Chinese hospital from January 2018 to July 2021. All the recruited patients underwent barium enema angiography preoperatively and the resected diseased intestinal tubes were evaluated intraoperatively. The OCM and the histopathological examination were performed successively on the surgical specimens, and the OCM images were compared with the relevant tissue sections to characterize different lesions. 10 non-HSCR fetal colorectal tissues at the same period were retained for OCM, the characteristics of which with and without HSCR under OCM imaging were analyzed. In the OCM images of in vitro tissue, it can be clearly observed that the scattering degree of HSCR narrow segment mucosal is high, glands and crypt structures are reduced or even atrophy, and the scattering degree of submucosal and intermuscular is low; In the dilated segment, the low scattering and high scattering are complex, and the muscle layer is obviously hypertrophy and structural disorder. Compared with the pathological findings, the OCM sensitivity, Kappa value, and AUC area reached 92.66%, 0.63, and 0.91, respectively. OCM can quickly and clearly display the structure of all layers of colorectal tissue, which is highly consistent with the corresponding histopathological examination results and has high sensitivity. which will provide a more reliable basis for OCM diagnosis of early HSCR, targeted biopsy and location of operative treatment, and has a certain potential for clinical application.
Topics: Humans; Hirschsprung Disease; Microscopy; Intestines; Biopsy; Colorectal Neoplasms
PubMed: 36746975
DOI: 10.1038/s41598-023-28341-5 -
Gastroenterology Research Dec 2022Gastrocolic (GC) fistula, a rare gastrointestinal pathological condition, is defined as an abnormal connection between the stomach and the colon. Mostly, it involves the... (Review)
Review
Gastrocolic (GC) fistula, a rare gastrointestinal pathological condition, is defined as an abnormal connection between the stomach and the colon. Mostly, it involves the greater curvature of the stomach and the transverse part of the colon. Its precise incidence rate is unknown and largely differs between western and eastern nations. Etiological causes differ as well between the two worlds. Although several precipitating diseases are reported, nowadays, the most common causes are malignant diseases of the stomach (eastern countries) and colon (western world). Patients with GC fistulas usually present late and complain mainly of vomiting, diarrhea, and severe weight loss. This in turn leads to malnutrition, vitamin deficiencies and electrolyte disturbances. Being a rare condition, and usually forgotten, diagnosis is usually challenging to the treating physicians. Workup usually involves a combination of radiological and endoscopic tests. Long-term survival is unknown, and patients usually have poor prognosis. The aim of this review is to summarize the relevant articles in the English literature for this abnormal medical condition, with emphasis on the different etiologies, pathogenesis, clinical presentation, and management, in order to increase physicians' awareness of such uncommon medical problem.
PubMed: 36660466
DOI: 10.14740/gr1576 -
Italian Journal of Pediatrics Dec 2022Congenital syphilis (CS) depends on the placental transmission of Treponema pallidum (TP) spirochetes from an infected mother to fetus during pregnancy. It shows a wide...
BACKGROUND
Congenital syphilis (CS) depends on the placental transmission of Treponema pallidum (TP) spirochetes from an infected mother to fetus during pregnancy. It shows a wide clinical variability with cutaneous and visceral manifestations, including stillbirths, neonatal death, and asymptomatic cases. Preterm infants with CS may have more severe features of disease than the term ones, due to the combined pathogenic effect of both CS and prematurity.
CASE PRESENTATION
We report on a female preterm (32 weeks of gestation) newborn showing most of the typical CS manifestations, in addition to gastrointestinal disorders including feeding difficulties, colon stenosis and malabsorption leading to postnatal growth restriction. The mother resulted positive at the syphilis screening test of the first trimester of pregnancy, but she did not undergo any treatment. At birth, our newborn was VDRL positive (antibody titer four times higher compared to the mother), and she was treated with intravenous benzathine benzylpenicillin G for 10 days (50,000 IU/Kg three times per day). Poor tolerance to enteral nutrition (abdominal distension, increased biliary type gastric secretions) was observed. A barium enema X-Ray identified a colon stenosis within the descending tract. However, the poor general conditions due to a concurrent fungal sepsis did not allow to perform any surgical procedure, and a conservative approach with total parenteral nutrition was started. The following evolution was marked by difficulties in enteral feeding including refusal of food and vomiting, to which also contributed the neurological abnormalities related to a perinatal asphyxia, and the affective deprivation for the physical absence of the mother during hospitalization. At 5 months of age, after the introduction of an amino acid-based formula (Neocate LCP Nutricia ®), an improvement of enteral feeding was observed, with no further and significantly decreased episodes of abdominal distension and vomiting respectively, and regular stool emission. A psychological support offered to the family allowed a more stable bond between the mother and her baby, thus providing a significant additional benefit to food tolerance and growth. She was discharged at 5 months of age, and included in a multidisciplinary follow-up. She at present shows global growth delay, and normal development apart from mildly increased tone of lower limbs.
CONCLUSIONS
Our report highlights less common clinical CS manifestations like gastrointestinal disorders including feeding difficulties, colon stenosis and malabsorption leading to postnatal growth delay. Moreover, it underlines how prematurity may worsen the clinical evolution of such congenital infection, due to the additional pathogenic effect of possible associated diseases and/or conditions like sepsis, hypoxic/ischemic injury, or use of drugs. CS may be observed also in high-income countries, with high rates of antenatal screening and availability of prenatal treatment. A multidisciplinary network must be guaranteed to the affected subjects, to ensure adequate care and improve the quality of life for patients and their families.
Topics: Infant; Infant, Newborn; Humans; Female; Pregnancy; Syphilis, Congenital; Infant, Premature; Quality of Life; Constriction, Pathologic; Placenta; Infant, Newborn, Diseases; Gastrointestinal Diseases; Vomiting; Sepsis
PubMed: 36581899
DOI: 10.1186/s13052-022-01404-5 -
Diagnostics (Basel, Switzerland) Nov 2022In recent years, due to the development of standardized diagnostic protocols associated with an improvement in the associated technology, the diagnosis of pelvic... (Review)
Review
In recent years, due to the development of standardized diagnostic protocols associated with an improvement in the associated technology, the diagnosis of pelvic endometriosis using imaging is becoming a reality. In particular, transvaginal ultrasound and magnetic resonance are today the two imaging techniques that can accurately identify the majority of the phenotypes of endometriosis. This review focuses not only on these most common imaging modalities but also on some additional radiological techniques that were proposed for rectosigmoid colon endometriosis, such as double-contrast barium enema, rectal endoscopic ultrasonography, multidetector computed tomography enema, computed tomography colonography and positron emission tomography-computed tomography with 16α-[18F]fluoro-17β-estradiol.
PubMed: 36552967
DOI: 10.3390/diagnostics12122960 -
Annals of Medicine and Surgery (2012) Dec 2022Internal rectal prolapse in children is one of the causes of annoying and drug-resistant constipation. The disease causes a type of obstructive constipation due to the...
OBJECTIVES
Internal rectal prolapse in children is one of the causes of annoying and drug-resistant constipation. The disease causes a type of obstructive constipation due to the appearance of mucosal folds in the distal rectum. If the diagnosis is made in time according to the methods proposed by the author, the treatment can also be done with simple techniques. In this article, the treatment methods for this well-known disease are presented.
METHODS
This is a prospective cross-sectional study, Sixty children (36 girls and 24 boys) between the ages of 6 months and 15 years who have specific symptoms of this disease and different degrees after definitive diagnosis of anesthesia with Delshad-mash have been treated with the sclerosing solution under the rectal mucosa or excision prolapse.
RESULTS
Depending on the severity of the disease, treatment with a subcutaneous injection of sclerosing solution responds well. The condition resolves after years of suffering from high degrees of prolapsed mucosal excision.
CONCLUSION
Diagnosis of internal rectal prolapse can be made based on specific symptoms and barium enema radiology before the anesthesia test for children and determine the patient's treatment path and prevent additional operations such as colostomy-pulmonary with misdiagnosis of Hirschsprung.
PubMed: 36536742
DOI: 10.1016/j.amsu.2022.104886 -
BMC Medical Imaging Nov 2022Intravascular papillary endothelial hyperplasia (IPEH) is a vascular tumor characterized by the proliferation of endothelial cells with papillary formation. It is a rare...
BACKGROUND
Intravascular papillary endothelial hyperplasia (IPEH) is a vascular tumor characterized by the proliferation of endothelial cells with papillary formation. It is a rare benign condition affecting the head and neck. Currently, no cases of IPEH of the spleen have been reported. Here, we report a case of IPEH of the spleen in a child and discuss its clinical manifestations, imaging features, and surgical treatment.
CASE PRESENTATION
A 5-year-old female presented with a 4-month-old tumor in the left upper abdomen, abdominal pain, and constipation. She underwent radiography, barium enema, US, and MRI. A solid space-occupying mass was found in the left abdominal cavity on preoperative imaging, and it was diagnosed as angiosarcoma. The lesion was surgically resected. Histopathological analysis was consistent with IPEH.
CONCLUSION
Clinicians should consider the possibility of IPEH in patients presenting with tumors in the spleen, which is curable by surgical resection. Malignant vascular tumors must be excluded in the differential diagnosis of IPEH to prevent misdiagnosis and inappropriate overtreatment.
Topics: Female; Child; Humans; Child, Preschool; Infant; Vascular Neoplasms; Spleen; Hyperplasia; Endothelial Cells; Abdomen
PubMed: 36434525
DOI: 10.1186/s12880-022-00936-w -
BMC Surgery Nov 2022Immaturity of ganglia (IG) is an extremely rare disease and always requires surgical intervention in the neonatal period, but without guidelines to choose the ideal...
BACKGROUND
Immaturity of ganglia (IG) is an extremely rare disease and always requires surgical intervention in the neonatal period, but without guidelines to choose the ideal enterostomy procedure, the timing of stoma closure remains controversial. The aim of this study was to report our experience using Santulli enterostomy for the treatment of nine infants diagnosed with IG.
METHODS
Patients who underwent Santulli enterostomy and were diagnosed with IG in our center between 2016 and 2021 were retrospectively studied. Temporary stoma occlusion and a 24-h delayed film of barium enema (BE) were performed to evaluate intestinal peristalsis function to determine the timing of stoma closure. The demographic data, clinical and radiological findings, stoma occlusion and stoma closure results were explored.
RESULTS
A total of 9 infants underwent Santulli enterostomy and were diagnosed with IG postoperatively. Their median gestational age at birth was 36 weeks (range 31-42), and their median birth weight was 2765 g (range 1300-3400). All patients had symptom onset in the neonatal period, including abdominal distension and biliary vomiting. Eight patients showed obvious small bowel dilatation in the plain films, except for one patient's films that suggested gastrointestinal perforation with free gas downstream of the diaphragm. BE was performed in 6 patients, all of which had microcolons. The median age at operation was 3 days (range 1-23). Seven patients had an obvious transitional zone (TZ) during laparotomy, and the position of the TZ was 25-100 cm proximal above the ileocecal (IC) valve. Immature ganglion cells were present in the colon in 7 patients and the terminal ileum in 6 patients. The median age of successful stoma occlusion was 5 M (range 2-17) and 8 M (range 4-22) at ostomy closure. There was little or no barium residue in the 24-h delayed film of BE before stoma closure, and all patients were free of constipation symptoms during the follow-up.
CONCLUSION
Santulli enterostomy appears to be a suitable and efficient procedure for IG, combined with temporary stoma occlusion and 24-h delayed film of BE to evaluate the recovery of intestinal peristalsis function.
Topics: Humans; Infant; Infant, Newborn; Retrospective Studies; Ileostomy; Enterostomy; Anastomosis, Surgical; Ganglia
PubMed: 36401255
DOI: 10.1186/s12893-022-01849-9 -
Journal of Gastrointestinal Oncology Oct 2022Recent advancements in molecularly targeted chemotherapy for stage IV colorectal cancer have enabled the possibility of complete resection in primary colorectal cancer,...
BACKGROUND
Recent advancements in molecularly targeted chemotherapy for stage IV colorectal cancer have enabled the possibility of complete resection in primary colorectal cancer, which often involves distant liver or lung metastases, by aggressive surgical resection followed by multi-combination chemotherapy.
CASE DESCRIPTION
A 73-year-old man treated previously for hyperuricemia, hypertension, and a dissecting abdominal aortic aneurysm was referred to us after an incidental finding of multiple liver masses on abdominal ultrasound during follow-up for the aneurysm. A detailed examination by contrast-enhanced computed tomography revealed a ring-enhancing mass larger than 5 cm in diameter in segment 3 of the liver and more than 6 low-density areas with total diameter of 1 to 2 cm in both lobes. A barium enema examination revealed a Borrmann type 2 lesion covering two-thirds of the circumference of the colon, with a 5-cm major axis in the rectosigmoid colon. Biopsy revealed a well-differentiated adenocarcinoma. The patient was diagnosed with stage IV rectal cancer. Because there was no intestinal obstruction, we administered 9 cycles of bevacizumab with capecitabine and oxaliplatin as chemotherapy. Subsequent diagnostic imaging revealed the metastatic lesions in liver segment 3 had reduced to 2 low-density areas with a diameter of 8 mm, and the other hepatic metastases had disappeared; the main tumor had flattened and shrunk. Therefore, we used hand-assisted laparoscopic surgery (HALS) to perform anterior resection of the rectosigmoid colon and partial resection of liver segment 3 as conversion therapy. The patient was discharged 10 days after surgery. The rectal lesion was a well-differentiated adenocarcinoma with a depth of invasion of p-MP and a spread of L0, V0, and pN0. The partial hepatectomy did not indicate viable cancer cells; only necrotic, lysed tissue was observed. Postoperative chemotherapy involved 4 cycles of bevacizumab with capecitabine and oxaliplatin. At more than 42 months postoperatively, no metastasis or recurrence has been observed.
CONCLUSIONS
This rare case demonstrates that conversion surgery can be a viable option following systemic chemotherapy in patients with advanced colon cancer and H3 liver metastases.
PubMed: 36388681
DOI: 10.21037/jgo-22-245 -
Frontiers in Pediatrics 2022Preoperative evaluation of the dysganglionic bowel segment is critical for establishing the optimal resection strategy for Hirschsprung's disease (HSCR), which...
BACKGROUND
Preoperative evaluation of the dysganglionic bowel segment is critical for establishing the optimal resection strategy for Hirschsprung's disease (HSCR), which facilitates patient outcomes.
OBJECTIVE
We set out to determine the utility of the 24-h delayed film of barium retention in predicting the length of dysganglionic bowel segment in HSCR.
MATERIALS AND METHODS
A retrospective study of patients with clinically suspicious HSCR who underwent a preoperative 24-h delayed film of barium enema and were surgically treated from January 2015 to December 2019 was conducted.
RESULTS
Two hundred and 58 patients were enrolled in this study. The sensitivity, specificity, positive and negative predictive values (NPVs) of the 24-h delayed film of barium enema to predict the neuropathological segment were 89.1, 91.5, 91.3, and 89.4%, respectively. The Youden index was 80.6%, with a kappa value of 0.806 ( < 0.001). The correlation rate between barium retention level and pathological results was 72.7% (16/22) when aganglionosis was restricted within the mid-distal rectum (short-segment type), increasing to 92.0% (46/50) and 93.5% (174/186) for patients that had aganglionosis extended beyond the mid-distal rectum (classical type) and sigmoid colon (long-segment type), respectively. Lastly, patients younger than 3 months showed a lower correlation rate (72.2%) compared to patients aged 3-12 months (91.0%) and > 12 months (92.6%).
CONCLUSIONS
Our investigation of the 24-h delayed film of barium enema performed for patients suspected of having HSCR indicated that the barium retention level remains crucial in predicting dysganglionic bowel segment, which contributes to the decision-making for surgical physicians.
PubMed: 36204664
DOI: 10.3389/fped.2022.979149